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Sample records for atracurium

  1. Interaction between atracurium and drugs used in anaesthesia.

    Science.gov (United States)

    Chapple, D J; Clark, J S; Hughes, R

    1983-01-01

    The effects of various drugs used during anaesthesia on the neuromuscular blocking activity of atracurium have been studied in anaesthetized cats. Clinically effective doses of diazepam, morphine, pentazocine, pethidine, ketamine, Althesin, methohexitone, Septrin, lignocaine, propranolol, calcium chloride or azathioprine did not significantly alter the neuromuscular blocking action of atracurium. Recovery from atracurium was not prolonged during an infusion of hexamethonium or sodium nitroprusside, indicating that, despite the severe hypotension, the inactivation of atracurium was unimpaired. Similar to that of other competitive neuromuscular blocking agents, the action of atracurium was enhanced by tubocurarine, halothane, gentamycin, neomycin and polymixin and was antagonized by adrenaline and transiently antagonized by suxamethonium. However, pretreatment with suxamethonium did not affect the subsequent block by atracurium. PMID:6688011

  2. Acute quadriparesis in an asthmatic treated with atracurium.

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    Tousignant, C P; Bevan, D R; Eisen, A A; Fenwick, J C; Tweedale, M G

    1995-03-01

    An 18-yr-old male asthmatic was paralyzed with atracurium for a period of seven days to facilitate mechanical pulmonary ventilation. After withdrawal of the muscle relaxant, train-of-four neuromuscular monitoring demonstrated rapid recovery of normal function. Three days later he developed acute quadriparesis without respiratory compromise. Electrophysiological studies showed normal conduction velocities, low compound muscle action potential amplitudes and evidence of denervation. Most cases of post-ventilatory weakness in the ICU involve the use of vecuronium and pancuronium. It has been suggested that the steroid nucleus in these muscle relaxants may be responsible. Our patient developed generalised weakness after treatment with atracurium, a benzylisoquinolinium muscle relaxant. Thus, it appears that the steroid nucleus of vecuronium and pancuronium is not essential in causing post-ventilatory weakness. PMID:7743575

  3. Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans

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    WENG Xiao-chuan; ZHOU Liang; FU Yin-yan; ZHU Sheng-mei; HE Hui-liang; WU Jian

    2005-01-01

    Objective: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. Methods: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under itravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored.The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2%~10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results: Rocuronium requirement, which were (0.468±0.167)unchanged during orthotopic liver transplantation. Conclusions: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed,which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.

  4. Effect of cisatracurium versus atracurium on intraocular pressure in patients undergoing tracheal intubation for general anesthesia

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    Mitra Jabalameli

    2011-01-01

    Conclusions: Compared with atracurium, administration of cisatracurium can better prevent the increase of IOP following tracheal intubation in general anesthesia. The observed difference might be related to different effects on hemodynamic variables. Application of these results in patients under ophthalmic surgery is warranted.

  5. Resistance to atracurium-induced neuromuscular blockade in patients with intractable seizure disorders treated with anticonvulsants.

    Science.gov (United States)

    Tempelhoff, R; Modica, P A; Jellish, W S; Spitznagel, E L

    1990-12-01

    Previous studies have demonstrated that, with the exception of atracurium, resistance to the neuromuscular blocking effects of various muscle relaxants develops in patients receiving anticonvulsant therapy. We studied the effects of 0.5 mg/kg IV atracurium in 53 neurosurgical patients: 21 nonepileptic patients receiving no anticonvulsant therapy (MED = 0); 14 epileptic patients treated with carbamazepine for years (MED = 1); and 18 epileptic patients treated with carbamazepine plus either phenytoin or valproic acid for years (MED = 2). The evoked compound electromyogram of the adductor pollicis brevis was recorded, and results were analyzed using analysis of covariance, with weight and age as covariables. The onset time was not significantly different among the three groups. Times for recovery of baseline and train-of-four responses to stimuli were significantly shorter in the MED = 1 and MED = 2 groups than in control patients (MED = 0). The recovery index (time between 25% and 75% recovery of baseline electromyogram values) was progressively shorter in the three groups (MED = 0: 8.02 min; MED = 1: 5.93 min; MED = 2: 1.96 min; P less than 0.001). This study demonstrates that atracurium, when used on epileptic patients requiring long-term (that is, years of) anticonvulsant therapy, has a shorter duration of action than when used in nonepileptic patients. PMID:2240640

  6. [Comparative study of circulatory response to tracheal intubation with atracurium and succinylcholine].

    Science.gov (United States)

    Nocite, J R; Serzedo, P S; Zuccolotto, E B; Leães, L F; de Carvalho Júnior, R J

    1990-01-01

    Changes in some circulatory parameters after orotracheal intubation (OTI) were investigated in 40 patients anesthetized with thiopental 5.0 mg.kg-1 and fentanyl 100 micrograms, receiving either atracurium 0.5 mg.kg-1 (n = 20) or succinylcholine 1.0 mg.kg-1 (n = 20) to facilitate intubation. In the succinylcholine group (SC), mean values of SAP, DAP, MAP, and HR rose significantly in relation to control at 30 sec and 2 min after OTI. In the atracurium group (A), mean values of SAP, DAP, and MAP rose significantly at 30 sec after OTI, however, contrary to the SC group, mean values of HR did not rise significantly after OTI. Mean values of the double product HR x SAP rose significantly at 30 sec, 2 min, and 5 min after OTI in the SC group, but only at 30 sec and 2 min after OTI in the A group. The magnitude of elevation of those circulatory parameters studied was always greater in the SC group than in the A group. The authors conclude that atracurium does not modify the nature of circulatory changes after OTI but is associated to such changes in a lesser degree when compared to succinylcholine in a standard induction technique with thiopental/fentanyl. PMID:2103060

  7. RANDOMIZED CLINICAL TRIAL TO COMPARE THE INCIDENCE OF RESIDUAL NEUROMUSCULAR BLOCK FOLLOWING PANCURONIUM AND ATRACURIUM USING TRAIN OF FOUR RATIO

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    Nagesha

    2014-04-01

    Full Text Available BACKGROUND: Several clinical studies have reported that significant number of patients receiving non depolarizing muscle relaxants during general anesthesia show postoperative residual neuromuscular block when assessed by neuromuscular monitor in the recovery room. The degree of residual neuromuscular block produced by non-depolarizing muscle relaxants can be evaluated by clinical tests as well as by neuromuscular monitoring y neuromuscular monitor in the recovery room. A randomized double blind clinical trial to determine and compare the incidence of postoperative residual neuromuscular block in patients receiving pancuronium and atracurium applying Train of Four ratio using Train of Four- Guard neuromuscular monitor. AIMS AND OBJECTIVES: To compare the incidence of postoperative residual neuromuscular block following pancuronium and atracurium using Train of Four Ratio in the recovery room. MATERIALS AND METHODS: Comparative randomized study done using 100 patients of age between 15-60 years belonging to either sex, ASA grade 1 and 2 with GROUP ‘P’ – Pancuronium was employed as the muscle relaxant, GROUP ‘A’ – Atracurium was employed as the muscle relaxant. Statistical analysis done using student “t” test. RESULTS: The mean duration required to attain Train of Four Ratio of 0.80 in patients with initial Train of four ratio <0.80 in group ‘P’ was 9.65±5.4413 min and in group ‘A’ was 2.8± 1.4832 min. CONCLUSION: 1. Our study concludes that the incidence of residual neuromuscular block in patients receiving pancuronium and atracurium were 40% and 10% respectively. Thus residual neuromuscular block can be a significant problem in recovery room, during the postoperative period. 2. The use of intermediate acting non depolarizing muscle relaxant like atracurium lowers the incidence of residual neuromuscular block but does not eliminate it.

  8. Assessment of atropine-sufentanil-atracurium anaesthesia for endotracheal intubation: an observational study in very premature infants.

    OpenAIRE

    Durrmeyer, Xavier; Dahan, Sonia; Delorme, Pierre; Blary, Sabine; Dassieu, Gilles; Caeymaex, Laurence; Carbajal, Ricardo

    2014-01-01

    BACKGROUND: Premedication before neonatal intubation is heterogeneous and contentious. The combination of a short acting, rapid onset opioid with a muscle relaxant is considered suitable by many experts. The purpose of this study was to describe the tolerance and conditions of intubation following anaesthesia with atropine, sufentanil and atracurium in very premature infants. METHODS: Monocentric, prospective observational study in premature infants born before 32 weeks of gestational age, ho...

  9. 血液稀释对顺式阿曲库铵药代学及药效学影响的研究%Effect of hemodilution on the pharmacokinetics and pharmacodynamics of cis-atracurium

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    袁晓红; 郭建荣; 金孝岠

    2014-01-01

    目的:研究血液稀释下顺式阿曲库铵药代学及药效学变化,为其血液稀释时的合理使用提供参考依据.方法:择期骨科手术患者90例,ASA Ⅰ~Ⅱ级,35~60岁.随机分为3组(n=30):A组行急性等容血液稀释(ANH);B组行急性高容血液稀释(AHH);C组为对照组,常规输血输液.每组患者再随机分为3个亚组(n=10),顺式阿曲库铵剂量分别为0.1、0.2、0.3 mg/kg.常规麻醉诱导后,静注相应剂量顺式阿曲库铵后气管插管.观察各组患者的肌松效应及血药浓度变化,并计算其药代学参数.结果:同等剂量下B组肌松起效时间显著延长(P<0.05);三组患者起效时间缩短,成串刺激(TOF)无反应期、肌松维持时间、肌松体内时间随剂量增大而延长(P<0.05);A、B组血液稀释后血药浓度均呈剂量正相关性下降,B组下降更显著.血液稀释组t1/2α延长,Vc显著增大(P<0.05),其中AHH组Vc增大约1倍.结论:AHH下使用顺式阿曲库铵时,应适当增加剂量;而ANH时可不调整剂量.%AIM:To compare the changes of pharmacokinetics and pharmacodynamics of cisatracurium administered in different methods of hemodilution to provide a reference for clinical anesthesia.METHODS:Ninety elective orthopedic surgery patients,ASA Ⅰ-Ⅱ,35 to 60 years old,were randomized into three groups by the different treatment methods in preoperative transfusion (n=30 each):group A acute normovolemic hemodilution (ANH),group B acute hypervolemic hemodilution (AHH) and control group (group C).Each group was divided into three subgroups(n=10 each) with the corresponding loading dose of cis-atracurium (0.1,0.2,0.3 mg/kg).General anesthesia was induced after intravenous doses corresponding cisatracurium after tracheal intubation.And then,we observed in each group of patients with muscle relaxant effects and changes in plasma concentration and calculated the pharmacokinetic parameters.RESULTS:The onset time of muscle relaxation was significantly

  10. Reversión del bloqueo neuromuscular residual por atracurio y vecuronio con dosis bajas de neostigmina Reversion of atracurium and vecuronium residual nondepolarising neuromuscular blockade with low doses of neostigmine

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    J.R. Ortiz-Gómez

    2006-08-01

    Full Text Available Objetivos. Comprobar la eficacia de dosis bajas de neostigmina en la reversión del bloqueo neuromuscular no despolarizante residual (BNM-R. Material y Métodos. Se realizó el trabajo con 119 pacientes adultos, ASA I-III, anestesiados con tiopental, fentanilo, O2-N2O-isoflurano y atracurio (n=62 o vecuronio (n=57. Se monitorizó el BNM-R mediante registro electromiográfico del adductor pollicis ante estímulo ulnar tipo tren de cuatro (TOF, considerando recuperación espontánea un TOF-Ratio 75%. En caso contrario se revertía el BNM-R en función del grado de bloqueo (0-1, 2, 3 ó 4 respuestas al TOF con neostigmina (0,035; 0,03; 0,025 ó 0,02 mg/kg y atropina (0,0175; 0,015; 0,0125 ó 0,01 mg/kg respectivamente. Se registró el tiempo de decurarización y los efectos secundarios. Resultados. Los grupos resultaron demográficamente homogéneos, con TOF-Ratio>75% el 25,8 (atracurio y 21,1% (vecuronio, mostrando el resto 0-1 respuestas al TOF (11,3 y 19,2%, 2 (6,5 y 11,5%, 3 (4,8 y 7,6% ó 4 respuestas (51,6 y 50% respectivamente, decurarizándose en 10,5±7 (atracurio y 10,3±6,4 min (vecuronio. Hubo predominio de efectos secundarios en el grupo del atracurio (p=0,027 a expensas de sialorrea, naúseas y vómitos. No se registró ningún caso de recurarización. Conclusiones. La reversión del BNM-R con dosis bajas de neostigmina y atropina ajustadas al grado de bloqueo es efectiva incluso en bloqueos profundos y reduce el riesgo de efectos secundarios de estos fármacos.Objectives. To assess the effectiveness of low doses of neostigmine in the reversion of residual nonpolarising neuromuscular blockade (RNMB. Material and methods. The work involved one hundred and nineteen adult patients, ASA I-III, anaesthetised with fentanyl, thiopental, O2-N2O-isoflurane and atracurium (n=62 or vecuronium (n=57. RNMB was monitored with continuous electromyography of adductor pollicis with TOF stimulation. When TOF-Ratio (TR < 75%, neostigmine 0.035, 0.03, 0

  11. Efeitos hemodinâmicos do atracúrio e do cisatracúrio e o uso de difenidramina e cimetidina Efectos hemodinámicos del atracurio y del cisatracurio y el uso de la difenidramina y la cimetidina Hemodynamic effects of atracurium and cisatracurium and the use of diphenhydramine and cimetidine

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    Claudia Maria Nogueira Correa

    2010-02-01

    hipotensión arterial en el hombre, se investigaron los efectos hemodinámicos promovidos por el atracurio y por el cisatracurio, y la protección hemodinámica dada por la difenidramina y la cimetidina en ratones. MÉTODO: 1 Ratones Wistar anestesiados con pentobarbital sódico y preparados de acuerdo con Brown y col. para evaluar las dosis de atracurio y cisatracurio para la reducción de T4/T1 de la secuencia de cuatro estímulos mayor o igual al 95%. 2 Evaluación de las alteraciones hemodinámicas del atracurio y el cisatracurio por inyección venosa, midiendo la presión arterial sistémica de la arteria carótida y electrocardiograma de ratones. 3 Observación de la protección hemodinámica por el tratamiento previo con difenidramina (2 mg.kg-1 y/o cimetidina (4 mg.kg-1 por inyección venosa. Análisis estadístico: test t de Student, ANOVA. RESULTADOS: El atracurio y el cisatracurio no modificaron la presión arterial promedio (PAP en las dosis de 1 mg.kg-1 y 0,25 mg.kg-1, respectivamente. Las dosis de 4 mg.kg-1 disminuyeron la PAP de 62,8 ± 4,5% del control para el atracurio, y de 82,5 ± 2,3% del control para el cisatracurio. Con la difenidramina y la cimetidina, la presión sistólica se redujo a 95,4 ± 2,5% del control. Con la cimetidina, la presión diastólica disminuyó 82,7 ± 8,4% del control. El efecto con-junto sobre las presiones sistólica y diastólica se reflejó en los valores observados de la PAP. CONCLUSIONES: La difenidramina y la cimetidina, aisladamente, no impidieron la disminución de la presión arterial promedio inducida por el atracurio. Sin embargo, la asociación de esos de los fármacos fue eficaz en la prevención de los efectos hemodinámicos inducidos por el atracurio. El cisatracurio, en las dosis del experimento, no promovió una disminución de la presión arterial que justificase las medidas preventivas aplicadas en los grupos donde se utilizó el atracurio.BACKGROUND AND OBJECTIVES: Since atracurium can cause hypotension in

  12. Pharmacodynamics comparative of cis-atracurium intermittent bolus injected according to real body weight and fat-free mass%顺苯磺酸阿曲库铵按无脂肪体重与实际体重间断静注给药药效学的对比研究

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    陈汉文; 磨凯; 刘中杰; 刘辉; 梁启波; 徐世元

    2014-01-01

    目的:比较顺苯磺酸阿曲库铵按无脂肪体重与实际体重间断静注给药的临床药效学及个体化差异,提供临床用药参考。方法:选择择期手术全麻患者40例,按给药剂量不同分为无脂肪体重组(FFM组)和实际体重组(RBW组),每组20例。全麻诱导采用静注芬太尼3μg/kg,丙泊酚2 mg/kg, FFM组静注顺苯磺酸阿曲库铵129.6μg/kg(2倍ED95),RBW组100μg/kg(2倍ED95),TOF-Watch SX Monitor加速度肌松监测仪行肌松监测。麻醉维持期间当 T1恢复至5%时 FFM 组静注顺苯磺酸阿曲库铵64.8μg/kg (1倍ED95),RBW组50μg/kg(1倍ED95),预计手术结束前20 min 不再追加顺苯磺酸阿曲库铵,使其自然代谢恢复。结果:两组间肌松药维持用量差异有统计学意义(P<0.05),FFM组肌松药维持用量显著<RBW组;两组间无反应期和药理作用时间的变异度差异有统计学意义,FFM 组的无反应期和药理作用时间的变异度更小(P<0.05)。结论:顺苯磺酸阿曲库铵按无脂肪体重间断静注给药,可获得按实际体重相似的肌松效应,减少肌松阻滞时效的个体差异和肌松药用药量,为临床顺苯磺酸阿曲库铵间断给药提供用药参考。%Ojective To compara the individual differences and clinical efficacy of cis-atracurium intermittent bolus injected according to fat-free mass and real body weight. Methods Forty patients (ASAI-II) who had no neuromuscular disease and underwent selective abdominal surgery under general anesthesia were randomly divided into group FFM (n=20) and group RBW(n=20) according to the different administration method. The responses of adductor pollicis to train-of-four (TOF) stimulation were monitored. Anesthesia was induced with propofol 2 mg/kg, fentanyl 3 ug/kg, cis-atracurium 129.6μg/kg (group FFM) or 100μg /kg (group RBW),and maintained with propofol and fentanyl given by target

  13. Effects of Chloral Hydrate and Atracurium Besilate on Compound Muscle Action Potential of Sciatic Nerves in Rats%水合氯醛和苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位的影响

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    孟祥虎; 臧光辉; 樊龙昌; 肖海涛; 权伟合; 刘继红; 张传汉; 罗爱林; 田玉科

    2012-01-01

    目的:研究水合氯醛和苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位(compound muscle action potential,CMAP)的影响.方法:成年SD大鼠20只,随机分为2组(n=10):水合氯醛组(C组)和水合氯醛复合苯磺酸阿曲库铵组(CA组).2组腹腔注射7%水合氯醛350 mg·kg-1麻醉,给予水合氯醛后8 min时CA组腹腔注射苯磺酸阿曲库铵2.5 μg·kg-1.于给予水合氯醛8 min时刺激坐骨神经,记录其所支配的腓肠肌的CMAP.刺激强度为0.50 v、0.55 v、0.60 v,波宽0.05 ms,频率10 Hz,每隔5 min重复上述刺激.结果:与8 min时比较,0.50 v,0.55 v,0.60 v强度下C组CMAP的峰峰值及潜伏期均无明显变化(P均>0.05);CA组与8 min时比较,0.50,0.55 及0.60 v强度下23~43 min时的CMAP峰峰值降低(P<0.05或0.01),0.50 v强度下38 min的CMAP潜伏期延长(P<0.05),0.55 v,0.60 v强度下,23~43 min的CMAP潜伏期延长(P<0.05或0.01).结论:水合氯醛对大鼠坐骨神经CMAP无明显影响;而复合肌松药苯磺酸阿曲库铵后对CMAP有一过性的抑制作用.%Objective: To study the effects of chloral hydrate with or without atracurium besilate on compound muscle action potential ( CMAP ) of sciatic nerves in rats. Method: Twenty adult SD rats were randomly divided into chloral hydrate group ( group C ) and chloral hydrate with atracurium besilate group ( group CA ). Group C was treated by chloral hydrate, and group CA was treated with chloral hydrate and atracurium besilate. Both the groups were anesthetized by intraperitoneal injection of 7% chloral hydrate with the dosage of 350 mg·kg-1. After 8min of successful anesthesia, group CA was intraperitoneally infused with atracurium besilate (2.5 μg ·kg-1). Meanwhile, the two groups were stimulated sciatic nerves with stimulus intensity of 0.50 v, 0.55 v and 0.60 v, width of 0. 05 ms and frequency of 10 Hz, respectively. Each stimulus repeated three times every 5 min. Result: In group C, the peak to peak values and incubation

  14. Cardiopulmonary effects and eyeball centralization with low-dose atracurium in spontaneously breathing, anesthetized dogs Avaliação cardiopulmonar e da centralização do globo ocular em cães com baixas doses de atracúrio mantidos em anestesia inalatória sob ventilação espontânea

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    Adriano Bonfim Carregaro

    2010-07-01

    Full Text Available The objective was to determine the cardiopulmonary effects and eyeball centralization time obtained with 15 or 30µg kg-1 of atracurium in anesthetized dogs under spontaneous breathing. Eighteen healthy adult mixed-breed dogs were used, which received 0.1mg kg-1 acepromazine and 0.5mg kg-1 morphine IM, followed by 4mg kg-1 propofol IV and maintained on isoflurane anesthesia with spontaneous breathing. Animals received 1mL 0.9% NaCl IV (CG, 15µg kg-1 (G15 or 30µg kg-1 (G30 of atracurium IV. Eyeball centralization time was measured; heart rate (HR, systolic (SAP, mean (MAP and diastolic (DAP arterial pressures, respiratory rate (RR, tidal volume (Vt and minute volume (Vm were determined every 5min, and pH, arterial CO2 pressure (PaCO2 , arterial O2 pressure (PaO2 , hemoglobin oxygen saturation (SaO2 , bicarbonate (HCO3- and base excess (BE every 15min until 60min. Both doses of atracurium produced a similar period of eyeball centralization. Vt in groups treated with atracurium was lower than in CG up to 15min. Vm in G15 differed from CG up to 10min and in G30 up to 25min. No differences were observed for cardiovascular parameters, RR, SaO2, PaO2, HCO3- and BE. pH decreased in CG between 30 and 60min and in G15 and G30 at 15min. G30 differed from CG between 15 and 30min. PaCO2 in GC differed from baseline between 30 and 60min and in G15 differed at 15min. Atracurium at the dose of 15µg kg-1 is adequate for short corneal procedures in inhalant-anesthetized dogs under spontaneous breathing.Objetivou-se determinar os efeitos cardiopulmonares e o tempo de centralização do globo ocular obtidos com 15 ou 30µg kg-1 de atracúrio em cães anestesiados sob ventilação espontânea. Dezoito cães adultos foram pré-medicados com 0,1mg kg-1 de acepromazina e 0,5mg kg-1 de morfina IM, anestesiados com 4mg kg-1 de propofol IV e mantidos sob anestesia inalatória com isofluorano em ventilação espontânea. Os animais receberam 1mL de NaCl 0,9% IV (GC, 15

  15. Effects of Pentobarbital Sodium Combined with Atracurium Besilate on CMAP of Sciatic Nerves in Rats%戊巴比妥钠联合苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位的影响

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    费胜琪; 唐京军

    2013-01-01

    目的:研究戊巴比妥钠和苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位(compound muscle action potential,CMAP)的影响.方法:成年SD大鼠随机分为2组(n=10),戊巴比妥钠+生理盐水组(PN组)和戊巴比妥钠+苯磺酸阿曲库铵组(PA组).2组均腹腔注射1%戊巴比妥钠40 mg·kg-1麻醉,给予戊巴比妥钠8 min时PA组腹腔注射苯磺酸阿曲库铵2.5 μg·kg-1,PN组注射等量生理盐水.而后立即刺激坐骨神经,记录其所支配的腓肠肌的CMAP.刺激强度为0.50 v,波宽0.05 ms,频率10 Hz,每隔5 min重复上述刺激.结果:PN组中,在0.5 v的刺激强度下,T18~28 min时峰峰值降低,而潜伏期延长(与T8 min时比较,P<0.05或0.01);PA组中,T18~43 min时CMAP峰峰值降低,而潜伏期延长(与T8 min时比较,P<0.05或0.01);两组比较,PA组T18~43 min时的峰峰值及潜伏期与PN组对应时间点的峰峰值及潜伏期差异有统计学意义(P<0.05或0.01).结论:戊巴比妥钠或复合苯磺酸阿曲库铵后均可一过性抑制大鼠坐骨神经CMAP,而复合苯磺酸阿曲库后其抑制作用更强.%Objective: To study the effects of pentobarbital sodium with or without atracurium besilate on compound muscle action potential ( CMAP ) of sciatic nerves in rats. Method: Twenty adult SD rats were randomly divided into the PN group ( pentobarbital sodium + normal saline ) and the PA group ( pentobarbital sodium + atracurium besilate ) according to the random digital table. The two groups were both anesthetized by intraperitoneal injection of 1 % pentobarbital sodium with the dose of 40 mg · kg-1 . After 8 min of the anesthesis, the rats in the PA group were intraperitoneally infused with atracurium besilate ( 2. 5 μg o kg-1), and those in the PN group were treated by normal saline with the same volume. The two groups were stimulated sciatic nerves immediately with the stimulus intensity of 0. 50 v, the width of 0.05 ms and the frequency of 10 Hz, and then repeated the above

  16. Avaliação comparativa entre o besilato de atracúrio e o cloreto de alcurônio sobre a frequência cardíaca e a ventilometria de cães anestesiados com halotano Comparative evaluation between atracurium besylate and alcuronium chloride on heart rate and ventilometry of the dogs anesthetized with halothane

    Directory of Open Access Journals (Sweden)

    Alexandre da Silva Polydoro

    1996-08-01

    Full Text Available Vinte cães provenientes da rotina anestésico-cirúrgica do Hospital de Clínicas Veterinárias da Universidade Federal de Santa Maria (UFSM, foram divididos em 2 grupos, I e II. e submetidos ao bloqueio neuromuscular com besilato de atracúrio 0,5mg/kg IV ou cloreto de alcurônio 0,1mg/kg IV consecutivamente. Foram monitorados a ventilometria, a freqüência cardíaca e o tempo de bloqueio neuromuscular dos animais que receberam besilato de atracúrio, submetidos à reversão espontânea, enquanto que a reversão do bloqueio produzido com cloreto de alcurônio foi realizada aos 60 minutos após instalação deste pela administração de neostigmina precedida de sulfato de atropina. Os resultados obtidos demonstraram diminuição do volume corrente pulmonar para ambos os grupos à partir da reversão do bloqueio, com diminuição significativa para o grupo que recebeu cloreto de alcurônio até vinte minutos após reversão e diferença estatisticamente significativa entre os grupos aos 20 minutos após reversão. Houve diminuição nos valores de frequência cardíaca à partir dos 10 minutos após indução anestésica até 30 minutos decorridos do bloqueio para ambos os grupos, com significando estatística no grupo que recebeu besilato de atracúrio. O tempo médio de bloqueio com besilato de atracúrio foi de 49,07 ± 12,67 minutos.Twenty dogs for the surgical-anaesthetic routine of the Veterinary Hospital of Federal University of Santa Maria - Brazil were divided in two groups, I and II, and submitted to neuromuscular block with atracurium besylate 0.5mg/kg (I or alcuronium chloride 0.1mg/kg (II. Ventilometry. heart rate and the time for reversion of the blockage were evaluated in group I. Reversal of relaxation in group II was carried with neostigmine preceded by atropine. The results demonstrated a reduction in tidal volume for both groups in the reversion of the blockage, with statistical significance between the groups 20 minutes

  17. Influência do lítio no bloqueio neuromuscular produzido pelo atracúrio e pelo cisatracúrio: estudo em preparações nervo frênico-diafragma de rato Influencia del litio en el bloqueo neuromuscular producido por el atracurio y por el cisatracurio: estudio en preparo nervio frénico-diafragma del ratón Influence of lithium on the neuromuscular blockade produced by atracurium and cisatracurium: study on rat phrenic nerve-diaphragm preparations

    Directory of Open Access Journals (Sweden)

    Samanta Cristina Antoniassi Fernandes

    2007-06-01

    alteraciones en los potenciales de placa terminal en miniatura mostraron una acción presináptica.BACKGROUND AND OBJECTIVES: Lithium is widely used for the treatment of bipolar disorders and can interact with neuromuscular blockers. There is a controversy about the mechanisms by which it affects neuromuscular transmission and its interaction with neuromuscular blockers. The objective of this study was to evaluate, on the rat diaphragm, the effects of lithium on the muscular response and indirect stimulation, and the possible interaction with neuromuscular blockers. METHODS: Rats weighing between 250 and 300 g were sacrificed under urethane anesthesia. The phrenic nerve-diaphragm preparation was assembled according to the Bulbring technique. The diaphragm was kept under tension, connected to an isometric transducer, and submitted to indirect stimulation with a frequency of 0.1 Hz. The contractions of the diaphragm were registered on a physiograph. The analysis of the amplitude of the muscular responses evaluated: the effects of the isolated drugs: lithium (1.5 mg.mL-1; atracurium (20 µg.mL-1, and cisatracurium (3 µg.mL-1; the lithium-neuromuscular blockers association; and the effects of lithium on the neuromuscular blockade produced by atracurium (35 µg.mL-1 and cisatracurium (5 µg.mL-1. The effects were evaluated before and 45 minutes after the addition of the drugs. The effects of lithium on membrane potentials (MP and miniature end-plate potentials (MEPP were also evaluated. RESULTS: Lithium by itself did not change the amplitude of the muscular responses, but it decreased significantly the neuromuscular blockade produced by atracurium and cisatracurium. It did not change MP and caused an initial increase in MEPP. CONCLUSIONS: Lithium by itself did not compromise neuromuscular transmission and increased the resistance to the effects of atracurium and cisatracurium. It did not show any action on the muscle fiber, and the changes in miniature end-plate potentials

  18. Influência da nifedipina no bloqueio neuromuscular produzido pelo atracúrio e pelo cisatracúrio: estudo em preparações nervo frênico-diafragma de rato Influencia de la nifedipina en el bloqueo neuromuscular producido por atracurio y cisatracurio: estudio en preparación nervio frénico diafragma de ratón Influence of nifedipine on the neuromuscular block produced by atracurium and cistracurium: study in rat phrenic-diaphragmatic nerve preparation

    Directory of Open Access Journals (Sweden)

    Silmara Rodrigues de Sousa

    2006-04-01

    neuromuscular del atracurio y del cisatracurio, no cambió el potencial de membrana y produjo el aumento inicial en la frecuencia de los PPTM, seguida de bloqueo. CONCLUSIONES: La nifedipina, en la concentración empleada, potenció el bloqueo neuromuscular que el atracurio e cisatracurio produjeron. Estudios electrofisiológicos demostraron una acción presináptica y la ausencia de acción despolarizante sobre la fibra muscular.BACKGROUND AND OBJECTIVES: Calcium channel blockers may interact with neuromuscular blockers, increasing its effects. Research studies about this interaction display controversial results. In some studies these drugs produced neuromuscular blockage, or contracture, or no effect at all was proved over skeletal neuromuscular response. This study assessed the nifedipine effects over muscular responses and its possible interaction with neuromuscular blockers in rat diaphragm. METHODS: A number of 25 rats were used, weighing between 250 and 300 g and sacrificed under anesthesia with intraperitoneal pentobarbital (40 mg.kg-1. Preparation was mounted according to the technique described by Bulbring. Diaphragm was kept under tension, connected to an isometric transducer and subjected to an indirect stimulation of 0.1 Hz frequency. Diaphragm contractions were registered on a physiograph. In order to evaluate the effect of these drugs on neuromuscular transmission, they were added separately or associated to the preparation, on the following concentrations: nifedipine (4 µg.mL-1; atracurium (20 µg.mL-1; cistracurium (3 µg.mL-1. On phrenic-nerve preparation, the assessed items were: 1 the extent of diaphragm muscle response to indirect stimulation, before and 45 minutes after adding nifedipine and neuromuscular blockers separately and after the association of both drugs; 2 nifedipine effects on membrane potentials (MP and miniature end-plate potentials (MEPP. RESULTS: Employed separately, nifedipine did not alter the extent of muscular responses, but it did

  19. Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos Tiempo de latencia y duración del efecto del rocuronio, atracúrio y mivacúrio en pacientes pediátricos Onset time and duration of rocuronium, atracurium and mivacurium in pediatric patients

    Directory of Open Access Journals (Sweden)

    Norma Sueli Pinheiro Módolo

    2002-04-01

    recuperación en los pacientes pediátricos anestesiados con sevoflurano. También, el rocuronio, el mivacúrio y el atracúrio no determinaron alteraciones hemodinamicas de importancia clínica relevante y proporcionaran excelentes condiciones de intubación traqueal.BACKGROUND AND OBJECTIVES: Neuromuscular blockers (NMB are widely used in pediatric anesthesia, but there is no ideal NMB. This study aimed at evaluating onset and recovery time, hemodynamic changes and tracheal intubation conditions of rocuronium, atracurium and mivacurium in pediatric patients. METHODS: Participated in this study 67 children aged 30 months to 12 years, physical status ASA I and II, who were allocated into three groups: G1 = 0.9 mg.kg-1 rocuronium (n = 22; G2 = 0.5 mg.kg-1 atracurium (n = 22; G3 = 0.15 mg.kg-1 mivacurium (n = 23. Anesthesia was induced with 50 µg.kg-1 alfentanil, 3 mg.kg-1 propofol, sevoflurane and N2O/O2. Neuromuscular block was monitored by acceleromyography on the ulnar nerve pathway. The following parameters were evaluated: onset time (OT, clinical duration (T25 relaxation time (T75 and recovery time (T25-75. Heart rate (HR and mean blood pressure (MBP were recorded in 6 moments, as well as tracheal intubation conditions. RESULTS: Median OT was: G1 = 0.6 min, G2 = 1.3 min, G3 = 1.9 min. Median T25 was: G1 = 38 min, G2 = 41.5, G3 = 8.8 min. Median T75 was: G1 = 57.7 min; G2 = 54.6 min, G3 = 13.6 min. Median T25-75 was: G1 = 19.7 min, G2 = 13.1 min and G3 = 4.8 min. Tracheal intubation conditions were excellent for most children in all groups. There were no significant MBP and HR clinical changes. CONCLUSIONS: Rocuronium (0.9 mg.kg-1 had the fastest onset time and mivacurium (0.15 mg.kg-1 the shortest recovery time in pediatric patients anesthetized with sevoflurane. Rocuronium, mivacurium and atracurium had also not determined significant hemodynamic changes and allowed for excellent tracheal intubation conditions.

  20. Influência do lítio no bloqueio neuromuscular produzido pelo atracúrio e pelo cisatracúrio: estudo em preparações nervo frênico-diafragma de rato Influencia del litio en el bloqueo neuromuscular producido por el atracurio y por el cisatracurio: estudio en preparo nervio frénico-diafragma del ratón Influence of lithium on the neuromuscular blockade produced by atracurium and cisatracurium: study on rat phrenic nerve-diaphragm preparations

    OpenAIRE

    Samanta Cristina Antoniassi Fernandes; Angélica de Fátima de Assunção Braga; Franklin Sarmento da Silva Braga; Yolanda Christina S. Loyola; Silmara Rodrigues de Souza; Caroline Coutinho de Barcelos

    2007-01-01

    JUSTIFICATIVA E OBJETIVOS: O lítio, fármaco amplamente utilizado nos distúrbios bipolares, pode interagir com os bloqueadores neuromusculares. Os mecanismos para explicar os seus efeitos na transmissão neuromuscular e a interação com bloqueadores neuromusculares são controversos. O objetivo deste trabalho foi avaliar, em diafragma de rato, os efeitos do lítio sobre a resposta muscular à estimulação indireta e a possível interação com os bloqueadores neuromusculares. MÉTODO: Utilizaram-se rato...

  1. Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos Tiempo de latencia y duración del efecto del rocuronio, atracúrio y mivacúrio en pacientes pediátricos Onset time and duration of rocuronium, atracurium and mivacurium in pediatric patients

    OpenAIRE

    Norma Sueli Pinheiro Módolo; Paulo do Nascimento Júnior; Lorena Brito da Justa Croitor; Pedro Thadeu Galvão Vianna; Yara Marcondes Machado Castiglia; Eliana Marisa Ganem; José Reinaldo Cerqueira Braz; Daniela Suemi Takito; Luciano Akira Takaesu

    2002-01-01

    JUSTIFICATIVA E OBJETIVOS: Os bloqueadores neuromusculares (BNM) são freqüentemente utilizados em anestesia pediátrica e não existe aquele considerado ideal. O objetivo deste trabalho foi avaliar o rocurônio, o atracúrio e o mivacúrio, em crianças, quanto ao tempo de latência e de recuperação, à interferência sobre as variáveis hemodinâmicas e às condições de intubação traqueal. MÉTODO: Sessenta e sete crianças, estado físico ASA I e II, com idade variando de 2 anos e 6 meses a 12 anos, foram...

  2. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: Conventional laryngoscopy versus an intubating laryngeal mask airway

    OpenAIRE

    Elif Bengi Sener; Emre Ustun; Burcu Ustun; Binnur Sarihasan

    2012-01-01

    OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST...

  3. Anaphylaxis to muscle relaxants: rational for skin tests.

    Science.gov (United States)

    Moneret-Vautrin, D A; Kanny, G

    2002-09-01

    IgE-dependent allergy to muscle relaxants (MR) has an estimated prevalence of 1 out of 6500 General Anesthesias (GA). 62% of anaphylaxis during surgery are due to MR anaphylaxis. All the molecules are divalent, carrying two NH4+ epitopes (quaternary ammonium ions), either structurally or after rapid in vivo protonization (vecuronium). The excellent overall performance of skin test makes them the golden standard for the diagnosis of anaphylactoid reactions. Techniques include intradermal tests and prick-tests. The current localizations are the forearm and the back. Positivity criteria are 3 mm for prick-tests. For IDTs, the criterium is the doubling of the size of the injection papula, when 0.02 to 0.04 ml is injected: 8 mm. The recommended concentrations are not falsely negative. Commercial concentrations can be tested by prick tests, except for mivacurium and atracurium tested of 1:10 dilution. A scale of concentrations is advised for IDT starting with 1:10,000, up to a normally non reactive concentration that is: 100 micrograms/ml (succinylcholine), 200 micrograms/ml (gallamine), 10 micrograms/ml (atracurium), 2 micrograms/ml (mivacurium), 200 micrograms/ml (pancuronium), 400 micrograms/ml (vecuronium), 1,000 micrograms/ml (rocuronium), 200 micrograms/ml (cis atracurium). The specificity and sensitivity of the skin tests to MRs are greater than 95%. The reproducibility over years is 88%. The overall concordance of PT and IDR is 97%. Both types of tests can be used for the diagnosis. IDT have to be carried out for the search of the cross sensitization. 84% of patients do have cross sensitization to MRs but only 16% react to all MRs. The further use of MRs selected by negative IDTs has been proved to be safe. PMID:12389445

  4. Impurity profiling and in-process testing of drugs for injection by fast liquid chromatography

    Institute of Scientific and Technical Information of China (English)

    Marie-Josee Rocheleau; Elaine Larouche; Cristina Salamu; Mihaela Curca

    2012-01-01

    Liquid chromatography (LC) is considered by many as a mature technique. Nonetheless, LC technology continues to evolve driven by the need for high-throughput and high-resolution analyses. Over the past several years, small particle size packing materials have been introduced by several column manufacturers to enable fast and efficient LC separations. Several examples of pharmaceutical analyses, including impurity profiling of taxanes and atracurium besylate, in-process testing of peptides in injectable dosage form, using sub-2 um column technology are presented in this paper, demonstrating some of the capabilities and limitations of the technology.

  5. Effect of different administration sequence on sufentanyl-induced cough response during anesthesia induction%不同给药顺序对舒芬太尼麻醉诱导时呛咳的影响

    Institute of Scientific and Technical Information of China (English)

    李商庚; 厉小丽; 叶永青

    2012-01-01

    目的:观察不同给药顺序对舒芬太尼麻醉诱导诱发呛咳的影响.方法:选择90例的择期全麻患者,年龄19~61岁,随机分为3组(A、B、C组),每组30例.麻醉诱导顺序:A组:丙泊酚-舒芬太尼-顺式阿曲库铵;B组:丙泊酚-顺式阿曲库铵(总量1/4)-舒芬大尼-顺式阿曲库铵(总量3/4);C组:丙泊酚-顺式阿曲库铵-舒芬太尼.诱导用药:丙泊酚:2.0 mg·kg-1(15 s),舒芬太尼0.6 μg·kg-1(10 s),顺式阿曲库铵:0.15mg·kg-1(5 s).观察各组给药后呛咳发生的例数及呛咳时血流动力学变化.结果:A组出现呛咳10例(33.3%),B组出现呛咳4例(13.3%),C组出现呛咳1例(3.3%).A组与B、C组呛咳发生率有显著性差异(P<0.05),B组与C组间呛咳发生有显著性差异(P<0.05).呛咳可引起血压明显升高、心率显著加快.结论:采用丙泊酚-顺式阿曲库铵-舒芬太尼的静脉诱导给药顺序,预先给予肌松药,不需额外用药,能显著减少舒芬大尼诱发呛咳反应的发生.%OBJECTIVE To investigate the effectiveness of different administration sequence in suppressing sufentanyl-induced cough response during anesthesia induction. METHODS Ninety ASA Ⅰ - Ⅱ selected general anesthesia patients were randomly assigned into three groups with thirty patients each group. Anesthesia induction sequence:Group A: propofol-sufenta-nyl-atracurium, Group B: propofol atracurium(quarter of total dosage)-sufentanyl, Group C: propofol atracurium-sufentanyl. Patients received propofol 2.0 mg·kg-1,sufentanyl 0.6 μg·kg-1 and atracurium 0.15 mg·kg-1 for anesthesia induction. The occurrence of cough and cough-induced haemodynamics change were observed. RESULTS The patient with coughing was ten in group A, four in group B and one in group C. The occurrence of cough was significantcy higher in group A than those in group B and group C, while there was no difference between group B and group C. Coughing could induce blood pressure and heart rate to heighten

  6. Comparison of effects of thiopental, propofol or ketamine on the cardiovascular responses of the oculocardiac reflex during strabismus surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Safavi

    2007-10-01

    Full Text Available BACKGROUND: The oculocardiac reflex (OCR, which is most often encountered during strabismus surgery in children,
    may cause bradycardia, arrhythmias and cardiac arrest following a variety of stimuli arising in or near the eyeball. The
    main purpose of this study was to evaluate the effects of various anesthetic regimens on modulation of the cardiovascular
    effects of the OCR during strabismus surgery.
    METHODS: Three hundred ASA physical status I-II patients, scheduled for elective strabismus surgery under general
    anesthesia, randomly allocated in a double blind fashion to one of the three anesthetic regimens: group P: propofol (2
    mg/kg, alfentanil 0.02 mg/kg and atracurium 0.5 mg/kg at induction; group K: ketamine racemate (2 mg/kg, alfentanil
    0.02 mg/kg and atracurium 0.5 mg/kg at induction; group T: thiopental (5 mg/kg, alfentanil 0.02 mg/kg, and atracurium
    0.5 mg/kg at induction. Mean arterial pressure (MAP and heart rate (HR were recorded just before induction, at
    1, 15, 30, 45 and 60 minutes after induction. OCR was defined as a 20 beats/minute change in HR induced by traction
    compared with basal value.
    RESULTS: Mean HR (± SD during total period of surgery in group P was significantly slower than that in group K
    (111.90 ± 1.10 vs. 116.7 ± 0.70, respectively; P<0.05. Mean HR changes (± SD in group K was significantly higher
    than that in group P (11.2 ± 1.44 vs. 8.7 ± 1.50 respectively, P<0.05. MAP changes (± SD was significantly lower in
    patients in group P compared with patients in group K or T (12.5 ± 1.13 vs. 19.3 ± 0.80 or 18.9 ± 0.91, respectively;
    P<0.05. Incidence of OCR was significantly lower in patients in group K compared with patients in group T or P (9%
    vs. 16% and 13%. Respectively; P<0.05.
    CONCLUSIONS: Induction of anesthesia with ketamine is associated with the least

  7. Immediate and prolonged effects of pre- versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Dahl, J B; Daugaard, J J; Rasmussen, B;

    1994-01-01

    Thirty-two patients scheduled for total knee arthroplasty were randomized to receive an identical epidural blockade initiated 30 min before surgical incision (N = 16), or at closure of the surgical wound (N = 16). Before induction of general anaesthesia the epidural catheter was tested with...... bupivacaine 7.5 mg.ml-1, 2 ml. General anaesthesia was induced with thiopentone, pancuronium or atracurium, and fentanyl 0.1-0.3 mg, and maintained with N2O/O2 and enflurane. The epidural regimen consisted of a bolus of 16 ml of bupivacaine 7.5 mg.ml-1 plus morphine 2 mg, and continuous infusion of......, during or after cessation of the epidural regimen. These results do not suggest timing of analgesia with a conventional, continuous epidural regimen to be of major clinical importance in patients undergoing total knee arthroplasty....

  8. Accidental intrathecal injection of magnesium sulfate for cesarean section

    Directory of Open Access Journals (Sweden)

    Mehryar Taghavi Gilani

    2014-01-01

    Full Text Available Magnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg (3.5 ml of 20% solution was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four (TOF reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked.

  9. Comparative effects of different anesthetic regimens on the oculocardiac reflex

    Directory of Open Access Journals (Sweden)

    MR Safavi

    2007-11-01

    Full Text Available Background: The oculocardiac reflex (OCR, which is most oftenencountered during strabismus surgery in children, may cause bradycardia,arrhythmias, and cardiac arrest following a variety of stimuli arising in ornear the eyeball. The main purpose of this study was to evaluate the effects ofvarious anesthetic regimens on modulation of the cardiovascular response of theOCR during strabismus surgery.Patients and Methods: Three hundred American Society of Anesthesia (ASAphysical status I-II patients, scheduled for elective strabismus surgery undergeneral anesthesia, randomly allocated in a double blind fashion to one of threeanesthetic regimens of group P ( propofol 2 mg/kg, alfentanil 0.02 mg/kg, andatracurium 0.5 mg/kg at induction , group K (ketamine racemate 2mg/kg,alfentanil 0.02 mg/kg, and atracurium 0.5 mg/kg at induction and group T(thiopental 5mg/kg, alfentanil 0.02 mg/kg, and atracurium 0.5 mg/kg atinduction. Mean arterial pressure (MAP and heart rate (HR were recorded justbefore and at 1, 15, 30, 45, and 60 min after induction. OCR was defined as a 20beats/min change in HR induced by traction compared with basal value.Results: Mean heart rate (± SD during the course of surgery in group Pwas significantly slower than in the K group (111.90 ± 1.10 vs. 116.7 ± 0.70respectively, P<0.05 .Mean HR changes (± SD in group K was significantlyhigher than in P group (11.2 ± 1.44 vs. 8.7 ± 1.50 respectively, P<0.05. Meanarterial pressure changes (± SD were significantly lower in group P than ingroup K or T patients (12.5 ± 1.13 vs. 19.3±0.80 or 18.9±0.91 respectively,P<0.05. Frequency of OCR was significantly lower in group K than group T or Ppatients (9% vs. 16% or 13% respectively, P<0.05.Conclusion: Induction of anesthesia with ketamine is associated withleast cardiovascular changes induced by OCR during strabismus surgery.

  10. Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial

    Directory of Open Access Journals (Sweden)

    Writuparna Das

    2015-01-01

    Full Text Available Background: Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia (GA is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. Objective: The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy (LC under GA and spinal anesthesia (SA in American Society of Anesthesiologists (ASA PS 1 patients. Materials and Methods: Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous (i.v, fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N2O:O2 (60:40 and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 μg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate (HR, oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA. All numerical data were analyzed using Student′s t-test and paired t-test. Any value <0.05 was taken as significant. Results: Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol

  11. Intraoperative Atelectasis Due to Endotracheal Tube Cuff Herniation: A Case Report

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    Hossein Madineh

    2012-09-01

    Full Text Available Endotracheal tube (ETT cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man ,a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room(OR for open reduction and internal fixation (ORIF of all fractures .The procedures were done under general anesthesia (G/A. The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O2 via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85 % and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.

  12. Feasibility of dexmedetomidine assisting sevoflurane for controlled hypotension in endoscopic sinus surgery

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    Guang-jie GAO

    2012-01-01

    Full Text Available Objective  To explore the feasibility of dexmedetomidine as an adjuvant of sevoflurane for controlled hypotension in endoscopic sinus surgery. Methods  Forty-eight patients (ASA Ⅰor Ⅱ scheduled for endoscopic sinus surgery were randomly assigned into two groups (n=24: control group (group I and dexmedetomidine group (group Ⅱ. In both groups, intravenous injection of midazolam, propofol, fentanyl, and atracurium besilate was given to induce anesthesia, and propofol, fentanyl, atracurium besilate, together with sevoflurane inhalation were used to maintain anesthesia. The radial artery was cannulated to monitor the invasive mean arterial pressure (MAP. Controlled hypotension was induced by adjusting the sevoflurane concentration in group Ⅰ. In group Ⅱ, within 15min to 30min before the induction of anesthesia, dexmedetomidine was administered in a dose of 0.8μg/kg via intravenous infusion pump, then maintained at 0.4μg/(kg·h. Sevoflurane concentration was adjusted to maintain the target blood pressure at the beginning of surgery. The MAP was maintained at 65-75mmHg up to the end of operation. Meanwhile, the heart rate (HR, MAP, epinephrine (E, and norepinephrine (NE concentrations were recorded at the time of induction of anesthesia (T0, beginning of controlled hypotension (T1, 30min after controlled hypotension (T2, and at the time when extubation was performed (T3. Blood gas analysis and determination of lactic acid concentration were conducted using the blood drawn from the radial artery during the operation. The surgical field quality was assessed based on Fromme scores of surgical field quality (SSFQ. Meanwhile, the dose of sevoflurane, propofol, and fentanyl, MAP, the recovery time of anesthesia, and the incidence rate of untoward effects were recorded. Results  The doses of propofol, fentanyl and sevoflurane, and MAC value in group Ⅱwas significantly diminished compared with group Ⅰ(P<0.01. In addition, the surgical

  13. The tof-guard neuromuscular transmission monitor and its use in horses O monitor da transmissão neuromuscular "tof-guard" e seu uso em eqüinos

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    Juliana Noda Bechara

    1999-03-01

    Full Text Available It has been emphasized in the human medical literature, that when using a neuromuscular blocking agent, it is of vital importance the monitoring of the neuromuscular block and that these agents should never be used without it. The purpose of this study was to evaluate the use of the neuromuscular transmission monitor TOF-Guard in horses. Twelve horses were randomly assigned whether to receive pancuronium or atracurium as the neuromuscular blocking agent. All horses were pre-medicated with romifidine, anaesthesia induced with diazepam and ketamine and maintenance with halothane. Abolition of spontaneous ventilation was accomplished by the administration of atracurium or pancuronium. The time from injection of the muscle relaxant agent to the onset of maximum block (T1=0, recovery of T1 to 25% and the recovery of TOF ratio to 0.7 were recorded, as was the time for recovery of T1 from 25 to 75%. It was concluded that it is very important the neuromuscular transmission monitoring during the use of a nondepolarizing neuromuscular blocking agent, since it provides a safer anaesthetic and surgical procedure with the use of adequate dosages and due to the impossibility of a superficialization of the neuromuscular blockade during a surgical procedure. The TOF-Guard showed to be a good option for neuromuscular monitoring in horses.Quando da utilização de bloqueadores neuromusculares, já foi enfatizado na literatura médica humana, que é de vital imporância a monitoração do bloqueio neuromuscular e que estes agentes nunca devem ser utilizados sem a mesma. O objetivo deste estudo foi o de avaliar o uso do monitor da transmissão neuromuscular TOF-Guard em eqüinos. Para tanto, doze eqüinos foram separados aleatoriamente para receberem como bloqueadores neuromusculares o pancurônio ou o atracúrio. Todos os eqüinos foram pré-medicados com romifidina, induzidos com diazepam e quetamina e mantidos com halotano. Foi administrado o atracúrio ou o

  14. THE CARDIOVASCULAR EFFECTS OF MIDAZOLAM CO-INDUCTION TO PROPOFOL FOR INDUCTION IN GERIATRIC PATIENTS

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    Kaushal

    2014-10-01

    Full Text Available : BACKGROUND: The aim of the study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent the cardiovascular change at tracheal intubation for induction in geriatric patients. METHODS: ninety patients over 65 (ASA physical status 1, 2 scheduled for elective surgery received general anaesthesia with fentanyl and propofol or midazolam. Patients in group P (n= 45 were induced with 0.9% NaCl 0.03 ml /kg, propofol 1.2 mg/kg and fentanyl. Patients in group MP (n= 45 were induced with midazolam 0.03 mg/ kg, propofol 0.8 mg/kg and fentanyl. The time taken to reach loss of consciousness (LOC. After LOC 0.5 mg/kg of atracurium was given and tracheal intubation was performed. The mean blood pressure (MBP and heart rate (HR were recorded were induction as the base value, before intubation, immediately post intubation and 3 minutes after intubation. RESULT: compared with the base values, MBP at before intubation and # minutes after intubation was significantly decreased in group P and group MP (P <0.05. compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P<0.05. The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P<0.05. There was no significant difference of HR at any time between the two groups. CONCLUSION: co-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in geriatric patients.

  15. Airtraq™ versus Macintoch laryngoscope in intubation performance in the pediatric population

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    Waleed Riad

    2012-01-01

    Full Text Available Purpose: Airtraq™ is an optical laryngoscope that allows viewing of the vocal cords without a direct line of sight. The main objective of this prospective, randomized, controlled trial was to evaluate Airtraq intubation characteristics, mainly intubation time and cardiovascular changes in the pediatric patients. Methods: Fifty children of American Society of Anesthesiologists class I, 2-10 years of age were divided into 2 groups using sealed envelope technique. Children were premedicated with midazolam. Anesthesia was induced with sevoflurane, fentanyl, and atracurium. Patients were randomly allocated to be intubated with either Airtraq (Airtraq group or Macintosh laryngoscope (Macintosh group. Intubation time, number of intubation attempts, optimization maneuvers, and ease of intubation were recorded. Hemodynamic variables were recorded before and after anesthetic induction, 1, 3, and 5 min after tracheal intubation. Results: The mean age of children was 6.1 years. Compared with Macintosh group, the use of Airtraq was associated with shorter intubation time (51.6±26.7 s vs 22.8±6.1 s, respectively, P=0.001, less median number of intubation attempts 2 (1-2 versus 1 (1-1, P=0.001, more ease of intubation [2 (1-3 versus 1 (1-1, P=0.001] and less increase in the heart rate 5 min after intubation (P=0.007. No optimization maneuvers required for Airtraq laryngoscope (P=0.001. Conclusion: Airtraq decreases intubation time, number of attempts, and optimization maneuvers, less heart rate changes during intubation compared with Macintosh laryngoscope.

  16. Comparison of propofol based anaesthesia to conventional inhalational general anaesthesia for spine surgery

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    L D Mishra

    2011-01-01

    Full Text Available Background : Often conventional Inhalational agents are used for maintenance of anaesthesia in spine surgery. This study was undertaken to compare propofol with isoflurane anaesthesia with regard to haemodynamic stability, early emergence, postoperative nausea and vomiting (PONV and early assessment of neurological functions. Patients & Methods: Eighty ASA grade I &II adult patients were randomly allocated into two groups. Patients in study group received inj propofol for induction as well as for maintenance along with N 2O+O2 and the control group patients received inj thiopentone for induction and N 2 O+O 2 +isoflurane for maintenance. BIS monitoring was used for titrating the anaesthetic dose adjustments in all patients. All patients received fentanyl boluses for intraoperative analgesia and atracurium as muscle relaxant. Statistical data containing haemodynamic parameters, PONV, emergence time, dose of drug consumed & quality of surgical field were recorded and compared using student t′ test and Chi square test. Results: The haemodynamic stability was coparable in both the groups. The quality of surgical field were better in study group. Though there was no significant difference in the recovery profile (8.3% Vs 9.02% between both the groups, the postoperative nausea and vomiting was less in propofol group than isoflurane group (25%Vs60%. The anaesthesia cost was nearly double for propofol than isoflurane anaesthesia. Conclusion: Haemodynamic stability was comparable in both the groups. There was no significant difference in the recovery time between intravenous and inhalational group. Patients in propofol group were clear headed at awakening and were better oriented to place than inhalational group.

  17. Reducing sore throat following laryngeal mask airway insertion: comparing lidocaine gel, saline, and washing mouth with the control group

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    Mehryar Taghavi Gilani

    2015-12-01

    Full Text Available BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4 h later and after 24 h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3% and lowest in the washing mouth group (25%. However, no significant statistical difference was observed between these four groups (recovery, p = 0.30; discharge, p = 0.31; examination, p = 0.52. In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p = 0.041. CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

  18. Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

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    Imantalab, Vali; Mirmansouri, Ali; Sedighinejad, Abbas; Naderi Nabi, Bahram; Farzi, Farnoush; Atamanesh, Hadi; Nassiri, Nassir

    2014-01-01

    Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 μg/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 μg/kg/min, fentanyl 1-2 μg/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ≥ 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ≤ 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery. PMID:25346897

  19. Chemical Compatibility of Depacon® with Medications Frequently Administered by Intravenous Y-Site Delivery in Patients with Epilepsy or Head Trauma

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    Rashed, Sahar M.; Sweatman, Trevor W.; Thoma, Laura; Hovinga, Collin A.; Phelps, Stephanie J.

    2004-01-01

    OBJECTIVES Intravenous Y-site administration of more than one medication through the same in-line catheter is a common practice used in the management of acute seizures. The objective of this study was to determine the compatibility of valproate sodium (Depacon®; 2 or 20 mg/mL) with 13 medications that are frequently administered to manage seizures or are given to patients with an acute head injury who are at risk for developing post-traumatic epilepsy. METHODS The study medications included atracurium, dexamethasone, diazepam, fosphenytoin, lorazepam, magnesium sulfate, mannitol, methyl-prednisolone, midazolam, pentobarbital, phenytoin, ranitidine, and thiopental. Equal volumes of valproate and each of the study drugs were admixed and immediately examined using several physiochemical criteria: Tyndall effect, color and pH change, gas evolution, and particle formation (HIAC/Royco liquid particle counter). Samples were also evaluated using HPLC analysis (C18 column; methanol/tetrahydrofuran/ phosphate buffer; 44/1/55% v/v, at 1.5 mL/min; 50°C) with UV (190-400 nm) photodiode detection. The valproate peak (220 nm) was quantified by both peak area and height. Samples were analyzed within 5 minutes of admixture and were reassessed at 15 and 30 minutes. RESULTS With the exception of diazepam, midazolam, and phenytoin, all of the remaining drugs were chemically compatible with valproate, both in 5% Dextrose Injection, USP(D5W) and in 0.9% Sodium Chloride Injection, USP (Normal Saline -NS). None of the compatible medications produced a significant pH change, discernible gas, particle formation, reduced valproate titer by HPLC analysis (coefficient of variability < 1.5%), or the temporal formation of unidentified UV absorbing (190–400 nm) peaks. CONCLUSIONS Intravenous valproate is compatible with most agents employed in seizure management or used in patients at risk for seizures following head injury and is safe for concurrent Y-site drug administration. PMID:23118699

  20. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

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    Elif Bengi Sener

    2012-01-01

    Full Text Available OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively (p<0.001. The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05. The rate pressure product values (heart rate x systolic blood pressure at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively (p<0.05. There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754. The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from

  1. Paracetamol, Ondansetron, Granisetron, Magnesium Sulfate and Lidocaine and Reduced Propofol Injection Pain

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    Alipour, Mohammad; Tabari, Masoomeh; Alipour, Masoomeh

    2014-01-01

    Background: Propofol is a most widely used intravenous anesthetic drug. One of its most common complications is the pain upon injection; therefore, different methods, with various effects, have been proposed in order to alleviate the pain. Objectives: This study investigates the effects of paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine drugs on reducing the pain of propofol injection during anesthetic induction. Also, the hemodynamic changes will be analyzed. Patients and Methods: This is an interventional study containing 336 patients underwent elective orthopedic surgeries in Educational Hospitals of Mashhad University, using systematic sampling, the patients were divided into six groups. A 20-gauge needle was inserted into a venous vessel in the back of the hand and 100 cc of Ringer serum was injected into the vein, which was applied proximal to the injection site. Afterwards, paracetamol 2 mg/kg (group p), magnesium sulfate 2 mmol (group M), ondansetron 4 mg (group O), granisetron 2 mg (group G), lidocaine 40 mg (group L) and 5 cc saline (group S) were injected into the vessel, after 60 seconds, the tourniquet was opened. One quarter of the total dose of propofol (2.5 mg/kg) was injected with a flow rate of 4 mg/sec and then the injection pain was measured. Finally, the fentanyl (2 µg/kg), atracurium 0.5 mg/kg, and the remaining dose of propofol were injected and the vital signs were recorded before the administration of propofol and 1, 3, 5 and 10 minutes after the propofol injection. Results: The six groups did not significantly differ, regarding their gender, weight or age. Propofol injection pain was less in L and G groups, in comparison with the others (P ≤ 0.001). By analyzing the hemodynamic changes, it was observed that the least amount of change in mean arterial pressure was observed in the paracetamol group. Conclusions: The reduction of propofol injection pain was observed by using medications (in comparison with normal

  2. Postoperative pain management after supratentorial craniotomy.

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    Verchère, Eric; Grenier, Bruno; Mesli, Abdelghani; Siao, Daniel; Sesay, Mussa; Maurette, Pierre

    2002-04-01

    The aim of this study was to compare the analgesic efficacy of three different postoperative treatments after supratentorial craniotomy. Sixty-four patients were allocated prospectively and randomly into three groups: paracetamol (the P group, n = 8), paracetamol and tramadol (the PT group, n = 29), and paracetamol and nalbuphine (the PN group, n = 27). General anesthesia was standardized with propofol and remifentanil using atracurium as the muscle relaxant. One hour before the end of surgery, all patients received 30 mg/kg propacetamol intravenously then 30 mg/kg every 6 hours. Patients in the PT group received 1.5 mg/kg tramadol 1 hour before the end of surgery. For patients in the PN group, 0.15 mg/kg nalbuphine was injected after discontinuation of remifentanil, because of its mu-antagonist effect. Postoperative pain was assessed in the fully awake patient after extubation (hour 0) and at 1, 2, 4, 8, and 24 hours using a visual analog scale (VAS). Additional tramadol (1.5 mg/kg) or 0.15 mg/kg nalbuphine was administered when the VAS score was > or = 30 mm. Analgesia was compared using the Mantha and Kaplan-Meier methods. Adverse effects of the drugs were also measured. The three groups were similar with respect to the total dose of remifentanil received (0.27 +/- 0.1 mircog/kg/min). In all patients, extubation was obtained within 6 +/- 3 minutes after remifentanil administration. Postoperative analgesia was ineffective in the P group; therefore, inclusions in this group were stopped after the eighth patient. Postoperative analgesia was effective in the two remaining groups because VAS scores were similar, except at hour 1, when nalbuphine was more effective (P = .001). Nevertheless, acquiring such a result demanded significantly more tramadol than nalbuphine (P < .05). More cases of nausea and vomiting were observed in the PT group but the difference was not significant (P < .06). In conclusion, pain after supratentorial neurosurgery must be taken into account

  3. Weight-based dosing in medication use: what should we know?

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    Pan, Sheng-dong; Zhu, Ling-ling; Chen, Meng; Xia, Ping; Zhou, Quan

    2016-01-01

    Background Weight-based dosing strategy is still challenging due to poor awareness and adherence. It is necessary to let clinicians know of the latest developments in this respect and the correct circumstances in which weight-based dosing is of clinical relevance. Methods A literature search was conducted using PubMed. Results Clinical indications, physiological factors, and types of medication may determine the applicability of weight-based dosing. In some cases, the weight effect may be minimal or the proper dosage can only be determined when weight is combined with other factors. Medications within similar therapeutic or structural class (eg, anticoagulants, antitumor necrosis factor medications, P2Y12-receptor antagonists, and anti-epidermal growth factor receptor antibodies) may exhibit differences in requirements on weight-based dosing. In some cases, weight-based dosing is superior to currently recommended fixed-dose regimen in adult patients (eg, hydrocortisone, vancomycin, linezolid, and aprotinin). On the contrary, fixed dosing is noninferior to or even better than currently recommended weight-based regimen in adult patients in some cases (eg, cyclosporine microemulsion, recombinant activated Factor VII, and epoetin α). Ideal body-weight-based dosing may be superior to the currently recommended total body-weight-based regimen (eg, atracurium and rocuronium). For dosing in pediatrics, whether weight-based dosing is better than body surface-area-based dosing is dependent on the particular medication (eg, methotrexate, prednisone, prednisolone, zidovudine, didanosine, growth hormone, and 13-cis-retinoic acid). Age-based dosing strategy is better than weight-based dosing in some cases (eg, intravenous busulfan and dalteparin). Dosing guided by pharmacogenetic testing did not show pharmacoeconomic advantage over weight-adjusted dosing of 6-mercaptopurine. The common viewpoint (ie, pediatric patients should be dosed on the basis of body weight) is not always

  4. BOTH TIDE VOLUMES’ IMPACT ON OVER WEIGHT PATIENTS’ PULMONARY OXYGENATION FUNCTION%两种潮气量对体重超重患者肺氧合功能影响

    Institute of Scientific and Technical Information of China (English)

    邓军; 韦克(通讯作者); 李明良; 左朝晖; 赵兰花

    2014-01-01

    Objective: To compare the different tide volumes’impact on pulmonary oxygenation function in over weight patients, a kind of ventilation model which could protect pulmonary oxygenation function was found .Material and Method : 80 patients were be randomly divided into 4 groups: the male control group, the female control group, the male experiment group and the female control group. The control group’s tidal volume (VT) = body weight × 8ml/kg, the experiment group’s VT = ideal body weight×8 ml/kg. Propofol, remifentanil and cis-atracurium were respectively adopted to al patients by vein, during induction of anesthesia. After tracheal intubation, the ventilation of tidal volume were adjusted to each group’s preset volume tide. Propofol and remifentanil also were continuously target control infused during maintenance of anesthesia . Cis-atracurium was discontinuously used by vein . The blood gas analysis and air way pressure were respectively monitored at mechanical ventilation start(T1), the post mechanical ventilation 1 hour(T2) , the end-operation (T3) and the respiratory recovery before extubation (T4).Results: 1.The volume tide in the control group and in the experiment group were compared(P <0.05). The difference was significant.2. Patients which oxygenation index(OI) at T3 less than 300 in the female control group and these in the female experiment group were 8, 1 , respectively. Patients whose oxygenation index at T3 were less than 300 in the male control group and those in the male experiment group were 10, 3, respectively. Patients whose oxygenation index at T3 was less than 300 in the male control group and those in the experiment group was compared(P <0.05), the difference was significant . 3.The arterial carbon dioxide pressure(PaCO2) at T2 and PaCO2 at T3 in the control group and in the experiment group were compared respectively(P <0.05), the difference was significant Conclusion: The ventilation model in the experiment group avoided

  5. 右美托咪啶联合硝酸甘油在鼻内镜手术控制性降压中的应用%The effects of dexmedetomidine combined with nitroglycerin in controlling hypotension during endoscopic sinus surgery

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    李启健; 魏昕; 方才

    2012-01-01

    Objective To compare the effects of using dexmedetomidine combined with nitroglycerin and nitroglycerin alone in controlling hypotension during endoBcopic sinus surgery. Methods Forty ASA I or II patients, aged 20-60yr,weighting 50-76 kg who undergoing endoscopic sinus surgery,were randomly divided into 2 groups (n = 20 each) , dexmedetomidine combined with nitroglycerin group (group ND) and nitroglycerin group (group N). Mid-azolam, refentanl, propofol and cis-atracurium were used for rapid intravenous induction. Refentanl, propofol and cis-atracurium were administrated for anesthesia maintenance. Group ND received dexmedetomidine 1 Μ/ kg over 10 min after intubation followed by 0.5 μg · kg-1 · h-1 infusion during maintenance, while group D received the same a-mounts of saline. When the surgeons began to sterilize the nasal cavity,nitroglycerin was administrated from 1.0 μg o kg-1 o min-1 and titrated according to target MAP. The target MAP during controlled hypotension was maintained between 55 and 65 mmHg. MAP and HR were recorded at the time points of pre-induction (T0) ,15 min (T1) ,30 min (T2) and 45 min (T3) after controlling hypotension and 15 min after extubation ( T4). The Fromme scores of surgical field were assessed by the same surgeon, blinded to the study drugs. The time of MAP reaching to target MAP and returning to preoperan've level,the operating time,extubation time and the total dosage of nitroglycerin were recorded. Results Compared with T0 ,MAP in both group decreased and HR in group N increased significantly at T, -T3 during operation (P < 0.05). Compared with group N, HR remained stable, the time of MAP reaching to target lever was shorter and the total dosage of nitroglycerin was less in group ND (P < 0.05). Meanwhile, group ND had lower From-me scores (P <0.05). Time of MAP returned to preoperative level and extubation time had no significant difference between two groups. Conclusion Dexmedetomidine combined with nitroglycerin can be

  6. Effect of of dexmedetomodine in total intravenous anesthesia: an observation on hemodynamics%右美托咪啶用于全凭静脉麻醉的血流动力学研究

    Institute of Scientific and Technical Information of China (English)

    韩梅; 聂宇; 熊君宇

    2011-01-01

    目的 全凭静脉麻醉术中使用右美托咪啶(dexmedetomodine,DEX)观察血流动力学变化,拔管期反应和对苏醒时间的影响,探讨国人术中使用DEX的合理剂量.方法 择期全麻行甲状腺手术的患者40例(ASA Ⅰ~Ⅱ级),随机数余数分组法分为两组(每组20例),实验组(D组)和对照组(N组).采用咪达唑仑、芬太尼、依托咪酯和顺式阿曲库铵静脉诱导,术中以丙泊酚、瑞芬太尼和顺式阿曲库胺维持麻醉.D组使用DEX,负荷量0.8μg/kg,给药时间10 min,继0.4 μg·kg-1·h-1持续输注至手术结束前10 min;N组在相同时间给予等量生理盐水.记录两组患者术中的循环变化和药物干预,记录拔管期和术后30 min内的循环情况,并计算心肌氧耗指数(rate pressure product,RPP)即心率收缩压乘积;记录苏醒及拔管时间、拔管评分及并发症情况.结果 ①负荷量期间,与N组相比D组从给药后2 min开始心率(HR)降低显著(P0.05).结论 ①DEX用于全凭静脉麻醉的中小手术可减弱血流动力学反应;有效减少拔管期间RPP,减少心肌氧耗量;对拔管评分、苏醒时间和拔管时间无明显影响.②负荷量0.8μg/kg,继以0.4μg·kg-1·h-1输注的给药方法 在全凭静脉麻醉的中小手术中使用是适宜的.%Objective To observe the effect of dexmedetomodine(DEX)on hemodynamics during operation and in extubation period in minor surgery. Methods Forty patients (ASA Ⅰ -Ⅱ Scheduled for thyroidectomy under intravenous anesthesia were randomly divided into 2 groups, DEX group (group D) and control group (group N), with 20 patients in each. Midazolam, fentanyl, etomidate and cis-atracurium were used for rapid intravenous induction and remifentanyl, propfol, cis-atracurium were observed in BP and HR in both groups during extubation (P<0.05) .The SBP in group D raise from( 123±14) mm Hg( 1 mm Hg=0.133 kPa) to( 129±14) mm Hg,while in group N it was from( 123±10) mm Hg to( 139±15) mm Hg, the

  7. 地佐辛和地塞米松对芬太尼呛咳反应的抑制作用%Dezocine and dexamethasone inhibition of choking cough relfex fentanyl

    Institute of Scientific and Technical Information of China (English)

    王志; 刘风

    2015-01-01

    Objective To evaluate the dezocine, dexamethasone suppress fentanyl-induced cough. Methods 90 cases ASAⅠ-Ⅱ grade anesthesia in patients undergoing elective surgery were randomly divided into three groups. 2 minutes before induction,Ⅰ、Ⅱ、Ⅲgroup were given saline 2 mL、the dezocine 0.1 mg/kg、dexamethasone 10 mg, each group was given fentanyl 4μg/kg , after 15seconds, midazolam 0.1 mg/kg, propofol 2 mg/kg (0.4 mL/s), cis-atracurium 0.2 mg/kg was given. The coughing rate and extent of fentanyl was observed, and the hemodynamic changes before and after induction was also observed.Results The incidence of cough was:Ⅰ group, 53.3%,Ⅱ group 13.3%,Ⅲ group, 20.0%. Compared with groupⅠ,Ⅱ,Ⅲ group, the incidence of cough was significantly lower (P<0.05), but between the two experimental groups cough incidence and intensity did not differ significantly. The hemodynamic changes of Each group before and after the induction was consistent. Conclusion Pre-injection of dezocine 0.1 mg/kg, 10 mg of dexamethasone can effectively reduce the fentanyl-induced cough response.%目的:评价地佐辛、地塞米松抑制芬太尼呛咳反应的作用。方法选择90例ASAⅠ~Ⅱ级择期行全麻手术的患者,随机均分为3组。Ⅰ、Ⅱ、Ⅲ组分别于诱导前1 min给予生理盐水2 mL、地佐辛0.1 mg/kg、地塞米松10 mg,各组均由外周静脉给予芬太尼4μg/kg,15 s后给予咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg(0.4 ml/s)、顺阿曲库铵0.2 mg/kg。观察芬太尼呛咳的发生率和程度、诱导前后血流动力学的变化。结果各组呛咳的发生率分别为:Ⅰ组53.3%、Ⅱ组13.3%、Ⅲ组20.0%,与Ⅰ组比,Ⅱ、Ⅲ组呛咳的发生率明显降低(P<0.05),但两个试验组间呛咳的发生率及强度并无明显差异。各组诱导前后血流动力学的变化一致。结论预注射地佐辛0.1 mg/kg、10 mg的地塞米松均能有效地减轻芬太尼引发的呛咳反应。

  8. 每搏量变异度与患者血容量变化的相关性%Correlation between stroke volume variation and blood volume

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    王合梅; 贾慧群; 雍芳芳; 李超; 王勇; 赵伟

    2010-01-01

    Objective To evaluate the correlation between stroke volume variation (SVV) and the blood volume. Methods Forty-eight ASA Ⅱ male patients, aged 50-60 yr, scheduled for elective radical operation for gastric cancer, were studied. Anesthesia was induced with fentanyl 4 μg/kg, propofol 2 mg/kg and cis-atracurium 0.15 mg/kg and maintained with inhalation of 2%-3% sevoflurane. 6% HES 130/0.4 was infused intravenously at a rate of 0.67 ml· kg - 1 · min - 1 30 min after induction. SVV,cardiac output (CO),SV and cardiac index (CI) were monitored and recorded using the FloTrac/Vigileo (Edwards Lifesciences, USA) system before HES was infused and when the dose of HES reached 2, 4, 6, 8, 10, 12, 14, 16 and 18 ml/kg. CVP was also recorded at the corresponding time points. Spearman's rank sum correlation coefficient was used to analyze the data. Results Correlation coefficients between the amount of HES infused and CO, SV, CI or CVP were rSVV = - 0.91 ± 0.06,rCO = 0.83 ± 0.04, rSV = 0.86 ± 0.09, rCI = 0.86 ± 0.09 and rCVP = 0.90 ± 0.03. Among the 5 correlation coefficients, rSVV was the highest, rCVP was significantly higher than rCO, rSV and rCI (P < 0.05), and there was no significant difference among rCO, rSV and r CI (P > 0. 05). Conclusion SVV is highly correlated with the blood volume and can be used to guide volume therapy.%目的 评价每搏量变异度(SVV)与患者血容量变化的相关性.方法 择期胃癌根治术男性患者48例,年龄50~60岁,ASA分级Ⅱ级.麻醉诱导后30 min静脉输注6%羟乙基淀粉130/0.40.67 ml·kg-1·min-1,分别于输注前、输注羟乙基淀粉剂量达2、4、6、8、10、12、14、16、18 ml/kg时,记录SVV、CO、SV、CI和CVP.SVV、CO、SV、CI和CVP与羟乙基淀粉输注量行Spearman等级相关分析.结果 SVV、CO、SV、CI和CVP与羟乙基淀粉输注量之间的相关系数分别为:rSVV=-0.91±0.06,rCO=0.83±0.04,rSV=0.86±0.09,rCI=0.86±0.09,rCVP=0.90±0.03.5个相关系数中,rSVV最高,r

  9. Anestesia em paciente portadora de doença de moyamoya: relato de caso Anestesia en paciente portadora de enfermedad de moyamoya: relato de caso Anesthesia in patient with moyamoya disease: case report

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    Adriano Bechara de Souza Hobaika

    2005-06-01

    , la paciente fue mantenida en normocapnia y normotermia. La extubación fue realizada y la paciente transferida a la sala de recuperación pos-anestésica sin complicaciones. CONCLUSIONES: Este artículo presenta los cuidados anestésicos dados a una paciente portadora de la enfermedad de moyamoya.BACKGROUND AND OBJECTIVES: Moyamoya disease is an uncommon progressive cerebral vasculopathy, more frequently diagnosed among Asian individuals, but which has also been described in Brazil. Moyamoya patients may be submitted to different surgical procedures throughout their lives. Anesthesiologists must understand the pathophysiology of the disease and institute adequate perioperative measures to improve patients' prognosis. CASE REPORT: Female patient, 22 yr-old, chronic renal failure, with moyamoya disease, scheduled for surgical arterial-venous fistula installation. Anesthesia was induced with fentanyl, propofol and atracurium and maintained with sevoflurane. Patient was maintained in normocapnia and normothermia throughout the procedure. Patient was extubated and transferred to the post-anesthetic care unit without complications. CONCLUSIONS: This article describes the anaesthetic care of a moyamoya disease patient.

  10. A comparative study of the effect of sevoflureane versus propofol on the maintenance of anesthesia in pediatric burn surgery%七氟醚与丙泊酚用于小儿烧伤手术麻醉维持的比较

    Institute of Scientific and Technical Information of China (English)

    张学康; 赵为禄; 徐琳; 闵佳

    2011-01-01

    Objective To compare the effects of sevoflureane and propofol on the maintenance of anesthesia in pediatric burn surgery. Methods Sixty pediatric burn patients were randomly divided into propofol group (group P) and sevoflureane group (group S). After tracheal intubation, anesthesia was maintained with infusion of propofol (3-8 mg·kg-1·h-1) in group P and inhalation of sevoflurane (l%-4%) in group S. Atracurium and fentanil were given intermittently when they were needed during the operation in both groups. Propofol and sevoflurane were discontinued five minutes before the end of surgery. The hemodynamics index, the time for recovery of spontaneously breathing, palinesthesia and extubation as well as the children's restlessness after surgery were recorded. Results After extubation, Spft declined significantly in group P, which was lower than that at the same point of group S (P<0. 05). The times for recovery of spontaneously breathing, palinesthesia and extubation were all shorter in group S than in group P (P<0. 01). Conclusion In pediatric burn surgery, sevoflureane maintenance anesthesia allows for a stabile circulatory system condition during the operation and fast recovery of spontaneously breathing, rapid awakening, timely extubation, and low incidence of restlessness. The anesthesia effect of sevoflureane is superior to propofol in the maintenance of anesthesia in pediatric burn surgery.%目的 比较七氟醚与丙泊酚用于小儿烧伤手术麻醉维持的效果.方法 择期手术烧伤患儿60例,随机分为丙泊酚组(P组)和七氟醚组(S组),每组30例.气管插管后P组泵注丙泊酚3~8 mg·kg-1·h-1维持麻醉,S组吸入1%~4%七氟醚维持麻醉;需要时均间断静注芬太尼和阿曲库铵.术毕前5 min停用丙泊酚和七氟醚.记录术中血流动力学指标以及术毕患儿自主呼吸恢复时间、苏醒时间、拔管时间、苏醒时躁动情况.结果 气管拔管后P组SpO2明显降低,且低于S组(P<0

  11. Compared haemodynamics effects of laryngeal mask airway and tracheal intubation in patients undergoing laparoscopic cholecystectomy%喉罩与气管插管在腹腔镜胆囊切除术中对血流动力学的影响

    Institute of Scientific and Technical Information of China (English)

    赵占志; 吴慧; 胡松; 许大伟

    2012-01-01

    Objective To compare the haemodynamics effects of laryngeal mask airway (LMA) and tracheal intubation in patients undergoing laparoscopic cholecystectomy (LC).Methods Sixty patients with cholecystolithiasis were divided into two groups:Laryngeal mask airway group (group A) and tracheal intubation group (group B).Anesthesia induction was performed by intravenous injection with midazolam(0.1 mg/kg),sulfentanyl(0.2 μg/kg),propofol(2 mg/kg),atracurium(0.15 mg/kg).The parameter of ventilation to be as follow,tidal volume 6-8 ml/kg,respiratory frequency 12-14 times/min intermittent positive pressure ventilation (IPPV),CO2 pneumoperitoneum pressure < 12 mm Hg (1 mm Hg =0.133 kPa).SBP,DBP,HR and postoperative complications were recorded before anesthesia induction(T0),three minutes after LMA or endotracheal tube insertion(T1),after pneumoperitoneum (T2),three minutes before departed LMA or endotracheal tube(T3) and three minutes after departed LMA or endotracheal tube (T4).Results In induced phase,awakening hemodynamic changes of laryngeal mask group was tracheal intubation small group,the postoperative complications of laryngeal mask was tracheal intubation less group.Conclusions Compared with group B,group A offered better general anesthesia on LC for LMA insertion,conduced to degrade stress reaction,more stable haemodynamics effects,beneficial ventilation and.reduced dosage.The occurrence of postoperative sore throat is obviously lower in group A.%目的 比较喉罩(LMA)与气管插管用于全身麻醉腹腔镜胆囊切除术(LC)患者血流动力学的影响.方法 选择胆石症患者60例,随机分为喉罩组(A组)和气管插管组(B组).全身麻醉诱导咪唑0.1 mg/kg,舒芬太尼0.2 μg/kg,异丙酚2 mg/kg,阿曲库铵0.15 mg/kg,静脉给药.通气设置为潮气量6~8 ml/kg,频率12~14次/min,间歇正压通气(IPPV),C02气腹(压力<12 mm Hg,1 mm Hg=0.133 kPa).记录两组在诱导前(T0),插喉罩或气管导管后3 min(T1),气腹后(T2),

  12. Dexmedetomidine and Propofol for Anesthesia Induction of Clinical Research%右美托咪定复合丙泊酚用于全麻诱导的临床研究

    Institute of Scientific and Technical Information of China (English)

    郭雄; 李雪刚

    2014-01-01

    目的研究右美托咪定复合丙泊酚全麻诱导对麻醉深度,血流动力学及丙泊酚用量的影响。方法 ASAⅠ~Ⅱ级择期行腹腔镜下胆囊切除术患者40例,年龄18~60岁,体重50~80kg。随机分为两组,每组20例。 D组右美托咪定1μg/kg10min内泵注完毕,N组给予同等容量生理盐水,随后两组推注丙泊酚待BIS值降到60后给3μg/kg芬太尼,0.2mg/kg顺式阿曲库铵,2.5min后插管。观察入室T0,诱导后5minT1,10minT2插管即刻T3,插管后1minT4,2minT5的心率,收缩压,舒张压和BIS值。结果 D组丙泊酚用量明显少于N组,D组在T1 T2时BIS值显著低于N组,N组在T3 T4收缩压,舒张压明显低于D组,D组心率在T2时明显低于N组。结论1μg/kg右美托咪定全麻诱导可明显降低BIS值减少丙泊酚用量,血流动力学更稳定。%Objective To investigate the change of bispectral,hemodynamic and the dose of propofol after the usage of Dexmedetomidine in the induction of general anesthesia.Methods Forty patients ,graded ASAⅠ~IIdegree,undergoing gal bladder resection ,were randomized to placebo (groupN) or Dexmedetomidine (groupD) group. Dexmedetomidine1μg/kg or the same volume of saline were intravenous injected in 10 minutes,respectively.Then the two groups induced with propofol,when BIS reduced to 60 we give them fentanly 3μg/kg and cis-atracurium 0.2μg/kg,2.5 minutes later we operated tracheal intubation.BIS,HR,SBP,DBP were recorded intervals before induction,5 minutes and 10 minutes after induction,tracheal intubation,1 minute,2 minute after tracheal intubation and we also recorded the dosage of propofol.Results There was no significant dif erence between the two group before anesthesia induction.The dosage of propofol in group D was significant fewer than group N.BIS of group D was lower than group N at time T1 and T2.Compared with group D,SBP and DBP of group N decreased significant at time T3 and T4.HR of group D decreased

  13. [Anesthesia and intensive therapy for a patient with mitochondrial myopathy].

    Science.gov (United States)

    Breucking, E; Mortier, W; Lampert, R; Brandt, L

    1993-10-01

    general anaesthetics in our clinic. The muscle biopsies, two in 1983 and one in 1985, were performed under local infiltration with procaine and were uneventful. The general anaesthetics were carried out without MH trigger substances following pretreatment with dantrolene for the following surgical procedures: the repair of an extensive arterio-venous fistula between the brachiocephalicus trunk and the right jugular and subclavian vein, revision of the sternum cerclage, implantations and explanations of infectious Port-A-Cath systems. We used etomidate, propofol and fentanyl or alfentanil with nitrous oxide and oxygen for induction and maintenance of anaesthesia. Muscle relaxation was induced with vecuronium or atracurium. All cardiovascular, respiratory, metabolic and temperature measurements stayed in normal ranges. After the extensive vascular repair (av fistula) the patient had to be mechanically ventilated for some hours until normal body temperature was restored. At the end of all other periods of anaesthesia she was extubated in the operating theatre. In five cases the postoperative period was uneventful. Only once she developed a crisis with hyperthermia, tachycardia, sweating and dyspnoea. INTENSIVE CARE. From 1985 to 1992 the patient was treated in our ICU 21 times. On 11 occasions she was already intubated and being ventilated by the emergency service on arrival. Extubation was usually possible within 2-20 h. During the crisis, heart rate was about 160-190 per minute and temperature above 40 degrees C. Serum values of CK, glucose, BUN, electrolytes, lactate and thyroid hormones were always in the normal ranges. Blood gas controls showed a constant respiratory alkalosis, arterial pCO2 values decreasing to 20 mm Hg or less. In addition to mechanical ventilation, treatment consisted in dantrolene infusions and droperidol injections, supplemented from 1989 onward with piritramide injections because of the increased severity of myalgia. In 1991 we gave propofol by

  14. COMPARISON OF DEXMEDETOMIDINE AND ESMOLOL FOR INDUCTION OF CONTROLLED HYPOTENSION IN SPINE SURGERIES

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    Deepali Sidhwani

    2016-05-01

    Full Text Available OBJECTIVE A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Spine surgeries. METHODS 60 patients ASA I or II scheduled for routine spine surgeries were equally randomly assigned to receive either dexmedetomidine or esmolol. In DEX group, patients received loading dose of 1 μg/kg dexmedetomidine diluted in 10 mL 0.9% saline infused over 10 min. before induction of anaesthesia, followed by continuous infusion of 0.5 μg/kg/h. In E group, patients received esmolol as a loading dose 1 mg/kg as 10 mL total vol. in saline infused over 1 min. followed by continuous infusion of 0.5 mg/kg/h. In both groups, aim was to maintain MAP within 55-65 mmHg. All patients were premedicated with IV glycopyrrolate 5 μg/Kg, IV midazolam 0.05 mg/kg and fentanyl 2 μg/kg. Patients received standard anaesthetic technique with propofol 2 mg/kg. Anaesthesia was maintained with O2, N2O, sevoflurane at 2 MAC and atracurium 0.1 mg/kg. Surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR; intraoperative fentanyl consumption; Emergence time and total recovery from anaesthesia (Aldrete score ≥9 were recorded. Sedation score was determined at 15, 30, 60 min. after tracheal extubation and time to first analgesic request was recorded. RESULTS Both DEX group and E group reached the desired MAP (55-65 mmHg with no intergroup differences in MAP or HR. The average category scale for quality of the surgical field in the range of MAP (55-65 mmHg were <=2 with no significant differences between group scores during hypotensive period. The induction propofol dose was significantly lower in DEX group than E group (1.63±0.19 mg/kg versus (2.00±0.05 mg/kg respectively (P<0.000. Baseline values of MAP and HR were comparable in both groups. Mean intraoperative fentanyl consumption in DEX group was significantly less than E group (21.67±22.75 µg vs

  15. The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: A randomized, double-blinded study

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    Khosrou Naghibi

    2013-01-01

    Full Text Available Background: The aim of this study was to compare the postoperative pain scores and morphine requirements between spinal anesthesia (SA with hyperbaric bupivacaine 0.5% and general anesthesia (GA with 1 Minimal alveolar concentration minimal alveolar concentration (MAC of isoflurane in 50% N 2 O and O 2 after elective lower abdominal surgery. Materials and Methods: In this randomized clinical trial, 68 patients with American Society of Anesthesiologists (ASA I or II undergoing lower abdominal surgery were randomly assigned to have elective lower abdominal surgery under SA (n = 34 or GA (n = 34. The SA group received 3 cc of 0.5% hyperbaric bupivacaine (15 mg, at L3-L4 interspace intrathecally and also 2 mic/kg fentanyl and 0.15 mg/kg morphine intravenously for intraoperative analgesia. In the GA group, induction of anesthesia was carried out with Na thiopental 6 mg/kg body weight, fentanyl 2 mic/kg body weight, morphine 0.15 mg/kg, and atracurium 0.6 mg/kg body weight, and then, trachea was intubated. The primary outcome was postoperative pain scores at rest and under stress on a visual analog scale and the secondary outcome was morphine requirement by the patients. Outcome measures were recorded at 2, 4, 6, 12, and 24 h postoperatively. The duration of postanesthesia care unit (PACU and hospital stay were recorded. Intraoperative parameters, postoperative pain scores, complications, recovery time, and the duration of hospital stay at follow up were compared between the two groups. Results: Patients in SA group had significantly lower scores of a postoperative pain at rest (3.4 ± 1.6 and 4.1 ± 1.2 at 2 and 4 h postoperatively vs. 5.2 ± 1.5 and 5.8 ± 0.9 in the GA group with P < 0.05, but there were no significant differences between both groups for scores of postoperative pain at 6, 12, and 24 h. The amount of morphine requirement in 6 h postoperatively was significantly lower in the SA group (10.2 ± 4.3 mg vs. 15.6 ± 5.6 mg in the GA group

  16. Weight-based dosing in medication use: what should we know?

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    Pan SD

    2016-04-01

    Full Text Available Sheng-dong Pan,1 Ling-ling Zhu,2 Meng Chen,3 Ping Xia,1 Quan Zhou3 1Division of Medical Administration, 2VIP Care Ward, Division of Nursing, 3Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China Background: Weight-based dosing strategy is still challenging due to poor awareness and adherence. It is necessary to let clinicians know of the latest developments in this respect and the correct circumstances in which weight-based dosing is of clinical relevance. Methods: A literature search was conducted using PubMed. Results: Clinical indications, physiological factors, and types of medication may determine the applicability of weight-based dosing. In some cases, the weight effect may be minimal or the proper dosage can only be determined when weight is combined with other factors. Medications within similar therapeutic or structural class (eg, anticoagulants, antitumor necrosis factor medications, P2Y12-receptor antagonists, and anti-epidermal growth factor receptor antibodies may exhibit differences in requirements on weight-based dosing. In some cases, weight-based dosing is superior to currently recommended fixed-dose regimen in adult patients (eg, hydrocortisone, vancomycin, linezolid, and aprotinin. On the contrary, fixed dosing is noninferior to or even better than currently recommended weight-based regimen in adult patients in some cases (eg, cyclosporine microemulsion, recombinant activated Factor VII, and epoetin α. Ideal body-weight-based dosing may be superior to the currently recommended total body-weight-based regimen (eg, atracurium and rocuronium. For dosing in pediatrics, whether weight-based dosing is better than body surface-area-based dosing is dependent on the particular medication (eg, methotrexate, prednisone, prednisolone, zidovudine, didanosine, growth hormone, and 13-cis-retinoic acid. Age-based dosing strategy is better than weight

  17. Feasibility study of dexmedetomidine for assisting sevoflurane controlled hypotension in endoscopic sinus surgery%右旋美托咪啶辅助七氟烷控制性降压用于鼻内窥镜手术的可行性

    Institute of Scientific and Technical Information of China (English)

    高光洁; 徐迎阳; 王兵,; 吕红梅; 杨闻宇; 尚宇

    2012-01-01

    Objective The present paper discusses the feasibility of dexmedetomidine in assisting sevoflurane-controlled hypotension in endoscopic sinus surgery. Methods Forty-eight patients (ASA I or II) scheduled for endoscopic sinus surgery were randomly assigned into two groups (n=24): control group (group I) and dexmedetomidine group (group II). In both groups adopted intravenous injection of midazolam, propofol, fentanyl, and atracurium besilate was given to induce anesthesia. Propofol, fentanyl, atracurium besilate, together with sevoflurane inhalation were used to maintain anesthesia. The radial artery was cannulated to monitor the mean invasive arterial pressure (MAP). Controlled hypotension was induced by adjusting the sevoflurane concentration in group I. In group II, within Ismin to 30min before the induction of anesthesia, dexmedetomidine was administered in a dose of 0.8 μ g/kg via intravenous pump infusion, then maintained at 0.4μ- g/(kg · h). Sevoflurane concentration was adjusted to maintain the target blood pressure at the beginning of surgery. The MAP was maintained at 65mmHg to 75mmHg up to the end of operation. Meanwhile, the heart rate (HR), MAP, Epinephrine (E), and Norepinephrine (NE) concentrations were recorded at the induction of anesthesia (T0), the beginning of controlled hypotension (T1), at 30min (T2), and extubation (T3). Blood gas analysis and determination of lactic acid concentration were conducted using the blood drawn from the radial artery during the operation. The surgical field quality was assessed based on Fromme scores of surgical field quality (SSFQ). Meanwhile, the dose of sevoflurane, propofol, and fentanyl, MAP, the recovery time of anesthesia, and the incidence rate of untoward effects were recorded. Results The dosage of propofol, fentanyl, sevoflurane, and MAC value in group II was significantly diminished compared with group I (P0.05). Moreover, the incidence rates of expanding pain in sinus, headache, delirium, and chill

  18. O uso de bloqueadores neuromusculares no Brasil El uso de bloqueadores neuromusculares en Brasil Neuromuscular blockers in Brazil

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    Maria Cristina Simões de Almeida

    2004-12-01

    BNM. Las complicaciones más apuntadas fueron el bloqueo prolongado, el broncoespasmo grave y la curarización residual. CONCLUSIONES: El atracúrio es el bloqueador neuromuscular más empleado en Brasil, hay alto percentual del uso de la succinilcolina en situaciones no emergenciales, el uso de monitores de la transmisión neuromuscular es raro, y, como un corolario, un percentual significativo de uso de criterios eminentemente clínicos para considerar el paciente descurarizado. Se registró que, cerca del 30% de los anestesiologistas tuvo algún tipo de complicación consecuente del uso de eses fármacos.BACKGROUND AND OBJECTIVES: There are no statistical data on the use of neuromuscular blockers in Brazil. This study aimed at statistically analyzing this topic. METHODS: Our study has compiled 831 answers to a questionnaire filled by anesthesiologists attending the 48th Brazilian Congress of Anesthesiology in Recife, 2001, and via Internet by anesthesiologists whose e-mail addresses are in the Brazilian Society of Anesthesiology web page (www.sba.com.br. The following data were evaluated: years of experience with the specialty, region where anesthesiologists practice, neuromuscular blockers (NMB usage in order of preference, indications for succinylcholine, neuromuscular transmission monitor usage, blockade recovery criteria, neostigmine usage, NMB administration routes and description of observed complications. RESULTS: Most anesthesiologists practice for more than 11 years and the highest number of answers have come from the Southeastern region of Brazil. Most common NMB is atracurium, followed by pancuronium and succinylcholine. Succinylcholine is more frequently used for rapid sequence induction and in children (80% and 25%, respectively. Neuromuscular transmission monitors are never used by 53% of anesthesiologists, and 92% of them use clinical signs as blockade recovery criteria. Neostigmine is routinely used by 45% of professionals and 94% of them administer

  19. Clinical pharmacodynamics of muscle relaxation effect of cisatracurium and post- operative reversal%顺式阿曲库铵肌松效应及恢复过程的临床药效学观察

    Institute of Scientific and Technical Information of China (English)

    王灿琴; 王中云; 潘寅兵

    2012-01-01

    目的 观察顺式阿曲库铵单次静注肌松效应及术后恢复的临床药效学指标,并与阿曲库铵进行对照.方法 ASAⅠ、Ⅱ级全麻择期腹腔镜下胆囊摘除手术90例,随机分为CisⅠ组,CisⅡ组和Atc组.3组分别单次静注Cis 0.10mg/kg(2倍ED95,95%有效药物剂量),0.15 mg/kg和Atc 0.5mg/kg.每组30例,每组再分别按肌松自主恢复、T1 10%拮抗及T125%拮抗分组,共9组(Cis Ⅰ 1、CisⅠ 2、CisⅠ 3;CisⅡ1、CisⅡ2、CisⅡ3及Atc1、Atc2、Atc3),每组10例.拮抗方法为静注新斯的明50μg/kg、阿托品10μg/kg.用TOF-2 Watch SX加速度仪进行肌松监测.记录各组的起效时间、插管条件、T1 25%、T190%恢复时间和TOF0.8的恢复时间.结果 CisⅠ组起效时间明显慢于CisⅡ组及Atc组,(分别为5 61±1 13、2 58±1.10、4.06±1.12,P<0.05).3组的插管条件及最大阻滞程度无显著性差异;Cis Ⅰ1、CisⅡ1、Atc1组90%恢复时间、TOF 0.8恢复时间均长于各自的Cis Ⅰ2、CisⅡ2、Atc2及Gis Ⅰ3、CisⅡ3、Atc3组,差别显著(P<0.05).结论 麻醉诱导时用2倍ED95顺式阿曲库铵可提供满意的插管条件;新斯的明可有效缩短肌松时间,且肌松恢复时间与肌松药剂量及拮抗时机无关.%Objective To observe the clinical pharmacological indexes of single vein injection of cisatracurium (Cis) - induced neuromuscular blockade and postoperative reversal and compare it with atracurium (Atc). Methods A total of 90 ASA I - II patients undergoing selective surgery were randomly allocated into three groups: Cisl (n =30), Cis2 (n = 30) and Atc (n = 30).Cis 0. 10 mg/kg (2× ED95), 0.15 mg/kg (3 ×ED95) or Ate 0.5 mg/kg(2×ED95) were administered respectively. Each group was subdivided into nine subgroups according to the spontaneous reversal of neuromuscular blockade, T1 10% andT,25% (Cis Ⅰ1, CisⅠ2, CisⅠ 3; CisDⅡ 1, Cis Ⅱ2, CisⅡ3; Atc1, Atc2, Atc3). Each subgroup had 10 patients. Antagonistic method

  20. 胃肠道肿瘤切除术患者不同补液方案的效应%Efficacy of different fluid replacement regimens in patients undergoing resection of gastrointestinal tumor

    Institute of Scientific and Technical Information of China (English)

    王勇; 宋子贤; 王合梅; 李超; 申军梅; 李瑞琴; 贾慧群

    2008-01-01

    -directed intraoperative fluid replacement (GDFR) in patients undergoing radical operation for gastrointestinal tumor. Methods Sixty ASA Ⅱ patients aged 40-60 yr undergoing elective resection of gastrointestinal tumor were randomly divided into 3 groups (n=20 each): group A RFR, group B AHH and group C GDFR. Anesthesia was induced with propofol, fentanyl and rocuronium and maintained with isoflurane, fentanyl and atracurium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg. Left ventricular ejection time (LVETc) and stroke volume (SV) were monitored during operation using esophageal doppler monitor (HemosonicTM 100. Arrow Co, USA) in addition to ECG, MAP and HR. RFR included (1)compensatory volume expansion (CVE), (2)physiological requirement, (3)cumulative loss, (4) continued loss = intraoperative blood loss and (5) 3rd space losses. CVE was replaced with lactated Ringer's solution (LR) 5 ml/kg before induction of anesthesia. The physiological requirement and cumulative loss were replaced with LR solution, Intraoperative blood loss was replaced with equal volume of 6% hydroxyethyl starch (HES 130/0.4). The 3rd space losses were replaced with LR solution 5 ml·kg-1·h-1. In group B CVE was replaced with LR solution as in group A. 6% HES (130/0.4) 15 ml/kg was infused over 30 rain after induction of anesthesia and before skin incision. Fluid was replaced during operation according to AHH routine fluid replacement. In group C fluid was replaced according to Gan. CVE was replaced as in group A. LR solution was infused during operation at 5 ml·kg-1·h-1. 6% HES was infused to maintain LVETc between 350-400 ms. The duration of low blood volume (LVETc < 350 ms) and high blood volume (LVETc400 ms) were calculated as percentage of operation time. Blood samples were taken before and after induction of anesthesia, and at the end of operation for measurement of plasma concentrations of lactate and β2-MG and blood gases. O2 delivery index (DO2 I) and

  1. 普鲁泊福复合瑞芬太尼控制性降压在小儿鼻内镜手术中的应用%Controlled hypotension with remifentanil and propofol in children during endoscopic sinus surgery

    Institute of Scientific and Technical Information of China (English)

    孙梅杰; 边雯; 李刚; 章玉菊; 时光刚

    2011-01-01

    Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P < 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P < 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P < 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.%目的 观察普鲁泊福

  2. 乙型病毒性肝炎肝硬化患者肝功能状况对靶控输注瑞芬太尼药物半衰期和镇痛效果的影响%Effects of Liver Function in Patients with Liver Cirrhosis and Virus B Hepatitis on Drug Half-life and An-algesic Effect of Target Controlled Infusion of Remifentanil

    Institute of Scientific and Technical Information of China (English)

    李晓宁; 张卫

    2016-01-01

    OBJECTIVE:To explore the safety and effects of liver function in patients with liver cirrhosis following virus B hepatitis(called“hepatitis B”for short)on drug half-life and analgesic effect of target controlled infusion of remifentanil. METH-ODS:100 patients with liver cirrhosis following hepatitis B underwent liver and gallbladder surgery under selective general anesthe-sia were collected from our hospital and divided into group A(mild abnormal liver function)and group B(severe abnormal liver function,3 cases withdrew from the test and 47 cases completed the test),with 50 cases in each group,according to Child-Pugh grading of liver function. Both group were given phenobarbital sodium 0.1 g+scopolamine 0.3 mg intramuscularly 0.5 h before oper-ation;midazolam 0.04 mg/kg+propofol 1.5 mg/kg+atracurium 0.6 mg/kg intravenously;target controlled infusion of Remifentanil hydrochloride for injection during operation with 0.125-0.250 μg/(kg·min). The distribution half-life and the elimination half-life of remifentanil were determined, and temperature pain perception threshold (tPDT) and electrical pain perception threshold (ePDT) were measured immediately after the operation;the occurrence of ADR was observed. RESULTS:The distribution and elimination half-life of remifentanil were (4.52 ± 1.25)min and(24.64 ± 1.30)min in group A and (4.68 ± 1.31)min and(25.45 ± 2.08)min in group B respectively,there was no statistical significance between 2 groups(P>0.05). tPDT and ePDT of group A were(8.88± 1.66)mA and(1.54±0.09)mA respectively,and those of group B were(9.16±1.58)mA and(1.34±0.15)mA,there was no sta-tistical significance between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:The abnormal liver function of patients with liver cirrhosis following hepatitis B have no significant effect on drug half-life and analgesic effect of remi-fentanil with good safety.%目的:探讨乙型病毒性肝炎(以下简称“乙肝”)肝硬化患者

  3. Anestesia em paciente portadora de síndrome de Mckusick-Kaufman: relato de caso Anestesia en paciente portadora de síndrome de Mckusick-Kaufman: relato de caso Anesthesia in Mckusick-Kaufman syndrome patient: case report

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    Adriano Bechara de Souza Hobaika

    2004-12-01

    índrome. RELATO DEL CASO: Paciente del sexo femenino de 11 años, 37 kg, portadora del síndrome de Mckusick-Kaufman, insuficiencia renal crónica, encefalopatia hipertensiva y asma grave sometida a la retirada de catéter peritoneal infectado y a una confección de fístula arteriovenosa. Historia anterior de intubación prolongada. La anestesia fue inducida con alfentanil (1 mg, propofol (50 mg y atracúrio (25 mg y mantenida con sevoflurano (2% a 4% y dosis fraccionadas de alfentanil. La tráquea fue intubada sin complicaciones y la extubación fue realizada en la sala de cirugía después del retorno satisfactorio de la función neuromuscular. CONCLUSIONES: A pesar que el síndrome de Mckusick-Kaufman se trate de una asociación variable de defectos congénitos, algunas atenciones anestésicas comunes pueden ser definidas. Este caso presentó factores complicadores de la anestesia y la inducción con propofol y alfentanil y el mantenimiento con sevoflurano proporcionaron a la paciente una anestesia con mínimas repercusiones ventilatorias y hemodinámicas.BACKGROUND AND OBJECTIVES: Mckusick-Kaufman syndrome is an uncommon disease, typically characterized by hydrometrocolpos, polydactyly and congenital heart defects. These patients are often submitted to different surgical procedures throughout their lives and the anesthesiologist must be prepared to deal with possible complications. This article aimed at reporting the anesthetic management adopted for a patient with this syndrome. CASE REPORT: A 11-year-old, 37 kg, female with Mckusick-Kaufman syndrome, chronic renal failure, hypertensive encephalopathy and severe asthma was scheduled for surgical arterial-venous fistula preparation and removal of infected peritoneal dialysis catheter. Previous prolonged tracheal intubation was reported. Anesthesia was induced with alfentanil (1 mg, propofol (50 mg and atracurium (25 mg and was maintained with inhalational sevoflurane (2% to 4% and intermittent IV alfentanil doses. Trachea

  4. Avaliação do efeito antinociceptivo do fentanil transdérmico no controle da dor lombar pós-operatória Evaluación del efecto antinociceptivo del fentanil transdérmico en el control del dolor lumbar postoperatorio Efficacy of fentanyl transdermal delivery system for acute postoperative pain after posterior laminectomy

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    Gabriela Rocha Lauretti

    2009-12-01

    ía posterior sobre anestesia general estandarizada. Los adhesivos transdérmicos fueron colocados en los pacientes diez horas antes del inicio de la cirugía y removidos 24 horas después de haber terminado la misma. Cetoprofeno por vía venosa fue administrado por vía venosa en el inicio de la cirugía. Dipirona estaba disponible para analgesia de rescate, si era necesario, a intervalos mínimos de seis horas. RESULTADOS: los pacientes que recibieron F transdérmico presentaron reducción de 60% en el consumo de dipirona en el periodo postoperatorio (pObjectives: patients who are submitted to posterior laminectomy often complain of severe pain that is difficult to treat. The transdermal application of the potent opioid fentanyl results in its continuous liberation and consequently could be useful in controlling the pain. This study evaluated the efficacy of transdermal fentanyl (F delivery system for acute postoperative pain after posterior laminectomy. METHODS: the study was approved by the local Ethic Committee and conducted in the Teaching Hospital. After the patient's consent, 24 patients were randomized to either transdermic F 25 mg/h (n=12 or transdermic placebo (n=12. All patients were submitted to posterior laminectomy under a standard general anesthesia. Transdermic systems were placed during 10 hours preoperatively and removed 24 hours later; 20 minute IV ketoprofen, 2.5 mg/kg was administered following traqueal intubation with propofol, alfentanil and atracurium. IV 20 mg/kg dipyrone act as rescue at a minimum six hours interval. Data was recorded for 36 hours. RESULTS: the transdermic F Group showed 60% of reduction in the rescue dipyrone consumption (p<0.05; and displayed lesser VAS scores after the 12th hour, which was maintained until the 36th hour (p<0.02. All physiological parameters fluctuated within normal range and no differences were observed between the treatments. The incidence of adverse events was similar between the groups, there was local erythema

  5. The influence of different facemask pressure controlled ventilation on gastric insufflation evaluated by ul-trasound in young children during anesthesia induction%超声评估全麻诱导不同通气压力对幼儿胃胀气的影响

    Institute of Scientific and Technical Information of China (English)

    孙震; 卜亚男; 吕晶

    2016-01-01

    目的:通过超声监测评估全麻诱导时不同的通气压力对幼儿胃胀气的影响。方法选择择期行气管内麻醉患儿60例,年龄1~3岁,BMI<22 kg/m2,ASA Ⅰ级,根据全麻诱导去氮供氧时的通气压力将患儿随机均分为三组:10 cm H 2 O通气组(P10组)、15 cm H 2 O通气组(P15组)和20 cm H 2 O通气组(P20组)。依次静脉推注丙泊酚2 mg/kg、芬太尼0.002 mg/kg、顺式阿曲库铵0.15 mg/kg 行全麻诱导,待意识消失后,压力控制面罩通气120 s。记录意识消失后即刻(T0)、面罩通气30 s(T1)、60 s(T2)、90 s(T3)、120 s(T4)及插管后即刻(T5)的呼吸参数(SpO 2、PET CO 2),使用超声监测仪在 T0及 T4时齐腹主动脉与肝左缘水平采集胃窦部横纵径计算截面面积。结果三组患儿所有观测时点的 SpO 2≥99%。T1~ T5时三组 PET CO 2明显高于 T0时,T5时三组PET CO 2明显高于 T4时(P <0.05);T5时 P10组PET CO 2高于45 mm Hg,而 P15组和 T5时 P20组PET CO 2低于45 mm Hg。P20组面罩正压通气后胃窦部面积明显大于面罩通气前(P <0.05)。结论幼儿全麻诱导去氮供氧时,面罩通气压力为15 cm H 2 O可保证通气效果,又可避免发生胃胀气。%Objective To observe of different facemask pressure controlled ventilation yongon gastric insufflation evaluated by ultrasound in infants during anesthesia induction.Methods Sixty ASA Ⅰ infants aged 1-3 yr,undergoing elective surgery,were randomly assigned to three groups ac-cording to facemask ventilation pressure:10 cm H 2 O (P10),1 5 cm H 2 O (P1 5 )and 20 cm H 2 O (P20)with twenty in each group.Infants were injected with propofol 2 mg/kg,fentanyl 0.002 mg/kg,cis-atracurium 0.1 5 mg/kg for general anesthesia induction until consciousness lost,then face-mask pressure controlled ventilation was applied for 120 s.Some respiratory parameters (SpO 2 , PET CO 2 )were recorded at the time of loss of consciousness (T0 )and after facemask pressure con-trolled ventilation for 30 s(T1

  6. Anestesia para septoplastia e turbinectomia em paciente portador de doença de von Willebrand: relato de caso Anestesia para septoplastia y turbinectomia en paciente portador de enfermedad de von Willebrand: relato de caso Anesthesia for septoplasty and turbinectomy in von Willebrand disease patient: case report

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    Múcio Paranhos de Abreu

    2003-06-01

    OBJECTIVES: Although von Willebrand’s disease is the most common hereditary hemorrhagic disorder, there are few reports in Brazilian literature relating this disease to anesthesia. This report aimed at describing a case of general anesthesia for septoplasty and turbinectomy in a von Willebrand’s disease type I patient, prophylactically treated with desmopressin (1-deamine-8-D- arginine vasopressin, DDAVP in the pre and postoperative period. CASE REPORT: A female patient, 19 years old, 58 kg, with hypothyroidism controlled with L-tiroxine (75 mg had her von Willebrand’s disease manifested three years before after a wisdom tooth extraction with persistent bleeding in the postoperative period. To prevent new per and postoperative hemorrhagic episodes, patient was prophylactically treated with desmopressin (0.3 µg.kg-1. Anesthesia was induced with midazolam (2.5 mg, fentanyl (150 µg, droperidol (2.5 mg, lidocaine (60 mg, atracurium (30 mg and metoprolol (4 mg, followed by tracheal intubation and ventilation under intermittent positive pressure. Anesthesia was maintained with 2% sevoflurane in a mixture of 50% oxygen and nitrous oxide. This technique provided a good heart rate and blood pressure control during surgery. Patient remained with a nasal tampon for 24 hours and no bleeding was observed at its removal. Patient was discharged the day after surgery uneventfully. There were no immediate or late postoperative bleeding. CONCLUSIONS: The prophylactic treatment with DDAVP associated to the anesthetic technique used in this case was effective in controlling peri and postoperative bleeding.

  7. Anestesia para implante de marca-passo em paciente adulto com ventrículo único não-operado: relato de caso Anestesia para implante de marcapaso en paciente adulto con ventrículo único no operado: relato de caso Anesthesia for pacemaker implant in an adult patient with unoperated univentricular heart: case report

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    Adriano Bechara de Souza Hobaika

    2007-02-01

    were reported in the literature. The aim of this report was to describe the anesthetic conduct in a patient with univentricular heart undergoing pacemaker implant. CASE REPORT: A female patient, 47 years old, with double outlet left ventricle, L-transposition of the great vessels, and pulmonary stenosis, without prior surgical correction, was scheduled for definitive implant of a sequential dual-chamber pacemaker. The ABPM demonstrated second degree atrioventricular block and a mean heart rate of 45 bpm. Preoperative exams showed a hematocrit of 57%, normal coagulation studies, and preserved ventricular function. Monitoring consisted of pulse oxymeter, ECG on D II and V5, IBP, capnograph, and gas analyzer. A temporary transcutaneous pacemaker was available in case of severe bradycardia. Anesthesia was induced with fentanyl (0.25 mg, etomidate (20 mg, and atracurium (35 mg. Four minutes after anesthetic induction, the heart rate decreased to 30 bmp and 1 mg of atropine was administered with reversal of the bradycardia. Anesthesia was maintained with 2.5% sevoflurane, 60% room air, and 40% oxygen. Hemodynamic parameters and oxygen saturation remained stable. The patient was transferred to the intensive care unit in stable condition and extubated at the end of the procedure. CONCLUSIONS: The anesthetic conduct for pacemaker implant in a 47-year old patient with non-operated double outlet left ventricle and pulmonary stenosis was appropriate, since it allowed the procedure to be performed.

  8. Efeito da anestesia geral na cognição e na memória do idoso Efecto de la anestesia general en la cognición y memoria del paciente de edad avanzada Effects of general anesthesia in elderly patients’ memory and cognition

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    Régis Borges Aquino

    2004-10-01

    en el post operatorio de paciente com edad 60 a 80 años de ambos los sexos, sometidos a la anestesia general con duración de 3 a 7 horas.BACKGROUND AND OBJECTIVES: General anesthesia and mental function have been subject to studies and considerations, especially for the feeling that, especially in the elderly, it could induce changes in cognition and memory. This study aimed at evaluating the effects of general anesthesia in cognition and memory of elderly patients, correlating them to gender, age and anesthesia duration. METHODS: This is a cohort, controlled study with patients divided in two observation groups: a - anesthetic; b - clinical (control. Outcome variables studied were Mini-mental test, Verbal Fluency test and Numeric Remembrance test scores; general anesthesia with halothane, isoflurane, sevoflurane, thiopental, propofol, etomidate, fentanyl, alfentanil, succinylcholine, atracurium and pancuronium; intraoperative period with PaCO2 30 to 45 mmHg, hemoglobin saturation above 90% and blood pressure tolerance with up to 20% decrease as compared to baseline. Patients presenting any intra and postoperative adverse event were excluded from the study. Chi-square test was used for categorical data. Student’s t test for independent samples was used for initial comparison between groups at baseline moment (preanesthetic. Analysis of variance (ANOVA for repeated measures was used to evaluate anesthetic process effects along time. RESULTS: Groups were similar in the Mini-Mental test with increased scores along time. Both groups had virtually unchanged Verbal Fluency test scores. Both groups were very similar in Numeric Remembrance test with increased scores in both groups. CONCLUSIONS: No postoperative cognition or memory decline has been observed in patients of both genders, aged 60 to 80 years, submitted to general anesthesia lasting 3 to 7 hours.

  9. Anestesia em paciente obstétrica portadora de anemia falciforme e traço talassêmico após plasmaféresis: relato de caso Anesthesia in obstetric patient with sickle cell anemia and thalassemic trait after plasmapheresis: case report

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    Eduardo Barbosa Leão

    2005-06-01

    encaminada a la UTI, bajo intubación orotraqueal, y en uso de drogas vasoactivas, habiendo sido extubada después de 3 horas. CONCLUSIONES: Este caso se mostró un desafío para el equipo, ya que la paciente presentaba inestabilidad hemodinámica y alteración del coagulograma, condiciones que contraindican la anestesia regional, además de esto, la plasmaféresis potencialmente depleta las existencias de colinesterasas plasmáticas, lo que interfiere en la anestesia. Mientras, el arsenal medicamentoso disponible, permitió el manoseo seguro de esta situación.BACKGROUND AND OBJECTIVES: Plasmapheresis is the technique of choice for severe hemolytic anemia patients. A consequence is plasma cholinesterase depletion, which interferes with metabolism of some neuromuscular blockers currently used in anesthesiology. CASE REPORT: Pregnant patient, 26 years old, physical status ASA IV, 30 weeks and 3 days gestational age, with sickle cell anemia, thalassemic trait and allo-immunization for high frequency antigens. Patient presented sickling crisis being transfused with incompatible blood. Patient evolved with massive hemolysis being admitted with 3 g/dL hemoglobin and 10% hematocrit, severe jaundice, tachycardia, apathic and pale. Hematological evaluation has concluded for the inexistence of compatible blood for transfusion. Patient was treated with steroids, immunoglobulins and plasmapheresis. In the second admission day patient evolved with acute renal failure and pulmonary edema, general state worsening and hemodynamic instability. Gestation resolution was indicated due to patient's clinical conditions and consequent acute fetal suffering. Patient was admitted to the operating room conscious, pale, with dyspnea, jaundice, 91% SpO2 in room air, heart rate of 110 bpm and blood pressure of 110 x 70 mmHg, under dopamine (1 µg.kg-1.min-1 and dobutamine (10 µg.kg-1.min-1. We decided for balanced general anesthesia with alfentanil (2.5 mg, etomidate (14 mg, atracurium (35 mg and

  10. Manuseio de grave diminuição de hemoglobina em paciente jovem, testemunha de Jeová, submetido à proctocolectomia total: relato de caso Manoseo de grave disminución de hemoglobina en paciente joven, testigo de Jehová, sometido a la proctocolectomia total: relato de caso Extreme intraoperative hemodilution in Jehovah’s witness patient submitted total proctocolectomy: case report

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    Luiz Eduardo Imbelloni

    2005-10-01

    family history of adenomatous polyposis. The disease was manifested at eight years of age, characterized by bleeding. At 13 years of age he was submitted to total colectomy. At 17 years of age he was submitted to total proctocolectomy. Patient was prepared with erythropoietin, folic acid, infusion of iron and vitamin B12. Red blood cell count revealed He = 4,200,000/mm³, hemoglobin = 10.5 g/dL, hematocrit = 37% platelets = 273,000/mm³ and normal prothrombin time. Patient was continuously monitored with NIBP, pulse oximetry, capnography and ECG. Anesthesia was induced with propofol, sufentanil, pancuronium and enflurane in closed system. Patient received 7,000 mL lactated Ringer’s and 150 mL of 20% human albumin. Total diuresis was 2,900 mL. Surgery lasted 10 hours and 30 minutes. Patient was referred to the ICU with 20% hematocrit, 2,300,000/mm³ red cells, 4,2 g/dL hemoglobin and was maintained with propofol and atracurium. Next day evaluation revealed 18% hematocrit, 2,050,000/mm³ red cells and 4 g/dL hemoglobin. Patient was extubated 18 hours after surgery and was referred to the ward. Patient started eating four days after surgery and was discharged the 10th postoperative day. Thirty days later patient presented 35% hematocrit, 4,000,000/mm³ red cells and 9.5 g/dL hemoglobin. Six months later he returned for ileostomy closing. Patient was submitted to 12 surgeries without a single blood transfusion. CONCLUSIONS: A good planning of the whole team (clinician, surgeon, anesthesiologist, intensive care staff allows us to perform surgical procedures associated to major blood losses without administering blood.

  11. Instabilidade hemodinâmica grave durante o uso de isoflurano em paciente portador de escoliose idiopática: relato de caso Severe hemodynamic instability during the use of isoflurane in a patient with idiopathic scoliosis: case report

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    Adriano Bechara de Souza Hobaika

    2007-04-01

    ámica grave causada por isoflurano en pacientes previamente saludables. Anafilaxia, taquicardia supraventricular con repercusión hemodinámica y sensibilidad cardiaca aumentada al isoflurano son discutidas como posibles causas de la inestabilidad hemodinámica. Actualmente, existen evidencias de que el isoflurano pude interferir en el sistema de acoplamiento y desacoplamiento de la contratilidad miocárdica a través de la reducción del Ca2+ citosólico y/o deprimiendo la función de las proteínas contráctiles. Los mecanismos moleculares fundamentales de este proceso deben ser elucidados todavía. El relato sugiere que la administración del isoflurano fue la causa de las alteraciones hemodinámicas presentadas por el paciente y que este, probablemente, presentó una sensibilidad cardiovascular no común al fármaco.BACKGROUND AND OBJECTIVES: Isoflurane is considered a safe inhalational anesthetic. It has a low level of biotransformation, and low hepatic and renal toxicity. In clinical concentrations, it has minimal negative inotropic effect, causes a small reduction in systemic vascular resistance, and, rarely, can cause cardiac arrhythmias. The objective of this report was to present a case of severe hemodynamic instability in a patient with idiopathic scoliosis. CASE REPORT: Male patient, 13 years old, ASA physical status I, with no prior history of allergy to medications, scheduled for surgical repair of idiopathic scoliosis. After anesthetic induction with fentanyl, midazolam, propofol, and atracurium, 1% isoflurane with 100% oxygen was initiated for anesthesia maintenance. After five minutes, the patient presented severe hypotension (MAP = 26 mmHg associated with sinus tachycardia (HR = 166 bpm that did not respond to the administration of vasopressors and fluids. Lung and heart auscultation, pulse oxymetry, capnography, nasopharyngeal temperature, and arterial blood gases did not change. The patient was treated for anaphylaxis and the surgery was cancelled. The

  12. Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica Estudio comparativo entre la anestesia epidural torácica y la anestesia general en mastectomia oncológica Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy

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    Sérgio D. Belzarena

    2008-12-01

    esthetic breast surgeries but reports of its use in mastectomies with axillary exploration are very rare. The present study compared this technique with general anesthesia in oncologic surgeries of the breasts. METHODS: Forty patients were divided in two groups. The epidural group (n = 20 underwent epidural thoracic block with bupivacaine and fentanyl associated with sedation with midazolam. The other group (n = 20 underwent conventional general anesthesia with propofol, atracurium, and fentanyl, and maintenance with O2 and isoflurane. Duration of the surgery, the need for intraoperative complementation of anesthesia or sedation, and intraoperative hemodynamic parameters were recorded. In the postoperative period, length of time until discharge from the recovery room and from the hospital, severity of pain, analgesic consumption, adverse effects, and satisfaction with the anesthetic techniques were recorded. RESULTS: Both groups were similar and differences in the duration of the surgery were not observed. Complementary sedation was necessary in 100% of the patients who underwent epidural block and complementary sedation with infiltration of local anesthetic in the axilla in 15% of the patients in this group. The rate of hypertension was more frequent in the group of patients who underwent general anesthesia, while hypotension was more frequent in the epidural group. Pruritus was observed in 55% of the patients in the epidural group. Nausea (30% and vomiting (45% were more frequent in the general anesthesia group. The quality of postoperative analgesia was better in the epidural group, which also presented lower consumption of analgesics; the length hospitalization in this group was also lower. CONCLUSIONS: Epidural block has some advantages when compared with general anesthesia and can be considered an anesthesia option in oncologic mastectomies with axillary lymph node dissection.

  13. Eficácia do propofol e da associação de propofol e dexametasona no controle de náusea e vômito no pós-operatório de laparoscopia ginecológica Eficacia del propofol y de la asociación de propofol y dexametasona en el control de náusea y vómito en el pós-operatorio de laparoscopia ginecológica Efficacy of propofol and propofol plus dexamethasone in controlling postoperative nausea and vomiting of gynecologic laparoscopy

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    Eliana Marisa Ganem

    2002-07-01

    patients submitted to gynecological laparoscopy. METHODS: Forty female patients, physical status ASA I and II, aged 18 to 46 years, with no previous gastric complaint, undergoing diagnostic or surgical laparoscopy were randomly distri- buted in 2 groups: Group 1 - patients were given 2 ml IV saline solution, while Group 2 was given intravenous dexamethasone (8 mg, before anesthetic induction. All patients were premedicated with oral midazolam (7.5 mg and induced with sufentanil (0.5 µg.kg-1 and propofol targed controlled infusion (BIS 60, with N2O/O2 (F I O2=0.4 for maintenance. Neuromuscular block was obtained with atracurium (0.5 mg.kg-1. Postoperative analgesia consisted of ketoprofen (100 mg and butyl-eschopolamine plus dipirone. Patients were evaluated in the PACU and in the ward after 1, 2, 3 and 12 hours after PACU discharge. RESULTS: Both groups were identical regarding demographics data as well as surgery and anesthesia duration. One Group 1 patient referred nausea in postanesthetic care unit and in the ward, and 3 patients referred vomiting in the ward. In Group 2, no patient referred nausea and vomiting, but the difference was not statistically significant. CONCLUSIONS: Propofol or propofol plus dexamethasone were efficient in preventing PONV in patients submitted to gynecological laparoscopy.

  14. Dexmedetomidina como droga adjuvante no despertar transitório no intra-operatório de correção cirúrgica de escoliose: relato de caso Dexmedetomidina como droga adyuvante en el despertar transitorio en el intra-operatorio de corrección quirúrgica de escoliosis: relato de caso Dexmedetomidine as adjuvant drug for wake-up test during scoliosis correction surgery: case report

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    Airton Bagatini

    2004-04-01

    infusión alvo-controlada. En el momento del test para movimentación de los miembros inferiores, fueron interrumpidas las infusiones de propofol y remifentanil, manteniendo la dexmedetomidina. Con la superficialización del plano anestésico, la paciente se encargó de la ventilación espontanea y después de 14 minutos de la interrupción de las drogas, sobre comando verbal, movimentó los miembros inferiores. Durante este procedimiento, la paciente permaneció en la parte 3 de sedación de Ramsay, esto es, bajo analgesia, respirando espontáneamente y tranquila. CONCLUSIONES: La dexmedetomidina asociada a la anestesia venosa total se mostró una opción interesante, como droga coadyuvante en el test de despertar, bien como para el propósito de analgesia y sedación en el período perioperatorio.BACKGROUND AND OBJECTIVES: Scoliosis is a spinal defect very often requiring surgical correction. A uniqueness of this correction is the need for intraoperative emergence and leg movement (wake up test to rule out central nervous system (CNS injury after correction of the orthopedic defect. In our report, dexmedetomidine was associated to total intravenous anesthesia with propofol and remifentanil to induce sedation, analgesia and ventilatory stability during wake up test in patient submitted to surgical scoliosis correction. CASE REPORT: Caucasian, female patient, 16 years old, physical status ASA I, with lumbar and thoracic scoliosis in 12 levels, submitted to surgery under general anesthesia. Patient was premedicated with 2 mg oral lorazepam the day before and 90 minutes before surgery. Venoclysis and left arm radial artery puncture were performed after monitoring; right subclavian vein was punctured with double lumen catheter for drug infusion and hemodynamic evaluation. Anesthesia was induced with 1 µg.kg-1 remifentanil and propofol in target-controlled infusion, for 3 µg.mL-1 plasma concentration. Neuromuscular block was achieved with 0.5 mg.kg-1 atracurium. Anesthesia