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Sample records for atracurium

  1. The role of histamine in the cardiovascular effects of atracurium.

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    Adt, M; Baumert, J H; Reimann, H J

    1992-02-01

    We have investigated the effect of a bolus injection of atracurium 0.6 mg kg-1 on the cardiovascular system in 16 patients undergoing aortocoronary bypass surgery. H1- and H2-receptor antagonists were administered to eight patients before the neuromuscular blocker. A standard anaesthetic was used comprising fentanyl, flunitrazepam, etomidate and enflurane. After administration of atracurium, haemodynamic changes and plasma histamine concentrations were measured at frequent intervals. In the first group, who received only atracurium, a brief but marked decrease in SVR and MAP occurred, accompanied by an increase in Cl, together with a marked increase in plasma concentration of histamine. In the second group, who received H1- and H2-receptor block, there was no decrease in MAP and only a small increase in plasma histamine concentration. However, there were significant changes in SVR and Cl similar to those in atracurium group.

  2. Anaphylaxis from atracurium without skin manifestation

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    Souvik Maitra

    2014-01-01

    Full Text Available Anaphylaxis is an acute, potentially fatal allergic reaction involving multi organ system that is triggered by a wide range of antigens with a subsequent release of chemical mediators from mast cells and basophils. Diagnosis is primarily clinical though laboratory studies are helpful in further confirmation. Anaphylactic reactions during anesthesia are rare, but can be fatal if not promptly recognized and treated. Among all drugs commonly used in anesthesia, muscle relaxants are the most notorious to trigger anaphylactic reactions and benzylisoquinolinium group of drugs are known to be less common an offender than the steroidal compounds. We report severe anaphylactic reaction after administration of atracurium that was promptly diagnosed and managed without any further morbidity.

  3. Atracurium-induced anaphylaxis and angioedema: a case report

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    Jyoti Sharma

    2015-08-01

    Full Text Available Drug-induced anaphylaxis has increased in frequency with the more widespread use of pharmaceutical agents. Neuromuscular blocking agents (NMBAs are one of the most common causes of anaphylaxis during general anesthesia. However, the incidence of anaphylaxis due to atracurium is very rare (<1/10,000 according to UK Summary of Product Characteristics. NMBAs can induce two types of reactions: one is immune mediated - immunoglobulin E dependent and the second one is associated with non-specific stimulation of mast cells. Systemic manifestations of anaphylaxis can be in the form of hypotension, difficulty in breathing. Rarely, it can be associated with cutaneous manifestations such as urticaria, angioedema, and flushing. If it is not promptly diagnosed and treated, it can be fatal. In the present case, the patient was posted for submandibular gland surgery. She was well-stabilized after general anesthesia and within the seconds of giving injection atracurium; she had difficulty in breathing and marked decrease in blood pressure that was soon followed by periorbital swelling and swelling of lips. The patient was diagnosed with anaphylaxis with angioedema due to atracurium and was promptly managed in operation theater. She was kept under observation for 2 days. Anaphylaxis along with angioedema with atracurium is a very rare event, and hence it is being reported here. [Int J Basic Clin Pharmacol 2015; 4(4.000: 802-804

  4. Chemical stability and adsorption of atracurium besylate injections in disposable plastic syringes.

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    Pramar, Y V; Loucas, V A; Word, D

    1996-06-01

    Atracurium besylate (AB) is supplied as a sterile, non-pyrogenic aqueous solution for intravenous use. Hospitals pre-fill disposable plastic syringes with these solutions so that they are ready for immediate use when required. Drug loss due to potential adsorption on to the plastic material of the syringes has not been studied. Atracurium is also administered by intravenous infusion using a diluted solution in either 5% dextrose injection (USP) or 0.9% sodium chloride injection USP. Drug solutions not used within 24 h are usually discarded, resulting in tremendous waste. The purpose of these investigations was to determine the adsorption behaviour of atracurium when stored in plastic syringes, and to study the degradation of atracurium in i.v. fluids. For the adsorption study, 10 mg/ml solutions were used, whereas the diluted infusion solutions were prepared to contain 0.5 mg/ml of atracurium. Drug degradation was monitored using a stability-indicating high-performance liquid chromatography method. Degradation studies were conducted at 5 degrees C, 25 degrees C and 40 degrees C. Refrigeration was observed to improve drug stability. The manufacturer's recommended expiry period was too conservative. Storage at room temperature for up to 6 weeks can be safely recommended, without significant loss of chemical stability.

  5. 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.

  6. ACTION DURATION OF ATRACURIUM IN HYPERTENSIVE PREGNANT PATIENTS WHO RECEIVED MAGNESIUM SULFATE

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    P SAJEDI

    2000-03-01

    Full Text Available Introduction. Usually, infusion of intermittent doses of succinylcholin is used for relaxation of muscles in the preeclamptic pregnant women treated with magnesium sulfate during cesarian. section This drug has complications such as hyperkalemia, phase 11block, etc. On the other hand non depolarizing muscle relaxant in these patients should be used only in the presence of nerve stimulator and with careful titration. Methods. Duration of clinical action of a medium acting non depolarizing muscle relaxant "atracurium" with succinylcolin's infusion was studied in 86 preeclamptic pregnant women who received therapeutic doses of magnesium sulfate. Findings. Magnesium sulfate did not prolong clinical action of atracurium. Conclusion. Based on this study it can be concluded that administration of atracurium in the pregnant women who received therapeutic dose of magnesium sulfate in the absence of peripheral nerve stimulator is not contraindicated.

  7. Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery

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    El-Kasaby A

    2010-01-01

    Full Text Available Background: Cisatracurium in clinical practice is devoid of histamine-induced cardiovascular effects. On the other hand, 2 ED 95 doses of cisatracurium (100 μg/kg do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. The recommended intubating dose of cisatracurium is 3 ED 95 . To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium. Materials and Methods: The study designed as randomized controlled clinical trial to compare between atracurium (2ΧED 95 and different doses of cisatracurium (2ΧED 95 , 4ΧED 95 , 6ΧED 95 regarding onset time, duration of action, condition of intubation, hemodynamic effects, and sings of histamine release clinically. Sixty four patients were randomly assigned to one of four groups, the first group (group 1 received 2ΧED 95 dose of atracurium, group 2 received 2ΧED 95 dose of cisatracurium , group 3 received 4ΧED 95 dose of cisatracurium, while group 4 received 6ΧED 95 dose of cisatracurium. The Datex relaxograph (Type NMT-100-23-01, S/N: 37541 for neuromuscular monitoring was used. Results : HR, MABP was statistically significant increased post-intubation with administration of 2ΧED 95 dose of atracurium in group 1 and the same dose of cisatracurium in group 2 but 5-20 min later was not statistically significant with administration of 4ΧED 95 and 6ΧED 95 doses of cisatracurium in groups 3 and 4, respectively. Onset time was found to be significantly lower with 2ΧED 95 dose of atracurium than with the same dose of cisatracurium. At the same time, higher doses of cisatracurium (4ΧED 95 and 6ΧED 95 showed onset time and longer duration of action that was significantly lower than with atracurium and with lower dose of cisatracurium (2ΧED 95 . Only 6ΧED 95 dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent

  8. 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.

  9. Atracurium Besylate and other neuromuscular blocking agents promote astroglial differentiation and deplete glioblastoma stem cells

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    Spina, Raffaella; Voss, Dillon M.; Asnaghi, Laura; Sloan, Andrew; Bar, Eli E.

    2016-01-01

    Glioblastoma multiforme (GBM) are the most common primary malignant brain tumor in adults, with a median survival of about one year. This poor prognosis is attributed primarily to therapeutic resistance and tumor recurrence after surgical removal, with the root cause suggested to be found in glioblastoma stem cells (GSCs). Using glial fibrillary acidic protein (GFAP) as a reporter of astrocytic differentiation, we isolated multiple clones from three independent GSC lines which express GFAP in a remarkably stable fashion. We next show that elevated expression of GFAP is associated with reduced clonogenicity in vitro and tumorigenicity in vivo. Utilizing this in vitro cell-based differentiation reporter system we screened chemical libraries and identified the non-depolarizing neuromuscular blocker (NNMB), Atracurium Besylate, as a small molecule which effectively induces astroglial but not neuronal differentiation of GSCs. Functionally, Atracurium Besylate treatment significantly inhibited the clonogenic capacity of several independent patient-derived GSC neurosphere lines, a phenomenon which was largely irreversible. A second NNMB, Vecuronium, also induced GSC astrocytic differentiation while Dimethylphenylpiperazinium (DMPP), a nicotinic acetylcholine receptor (nAChR) agonist, significantly blocked Atracurium Besylate pro-differentiation activity. To investigate the clinical importance of nAChRs in gliomas, we examined clinical outcomes and found that glioma patients with tumors overexpressing CHRNA1 or CHRNA9 (encoding for the AChR-α1 or AChR-α9) exhibit significant shorter overall survival. Finally, we found that ex-vivo pre-treatment of GSCs, expressing CHRNA1 and CHRNA9, with Atracurium Besylate significantly increased the survival of mice xenotransplanted with these cells, therefore suggesting that tumor initiating subpopulations have been reduced. PMID:26575950

  10. INCIDENCE OF RESIDUAL NEUROMUSCULAR BLOCKADE AT TRACHEAL EXTUBATION: COMPARISON OF ATRACURIUM WITH VECURONIUM

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    Shwetha S

    2015-11-01

    Full Text Available BACKGROUND: Occurrence of undetected residual neuromuscular blockade is a common event in the post anaesthesia care unit. AIM: To compare the incidence and degree of residual neuromuscular blockade with the use of intermediate acting neuromuscular blocking agents Atracurium and Vecuronium. METHODS: 360 patients satisfying the inclusion and exclusion criteria were enrolled in the study and randomly allocated into one of the two study groups of 180 each to receive either Atracurium or Vecuronium intraoperatively. The anaesthesiologist blinded from the study extubated the patient based on the standard clinical criteria and the corresponding Train of Four(TOF ratios were noted by a blinded research assistant using a TOF watch (TOF- Watch® SX Organon, Ireland Ltd., Dublin, Ireland. Residual neuromuscular blockade was defined as a TOF ratio of 0.9 thirty minutes after tracheal extubation. CONCLUSION: We conclude from our study that significant post-operative residual curarization (TOF < 0.9 exists in majority of patients at the time of tracheal extubation (54.4% incidence despite the use of intermediate acting neuromuscular blocking drugs. The incidence and degree of post-operative residual curarization is significantly greater with Vecuronium compared to Atracurium. Thus we suggest that quantitative neuromuscular monitoring is required to assure complete neuromuscular recovery.

  11. Potentiation of atracurium by pancuronium during propofol-fentanyl-N2O anesthesia.

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    Nathan, N; Bonada, G; Feiss, P

    1996-01-01

    At the end of abdominal surgery deep neuromuscular blockade is required for peritoneal closure. Ideally injecting an intermediate acting drug like atracurium after a long acting drug such as pancuronium should deepen the neuromuscular block without the fear of an inadequate reversal at the completion of surgery. Thirty patients ASA I or II status, without known allergy to myorelaxant and without neuromuscular, hepatic or renal failure were included in this study. Anesthesia was induced and maintained with propofol, fentanyl, and N20. Normal core temperature was maintained by active warming of the upper part of the body. Blood electrolytes and the acid-base status were within the normal range. The accelerographic responses to Train-Of-Four supramaximal stimulation (TOF) of the ulnar nerve was monitored at the thumb. After obtaining a stable response with the accelerograph, the patients randomly received pancuronium (0.10 mg.kg-1, group I, n = 10 and group II, n = 10) or atracurium (0.50 mg.kg-1, group III, n = 10). An additional dose of atracurium (0.16 mg.kg-1, group I and III) or pancuronium (0.03 mg.kg-1, group II) was injected when the first response of TOF stimulation (T1) reached 25% of its initial value. Then the time to obtain a 25% twitch height of T1 (T25), the recovery index (RI 25-75), the delay to obtain 4 responses to TOF and an adequate recovery [TOF ratio of 0.70 (TOF70)] were monitored. Injection of 60% ED95 of atracurium after pancuronium resulted in a similar recovery of neuromuscular function as after 45% ED95 of pancuronium as shown by the same recovery of T25 (66.5 +/- 4.2 min versus 71.4 +/- 7.8 min, group I versus group II, p > 0.05) and TOF70 (131.6 +/- 15.7 min versus 144.0 +/- 17.5, group I versus II, p > 0.05). Nevertheless the RI 25-75 of group I was of intermediate duration between those of group II and III. Electrolytes and acid-base status were similar between groups at the beginning of surgery. Thus this study shows a synergistic

  12. 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.

  13. VOLUME OF DISTRIBUTION OF ATRACURIUM IN DIFFERENT COHORTS : A COMPARITIVE STUDY

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    Abhimanyu

    2015-09-01

    Full Text Available BACKGROUND : Comparison of volume of distribution of Atracurium in peritonitis versus elective surgeries and establishing a relationship between manifest variables and distributive value index. METHODS: The volume of distribution was derived by a surrogate variable after extrapolating the concentration time decay curve in a graph by plotting TOF values on Y axis and time on X axis. RESULTS: The onset of action , duration of relaxant effect and recovery from anaesthesia was prolonged in peritonitis g roup compared to otherwise healthy group coming up for non - peritonitis surgery. CONCLUSIONS: All these findings can be explained by the assumption of hypothetical compartment attached to central compartment varies in its capacity and equilibration , dependi ng on the prevailing level of hyperemia of the inflamed peritoneal compartment at any given point of time

  14. Effect of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium.

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    Vanlinthout, L E; Booij, L H; van Egmond, J; Robertson, E N

    1996-03-01

    We have compared the ability of equipotent concentrations of isoflurane and sevoflurane to enhance the effect of non-depolarizing neuromuscular blocking drugs. Ninety ASA I and II patients of both sexes, aged 18-50 yr, were stratified into three blocker groups (Vec, Pan and Atr), to undergo neuromuscular block with vecuronium (n = 30), pancuronium (n = 30) or atracurium (n = 30), respectively. Within each group, patients were allocated randomly to one of three anaesthetic subgroups to undergo maintenance of anaesthesia with: (1) alfentanil-nitrous oxide-oxygen (n = 10); (2) alfentanil-nitrous oxide-oxygen-isoflurane (n = 10); or (3) alfentanil-nitrous oxide-oxygen-sevoflurane (n = 10) anaesthesia. During maintenance of anaesthesia, end-tidal concentrations of isoflurane, sevoflurane and nitrous oxide were 0.95, 1.70 and 70%, respectively. Both the evoked integrated electromyogram and mechanomyogram of the adductor pollicis brevis muscle were measured simultaneously. In the Vec and Pan groups, a total dose of 40 micrograms kg-1 of vecuronium or pancuronium, respectively, was given, and in the Atr group a total dose of atracurium 100 micrograms kg-1. Each blocker was given in four equal doses and administered cumulatively. We showed that 0.95% isoflurane and 1.70% sevoflurane (corresponding to 0.8 MAC of each inhalation anaesthetic, omitting the MAC contribution of nitrous oxide) augmented and prolonged the neuromuscular block produced by vecuronium, pancuronium and atracurium to a similar degree.

  15. Influence of sevoflurane on cis-atracurium efficacy%七氟醚对顺式阿曲库铵药效的影响

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    李娜

    2014-01-01

    Objective:To explore the Influence of different concentrations of sevoflurane on cis-atracurium efficacy.Methods:80 patients with anesthesia laparoscopic-assisted vaginal hysterectomy surgery were selected,they were randomly divided into 4 groups to explore the influence of sevoflurane on muscle relaxation effect of cis-atracurium.Results:Different concentrations of sevoflurane had different levels of influence on muscle relaxation effect of cis-atracurium.Conclusion:Sevoflurane can enhance the muscle relaxation effect of cis-atracurium,this effect was dose dependent.In the process of intravenous inhalation anesthesia, the neuro-muscular blockade of patients should be correctly assessed.We should grasp the cis-atracurium dose and time interval reasonable,and recover the neuro-muscular functionin of patients after operation,and extubation safe and early.%目的:研究不同浓度七氟醚对顺式阿曲库胺药效的影响。方法:收治全麻腹腔镜辅助经阴子宫全切手术患者80例,随机分为4组,研究七氟醚对顺式阿曲库铵肌松作用的影响。结果:吸入不同浓度的七氟醚对顺式阿曲库铵肌松作用存在不同程度的影响。结论:七氟醚呈剂量依赖性增强顺式阿曲库铵的肌松作用,静吸复合麻醉过程中应正确评估患者的神经-肌肉阻滞程度,合理掌握顺式阿曲库铵的应用剂量和间隔时间,争取术毕及时恢复患者的神经-肌肉功能,及早安全拔管。

  16. Pharmacodynamics of cis-atracurium in adults and children undergoing live donor liver transplantation%婴幼儿和成年患者活体肝移植术中顺阿曲库铵的药效学

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    周洁; 王祥瑞

    2010-01-01

    Objective To investigate the pharmacodynamics of cis-atracurium after a single bolus injection in adults and children undergoing live donor liver transplantation during preanhepatic,anhepatic and neohepatic phase.Methods Twenty-six ASA Ⅲ or Ⅳ patients aged 7 months-64 yr,werghing 6-80 kg of beth sexes undergoing live donor liver transplantation were assigned to one of 2 groups:group A adults (n=16) and group B children(n=10).Anesthesia was induced with midazolam 0.05 mg/kg and fentanyl 3-5 μg/kg in both groups and propofol TCI (Cp 3μg/ml) in adults.As soon as the patients lost consciousness,tracheal intubation was facilitated with 2×ES95 of cis-atracurium (0.1 mg/kg).The intubation condition wag recorded.The response of the adductor pollicis to TOF stimulation of the ulnar nerve was recorded (TOF-Guard).An increment of cis-atracurium 0.03 mg/kg was given when T1 returned to 25% of baseline value or the four twitches appeared.Cis-atracurium administration and sevoflurane inhalation were stopped before the three phases and resumed when T1 reached 75% of baseline value.The onset time,mterval between the 2 cis-atracurium administrations,duration of clinical action and recovery of neuromuscular block were recorded.The intubation condition was evaluated.Results The onset time was significantly shorter in adults than in children.There was no significant difference in intubation condition between the 2 groups.The interval between the 2 cis-atracurium administrations and duration of clinical action were similar during the 3 phases in adults and significantly shorter during neohepatic phase than during anhepatic phase in children.The recovery was faster in children than in adults.Conclusion Cis-atracurium 2×ED95 (0.1 mg/kg)can be used for both adults and children undergoing live donor liver transplantation.The onset time is longer and recovery is faster in children than in adults.Cis-atracurium is suitable for patients of different ages and liver function.%目的

  17. Intro duction of vecuronium bromide and atracurium in the application of surgery%浅谈维库溴铵与阿曲库铵在手术患者中应用效果

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    秦旭

    2013-01-01

    Objective To investigate the impact of the different block depth of vecuronium bromide and atracurium (non depolarizing muscle relaxant) on undergoing elective surgery patients. Methods To select 54 cases of patients accepting selective surgical treatment in our hospital from May 2011 to May 2013. To divede patients into control group (27 cases) and observation group (27 cases) according to their order number of accepting surgical treatmentdi, and the anesthesia of control group patients was vecuronium bromide, the anesthesia of observation group of patients was atracurium, neostigmine antagonism was used after operation. Results The dose of muscle relaxant of the observation group of patients was significantly higher than that of the control group, the differences between groups was with statistical significance (P0.05). Conclusion The muscle relaxant effect of vecuronium bromide and atracurium is similar, the postoperative antagonist of muscle relaxant is good with higher safety.%目的:探讨维库溴铵和阿曲库铵非去极化肌松药不同阻滞深度对择期手术患者的影响。方法选取2011年5月~2013年5月间于本院行择期手术治疗的患者54例,按其手术治疗顺序进行编号并随机分为对照组(27例)和观察组(27例),对照组患者麻醉应用维库溴铵肌松药,观察组患者麻醉应用阿曲库铵肌松药,术后均进行新斯的明拮抗。结果观察组患者肌松药用量明显高于对照组,组间差异具有统计学意义(P0.05)。结论维库溴铵和阿曲库铵肌松效果类似,新斯的明术后拮抗肌松效果优,安全性更高。

  18. 七氟醚麻醉诱导对顺式阿曲库铵起效时间的影响%The effects of anesthesia induction with sevoflurane on the onset of cis-atracurium

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    刘春明; 黄宁; 赵海芳; 王国年

    2011-01-01

    目的 探讨七氟醚肺活量法吸入诱导和丙泊酚静脉诱导对顺式阿曲库铵起效时间的影响.方法 择期行胸外科或普外科手术的全麻患者60例,ASA Ⅰ或Ⅱ级,年龄18~65岁,随机均分为七氟醚组(S组)和丙泊酚组(P组).麻醉诱导:P组静脉注射咪达唑仑0.05 mg/kg、芬太尼2μg/kg、丙泊酚1 mg/kg;S组采用肺活量吸入法,七氟醚吸入浓度8%.两组患者意识消失后均给予顺式阿曲库铵0.15 mg/kg.监测肌松药起效时间,意识消失时间,血流动力学指标,并评价气管插管条件.结果 患者意识消失时间、顺式阿曲库铵起效时间S组明显短于P组(P<0.05或P<0.01).插管引起的心血管反应S组小于P组(P<0.05).结论 七氟醚吸入诱导能明显缩短顺式阿曲库铵的起效时间,且循环功能稳定.%Objective To compare the induction quality of intravenous propofol and inhalational sevoflurane on the skelaxin onset time of cis-atracurium. Methods Sixty ASA Ⅰ or Ⅱ patients, aged from 18 to 65, undergoing selective surgery with general anesthesia, were equally randomized into two groups, group P with intravenous propofol, group S with inhalational sevoflurane. Group P: intravenous induction with midazolam 0. 05 mg/kg, fentanyl 2 μg/kg, propofol 1 mg/kg. Group S: inhalation of 8% sevoflurane in vital capacity respiration. 0. 15 mg/kg cis-atracurium was infused after loss of consciousness in both groups. Time for loss of eyelash reflex, hemodynamic changes, onset time of cis-atracurium and conditions of tracheal intubation were recorded. Results The time to loss of eyelash reflex in group S is significantly shorter than that in group P(P<0. 05). The onset time of cisatracurium in group S is significantly shorter than that in group P (P<0. 01). Tracheal intubation causes less stress response in group S than in group P(P<0.05). Conclusion Sevoflurane induction can greatly shorten the onset time of cis-atracurium with stable hemodynamic state.

  19. Efficacy comparison of atracurium through target control infusion and continuous close-loop muscle relaxant injection%靶控输注与闭环式肌松注射阿曲库铵效果比较

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    刘畅; 刘庆; 刘萍; 唐燕红

    2013-01-01

    Objective To compare the efficacy of atracurium administered through target control infusion and closed-loop muscle relaxant injection. Methods 75 patients undergoing laparotomy under total intravenous anesthesia were randomly divided into two groupsGroup T(n=39)received atracurium by target control infusion. The target concentration during induction was set at 5 mg/L,after trachea cannula at 1 mg/L, and during opera-tion according to the requirement. Group C (n=36),received atracurium by closed-loop muscle relaxant injection systemthe induction dose of atracurium was 0.5 mg/kg,the maintenance dose 2.5 μg/kg/min, increase to 10 μg/kg/min when T1/Tc > 10%. The onset time,recovery index, the time from stopping injection to extubation,dosages,frequence of dissatisfying muscle relaxation,mean arterial pressure,heart rate,respiratory rate,and SpO2 in the two groups were compared. No antagonist was used in both groups. It was the time for extubation when T1/Tc recovered to 90%. Results There were no statistical differences in onset time,mean arterial pressure, heart rate,respiratory rate,and SpO2 between the two groups (P> 0.05). Compared with group T, the recovery index,the time form stopping injection to extubation of group C was shorter,dosages larger and frequence of dissatisfy-ing muscle relaxation less (P10%,增药速度为10μg/kg/min,记录2组肌松起效时间、恢复指数、停药至拔管时间、用药量、术中肌松不足出现次数、各阶段平均动脉压、心率、呼吸频率、SpO2。2组均不使用拮抗剂,术毕待T1/Tc恢复至90%后拔管。结果:2组一般资料,各阶段平均动脉压、心率、SpO2比较无统计学意义(P>0.05),阿曲库铵起效时间、插管条件比较无统计学意义(P>0.05),与T组相比,C组恢复指数,拔管时间缩短,用药量增大,肌松不足出现次数减少(P<0.05);结论:靶控输注与闭环式肌松注射两种方式注射均能安全应用于临床,但闭环式肌松

  20. Inadvertent intrathecal injection of atracurium

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    Nahid Zirak

    2011-01-01

    Full Text Available This report relates how tracurium was given by mistake, intrathecally, during spinal anesthesia, to a 38-year-old woman, who was a candidate for abdominal hysterectomy. When no analgesia was observed, the mistake in giving the injection was understood. She was evaluated postoperatively by train of four ratio, measuring her breathing rate, eye opening, and protruding of tongue at one, two, twenty-four, and forty-eight hours, and then at one and two weeks, with the final evaluation the following month. The patient had normal timings during the operation and postoperation periods, and no abnormal findings were observed through the first month. This finding was contrary to several studies, which described adverse reactions due to accidental intrathecal injection of neuromuscular blocking drugs.

  1. 顺阿曲库铵的药效学及其对组胺释放的影响%Pharmacodynamics and histamine-me-releasing potency of cis-atracurium

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    吴新民; 李玲; 刘毓和; 张兰霞

    2010-01-01

    CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.

  2. 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

  3. 顺式阿曲库铵用于阻塞性黄疸患者的药效学研究%A pharmacodynamic study on cis-atracurium treatment for patients with obstructive jaundice

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    杨丽华; 徐玉灿; 马民玉; 张卫

    2012-01-01

    Objective To study the safety and muscle relaxation effect of cis-atracurium on patients with obstructive jaundice subjected to intravenous general anesthesia. Methods 40 patients with obstructive jaundice(Child-Pugh grade B) who accepted surgery were randomly divided into group Al(n=20) and group A2(n =20) ,and 40 patients with normal liver function who subjected to abdominal surgery in the corresponding period were randomly divided into Bl(n =20) and group B2(n=20). Patients in group A1,B1 and group A2,B2 were administrated with single intravenous injection of 2ED95 , 3ED95 cis-atracurium,respectively,at the time of anesthesia induction. TOF-Watch SX acceleration instrument was employed to estimate the degree of neuromuscular blockade via train-of-four (TOF) stimulation of forearm ulnar nerve. Changes of vital signs, intubation conditions and muscle relaxation effect of patients before and after anesthesia induction were observed. Results Serum levels of alanine aminotransferase (ALT), total bilirubin(TBIL) of patients in group A1,B1 were significantly higher than those in group A2 , B2 , respectively(P0. 05) ,and no adverse reactions of histamine release were found in patients during anesthesia. Conclusion Cis-atracurium can be safely used in patients with obstructive jaundice for general anesthesia.%目的 研究顺式阿曲库铵用于阻塞性黄疸患者静脉全身麻醉的安全性和肌松效应.方法 将40例因阻塞性黄疸接受手术的患者(Child-Pugh B级)随机分为A1组(n=20)和A2组(n=20);将同期行腹部手术的40例肝功能正常患者随机分为B1组(n=20)和B2组(n=20).麻醉诱导时A1、B1组患者及A2、B2组患者分别单次静脉注射2ED95或3ED95顺式阿曲库铵;用TOF-Watch SX加速度仪对前臂尺神经行4个成串(TOF)刺激来评估神经-肌肉阻滞程度.观察麻醉诱导前、后4组患者生命体征的变化、插管条件和肌松效应.结果 A1、A2组患者血清丙氨酸转氨酶(ALT)、总胆红

  4. 顺式阿曲库铵闭环注射系统在腹腔镜手术中的应用%The use of cis-atracurium by guidance of closed-loop muscle relaxant injection system in the laparoscopic surgery

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    薛纪秀; 叶新; 李冰; 李燕虹; 范隆

    2012-01-01

    目的 探讨顺式阿曲库铵闭环注射在腹腔镜手术中的肌松效果.方法 选择腹腔镜手术患者20例,随机均分成闭环注射组(G组)和对照组(C组).C组持续输注顺式阿曲库铵1.5~2 μg·kg-1·min-1直至手术结束前30 min;G组输注顺式阿曲库铵0.8μg·kg-1 ·min-1,设定肌松深度反馈值T1=15%,近手术结束时由研究实施者根据术中肌松监测指标决定停药时机.记录麻醉时间、顺式阿曲库铵的总用量、恢复指数、TOFr75及TOFr90.结果 G组顺式阿曲库铵总用量均明显少于C组(P<0.05),恢复指数、TOFr75及TOFr90明显缩短于C组(P<0.05).结论 与持续输注方式相比,闭环肌松药注射方式肌松药用量更少,恢复指数、TOFr75和TOFr90明显缩短,实现个性化和合理化用药.%Objective To explore the effect of closed-loop muscle relaxant injection system on the dosage of cis-atracurium. Methods Twenty patients, scheduled to accept laparoscopic surgery, were randomly divided into two groups: continuous infusion groupCgroup C) and guidance group (group G). Keeping the ram velocity of cis-atracurium at 1. 5-2 μg·k-1·min-1 in group C until 30 minutes before the end of surgery. Keeping the ram velocity of cis-atracurium at 0. 8 μg·kg-1 -min-1 in group G, and setting the feedback value of muscle relaxation depth (Tl) al 15%. Reserchers withdrew the relaxant according to the monitoring information nearby the end of surgery. The duration of anesthesia, the total amount of cis-atracurium, recovery index (Rl). TOFr75, and TOFr90 were recorded. Results The total amount of cis-atracurium in group G was lower than group C(P<0. 05). Compared to group CRI, recovery lime, TOFr75 and TOFr90 in group G significantly shortened{P<0. 05). Conclusion Compared to the continuous injection mode, the total consumption of relaxant in the closed-loop injection system was less; in addition.the RI, TOFr75 and TOFr90 were shortened. It can personalize and rationalize the

  5. 小儿腹腔镜短小手术中小剂量阿曲库铵的应用%Application Small Dose Atracurium in Short-time Pediatric Operation with Laparoscope

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    邢大军; 马星钢

    2011-01-01

    目的 比较小儿腹腔镜手术中多种不同方式不同用量阿曲库铵的应用,选出合适方式以加快手术周转.方法 80例患儿随即分为4组,以A组以阿曲库铵0.5mg/kg为肌松剂;B组以阿曲库铵0.5mg/kg为肌松剂,术毕自主呼吸恢复即给予拮抗剂.C组以阿曲库铵0.25mg/kg为肌松剂;D组不使用肌松剂,以咪唑安定0.1mg/kg辅助气管插管.结果 以阿曲库铵0.25mg/kg为肌松剂在自主呼吸恢复、清醒、拔管均优于其余三组.结论 小剂量阿曲库铵在诱导平稳的基础上,苏醒及自主呼吸恢复迅速,适于短小手术对快速周转的要求.%Objective To find a proper dose of atracurium for short-time LP operation for children.Methods Contrast four groups of full dose muscle relaxant,no muscle relaxant,half dose muscle relaxant and full dose muscle relaxant with antagonist.Observe the time of the recovery of auto respiration,awake and extubation. Results Croup of half dose muscle relaxant has the shortest time of the recovery of auto respiration,awake and extubation.Conclusion Method of half dose muscle relaxant has a stable anesthesia induction and a quick recovery of auto respiration. It is a good method for LP operation for children.

  6. 七氟醚对顺式阿曲库铵肌松效应影响的性别差异%Difference of neuromuscular blocking effect of cis-atracurium under sevoflurane anesthesia between the genders

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    龚楚链; 关健强; 池信锦; 黑子清

    2010-01-01

    Objective To investigate the difference of neuromuscular blocking effect of cis-atracurium under sevoflurane anesthesia between the genders. Methods 30 ASA Ⅰ or Ⅱ patients aged from 18 to 45 years who scheduled for laparoscopic operation were divided into two groups, male group( M group, n = 15 ) and female group ( F group,n = 15). After induction of Anesthesia all cases were maintained with remifentanyl 3μg/L(TCI) and sevoflurane.After 40 minutes of stable end-tidal anaesthetic concentration, a total dose of cisatracurium 45 μg/kg was divided into 3 equal doses( 15μ g/kg each) ,which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak ( T1 was no longer depressed in the height of 3 successive stimuli).Neuromuscular block was monitored using accelograph(TOF GUARD,Denmark). The onset time and maximum depression of T1 of the initial dose and 2 incremental doses were recorded. The cumulative dose-response curves of the two groups were established. The effective dose to obtain 50% and 95% neuromuscular block( ED5o and ED95 ,respectively) were calculated from individual dose-response curves. After the lastincrement of 15 μg/kg, the time for T1 to return to 25% ,50% ,75% and TOF ratio(T4/T1 )to 70% were recorded. The recovery index( RI)was also calculated.Results The mean ED5o and ED95(95% confidence interval)of cisatracurium of women were 22.2( 15.8 ~27.2)and 38.4 ( 32.1 ~ 54.4) μg/kg during sevoflurane (1.3MAC) anaesthesia, while the data of men were 25.6 ( 19.7 ~30.8) μg/kg and 42.8 ( 36.3 ~ 58.2 ) μg/kg, the difference between groups had no statistical significance ( P >0. 05). There was no significant difference in the TOF ratio ( T4/T1 ) to 70% and recovery index between the two groups( P >0.05 ). The onset time of F group was shorter than M group. The time for T1 to return to 25% ,50% and TOFR 0.7 was significantly longer in the F group than in the M group (P

  7. 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

  8. 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

  9. Research on muscle relaxant effects of different doses of cis-atracurium in pediatric anesthesia%探讨不同剂量顺式阿曲库铵在小儿麻醉中对肌肉松弛的影响

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    温小林

    2015-01-01

    Objective Research on muscle relaxant effects of different doses of cis-atracurium in pediatric anesthesia. Method 78 cases surgical treatment children were divided into group Ⅰ and group Ⅱ (n = 39) according to different anesthetic drugs (cis-atracurium) dose. Dose of cis-atracurium in groupⅠwas 0.10 mg/kg, 0.15 mg/kg in groupⅡ. Hemodynamic changes, muscle relaxant effect, incubating conditions and adverse reaction of the two groups were compared. Result GroupⅠwith good intubating conditions was 27 cases (69.23%), group Ⅱwas 33 cases (84.62%), the differences between the two groups was signiifcant (P0.05). The two groups anesthetic onset time, muscle relaxation recovery time were not statistically different (P>0.05);groupⅡwith TOF no reaction time (T1 continuing to 0%of the time), blocking duration, time of produce effectiveness in the body were signiifcantly longer than that of groupⅠ, the differences were statistically signiifcant (P0.05). Conclusion 0.15 mg/kg cis-atracurium for pediatric anesthesia could achieve good muscle relaxant effect, help smooth intubation, and will not cause a signiifcant impact on hemodynamics, is a safe, reliable pediatric anesthesia drugs, should be widely applied.%目的:探讨不同剂量的顺式阿曲库铵在小儿麻醉中对肌肉松弛的影响。方法选取本院收治的78例需手术治疗的患儿作为研究对象,麻醉药物均选用顺式阿曲库胺,根据使用剂量的不同,分为Ⅰ、Ⅱ两组,每组各39例。Ⅰ组患儿顺式阿曲库胺剂量为0.10 mg/kg,Ⅱ组为0.15 mg/kg,比较两组患儿的血流动力学变化、肌肉松弛效果、插管条件以及不良反应发生情况。结果Ⅰ组患儿插管条件良好27例(69.23%),Ⅱ组患儿插管条件良好33例(84.62%),组间比较差异具有显著性(P<0.05)。两组患儿注射前后收缩压(SBP)、舒张压(DBP)、心率(HR)比较差异均无显著性(P>0.05)。两组患儿麻

  10. Efeito da administração do atracúrio sobre a recuperação do bloqueio neuromuscular induzido pelo pancurônio Efecto de la administración del atracúrio sobre la recuperación del bloqueo neuromuscular inducido por el pancuronio Effect of atracurium on pancuronium-induced neuromuscular block recovery

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    Luís Fernando Rodrigues Maria

    2004-06-01

    complementación con atracúrio no promovió alteración en la recuperación espontanea inicial del bloqueo neuromuscular inducido por el pancuronio y promovió diminución de 20% en el tiempo de recuperación total.BACKGROUND AND OBJECTIVES: Additional neuromuscular blocker doses are in general needed during wall closing after abdominal surgeries. This study aimed at determining during partial pancuronium-induced neuromuscular block recovery, the effect of additional atracurium dose on spontaneous neuromuscular block recovery. METHODS: Participated in this study 30 patients divided in two groups: pancuronium group (n = 14 and atracurium group (n = 16. Neuromuscular function was continuously monitored by accelerometry of abductor pollicis muscle using TOF to supramaximally stimulate ulnar nerve. Anesthesia was induced with propofol, fentanyl and 0.08 mg.kg-1 pancuronium, and was maintained with 60% N2O in oxygen and 0.5% isoflurane expired concentration. When T1 returned to 25% of control, 0.025 mg.kg-1 pancuronium or 0.20 mg.kg-1 atracurium were administered to pancuronium or atracurium group, respectively. Time for spontaneous T1 recovery = 10%, 25%, 75% of recovery index (RI 25-75% and time to T4/T1 equal 0.8 after complementary dose, were recorded. RESULTS: There were no differences between groups on T1 spontaneous recovery to 10% (45.00 ± 15.50 vs. 49.69 ± 9.41, 25% (61.64 ± 18.58 vs. 64.25 ± 12.51 and 75% (94.00 ± 28.52 vs. 84.69 ± 16.50. Recovery index (RI 25-75% and time to T4/T1= 0.8 were shorter in the atracurium group. CONCLUSIONS: In this study, atracurium complementation has made no difference in initial spontaneous recovery of pancuronium-induced neuromuscular block, but has decreased total recovery time in 20%.

  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. The intraoperative muscle-relaxant effect of cis-atracurium on the patients with impaired renal function%顺式阿曲库铵在肾功损害患者手术中肌松效应的观察

    Institute of Scientific and Technical Information of China (English)

    王静; 丁冠男

    2012-01-01

    Objective To investigate the intraoperative muscle-relaxant effect and safety of Cis-atracurium on the patients with impaired renal function.Methods 20 patients with impaired renal function undergoing emergency laparotomy were the observation group,20 patients with normal renal function undergoing emergency laparotomy were the control group.All patients were anesthetized and maintained in the same method.Neuromuscular blocking effects were monitored using the Organon accelograph.The onset time (T1 up to a maximum block time),no reaction time (T1 of the greatest block to T1 recovery),T1 25% recovery time,T1 75% recovery time and recovery index (T1 recovery from 25% to 75% of the time) were recorded.Results There were not significant differences in sex,height,weight and operative time between two groups (P>0.05).The renal function indicators[blood urea nitrogen (15.4±5.6) mmol/L,serum creatinine (320±45) μmol/L] in the observation group were higher than those[blood urea nitrogen (4.4±2.6) mmol/L,serum creatinine (132±25) μmol/L] in the control group (P<0.05).The onset time in the observation group is slightly longer than that in the control group,but the difference was not significant (P>0.05).There were no significant difference in no reaction time,T1 25% recovery time,T1 75% recovery time and recovery index between two groups (P>0.05).Conclusions Cis-atracurium could be safely used in patients with impared renal function.%目的 探讨顺式阿曲库铵在肾功损害患者手术时应用的肌松效果及安全性.方法 选择20例肾功损害患者行急诊剖腹探查手术为观察组,20例肾功正常患者行急诊剖腹探查手术为对照组.两组均采用相同方法麻醉及维持,用Organon加速度仪进行肌松监测,分别记录起效时间(T1达最大阻滞时间),无反应期(T1达最大阻滞至T1开始恢复的时间),T1恢复到25%、75%的时间及恢复指数(T1从25%恢复至75%的时间).结果 两组患

  13. Efeitos neuromusculares in vitro e in vivo do atracúrio e do rocurônio em ratos submetidos a tratamento de sete dias com carbamazepina Efectos neuromusculares in vitro e in vivo del atracurio y del rocuronio en ratones sometidos a tratamiento de siete días con carbamazepina In vitro and in vivo neuromuscular effects of atracurium and rocuronium in rats treated with carbamazepine for seven days

    Directory of Open Access Journals (Sweden)

    Caroline Coutinho de Barcelos

    2008-04-01

    neuromuscular producido por el rocuronio y atracurio en ratones tratados con carbamazepina y determinó las concentraciones de citocromo P450 y b5 reductasis en microsomas hepáticos. MÉTODO: Ratones fueron tratados por siete días con carbamazepina (CBZ - 40 mg.kg-1 a través de una sonda y sacrificados al octavo día bajo anestesia con uretana. Las preparaciones in vitro e in vivo fueron montadas de acuerdo con las técnicas de Bulbring y de Leeuwin y Wolters, respectivamente. Las concentraciones y dosis utilizadas de los bloqueadores en las preparaciones in vitro e in vivo fueron, respectivamente, 20 µg.mL-1 y 0,5 mg.kg-1 para atracurio (ATC; 4 µg.mL-1 y 0,6 mg.kg-1 para rocuronio (ROC. Cada protocolo tuvo un n = 5 y las respuestas fueron observadas por 60 minutos. Los efectos del ATC y ROC fueron evaluados en las preparaciones de ratones tratados (Cbz t y comparados a los observados en los de ratones no tratados (CBZst. Las concentraciones de citocromo P450 y b5 reductasis fueron determinadas en microsomas aislados de hígados de ratones tratados (CBZt y comparadas con las obtenidas en ratones no tratados (CBZst RESULTADOS: La carbamazepina no alteró la amplitud de las respuestas musculares; in vitro y in vivo, no hubo diferencia entre el bloqueo neuromuscular producido por el atracurio en las preparaciones CBZt versus CBZst; el bloqueo neuromuscular producido por el Rocuronio en las preparaciones CBZt fue potenciado in vitro. La carbamazepina no alteró las concentraciones de citocromo P450 y b5. CONCLUSIONES: El tratamiento por siete días con carbamazepina, no influenció en el bloqueo producido por el atracurio, y alteró in vitro los efectos del rocuronio. El tiempo de tratamiento no fue suficiente para causar la inducción enzimática y disminuir la sensibilidad al rocuronio.BACKGROUND AND OBJECTIVES: This experimental study investigated the in vitro and in vivo neuromuscular blockade of rocuronium and atracurium in rats treated with carbamazepine and determined

  14. 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

  15. 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

  16. Dose preparatória de atracúrio: aferição da fadiga no músculo orbicular do olho e condições de intubação orotraqueal Dosis preparatoria de atracurio: comparación de la fatiga en el músculo orbicular del ojo y condiciones de intubación orotraqueal Priming dose of atracurium: measuring orbicularis oculi muscle fade and tracheal intubation conditions

    Directory of Open Access Journals (Sweden)

    Giovani de Figueiredo Locks

    2003-12-01

    és de un minuto. Fue considerada fatiga clínicamente importante la relación T4/T1 inferior a 0,9. RESULTADOS: Ningún paciente presentó fatiga durante el intervalo de monitorización. En 80% y 69% de los pacientes de G1 ó G2, respectivamente, las condiciones de intubación traqueal fueron consideradas clínicamente aceptables (p > 0,05. CONCLUSIONES: La dosis preparatoria de atracúrio (0,02 mg.kg-1 no causa fatiga en el músculo orbicular del ojo y no hay diferencia entre esperar 5 ó 7 minutos como intervalo entre las dosis del bloqueador neuromuscular.BACKGROUND AND OBJECTIVES: The priming principle consists of administering a low neuromuscular blocker dose, minutes before the total dose for tracheal intubation, to shorten non-depolarizing blockers onset. There is, however, the risk for muscle fade and bronchoaspiration. Laryngeal muscles are of especial interest for tracheal intubation maneuvers and airway protection. Since their direct monitoring imposes technical difficulties, it has been reported that orbicularis oculi correlates with laryngeal muscles in terms of sensitivity to neuromuscular blocks. This study aimed at evaluating the presence of orbicularis oculi muscle fade after priming atracurium dose and at comparing clinical tracheal intubation conditions after two priming dose intervals. METHODS: Participated in this study 35 adult patients, physical status ASA I or II, without risk factors for bronchoaspiration and submitted to elective surgeries. General anesthesia was induced with alfentanil and propofol and patients were manually ventilated under mask. Surface electrodes were then positioned on the temporal branch of the facial nerve, and the acceleration transducer was placed on the orbicularis oculi. Priming atracurium dose (0.02 mg.kg-1 was administered and T4/T1 ratio was evaluated every minute during 5 minutes in 20 cases (G1 and during 7 minutes in 13 cases (G2. After this interval, complementary atracurium dose (0.5 mg.kg-1 was administered

  17. 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.

  18. 艾司洛尔对维库溴铵/阿曲库铵肌松时效的影响%Effect of esmolol on time-response relationships of vecuronium and atracurium

    Institute of Scientific and Technical Information of China (English)

    穆娅玲; 张宏

    2004-01-01

    目的探讨艾司洛尔对维库溴铵、阿曲库铵肌松时效的影响.方法45例ASA(Ⅰ,Ⅱ)级择期手术的全麻惠者,随机分为4组,Ⅰ组10例,静注维库溴铵0.1 mg/kg(2×ED95);Ⅲ组10例,静注阿曲库铵0.5mg/kg(2×ED95);心率超过基础值的30%时,Ⅱ组15例,Ⅳ组10例,均给予艾司洛尔2mg/kg,用生理盐水稀释至5 ml,10秒左右静注,1min后分别静注与Ⅰ组、Ⅲ组同等剂量的维库溴铵或阿曲库铵.用Biometer加速度仪监测肌松情况.结果Ⅰ组与Ⅱ组维库溴铵T190%恢复时间(min)分别为49.9±12.2和60.6±8.8,Ⅱ组明显延长(P<0.05);Ⅲ组与Ⅳ组阿曲库铵T190%恢复时间(min)分别为54.8±6.5和66.3±14.2,Ⅳ组明显延长(P<0.05),两组恢复指数(min)分别为10.6±2.3和17.9±7.0,Ⅳ组明显延长(P<0.01),其余各指标Ⅰ组与Ⅱ组相比,Ⅲ组与Ⅳ组相比,差异均无统计学意义.结论艾司洛尔能延长维库溴铵、阿曲库铵T190%恢复时间以及阿曲库铵的恢复指数.

  19. Effect of nicardipine on the time-response relationships of vecuronium and atracurium%尼卡地平对维库溴铵和阿曲库铵肌松时效的影响

    Institute of Scientific and Technical Information of China (English)

    穆娅玲; 李军; 张宏; 北京

    2000-01-01

    目的探讨尼卡地平对维库溴铵、阿曲库铵肌松时效的影响.方法40例ASAⅠ~Ⅱ级择期手术的全麻患者,随机分为四组,每组10例.四组病人均行健忘镇痛慢诱导气管内插管.吸入5096N2O-氧混合气,静注芬太尼、羟丁酸钠维持麻醉.Ⅰ组静注维库溴铵0.1mg@kg-1(2×ED95);Ⅲ组静注阿曲库铵0.5mg@kg-1(2×ED95);收缩压超过基础值30%时,Ⅱ组和Ⅳ组均给予尼卡地平20μg@kg-1,1 min后分别静注与Ⅰ组、Ⅲ组同等剂量的维库溴铵或阿曲库铵.用Biometer加速度仪监测肌松情况.结果Ⅰ组、Ⅱ组维库溴铵起效时间分别为(2.6±0.2)min和(2.0±0.2)min,Ⅲ组、Ⅳ组阿曲库铵起效时间分别为(3.1±0.7)min和(2.3±0.5)min,Ⅱ组和Ⅳ组均明显缩短(P<0.05);Ⅱ组临床作用时间较Ⅰ组延长(P<0.05);Ⅳ组T1 90%恢复时间及恢复指数较Ⅲ组延长(P<0.05);Ⅱ组无反应期、T1 50%恢复时间、9096恢复时间及恢复指数,均长于Ⅰ组;Ⅳ组无反应期、临床作用时间及T1 5096恢复时间均长于Ⅲ组,但无统计学意义).结论尼卡地平能缩短维库溴铵、阿曲库铵的起效时间,延长维库溴铵、阿曲库铵的临床作用和恢复时间.

  20. 异氟醚.安氟醚对阿曲库铵残余肌松作用影响%Comparison of effects of isoflurane and ethrane on the residual curarization following atracurium administration

    Institute of Scientific and Technical Information of China (English)

    于淼舒; 张锐; 刘凤娟

    2007-01-01

    目的:观测异氟醚.安氟醚对阿曲库铵残余肌松作用的影响.方法:选择90例ASAⅠ-Ⅱ级成年择期全麻病人,随机分为三组,丙泊酚组(Ⅰ组,30例);异氟醚组(Ⅱ组,30例),安氟醚组(Ⅲ组,30例),使用Biometer加速仪观测下,恢复至25%,75%及ToF比值(T4/T1)恢复至0.7的时间.结果:上述恢复时间中Ⅱ、Ⅲ组与Ⅰ组比较均延长,有显著差异(P<0.05);Ⅱ、Ⅲ组比较差别无统计学意义(P>0.05).结论:异氟醚.安氟醚均可延长阿曲库铵残余的肌松作用,但两者比较无明显差别.

  1. Train-of-four fade during onset of neuromuscular block with nondepolarising neuromuscular blocking agents.

    Science.gov (United States)

    Gibson, F M; Mirakhur, R K

    1989-04-01

    Fade in the train-of-four (TOF) responses during onset of neuromuscular block was studied following administration of atracurium (225 or 450 micrograms/kg), vecuronium (40 or 80 micrograms/kg), pancuronium (60 or 120 micrograms/kg) and tubocurarine (450 micrograms/kg). TOF ratios were measured at approximate heights of T1 (first response in the TOF) of 75, 50 and 25%. Fade in TOF increased as the height of T1 decreased, with maximum fade being observed at T1 of 25%. The greatest difference between relaxants was observed at T1 of 25%, vecuronium showing the least fade and pancuronium, atracurium and tubocurarine showing increasing fade, in that order. The difference between atracurium and tubocurarine or between vecuronium and pancuronium was not significant, but the degree of TOF fade was significantly greater with atracurium and tubocurarine in comparison to vecuronium or pancuronium.

  2. Choice of Intravenous Agents and Intubation Neuromuscular Blockers by Anesthesia Providers

    Science.gov (United States)

    1996-09-01

    nondepolarizing muscle blockers (Omoigui, 1995). 8 Neuromuscular Blockers Atracurium is a nondepolarizing skeletal muscle relaxant and its...vecuronium. Feldman (1994) and Wicks (1994) report that rocuronium has the most rapid onset of any other nondepolarizing muscle relaxant with...prolonged muscle relaxant block at usual intubation doses. Mirakhur (1994) and Robertson, Hull, Verbeek, 8L Bonjii (1994) report minimal changes in

  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.

  4. [Alfentanyl and midazolam in combined anesthesia. Clinical evaluation].

    Science.gov (United States)

    Arena, L; Di Sebastiano, N; Russo, L; Di Filippo, A

    1992-06-01

    We have evaluated the effectiveness of a technique of blended anaesthesia (epidural-general) in 31 patients undergoing major surgery. Thoracic epidural blockade with lidocaina CO2, adrenalin 1/200000, ensures analgesia while induction and hypnosis maintenance were obtained with midazolam, alfentanil, atracurium and N2O/O2. This technique seems able to protect the patients from endotracheal intubation and surgical stress and also to enable a rapid, quiet awakening. The dose of midazolam necessary to maintain hypnosis was inversely proportional to the patient's age. The reversal of hypnosis was necessary in 4 patients only.

  5. 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.

  6. Tetanic fade following administration of nondepolarizing neuromuscular blocking drugs.

    Science.gov (United States)

    Gibson, F M; Mirakhur, R K

    1989-06-01

    Fade in response to tetanic stimulation was studied following administration of atracurium 120 or 225 micrograms/kg, vecuronium 23 or 40 micrograms/kg, pancuronium 30 or 60 micrograms/kg, or d-tubocurarine 185 or 450 micrograms/kg. Ten patients received each dose and tetanic fade was measured at maximum block in the patients, who received the lower doses of the relaxants or at 10% recovery in those who received the higher doses. Fade during tetanic stimulation was generally similar in all the groups with the exception of the higher dose of pancuronium which showed a significantly greater fade in comparison with the higher doses of atracurium and d-tubocurarine. If fade in response to tetanic stimulation represents a prejunctional effect, the results from the present study suggest that neuromuscular blocking drugs cannot be differentiated with respect to their relative prejunctional effects by measurement of tetanic fade during established block after administration of clinically useful doses as used in the present study.

  7. 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

  8. 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......, 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....

  9. 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)

    陈毅科

    2015-01-01

    objective:to cis atracurium muscle relaxant effect and clinical observe pharmacodynamic indexes of the recovery process.Methods:all patients were divided into three groups,each group of 60 cases,respectively,a single injection for its Atc0.6 mg/kg,Cis Ⅰ 0.15 mg/kg and Cis Ⅱ 0.20 mg/kg.Car-ried out in accordance with the T115 % % and T120 jie grouping resistance,injection of neostigmine 45 g/kg and 15 g/kg atropine.Observation of patients with muscle relaxant effect and muscle relaxant recovery time.Results:the muscle relaxant drug effect time Atc significantly faster than Cis group,Cis Ⅱ muscle re-laxant drug effect time compared with Cis Ⅰ,statistically significant differences in two groups,P <0.05).Atc1,Cis and Cis Ⅱ Ⅰ 1 1 is far greater than in 85% of its recovery between Atc2,Cis 2,2 and Atc3 Cis Ⅱ Ⅰ,Cis,Cis Ⅱ Ⅰ 3 3 categories,statistically significant differences between groups,P 0.05 or less.Conclusion:cis atracurium muscle relaxant effect and the way of metabolic and atracurium is similar,but the effect than atracurium significantly,the rela-tively small impact on the human body heart head blood -vessel,clinical anesthesia as the most ideal depolarization of muscle relaxant drugs,can be widely used in the middle of the clinical anesthesia.%目的:对顺式阿曲库铵肌松效应及恢复过程的临床药效学指标进行观察。方法:将所有患者分为3组,每组60例,分别单次为其注射Atc0.6mg/kg、CisⅠ0.15mg/kg 和 CisⅡ0.20mg/kg。按照 T115%和 T120%进行抗洁分组,注射新斯的明45g/kg 和阿托品15g/kg。观察患者肌松效应和肌松恢复时间。结果:肌松药物起效时间 Atc 明显快于 Cis 组别,Atc1、CisⅠ1和 CisⅡ1在其85%的恢复之间中均远远大于 Atc2、CisⅠ2、CisⅡ2以及 Atc3、CisⅠ3、CisⅡ3组别。CisⅡ肌松药物起效时间与 CisⅠ相比,以及抗洁各组之间差异具有统计学意义,P≤0.05。结论:顺式阿

  10. Analysis of the effects of dexmedetomidine on stress responses and circulation of ICU patients with trachea cannula treatment

    Institute of Scientific and Technical Information of China (English)

    Zhou Zhang; Ruan Yundan; Song Jun

    2016-01-01

    Objective:To observe the effects of dexmedetomidine on stress responses and circulation of ICU patients with trachea cannula treatment and to discuss its clinical values. Methods:A total of 60 cases who were admitted in our hospital from June 2014 to February 2016 were selected and were randomly divided into study group and control group (n=30). Intravenous line of 60 cases was opened before trachea cannula treatment and radial artery puncture was performed for monitoring the invasive artery blood pressure. Patients in study group were given dexmedetomidine treatment for 10 min, with pump injection of 0.5μg•kg-1;then patients in study group were given the right dosage of propofol and cis-atracurium treatment, with intravenous injection;while patients in control group were given the equivalent normal saline (NS) treatment with pump injection and then were given the right dosage of propofol and cis-atracurium treatment. After mask oxygen inhalation, trachea cannula treatment was performed. Haemodynamics relevant index changes of both groups at different time were recorded and arterial blood was collected for determining the cortisol levels for statistical analysis. Results:The used dosage of propofol and cis-atracurium in both groups had no obvious statistical significance. MAP and HR levels of patients in study group were (85.5±10.6) mmHg and (68.5±6.9) times/min respectively immediately after trachea cannula treatment and were (83.7±9.4) mmHg and (68.4±6.5) times/min respectively 5 min after trachea cannula treatment, which were lower than that in control group, with (95.2±9.5) mmHg and (75.5±6.6) times/min respectively immediately after trachea cannula treatment and (92.2±9.6) mmHg and (76.5±7.2) times/min respectively 5min after trachea cannula treatment, haemodynamics was more stable. Cortisol levels of patients in study group were (33.4±1.5), (34.1±1.8), (34.5±1.6) respectively after pump injection of dexmedetomidine, immediately after trachea

  11. Application of muscle relaxants in pediatric anesthesia with tracheal foreign body removal%肌松药在小儿气管异物取出术的麻醉应用

    Institute of Scientific and Technical Information of China (English)

    张文斌; 石泉; 赵振海; 秦学斌

    2011-01-01

    Objective To investigate the efficacy and safety of muscle relaxant atracurium in pediatric anesthesia with tracheal foreign body removal. Methods 60 cases with foreign body in children were randomly divided into two groups: without muscle relaxant anesthesia group (A group): intravenous injection of midazolam 0.05~0.1 mg/kg,etomidate 0.2~0.3 mg/kg, fentanyl 1~2μg/kg, spontaneous respiration or mask ventilation; muscle relaxant anesthesia group (B group): A group in the method of anesthesia based on the use of atracurium O. 1~0.3 mg/kg, mask artificial ventilation; bronchoscope into two groups after the high-frequency ventilation were used. Surgery in children with breath holding record cough, SpO2<90% of the frequency and recovery time, postoperative nausea and vomiting (PONV), set to mirror the number of times and had set off glottic foreign bodies mirror the degree of difficulty. Resuits Breath-hold technique in the cough, SpO2<90% of the frequency and recovery time, PONV, home mirror the number of times over the glottis off foreign bodies in B groups were less than those in the A group (P<0.05). Conclusion In pediatric foreign body removal surgery, the application of atracurium to eliminate the choking breath-hold technique, can reduce the occurrence of hypoxia, rapid postoperative recovery.%目的 探讨肌松药阿曲库铵用于小儿气管异物取出术的麻醉效果和安全性.方法 60例气管异物患儿,随机分为两组.无肌松麻醉组:静脉注射咪达唑仑0.05~0.1 mg/kg、依托咪酯0.2~0.3 mg/kg、芬太尼1~2 μg/kg,保留自主呼吸或面罩辅助呼吸;肌松麻醉组:在无肌松麻醉组的麻醉方法基础上加用阿曲库铵0.1~0.3 mg/kg,面罩人工通气;两组置入气管镜后均采用高频通气.记录患儿术中屏气呛咳、SPO2<90%的次数和苏醒时间、术后恶心呕吐(PONV)、置镜次数、过声门异物脱落次数及置镜的难易程度.结果 术中屏气呛咳、SPO2<90%的

  12. 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

  13. Agreement between cardiac index measured with FloTrac-Vigileo system and pulmonary artery catheter in patients undergoing off-pump coronary artery bypass grafting%非体外循环冠状动脉旁路移植术患者FloTrac-Vigileo系统与肺动脉导管技术监测心指数的一致性

    Institute of Scientific and Technical Information of China (English)

    杜伯祥; 史宏伟; 宋杰

    2014-01-01

    Objective To determine if the cardiac index (Cl) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midazolam,sufentanil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.Cl was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:Cl (2.8 ± 0.6) L·min-1 ·m-2,bias was 0.23 L·min-1 ·m-2 and limit of agreement was (-0.57,1.02) L·min-1 ·m-2,resulting in κ =0.546 and an overall percentage error of 28.6%.Conclusion Cl values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.

  14. Effects of isoflurane and propofol on hepatic and renal functions and coagulation profile after right hepatectomy in living donors.

    Science.gov (United States)

    Ozgul, U; Ucar, M; Erdogan, M A; Aydogan, M S; Toprak, H I; Colak, C; Durmus, M; Ersoy, M O

    2013-04-01

    We compared postoperative hepatic and renal functions and coagulation profiles in living donors undergoing right hepatectomy under isoflurane (n = 40) versus propofol (n = 40) anesthesia. After induction, anesthesia was maintained with isoflurane/air-O2 (group I) or propofol/air-O2 (group P) in addition to remifentanil and atracurium infusion in both groups. Aspartate aminotransferase, alanine aminotransferase, international normalized ratio (INR), activated partial thromboplastin time (aPTT), albumin, total bilirubin, blood urea nitrogen, creatinine, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were measured in the preoperative period, after end of the operation, and on the first, third, fifth and seventh postoperative days (PODs). INR was significantly increased on POD 3 and aPTT on POD 5 in group I compared with group P (P < .05). Albumin level was significantly lower in Group I on POD 1 and 3 (P < .05). GFR was significantly lower on POD 1 in the group I compared with group P (P < .05). The postoperative coagulation, GFR, and albumin values were superior following administration of propofol than isoflurane in donors who underwent living hepatectomy; however, both approaches were clinically safe, with no significant clinical difference.

  15. [General anaesthesia with sevoflurane in dental surgery with use of LMA-Flexible and LMA-ProSeal].

    Science.gov (United States)

    Elizar'eva, N L; Sysoliatin, P G; Kokhno, V N; Kolosov, A N; Palkin, S L; Baĭdik, O D

    2011-01-01

    To compare the laryngeal mask airways (LMA), LMA - Flexible (LMA-F) and LMA-ProSeal (PLMA) with respect to airway management in dental surgery. 35 patients, with the pathology of stomatological area (cysts of the lower jaw; diseases maxillary sinus) were investigated during the operation. Anesthesia was induced with propofol, fentanyl and atracurium besylate. Anesthesia was maintained with sevoflurane and neuromuscular blockade with mechanical ventilation. The operation lasted 30-40 min. For airway management was used LMA-F in 20 patients, in 15 patients was made PLMA. There were no statistically significant differences between LMA-F/PLMA groups for SpO(2), ET CO(2) or airway pressure during anesthesia. As for the gas exchange no difference was noticed in both groups (pLMA-F and PLMA was absent. As for the gas exchange no difference was noticed in both groups (pLMA-F or PLMA during general anaesthesia with sevoflurane is effective for airway management in surgery.

  16. Immunoassay screening of lysergic acid diethylamide (LSD) and its confirmation by HPLC and fluorescence detection following LSD ImmunElute extraction.

    Science.gov (United States)

    Grobosch, T; Lemm-Ahlers, U

    2002-04-01

    In all, 3872 urine specimens were screened for lysergic acid diethylamide (LSD) using the CEDIA DAU LSD assay. Forty-eight samples, mainly from psychiatric patients or drug abusers, were found to be LSD positive, but only 13 (27%) of these could be confirmed by high-performance liquid chromatography with fluorescence detection (HPLC-FLD) following immunoaffinity extraction (IAE). Additional analysis for LSD using the DPC Coat-a-Count RIA was performed to compare the two immunoassay screening methods. Complete agreement between the DPC RIA assay and HPLC-FLD results was observed at concentrations below a cutoff concentration of 500 pg/mL. Samples that were LSD positive in the CEDIA DAU assay but not confirmed by HPLC-FLD were also investigated for interfering compounds using REMEDI HS drug-profiling system. REMEDI HS analysis identified 15 compounds (parent drugs and metabolites) that are believed to cross-react in the CEDIA DAU LSD assay: ambroxol, prilocaine, pipamperone, diphenhydramine, metoclopramide, amitriptyline, doxepine, atracurium, bupivacaine, doxylamine, lidocaine, mepivacaine, promethazine, ranitidine, and tramadole. The IAE/HPLC-FLD combination is rapid, easy to perform and reliable. It can reduce costs when standard, rather than more advanced, HPLC equipment is used, especially for labs that perform analyses for LSD infrequently. The chromatographic analysis of LSD, nor-LSD, and iso-LSD is not influenced by any of the tested cross-reacting compounds even at a concentration of 100 ng/mL.

  17. Anesthetic Management of a Pediatric Patient With Wilsons Disease

    Science.gov (United States)

    Baykal, Mehmet; Karapolat, Sami

    2010-01-01

    Wilsons disease, characterized by cirrhosis, extrapyramidal symptoms and Kayser-Fleischer corneal rings, is a rare hereditary disease of human copper metabolism. Clinical findings in Wilsons disease are complex and neurological symptoms such as tremor, dysarthria, rigid dystonia, seizures, psychiatric disorders, acute liver failure, chronic hepatitis or cirrhosis may develop. A 4-year-old male patient was operated for traumatic depressed skull fracture and intracerebral hematoma. He was diagnosed with Wilsons disease at the age of 2.5 years and treated with zinc sulphate and D-penicillamine. General anesthesia was induced with propofol, fentanyl, atracurium, and maintained with isoflurane, and oxygen. No complications were encountered during the operation or in the postoperative period. We concluded that general anesthesia can successfully be given to Wilsons disease patients using an anesthetic agent, the metabolism of which is least affected by the liver disease, one that induces least hepatic toxicity. By close follow-up of patients clinically and biochemically, it is possible to reduce the complication rates to a minimum. Keywords Wilson's Disease; Craniocerebral trauma; Thoracic injuries; General anesthesia; Surgery PMID:21811529

  18. [Anesthesia in thymectomy. Experience with 115 cases].

    Science.gov (United States)

    Villani, A; Primieri, P; Adducci, G; Mennella, M; Lattanzi, A; De Cosmo, G

    1993-03-01

    The authors have conducted a retrospective study on 115 patients with myasthenia gravis undergoing transsternal or transcervical thymectomy at the Policlinico A. Gemelli of Rome in the period June 1984- to June 1991. A prolonged postoperative mechanical ventilation immediately and a few days following surgery was required respectively in 7 and 3 patients, while atelectasia and broncopneumonia have developed in 10 patients. No relationship could be established between the incidence of respiratory complications and factors such as preoperative symptomatology and treatment anesthetic agents, the surgical approach to the thymus and thymic pathology. However a significantly greater postoperative morbidity has been observed in the group of patients receiving suxametonium as compared to the patients receiving non-depolarizing muscle relaxants. Vecuronium and atracurium very frequently allowed ad adequate resumption of spontaneous respiration after anesthesia and made possible a safe early extubation of patients before leaving the operating room. The authors also stressed that all patients, irrespective of their clinical conditions, must be transferred after thymectomy. Oto the surgical ICU where anticholinesterase therapy can be safely restarted and cardiorespiratory status carefully monitored.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Effect of one minimum alveolar concentration sevoflurane with and without fentanyl on hemodynamic response to laryngoscopy and tracheal intubation

    Directory of Open Access Journals (Sweden)

    Anwar Hoda

    2011-01-01

    Full Text Available Background : Drug combinations can be used for optimum obtundation of the hemodynamic response to tracheal intubation. The objective of this trial was to compare the hemodynamic response to laryngoscopy and tracheal intubation after administration of 2 μg/kg fentanyl bolus or a placebo with 2% end tidal sevoflurane at induction of anesthesia. Materials and Methods : A total of 70 surgical patients of either gender, age 18-45 years were selected for this double blind, randomized, placebo controlled trial, with 35 in each group. All patients received a standardized induction with thiopentone, atracurium, and an end tidal concentration of 1 minimum alveolar concentration (MAC sevoflurane. Heart rate and noninvasive blood pressure were compared to the baseline post induction and for seven minutes post intubation. Some adverse events were noted. Results : The maximum heart rate response was significantly less in the sevoflurane fentanyl group (15% vs. 22%. Significant difference between groups was observed in the systolic blood pressure at six minutes post intubation. Hemodynamic adverse events recorded were similar. Conclusion : Addition of 2 μg fentanyl bolus to 1 MAC sevoflurane anesthesia at induction attenuated the hemodynamic response to a maximum of 15% above baseline values.

  1. Effect of previous frequency of headache, duration of fasting and caffeine abstinence on perioperative headache.

    Science.gov (United States)

    Nikolajsen, L; Larsen, K M; Kierkegaard, O

    1994-03-01

    We have examined the relationship between perioperative headache and various factors in 219 patients who fasted from midnight and underwent minor surgery under general anaesthesia. Four to six hours after operation all patients completed a questionnaire on previous frequency of headache, daily consumption of caffeine and occurrence of perioperative headache. The duration of fasting, type of surgery, premedication and anaesthetic agents used were obtained from the anaesthetic record. After multivariate logistic regression analysis a significant risk of preoperative headache was found in patients who normally experienced headache more than twice a month (odds ratio (OR): 7.7; confidence interval (CI): 2.9-20.1), had a daily caffeine consumption > 400 mg/24 h (OR: 5.0; CI: 1.6-14.8) and who were anaesthetized after 12:00 (OR: 3.7; CI: 1.4-9.8). The risk of postoperative headache was significantly greater in patients with preoperative headache (OR: 16.9; CI: 6.5-43.8), daily caffeine consumption > 400 mg/24 h (OR: 3.9; CI: 1.5-9.6) and in those patients who received atracurium, which was similar to the risk of tracheal intubation.

  2. Ultrasound for critical care physicians: two's a crowd

    Directory of Open Access Journals (Sweden)

    Abukhalaf J

    2016-03-01

    Full Text Available No abstract available. Article truncated after 150 words. A 43 year old previously healthy woman was transferred to our hospital with refractory hypoxemia secondary to acute respiratory distress syndrome (ARDS due to H1N1 influenza. She had presented to the outside hospital one week prior with cough and fevers. Chest radiography and computerized tomography of the chest revealed bilateral airspace opacities due to dependent consolidation and bilateral ground glass opacities. A transthoracic echocardiogram at the time of the patient’s admission was reported as not revealing any significant abnormalities. At the outside hospital she was placed on mechanical ventilation with low tidal volume, high Positive end-expiratory pressure (20 cm H20, and a Fraction of inspired Oxygen (FiO2 of 1.0. Paralysis was later employed without significant improvement. Upon arrival to our hospital, patient was severely hypoxemic with partial pressure of oxygen / FiO2 (P/F ratio of 43. She was paralyzed with cis-atracurium and placed on airway pressure release ventilation (APRV with ...

  3. Effect of thoracic epidural anesthesia with bupivacaine on arterial oxygenation during one-lung ventilation%食管癌术中硬膜外阻滞对单肺通气期间动脉氧合的影响∗

    Institute of Scientific and Technical Information of China (English)

    蒋大明; 王丽君; 顾连兵

    2014-01-01

    目的:探讨食管癌手术采取全麻复合硬膜外阻滞麻醉时对单肺通气( OLV)期间动脉氧合的影响。方法选择60例行经左胸食管癌根治术患者( ASAIII级),随机分为静脉全麻复合硬膜外阻滞麻醉组( A组,30例)和仅静脉全麻组( B组,30例)。两组患者分别于OLV前( T1)、OLV 15min( T2)、OLV 30min( T3)抽取桡动脉血和混合静脉血行血气分析,计算通气/血流比(Qs/Qt)值。结果在T2和T3时,A组氧分压(PaO2)分别为(219�3±48�2)mmHg和(174�7±37�6)mmHg,显著低于B组的(268�1±81�2)mmHg和(221�6±87�0)mmHg。在OLV期间,A组的Qs/Qt显著高于B组(P<0�05),各时间点A组血压均显著低于B组( P<0�05)。结论全麻复合硬膜外阻滞麻醉时会引起食管癌患者术中血压下降,而且会引起OLV期间肺内分流的增加和氧分压的降低。%Objective To study the effects of thoracic epidural anesthesia(TEA) with bupivacaine on oxygenation, shunt fraction during one-lung ventilation( OLV) . Methods Sixty patients who had prolonged periods of OLV for elective thoracic surgery for esophageal cancer were randomized into two groups. Thirty patients ( group A) were anesthetized with propofol/atracurium/epidural thoracic bupivacaine 0�5%. In another 30 patients ( group B) , fentanyl/propofol/atracurium anesthesia was used. A double-lumen en-dotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV ( OLV+15 and OLV+30, respectively) in all patients. PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture per-centage (Qs/Qt) were measured. Results The mean values for PaO2 during OLV in the group A after 15min with (219�3±48�2)mm-Hg and 30min with

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

    Directory of Open Access Journals (Sweden)

    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

  5. The effect of propofol and sevoflurane on the quality of patient recovery from anesthesia with laparoscopic placement of peritoneal dialysis catheter%异丙酚和七氟醚麻醉用于腹腔镜腹膜透析置管术患者苏醒质量研究

    Institute of Scientific and Technical Information of China (English)

    李进; 龚昭; 丰新民; 熊飞

    2011-01-01

    [Objective] To observe the effects of propofol and sevoflurane on the quality of patient recovery from anesthesia with laparoscopic placement of peritoneal dialysis catheter. [Methods] One hundred patients with end-stage renal disease scheduled for elective laparoscopic placement of peritoneal dialysis catheter were randomly divided into two groups. The propofol group (n =50) were given fentanyl, atracurium, and propofol for tracheal intubation and given propofol and remifentanil for anesthesia maintenance. The sevoflurane group (n =50) were given fentanyl, atracurium, and sevoflurane for tracheal intubation and given sevoflurane for anesthesia maintenance. The hemody-namics during perioperative, the time to recovery from anesthesia, the pain and vomiting score were observed. [Results] The blood pressure and HR rised in both groups in intubation (P 0.05). [Conclusions] Using sevoflurane for intubation and anesthesia maintenance can obtain more stable hemodynamics and soon recovery from anesthesia for the patients underwent laparoscopic placement of peritoneal dialysis catheter.%目的 探讨异丙酚和七氟醚麻醉对腹腔镜腹膜透析置管术患者麻醉后苏醒质量的影响.方法 选择择期行腹腔镜腹膜透析置管术的终末期肾病患者100例,随机分成两组:异丙酚组(n=50),给予芬太尼、阿曲库铵、异丙酚行麻醉诱导,异丙酚、瑞芬太尼维持麻醉;七氟醚组(n=50):给予芬太尼、阿曲库铵、七氟醚行麻醉诱导,七氟醚维持麻醉.观察围手术期患者的血液动力学状态,术后麻醉恢复时间,疼痛、呕吐评分.结果 两组患者在气管插管时,血压、心率均升高(P<0.05),七氟醚组较异丙酚组升高较低(P<0.05);七氟醚组麻醉后苏醒时间较异丙酚组快(P<0.05),两组疼痛、呕吐评分差异无显著性(P>0.05).结论 七氟醚用于腹腔镜腹膜透析置管术麻醉诱导和维持,具有血液动力学平稳,苏醒快速的优点.

  6. 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

  7. Influence of head flexion on intraocular pressure, cardiovascular, and respiratory responses in patients undergoing cataract surgery after endotracheal intubation

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    MR Safavi

    2007-11-01

    Full Text Available Background: In cataract surgery, the periorbital area is prepared anddraped after induction of general anesthesia and endotracheal intubation (ETI.For this purpose, the patient’s head and neck is usually flexed 30 to 45degrees. Neck flexion causes displacement of the endotracheal tube tip towardthe carina. Stimulation of the tracheal mucosa may cause bucking, increasedintraocular pressure (IOP, laryngospasm and/or bronchospasm, during lightanesthesia. Laryngeal constriction and all components of the tracheal responsemay affect end-tidal carbon dioxide pressure (PETCO2 and peripheral arterialhemoglobin oxygen saturation (SpaO2. Thus, in the current study, weinvestigated the influence of head and neck flexion on heart rate (HR, systolicand diastolic blood pressure (SAP and DAP, SpaO2, PETCO2, and IOP in patientsundergoing cataract surgery with endotracheal intubation during generalanesthesia.Patients and Methods: The present prospective study comprised patientsaged from 40 to 80 year with 106 American Society of Anesthesia (ASA physicalstatus I and II. Anesthesia was induced with thiopental sodium, lidocaine andfentanyl. Atracurium 0.5 mg/kg was administered to facilitate trachealintubation. HR, SAP, DAP, SpaO2, PETCO2, and IOP were measured at 1, 2, and 5minutes after head flexion.Results: Mean SAP, DAP, IOP, and HR was increased after ETI and headflexion compared with baseline values. PETCO2 and SpaO2 were decreased after ETIand at 1, 2 minutes after head flexion compared with baseline values.Conclusion: In patients undergoing cataract surgery during generalanesthesia, endotracheal tube movement caused changes in head and neck positionresulting in significant effects on heart rate, systolic and diastolic bloodpressures, laryngeal reflexes, SpaO2, PETCO2, and intraocular pressure.

  8. 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.

  9. 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.

  10. Drug-induced anaphylactic reactions in Indian population: A systematic review

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    Tejas K Patel

    2014-01-01

    Full Text Available Background: Epidemiological data on drug-induced anaphylactic reactions are limited in India and are largely depending on studies from developed countries. Aim: The aim was to analyze the published studies of drug-induced anaphylaxis reported from India in relation with causative drugs and other clinical characteristics. Materials and Methods: The electronic databases were searched for Indian publications from 1998 to 2013 describing anaphylactic reactions. The information was collected for demographics, set up in which anaphylaxis occurred, causative drugs, incubation period, clinical features, associated allergic conditions, past reactions, co-morbid conditions, skin testing, IgE assays, therapeutic intervention and mortality. Reactions were analyzed for severity, causality, and preventability. Data were extracted and summarized by absolute numbers, mean (95% confidence interval [CI], percentages and odds ratio (OR (95% CI. Results: From 3839 retrieved references, 52 references describing 54 reactions were included. The mean age was 35.31 (95% CI: 30.52-40.10 years. Total female patients were 61.11%. Majority reactions were developed in perioperative conditions (53.70%, ward (20.37% and home (11.11%. The major incriminated groups were antimicrobials (18.52%, nonsteroidal antiinflammatory drugs-(NSAIDs (12.96% and neuromuscular blockers (12.96%. Common causative drugs were diclofenac (11.11%, atracurium (7.41% and β-lactams (5.96%. Cardiovascular (98.15% and respiratory (81.48% symptoms dominated the presentation. Skin tests and IgE assays were performed in 37.03% and 18.52% cases, respectively. The fatal cases were associated with complications (OR =5.04; 95% CI: 1.41-17.92, cerebral hypoxic damage (OR =6.80; 95% CI: 2.14-21.58 and preventable reactions (OR =14.33; 95% CI: 2.33-87.97. Conclusion: Antimicrobials, NSAIDs, and neuromuscular blockers are common causative groups. The most fatal cases can be prevented by avoiding allergen drugs.

  11. Effects of avoiding neuromuscular blocking agents during maintenance of anaesthesia on recovery characteristics in patients undergoing craniotomy for supratentorial lesions: A randomised controlled study

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    Ruchi A Jain

    2017-01-01

    Full Text Available Background and Aims: Neuromuscular blocking agents have been one of the cornerstones of anaesthesia. With the advent of newer surgical, anaesthetic and neurological monitoring techniques, their utility in neuroanaesthesia practice seems dispensable. The aim of this prospective, comparative, randomised study was to determine whether neuromuscular blocking agents are required in patients undergoing supratentorial surgery when balanced anaesthesia with desflurane, dexmedetomidine and scalp block is used. Methods: Sixty patients with the American Society of Anesthesiologists physical status I or II, aged between 18 and 60 years were included in the study. All patients received anaesthesia including desflurane, dexmedetomidine and scalp block. The patients were randomly allocated to receive no neuromuscular blocking agent (Group A or atracurium infusion to keep train-of-four count 2 (Group B. The two groups were compared with respect to haemodynamic stability, brain relaxation scores and recovery characteristics. Haemodynamic parameters and time taken to achieve Aldrete score >9 and other secondary outcomes were analysed using Student's t-test. Non-parametric data were analysed using the Mann–Whitney test. Results: The mean arterial pressure was comparable between the groups. The intraoperative heart rate was comparable; however, in the post-operative period, it remained higher in Group B for 30 min after extubation (P = 0.02. The brain relaxation scores were comparable among the two groups (P = 0.27. Tracheal extubation time, time taken for orientation and time required to reach Aldrete score ≥9 were comparable among the two groups. Conclusion: The present study suggests that balanced anaesthesia using desflurane, dexmedetomidine and scalp block can preclude the use of neuromuscular blocking agents in patients undergoing supratentorial surgery under intense haemodynamic monitoring.

  12. 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.

  13. Effects of different muscle relaxants on blood pressure and heart rate of the patients with congenital heart diseases during anesthetic induction%不同肌肉松弛药对于先心病患者麻醉诱导时血压和心率的影响

    Institute of Scientific and Technical Information of China (English)

    李树志; 熊利泽; 侯立朝; 陈绍洋; 计根林

    2001-01-01

    目的:研究不同肌肉松弛药用于先心病患者麻醉诱导时对血压和心率的影响。方法:48例择期先天性心脏病矫形手术患者,心功能Ⅱ~Ⅲ级,随机分为6组,每组8例。泮库溴铵、阿曲库铵和维库溴铵(剂量均为0.1 mg/kg)分别合用安定(0.2 mg/kg)和小剂量芬太尼(5 μg/kg)或大剂量芬太尼(10 μg/kg)。记录插管前、后的血压、心率变化。结果:与小剂量芬太尼合用进行麻醉诱导时,泮库溴铵有增快心率作用(P<0.01),对血压影响不明显,阿曲库铵有明显减慢心率作用和降压作用(P<0.05或P<0.01),维库溴铵有轻度减慢心率作用(P<0.01),对血压影响不大;与大剂量芬太尼合用时,泮库溴铵对心率的影响不显著,并引起血压轻度下降(P<0.05),阿曲库铵仍表现明显有减慢心率作用(P<0.05),其降压作用的时间有所延长(P<0.05或P<0.01),维库溴铵减慢心率作用时间有所延长(P<0.01),并使血压显著下降(P<0.05或P<0.01)。结论:先心病矫治术麻醉诱导时宜选择泮库溴铵和较小剂量芬太尼(5 μg/kg)合用,可减少诱导时心动过缓的发生率。%AIM: To study the effects of different muscle relaxants on blood pressure and heart rate of the patients with congenital heart disease during anesthetic induction. METHODS: Forty-eight patients with Grade Ⅱ~Ⅲ of ASA physical status, scheduled forelective correction surgery for the heart defects, were randomly divided into six groups with 8 cases in each group. 0.1 mg/kg of pancuronium, atracurium or vecuronium was used combined with diazepam 0.2 mg/kg and fentanyl 5 μg/kg or 10 μg/kg respectively. Blood pressure(BP) and heart rate (HR) before and after intubation were recorded in this study. RESULTS: When co-administered with fentanyl 5 μg/kg for anesthetic induction, pancuronium induced an increase in HR (P<0.01) with no significant change in BP, atracurium resulted in slight

  14. 患者硬膜外注射不同浓度左旋布比卡因的药代动力学%Pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia

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    马民玉; 王承海; 冉菊红

    2010-01-01

    Objective To investigate the pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes, aged 35-59 years and scheduled for elective radical resection of rectal or colon carcinoma under general anesthesia combined with epidural block, were randomly divided into 2 groups (n=10 each):group Ⅰ (receiving 0.75% levobupivacaine) and group Ⅱ (receiving 0.5% levobupivacaine). Epidural block was performed at L1-2 interspace. Group Ⅰ and Ⅱ received epidural 0.75% and 0.5% levobupivacaine 2 mg/kg (containing adrenaline 5 μg/kg)injected slowly over 2 min, respectively. And 30 min later, general anesthesia was induced with y-hydroxybutyrate 60-80 mg/kg and remifentanil 1-2μg/kg. Tracheal intubation was facilitated with succinylcholine 1-1.5 mg/kg and the patients were mechanically ventilated. Anesthesia was maintained with inhalation of nitrous oxide (N2 O) and O2 (1:1) and continuous infusion of remifentanil 0.01-0.1μg·kg-1·min-1 and intermittent intravenous boluses of atracurium. Sensory and motor blocks were assessed after epidural levobupivacaine. Blood samples were taken from the central vein at 0, 10, 20, 30, 45, 60, 90, 120, 210, 300, 420,540, 660 and 840 min, respectively, after epidural administration for determination of plasma concentrations of levobupivacaine by high performance liquid chromatography.Results The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the two groups and there were no significant differences in the pharmacokinetic profiles between the two groups. The onset time of sensory and motor blocks was shorter and the duration of the two blocks was longer with 0.75% levobupivacaine as compared with 0.5%levobupivacaine. The incidences of nausea and vomiting and hypotension were low and no severe cardiovascular and neurological side-effects developed.Conclusion The pharmacokinetic parameters do not

  15. 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

  16. 单次肌松药全身麻醉下进行神经外科手术的可行性%The feasibility of neurosurgery under general anesthesia with a single dose of muscle relaxant

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    李玉兰; 刘映龙; 徐成明; 吕兴华; 万占海

    2012-01-01

    Objective To evaluate the feasibility of neurosurgery under general anesthesia with single dose of muscle re -laxant. Methods 60 patients with ASA I - II scheduled for neurosurgery were randomly divided into Atracurium (group A) and Succinylcholine (group S), each group had 30 cases. After anesthesia induction and intubation with a single use of Atracuri -um or Succinylcholine, anesthesia was maintained with Propofol and Remifentanil at BIS level. The duration of neuromus -cular blocking, the anesthetics consumption, the presence of unwanted patient movement, the airway pressure, the extuba -tion delay and the rate of residual neuromuscular blockade of two groups were recorded. The surgical conditions were scaled by surgeons after operation. Results No patients' movement was observed during operation, there were 2 patients of control group had cough. The recovery time of muscle tone in group A was longer than group S (P 0.05). Conclusion The feasibility of neurosurgery under general anesthesia with a single dose of muscle relaxant is affirmed, but airway stimulation is not allowed in this condition.%目的 探究单次肌松药全身麻醉下进行神经外科手术的可行性.方法 选取我院ASA Ⅰ~Ⅱ级全身麻醉下进行神经外科手术患者60例,随机分为阿曲库铵组(A组)和琥珀酰胆碱组(S组),每组各30例.麻醉诱导后停用肌松药,全程仅用得普利麻、瑞芬太尼静脉泵注维持电脑双频指数(BIS)麻醉.观察两组麻醉药用量、肌松恢复时间、术中体动次数、气道压、拔管时间、残余肌松发生率、拔管时间及外科麻醉评分.结果 两组患者均无术中体动,S组2例发生呛咳;A组肌松恢复时间较S组长(P0.05).结论单次肌松药全身麻醉下进行神经外科手术是基本可行的,但在这种麻醉状态下不宜进行气管内操作.

  17. Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts

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    Flamer D

    2011-11-01

    Full Text Available David Flamer, Philip WH PengDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaPurpose: To provide a review of local anesthetic (LA agents and adjuncts, opioids and muscle relaxants, and their intraoperative effects and postoperative outcomes in intravenous regional anesthesia (IVRA.Source: A search for prospective, double-blind, randomized controlled trials evaluating LA agents, opioids and muscle relaxants as adjuvants for IVRA, was conducted (MEDLINE®, Embase. Intraoperative benefits (onset/recovery of sensory and motor block, intraoperative analgesia, tourniquet pain, postoperative benefits (pain score, analgesic consumption, time to first analgesia, and side effects were recorded. A conclusion for overall benefit was made based on statistical significance and clinical relevance.Findings: Thirty-one studies were evaluated, with data collected on 1523 subjects. LA agents evaluated were lidocaine, ropivacaine, and prilocaine. Adjuncts evaluated were opioids (morphine, fentanyl, meperidine, sufentanil, tramadol and muscle relaxants (pancuronium, atracurium, mivacurium, cisatacurium. There was good evidence that ropivacaine provided effective IVRA and improved postoperative analgesia. Lidocaine and prilocaine were effective LA agents, however they lacked postoperative benefits. Morphine, fentanyl, and meperidine as sole adjuncts did not demonstrate clinically significant benefits or result in an increased risk of side effects. Sufentanil data was limited, but appeared to provide faster onset of sensory block. Tramadol provided faster onset of sensory block and tourniquet tolerance, however postoperative benefits were not consistent and the risk of minor side effects increased. Muscle relaxants improved the quality of motor block, but at the expense of delayed motor recovery. The combination of fentanyl and muscle relaxants can achieve an equivalent quality of IVRA with 50

  18. Comparison on wake-up time of sufentanil and fentanyl on intraoperative wake-up test in general anesthesia patients undergoing spinal correction surgery%舒芬太尼与芬太尼用于全麻下脊柱矫形术中唤醒效果的比较

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    吴礼平; 王文军; 彭建明; 高利臣

    2011-01-01

    AIM: To research the effect of sufentanil and fentanyl on intraoperative wakeup time and quality in patients undergoing spinal correction surgery, and to study the operation method of intraoperatie wake-up test of spinal correction surgery, and further evaluate the effect of wake-up test. METHODS: Thirty eight cases of patients with spinal deformity were treated by spinal correction surgery. They were randomly divided into sufentanil group and fentanyl group with 19 patients in each group. The anesthesia induction was begun with intravenous infusion 0.1 mg/kg midazolam, 1.5-2.0 mg/kg propofol, 0. 15-0.20 mg/kg atracurium and 0.2 μg/kg sufentanil or 4.0μg/kg fentanyl. The anesthesia was maintained with continuous pump injection sufentanil 0.1 μg/(kg · h) or fentanyl 1 μg/(kg · h). Atracurium, sufentanil or fentanyl were stopped pump injection in the time of 30 min before needing awakening. The pump injection of propofol in the time of need awakening was stopped, and the process of waking up was begun. The wake-up time and quality were studied. RESULTS: The gender, age, weight and operation time were no statistically significant differences between sufentanil group and fentanyl group during the research. The recovery time of spontaneous breathing, open eyes, instruction moves of sufentanil group were shorter than fentanyl group (P< 0.05). The wake-up quality of sufentanil group was better than fentanyl group (P<0.05). There was 1 case of patients with intraoperative pain and awareness in fentanyl group. Both groups had no other complications. CONCLUSION: This method of intraoperative wake-up test is fast and effective. The wake-up time of the anesthesia which used sufentanil is shorter than those of fentanyl group, and the wake-up quality is higher than the later.%目的:对比研究舒芬太尼与芬太尼对脊柱畸形矫形术中唤醒时间及质量的影响,探讨在脊柱畸形矫形术中唤醒试验的操作方法,评估唤醒效果.

  19. Re-expansion of the collapsed lung with room air mitigates oxidative stress injury following one-lung ventilation during esophageal cancer resection%空气肺复张对食管癌根治术患者单肺通气后肺组织氧化应激损伤的影响

    Institute of Scientific and Technical Information of China (English)

    夏斌; 王公明; 张孟元

    2009-01-01

    Objective To determine whether re-expansion of the collapsed lung with room air can attenuate oxidative stress injury following one-lung ventilation during esophageal cancer resection. Methods Twenty-four ASA Ⅰ or Ⅱ patients aged 40-60 yr weighing 44-65 kg undergoing esophageal cancer resection were randomly divided into 2 groups (n=12 each) : room air group and pure oxygen group. Anesthesia was induced with midazolam, fentanyl, etomidate and atracurium and maintained with propofol and atracurium infusion and intermittent iv boluses of fentanyl. Right or left side double-lumen catheter (Fr 35, 37, 39) was inserted in each patient. Correct placement was verified by fiber-optic bronchoscopy. The patients were mechanically ventilated ( V_T 7-10 ml/kg, RR 12-16 bpm, FiO_2 1.0 during one-lung ventilation). P_(ET)CO_2 was maintained at 35-45 mm Hg. SpO_2 was maintained at 95%-100% during one-lung ventilation. Blood samples were collected at the beginning of one-lung ventilation (T_1 ), immediately before re-expansion of the collapsed lung (T_2) and 30 rain after re-expansion of the collapsed lung (T_3) for determination of serum levels of MDA, SOD and plasma level of protein carbonyl. Arterial blood samples were obtained at 2 h after operation for blood gas analysis. Results The plasma protein carbonyl level and serum MDA level were significantly increased while the serum SOD level was significantly decreased at T_3 as compared with thost at T_1 and T_2 in pure oxygen group. No significant change in serum levels of MDA, SOD and plasma level of protein carbonyl occurred during operation in room air group. The oxygenation index was significantly higher at 2 h after operation in room air group than in pure oxygen group. Conclusion Re-expansion of the collapsed lung with room air can attenuate the oxidative stress injury following one-lung ventilation during esophageal cancer resection.%目的 评价空气肺复张对食管癌根治术患者单肺通气后肺组织氧

  20. Apnéia na sala de recuperação pós-anestésica: relato de caso Apnea en la sala de recuperación pós-anestésica: relato de caso Apnea in the postanesthetic recovery room: case report

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    Joel Massari Rezende

    2003-06-01

    inducida con propofol (140 mg, fentanil (350 µg, atracúrio (30 mg y mantenida con isoflurano, dos dosis subsecuentes en bolus de atracúrio (10 mg cada y ventilación controlada mecánica. En el final de la cirugía, después de antagonización del bloqueo neuromuscular, la paciente fue extubada, obedeció a los comandos para respirar y colaboró en el pasaje a la maca, siendo transportada para la SRPA, donde llegó consciente. Minutos después presentó apnea, cianosis e inconsciencia. Fue realizada ventilación manual con oxígeno a 100% seguida de inyección de naloxona (0,2 mg por vía venosa, habiendo retorno de la ventilación espontanea y de la consciencia. CONCLUSIONES: Los cuidados ventilatorios en el pós-operatorio, durante el transporte, admisión a la SRPA, y permanencia en esa unidad, deben ser continuos en pacientes que recibieron opioides, mismo demostrando estar conscientes al dejar la sala quirúrgica.BACKGROUND AND OBJECTIVES: Respiratory depression is a postoperative complication which may occur when opioids are employed in anesthesia. This report aimed at discussing a case of apnea in a conscious patient admitted to the post anesthetic recovery room, after thyroidectomy under general anesthesia with propofol, fentanyl and isoflurane. CASE REPORT: Female patient, 50 years old, 60 kg, physical status ASA I, submitted to thyroidectomy under general anesthesia induced with propofol (140 mg, fentanyl (350 µg and atracurium (30 mg, and maintained with isoflurane, two subsequent atracurium boluses (10 mg each and mechanically controlled ventilation. At surgery completion and after neuromuscular block recovery, patient was extubated, responded to breathing commands and cooperated during transfer to the stretcher, being taken to the PACU, where she arrived fully conscious. Minutes after, she was apneic, cyanotic and unresponsive. Manual ventilation was installed with 100% oxygen, followed by intravenous naloxone (0,2 mg and patient recovered spontaneous

  1. 布托啡诺与芬太尼对全凭静脉麻醉中诱导期脑电双频指数与异丙酚效应室浓度曲线的影响%Effects of butorphanol and fentanyl on the BIS-propofol effect-site concentration curve during total intravenous anesthesia induction

    Institute of Scientific and Technical Information of China (English)

    吴桂生; 王洁; 姚尚龙

    2010-01-01

    Objective To compare the effects of butorphanol and fentanyl on the bispectral index (BIS)-propofol effect-site concentration curve during total intravenous anesthesia induction. Methods One hundred and twelve patients, scheduled for selective surgery of the thyroid or breast between February 2009 and May 2009 in our hospital under total intravenous anesthesia (ASA Ⅰ-Ⅱ), were randomly divided into four groups: control group (Group C) , fentanyl group (Group F) , butorphanol group (Group B) , and butorphanol plus fentanyl group (Group BF) , 28 patients in each group. Target controlled infusion of propofol was used for anesthesia induction in all groups. Group C received an intravenous (Ⅳ) bolus of 4 μg/kg fentanyl and 0.2 mg/kg cis-benzene atracurium after loss of consciousness. Group F was given an Ⅳ bolus of 4 μg/kg fentanyl at two minutes before induction; Group B was given an Ⅳ bolus of 40 μg/kg butorphanol at five minutes before induction; Group BF was given an Ⅳ bolus of 20 μg/kg butorphanol at five minutes and fentanyl 2 μg/kg at two minutes before induction. Moreover, a post-induction Ⅳ bolus of 0.2 mg/kg cis-benzene atracurium was given to groups B, F and BF. Endotracheal intubation was used for mechanical ventilation. Bispoctral index (BIS) and corresponding effect-site concentrations (Ce) of propofol were recorded and graphed. Results At each corresponding effect-site concentration, the bispectral indexes were lower in Group F compared to Group C (68±14 vs 76±12, P=0.036), and in Group B compared to Group F (61±11 vs 68±14, P=0.041). Compared with the Group BF, Group B had a higher BIS when the effect-site concentration of propofol was below 1.4 mg/L, and a lower BIS when the effect-site concentration of propofol was above 1.4 mg/L. The group B was the quickest to fulfill the sedation level required of surgery,followed by Group BF, Group F and Group C. Conclusions Both butorphanol and fentanyl may reduce the BIS at each

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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

  3. 胸腔镜胸交感神经切断术病人舒芬太尼复合异丙酚麻醉的效果%Efficacy of sufentanil combined with propofol for video-assisted endoscopic transthoracic sympathectom

    Institute of Scientific and Technical Information of China (English)

    戴国峰; 田新民; 蒋仲敏; 王月兰

    2008-01-01

    目的 评价胸腔镜胸交感神经切断术病人舒芬太尼复合异丙酚麻醉的效果.方法 择期行胸腔镜胸交感神经切断术的手汗症病人20例,ASA Ⅰ或Ⅱ级,静脉注射舒芬太尼0.5 μg/kg、异丙酚2.0~2.5 mg/kg和阿曲库铵0.6 mg/kg麻醉诱导,麻醉维持:静脉输注舒芬太尼0.2~0.3 μg·kg-1·h-1、异丙酚2~4 mg·kg-1·h-1,间断静脉注射阿曲库铵0.3 mg/kg.手术结束前30 min舒芬太尼输注速率减至0.1 μg·kg-1·h-1,异丙酚减至1~2 mg·kg-1·h-1.分别于麻醉诱导前(基础状态)、气管插管时、CO2充气时、CO2充气5 min、30min、放气后5min、拔管时记录SP、DP、HR,并于上述时点采集静脉血样,测定血浆皮质醇、醛固酮和血糖浓度,记录自主呼吸恢复时间、呼之睁眼时间和拔管时间.结果 术中SP、DP和HR波动在正常范围内;与基础值比较,血浆皮质醇、醛固酮和血糖浓度升高(P<0.05),自主呼吸恢复时间、呼之睁眼时间和拔管时间分别为4.5±1.9、6.4±2.7、(12.6±1.5)min.结论 胸腔镜胸交感神经切断术病人舒芬太尼0.1~0.3 μg·kg-1·h-1复合异丙酚1~4mg·kg-1·h-1麻醉能维持血液动力学的稳定,可减轻应激反应.%Objective To evaluate the efficacy of sufentanil combined with propofol for video-assisted endoscopic transthoracic sympathectomy.Methods Twenty ASA I or II patients of both sexes aged 17-40 yr weighing 52-75 kg undergoing video-assisted endoscopic transthoracic sympathectomy were enrolled in this study.Anesthesia was induced with propofol 2.0-2.5 mg/kg and sufentanil 0.5 μg/kg.Tracheal intubation was facilitated with atracurium 0.6 mg/kg.The patients were mechanically ventilated (VT=8-10 ml/kg,RR=10-12 bpm,I:E =1:2,FiO2=80%).Anesthesia was maintained with infusion of propofol 2-4 mg·kg-1·h-1 and sufentsnil 0.2-0.3/.μg·kg-1 h-1 and intermittent iv boluses of atracurium.At the 30 rain before the end of operation propofol infusion was reduced to 1-2 mg.kg-1

  4. The observation of complications in elderly patients recovering from general anesthesia under different administration patterns%不同给药模式对老年全麻患者术后苏醒期并发症的观察

    Institute of Scientific and Technical Information of China (English)

    莫洪; 吴雪峰; 彭磊

    2012-01-01

    间均有统计学意义(P0.05).结论在老年患者全麻术中采用七氟烷复合瑞芬维持,手术后期采用静安(丙泊酚MCT)复合瑞芬维持,同时充分、快速排除七氟烷的情况下,患者的拔管时间、清醒时间、离室时间均较全凭静脉麻醉明显缩短,且术后谵妄躁动的发生率与全凭静脉麻醉的发生率相似,无术中知晓的发生.surgery. Method abdominal surgery 40 patients, aged 65-76 years old, weighing 56-78kg, ASA I ~Ⅱ grade,14 females and 26 males. Al patients were receiving general anesthesia for the first time without serious major organ dysfunction, no long-term alcoholism, drug abuse, mental history and history of diabetes. Al the operations carried on more than 4 hours. Randomly divided into experimental and control group,20 cases in each group. No premedication and al the catheter tube placement were completed before induction of anesthesia . The two groups are administrated with Jing (propofol MCT)1mg/kg IV, then folowed by fentanyl 4ug/kg, atracurium 0.5mg/kg when the patients were sleepy. finaly ,1mg/kg propofolMCT before intubation . Make sure the tube is in the trachea, then began the mechanical ventilation. The control group was maintained with total intravenous anesthesia: continuous infusion of propofol MCT(3-6mg/kg.h) and remifentanil (0.3-0.8ug/kg.min), intermittent infusion of atracurium 10mg/kg each time; the experimental group was maintained with low concentrations sevoflurane within a closed system, and keep the exhaled gas in a concentration around 1.5MAC. The concentration of PetCO2was maintained at 40mmhg, continuous infusion of remifentanil (0.3-0.8ug/kg.min) and intermittent infusion of atracurium 10mg/kg each time. If there are changes in depth of anesthesia, adjust the dose of propofol and remifentanil in the control group ; maintain the inhaled concentration of sevoflurane in the experimental group the same, only regulate the dose of remifentanil. Appropriate add fentanyl 0.1mg each time for

  5. Anestesia em paciente com síndrome de Gilbert: relato de caso Anestesia en paciente con síndrome de Gilbert: relato de caso Anesthesia in a patient with Gilbert's syndrome: case report

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    Fabiano Timbó Barbosa

    2004-06-01

    forma segura sin el aparecimiento de toxicidad desde que sean evitados los factores que puedan llevar a la diminución de la actividad de la glicuroniltransferasis.BACKGROUND AND OBJECTIVES: Gilbert's syndrome is a chronic benign disease leading to recurrent jaundice and major unconjugated bilirubin increase that may be toxic after the use of routine medication. This report aimed at describing the anesthetic approach in Gilbert's syndrome patient submitted to videolaparoscopic surgery. CASE REPORT: Female patient, 22 years old with Gilbert's syndrome, submitted to videolaparoscopic surgery under general anesthesia with propofol, alfentanil, succinylcholine, atracurium and isoflurane. There were no evidences of toxicity during anesthesia. Postoperative recovery was satisfactory and patient was discharged three days later. CONCLUSIONS: Gilbert's syndrome patients may be safely submitted to general anesthesia without toxicity, provided factors leading to glucuronosyltransferase activity decrease are avoided.

  6. 舒芬太尼预防全麻术后躁动和咽喉疼痛的临床观察%Clinical observation of preventive effects of sufentanil on restlessness and sore throat after surgery under general anesthesia

    Institute of Scientific and Technical Information of China (English)

    姚猛飞; 何丽云

    2011-01-01

    Objective To observe preventive effects of intravenous injection of sufentanil by the end of surgery under general anesthesia on restless during awakening and sore throat within postoperative 24 h. Methods 122 patients who would undergo selective operation under general anesthesia were randomly divided into group A and group B( n= 61 ). Both groups received anesthesia induction with midazolam, atracurium, fentanil and propofol,then maintenance anesthesia with propofol + remifentanil + isoflurane. B group was intravenously injected with sufentanil at 0.25 - 0.5 μg/kg 30 - 40 min before the anesthetic withdrawal ,while in group A no drug was administered by the end of surgery The recovery time of spontaneous breathing, eye opening time, incidence of restless during postanaesthetic recovery and incidence of sore throat within postoperative 24 h were recorded in the two groups. Results The recovery time of spontaneous breathing and eye opening time were not significantly different between the two groups( P > 0.05 ). However, the incidences of restless and sore throat in group B were significantly lower than those in group A( P < 0.05 ). Conclusion Low - dose sufentanil administration before awakening from general anesthesia can not only prevent restless during postanaesthetic recovery, but also prevent sore throat within postoperative 24 h.%目的 观察术毕前静脉注射舒芬太尼预防全麻术后苏醒期躁动和术后24 h咽喉疼痛的效果.方法 随机将122例需要全麻的择期手术患者分为A组和B组,每组61例,两组均以咪唑安定、阿曲库铵、芬太尼、丙泊酚诱导,丙泊酚+瑞芬太尼+异氟醚维持麻醉.B组于手术结束麻醉停药前30~40 min给予舒芬太尼0.25~0.5 μg/kg;A组手术结束前不给药.分别纪录两组患者的自主呼吸恢复时间、呼之睁眼时间及苏醒期患者的躁动发生率、术后24 h咽喉疼痛发生率.结果 两组患者手术结束后,自主呼吸恢复时间、呼

  7. Comparison of two methods of Supreme TM laryngeal mask size selection effect on the throat complication%两种选择喉罩型号的方法对术后咽喉部并发症的影响

    Institute of Scientific and Technical Information of China (English)

    杨海涛; 耿宝淳; 周峰

    2013-01-01

    Objective To observe the effect of two methods of LMA model in use,comparing the throat surgery complications.Methods The 40 patients undergoing general anesthesia are randomly divided into A,B two groups.Each group is 20 cases.Group A is selected according to the actual weight of the LMA; The patients of Group B are calculated with standard weight,selecting the laryngeal mask based on body weight.In the operation room,the patients are induced routinly of general anesthesia,inserted the selected model LMA.Laryngeal mask ventilation and parity,the inspection is completed and satisfactory after fixation,mechanical ventilation.Intraoperative continuous infusion of propofol and remifentanil,the interval to give cis-benzene sulfonamide atracurium.After surgery,the patients awake,removing of laryngeal mask.The laryngeal cast is observed and recorded with bloodshot.After surgery,patients are observed the incidence of throat complications.Results In Group A,the seal pressure of laryngeal mask (21.00 ± 2.08)cmH20 is lower than Group B (24.00 ±2.83) cmH20.The insertion time of Group B (15.05 ± 2.56) seconds is shorter than Group A (16.95 ± 3.20) seconds.throat Department of the lowest incidence of mucosal injury (5%),the lowest incidence of postoperative sore throat (15%).Conclusion Both methods achieve to complete selection laryngeal mask ventilation goal,but in accordance with the standard weight calculation,the throat mucosa damage is smaller,fewer throat complications.%目的 观察两种选择喉罩型号的方法在使用中的效果,比较术后咽喉部并发症.方法 择期全麻患者40例,随机分为A、B两组,每组20例,A组按照实际体重选择喉罩;B组计算患者的标准体重,再根据体重选择喉罩.患者入室,常规行全麻诱导,插入选定型号的喉罩.行喉罩的通气和对位检查,各项检查完成并达到满意后固定,行机械通气.术中持续泵入丙泊酚,瑞芬太尼,间隔给予顺苯磺阿曲库铵.手术

  8. 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

  9. EPIDURAL COMBINED INTRAVENOUS ANESTHESIA AND TOTAL INTRAVENOUS ANESTHESIA IN UPPER ABDOMINAL SURGERY%硬膜外复合静脉全麻与全凭静脉麻醉在上腹部手术中的比较

    Institute of Scientific and Technical Information of China (English)

    朱洪远; 刘充卫; 姜华华

    2011-01-01

    [目的]比较硬膜外复合静脉全麻与全凭静脉麻醉对上腹部手术患者血流动力学、静脉麻醉药用量、术后苏醒、躁动及术后疼痛的影响.[方法]80例择期行上腹部手术患者完全随机分为硬膜外复合全麻组(A组)与全凭静脉麻醉组(B组).观察记录不同时间点两组患者血流动力学、静脉麻醉药用量、术后苏醒时间、躁动例数及术后疼痛VAS评分.[结果]两组患者术前术中血流动力学变化比较,差异无统计学意义.拔管后B组患者MAP和HR明显比A组增加,差异有统计学意义(P<0.05).A组患者丙泊酚、芬太尼、顺苯阿曲库铵用量明显比B组少,差异有统计学意义(P<0.01),术后清醒早,拔管时间明显缩短、躁动例数明显减少、术后镇痛良好.[结论]胸段硬膜外复合静脉全麻用于上腹部手术是一种安全、经济、有效并利于患者术后恢复快通道麻醉的首选麻醉方法.%[Objective] To compare the epidural combined intravenous anesthesia and total intravenous anesthesia on hemodynamics, drug dosage, intravenous anesthesia postoperative effects of waking up, restlessness and postoperative pain of patients with upper abdominal surgery. [Methods] 80 patients with elective abdominal operation on a row totally were randomly divided into epidural combined with General anesthesia Croup (group A) and total intravenous anaesthesia group (Group B). We recorded the blood flow dynamics in patients with two groups at various points the dosage, intravenous anesthesia, postoperative recovery time, number of restlessness and postoperative VAS pain score. [ Results] We compared the hemodynamic changes in patients of the two groups before surgery, and there was significant difference between the two groups. MAP and HR in Group B after extubation significantly increased than the group A (P < 0.05). The propofol, fentanyl and CIS-Atracurium dosage of benzene in Group A were significantly lower than in the B group

  10. 联合应用顺阿曲库铵与维库溴铵后ED50和ED95的改变%The change of ED50 and ED95 for combination of cisatracurium and ve-curonium

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    葛培青; 叶照君; 陶伟平; 梁伟民

    2014-01-01

    目的:观察顺式阿曲库铵联合维库溴铵用药后ED50和ED95的变化。方法将75例择期手术患者(ASAⅠ~Ⅱ级)随机分为3组:顺式阿曲库铵组、维库溴铵组和顺式阿曲库铵+维库溴铵组,每组各25例。麻醉诱导后,以单次给药法观察起效时间和T1达到最大抑制的时间,描绘3组患者的量-效曲线,求得各自的ED50和ED95值,并运用等效图法和代数法对两药相互作用进行分析。结果单用顺式阿曲库铵组、维库溴铵组ED50值分别为32.35、28.78μg/kg,ED95值分别为52.67、51.20μg/kg。联合用药时ED50值为16.81、12.17μg/kg,ED95值为23.49、22.16μg/kg,与单独用药相比,差异均有统计学意义。联合用药时ED50和ED95的合用代数值分别为0.942、0.879。结论联合使用顺式阿曲库铵和维库溴铵具有协同作用,且量-效曲线产生左移。%Objective To observe the change of ED50 and ED95 for the treatment with cisatracurium and vecuronium. Methods 75 cases of patients undergoing elective surgery (ASA Ⅰ to II level) were ramdomly divided into three groups:cisatracurium group,vecuronium group and cisatracurium+vecuronium group,each group of 25 cases.The onset time and T1 maximum inhibition time were determined by the single-injection doseresponse technique after anesthesia induction.Their respective ED50 of ED95 values were caculated by the depicted dose-response curve among the three groups of patients.The two medicine interaction analysis was caculated by the equivalent diagram method and algebraic method. Results ED50 was 32.35,28.78 μg/kg and ED95 was 52.67,51.20 μg/kg when patients were given single dose of atracurium or vecuronium.ED50 was 16.81,12.17 μg/kg and ED95 was 23.49,22.16 μg/kg when it combined the both two groups.Compared with other group,the differences in cisatracurium+vecuronium group were statistically significant.The combinational value of ED50 and ED95 was 0.942 and 0.879,respectively

  11. Correlation of preoperative pain threshold and pain tolerance threshold with postoperative fentanyl consumptions%术前痛阈和耐痛阈与妇科手术后芬太尼消耗量的关系

    Institute of Scientific and Technical Information of China (English)

    张卫; 路辉; 阚全程; 储勤军; 常琰子; 王中玉

    2008-01-01

    Objective To investigate the correlation of preoperative pain threshold and pain tolerance threshold with postoperative fentanyl consumptions after gynecologic surgery. Methods Forty-four ASA Ⅰ or Ⅱ patients aged 20-50 yr scheduled for elective myomectomy or total hysterectomy were studied. The pain threshold and pain tolerance threshold were measured with electric stimulator (type MEB-5100, Photoelectricity Co., Japan) before induction of anesthesia. Anesthesia was induced with midazolam, remifentanil, propofol and snceinyl choline and maintained with infusion of propofol and remifentanil and intermittent Ⅳ boluses of atracurium. The patient-controlled intravenous analgesia (PCIA) with fentanyl and droperidol was used for postoperative analgesia. PCIA solution contained fentanyl 1 mg and droperidol 5 mg in 100 ml of normal saline. The PCA pump was set up with a 2 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 0.5 ml/h. Postoperative pain was assessed immediately and at 24 h after operation using VAS (0=no pain, 10=worst possible pain). The number of successfully delivered doses and the total fentanyl consumptions during the 24 h after operation were recorded. Results The preoperative pain tolerance threshold was negatively correlated with the number of successfully delivered doses and fentanyl consumption during the 24 h after operation (r=-0.71, -0.70 respectively), but the preoperative pain threshold was not. Conclusion Preoperative pain threshold can not predict fentanyl consumptions for postoperative analgesia, but preoperative pain tolerance threshold can predict it after gynecologic surgery.00703018)%目的 评价妇科手术病人术前痛阈、耐痛阈与术后芬太尼消耗量之间的关系.方法 择期全麻下行子宫肌瘤剔除术或子宫全切术病人44例,年龄20~50岁,ASA Ⅰ或Ⅱ级.麻醉诱导前采用电刺激仪测定痛阈和耐痛阈;静脉注射咪达唑仑、瑞芬太尼、异丙酚和琥珀

  12. [Effect of capnoperitoneum on postoperative carbon dioxide homeostasis].

    Science.gov (United States)

    Blobner, M; Felber, A R; Hösl, P; Gögler, S; Schneck, H J; Jelen-Esselborn, S

    1994-11-01

    After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption. Studies exist on the course of end-expiratory CO2 (Pe-CO2) alone over a longer postoperative period of time in extubated patients during spontaneous breathing. The goal of this prospective study was to investigate the amount of CO2 resorbed from the abdominal cavity in the postoperative period by means of CO2 metabolism. METHODS. After giving informed consent to the study, which was approved by the local ethics committee, 20 patients underwent laparoscopic cholecystectomy. All patients received general endotracheal anaesthesia. After induction, total IV anaesthesia was maintained using fentanyl, propofol, and atracurium. Patients were ventilated with oxygen in air (FiO2 0.4). The intra-abdominal pressure during the surgical procedure ranged from 12 to 14 mm Hg. Thirty minutes after releasing the capnoperitoneum (KP), CO2 elimination (VCO2), oxygen uptake (VO2), and respiratory quotient (RQ) were measured every minute for 1 h by indirect calorimetry using the metabolic monitor Deltatrac according to the principle of Canopy. Assuming an unchanged metabolism, the CO2 resorption (delta VCO2) at any given time (t) can be calculated from delta VCO2 (t) = VCO2 (t)-RQ(preop) VO2 (t). It was thus necessary to define the patient's metabolism on the day of operation. The first data were collected before surgery and after introduction of the arterial and venous cannulae for a 15-min period. Measuring point 0 was determined after exsufflation of the KP and emptying of the remaining CO2 via manual compression by the surgeon at the end of surgery. Patient's tracheas were extubated and metabolic monitoring started 30 min after

  13. 全麻在血小板减少症剖宫产术中的应用体会15例%The sentiment of 15 general anaesthesia used in cesarean section of thrombocytopenia patients

    Institute of Scientific and Technical Information of China (English)

    王峰; 周志鹏; 蔡迪盛; 宋歌

    2012-01-01

    Objective: To observe selective treatment of intravenous anesthesia supplemented with local anesthesia used in patieflts with thrombocytopenia in cesarean section, whether the mother and the fetus are safer, the management of anesthesia are better, the anesthetic effect are more precisely, the surgeon are more satisfied. Method: select 15 patients,39w±2.0 for pregnancy, preoperative Pit <7.0×109/L.Give cryoprecipitate infusion and induction of anesthesia prior to anesthesia, midazolam 0.2mg/kg.When the patient were falling asleep, the surgeon plus local infiltration of 1 % lidocaine 20ml (on the incision), while giving intravenous infusion of atracurium 0.4mg-0.5mg/kg. Butorphanol 8ug/kg were given immediately in intravenous after the fetus removed (no propofol and less isoflurane were given during the operation). Results: 15 cases of general anesthesia patients wew anesthesia managed with satisfactory results. The surgeon were satisfied with operation, and the maternal and the newborn was delivered safely. Conclusion: inhalation anesthesia in the selectivity of drug safety, support to local anesthesia, is indeed the safe and effective method of anesthesia in cesarean section patients with thrombocytopenia, and it is the superior choice, that played a good sedative and analgesic effects , but also ensure that the patient airway to facilitate the safe surgery and take the baby out fast.%目的:观察体会静脉复合麻醉,选择性用药,辅以局部麻醉,应用于血小板减少症剖宫产术患者,是否使产妇、胎儿娩出更安全,麻醉管理更完善,麻醉效果更确切,手术医生更满意.方法:①选择15例患者,孕39w±2.0,术前Pit< 7.0×109/L,麻醉开始前冷沉淀输注;完毕后行麻醉诱导,咪唑安定0.2mg/kg,入睡后,术者再加局部浸润1%利多卡因20ml(切口处),同时静注阿曲库铵0.4mg-0.5mg/kg,胎儿取出后,立即静脉布托啡喏8ug/kg(术中不用丙泊酚,少用异氟醚).结果:15例全麻手术患

  14. Comparison of risk of tumor invasion and metastasis under paravertebral block combined with general anesthesia versus general anesthesia in the patients undergoing radical lung cancer resection performed via video-assisted thoracoscope:plasma VEGF and M%椎旁神经阻滞联合全麻与全麻下胸腔镜肺癌根治术病人肿瘤侵袭和转移风险的比较:VEGF和MMP-9血浓度

    Institute of Scientific and Technical Information of China (English)

    陈冀衡; 范志毅; 张云霄; 金云玉; 李萍

    2015-01-01

    Objective To compare the risk of tumor invasion and metastasis under paravertebral block (PVB) combined with general anesthesia versus general anesthesia in the patients undergoing radical resection for lung cancer performed via video-assisted thoracoscope in terms of plasma concentrations of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9).Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 30-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective radical resection for lung cancer performed via video-assisted thoracoscope,were randomly divided into 2 groups (n =20 each) using a random number table:general anesthesia group (group G) and PVB combined with general anesthesia (group PG).PVB of T4-7 was performed successfully with local injection of 0.375% ropivacaine 5 ml before induction of anesthesia.Double-lumen endotracheal tube was placed after induction of anesthesia,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 1%-2%),and intravenous infusion of remifentanil 0.2-0.3 μg · kg-1 · min-1,and intermittent intravenous boluses of atracurium.Before anesthesia and at 24 h after surgery,the venous blood samples were collected for measurement of plasma concentrations of VEGF and MMP-9.Results The plasma VEGF and MMP-9 concentrations were significantly lower after surgery in group PG than in group G.Conclusion PVB combined with general anesthesia significantly decreases the risk of tumor invasion and metastasis in the patients undergoing radical lung cancer resection performed via video-assisted thoracoscope in comparison to general anesthesia.%目的 采用血管内皮生长因子(VEGF)和基质金属蛋白酶-9(MMP-9)血浓度,比较椎旁神经阻滞联合全麻与全麻下胸腔镜肺癌根治术病人肿瘤侵袭和转移风险.方法 择期行胸腔镜肺癌根治术病人40例,年龄30 ~ 64岁,性别不限,BMI 18

  15. 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

    Directory of Open Access Journals (Sweden)

    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.

  16. 胸主动脉夹层动脉瘤腔内隔绝术的麻醉管理%Anesthesia for endovascular stent-graft implantation of thoracic aortic dissection

    Institute of Scientific and Technical Information of China (English)

    夏氢; 陈伟; 李卫; 蒋岚杉; 崔驰

    2011-01-01

    Objective To present the anesthetic management of patients for endovascular stent-graft implantation of thoracic aortic dissection. Methods Twenty-nine patients with thoracic aortic dissection were underwent endovascular stent-graft implantation under combined intravenous-inhalation anesthesia and controlled hypotension. Anesthesia was induced with midazolam, propofol, fentanyl and atracuriura, and maintained with propofol, fentanyl, atracurium, isoflurane or sevoflurane. Continuous e-lectrocardiogram, invasive blood pressure, central venous pressure, percutaneous oxygen saturation, end-tidal carbon dioxide tensions and urine output were monitored. Arterial blood gas, plasma electrolyte and blood sugar were monitored if necessary. An intravenous infusion of nitroglycerin[0. 5~5 μg/(kg ? Min) ] was given to maintain systolic pressure at 90~100mmHg before release of the stent. Results The anaesthesia times were ( 120. 28 ± 15. 25) minutes. The anesthetic effects were satisfactory and the hemodynamics was steady. Before release of the stent, mean arterial blood pressure was reduced to (65.13 ± 14. 32) mmHg. All of them had no anesthesia complications. Conclusion Appropriate preoperative preparation, controlled hypotension and systemic organ protection are very important in the anesthetic management of patients for endovascular stent-graft implantation of thoracic aortic dissection.%目的 探讨胸主动脉夹层动脉瘤实施腔内隔绝术的麻醉方法及麻醉管理要点.方法 29例胸主动脉夹层动脉瘤患者均在静吸复合全身麻醉和控制性降压下实施手术,麻醉诱导采用咪唑安定、丙泊酚、芬太尼及阿曲库铵,麻醉维持采用丙泊酚、芬太尼、阿曲库铵、异氟烷或七氟烷.术中持续监测心电图、有创动脉血压、中心静脉压、脉搏血氧饱和度、呼气末二氧化碳分压及尿量,必要时监测动脉血气、电解质及血糖等.支架释放时微泵输注硝酸甘油0.5~5μg

  17. Application of anesthesia without muscle relaxant in pediatric myasthenia gravis patients undergoing thymectomy%无肌松剂麻醉在儿童重症肌无力患者胸腺切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    王显望; 王卓强; 王恒林; 王庆东; 刘峰

    2012-01-01

    目的 观察无肌松药麻醉技术对儿童重症肌无力(MG)患者经胸骨胸腺切除围术期及拔管时间的影响,并与肌松药麻醉技术比较.方法 将26例儿童MG患者随机分为肌松药组(M组)和无肌松药组(N组)各13例.所有患者以咪唑安定、丙泊酚和芬太尼麻醉诱导,气道表面麻醉后行气管插管.异丙酚复合七氟醚维持麻醉.M组中麻醉诱导和维持使用少量卡肌宁,N组不使用肌松药.记录两组患者插管条件、血流动力学变化、清醒及拔管时间、术后并发症等.结果 所有患者均顺利插管;两组血流动力学变化比较差异无统计学意义(P>0.05),N组插管后收缩压(SBP)和舒张压(DBP)显著低于麻醉前(P0.05);N组拔管时间显著少于M组(P0.05).结论 无肌松药麻醉技术对儿童MG胸腺切除术患者是一种安全、可靠的麻醉方法,可以缩短患者术后拔管时间,有利于患者迅速恢复.%Objective To compare non-muscle relaxant anesthetic techniques with muscle relaxant anesthetic techniques in pedi-atric myasthenia gravis(MG) patients undergoing trans-sternal thymectomy and evaluate the intra and postoperative conditions including extubation time in the operating room. Methods Twenty-six pediatric patiens with MG were randomly divided into two groups:non-muscle relaxant(N group,n= 13) and muscle relaxant(M group,n= 13). In both groups anesthesia was induced with midazolam,fentanyl and propofol and intubation was performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained with propofol-sevoflurane. In M group small dose of atracurium was used in induction and maintenance of anesthesia and no neuromuscular blocker in N group. Intubating conditions, hemodynamic changes, wakeup time, extubation time and postoperative complications were evaluated. Results Intubating conditions were good in all patients. There were no significant haemodynamic changes between two groups(P>0. 05). The SBP and

  18. Clinical study of OSAHS surgery under general anesthesia without muscle relaxants%无肌松药全身麻醉用于鼾症手术的临床研究

    Institute of Scientific and Technical Information of China (English)

    张玉琴; 孟凡民; 王红国; 王高宏; 栾秀坤

    2013-01-01

    目的 尝试在鼾症(OSAHS)手术全身麻醉维持中免用肌松药的可行性,探讨其临床价值.方法 选择ASA Ⅰ~Ⅱ级悬雍垂腭咽成形术(UPPP)鼾症患者180例,随机分为A、B、C三组(每组n=60),均以瑞芬太尼、丙泊酚及氯化琥珀胆碱静脉快诱导,经鼻明视或盲探气管插管,A组以瑞芬太尼、丙泊酚维持麻醉,B、C组分别在A组基础上加用阿曲库铵、维库溴铵维持麻醉.观察记录三组患者各时点循环和呼吸功能指标及术中肌松程度、体动次数、麻醉苏醒时间、拔管时间、不良反应及并发症等.结果 三组气管插管成功率100%,麻醉维持平稳,无体动反应,均顺利完成手术;A组拔管前后清醒彻底,呼吸功能和肌力正常,无麻醉并发症发生,B、C组清醒后有不同程度肌松药残余,须使用新斯的明拮抗,拔管后分泌物增多、出血、心动过缓、低氧血症、舌后坠、喉痉挛、呼吸道梗阻、支气管痉挛发生率明显高于A组(P<0.01).结论 瑞芬太尼-丙泊酚无肌松药全凭静脉麻醉维持用于鼾症手术安全有效,可明显缩短麻醉恢复时间,提高麻醉恢复质量,降低麻醉恢复期风险,减少并发症发生.%Objective To invertigate the feasibilityand clinical efficacy of OSAHS surgery under general anesthesia without muscle relaxants. Methods Totally 180 ASA Ⅰ or Ⅱ OSAHS cases underwent UPPP surgery were randomly divided into 3groups(n =60) , general anesthesia was induced with Remifentanil, Propofol and Succinylcholine, and maintained with Propofol and Remifentanil at group A. Group B, C added atracurium, vecuronium to maintain anesthesia, on the basis of group A. Observed and recorded the three groups of patients at each time point circulatory and respiratory function parameters and the number of intraoperative muscle relaxants degree of body movement, anesthesia time, time to extubation, adverse reactions and complications. Results All patients of the

  19. Effect of Different Muscle Relaxant on Residual Muscle Relaxant Effect around the Time of Perioperative Decannulation for Patients Undergoing Endotracheal Intubation Anesthesia Surgery%不同肌松药物对气管插管下全麻手术患者围拔管期残余肌松效应的影响

    Institute of Scientific and Technical Information of China (English)

    张友高

    2016-01-01

    目的:探讨不同肌松药物对气管插管下全麻手术患者围拔管期残余肌松效应的影响。方法:选取2010年7月-2014年10月期间本院行气管插管下全麻手术治疗的患者176例,依据随机数字表法分为库铵组和对照组,所有患者均给予常规全麻治疗,对照组患者给予0.08~0.12 mg/kg维库溴铵处理,库铵组患者给予0.05~0.10 mg/kg顺式阿曲库铵处理,其中库铵组依据给药方式又分为泵注组和静脉组,统计分析所有患者麻醉前(T0)、麻醉时(T1)、插管(T2)、切皮(T3)、拔管时(T4)的平均动脉压(MAP)和心率(HR),并通过TOF-GUARD监测仪监测围拔管期肌松情况。结果:在T0、T1时,所有患者MAP、HR水平之间比较,差异无统计学意义(P>0.05);T2、T3、T4时各组MAP、HR水平方面比较,泵注组0.05).At T2,T3 and T4,in terms of MAP and HR levels,the pump injection groupatracurium can effectively stabilize the hemodynamic fluctuations for patients with endotracheal intubation general anesthesia surgery,it is conducive to suppressing the occurrence of residual muscle relaxant effect around the time of decannulation,which has a better effect by pump injection way of drug-delivery,it’s worthy of further clinical promotion.

  20. The Experience of Anesthesia and the Practice of Transesophageal Echocardiography in Thoracoscopy-assisted Mitral Valve Surgery%胸腔镜直视微创二尖瓣手术24例麻醉体会

    Institute of Scientific and Technical Information of China (English)

    卢静; 兰志勋; 蔡兵; 胡云霞; 苏文杰

    2015-01-01

    目的:总结胸腔镜直视微创二尖瓣手术的麻醉经验,并评价经食道超声在术中的应用价值。方法:24例行胸腔镜直视微创二尖瓣手术的患者,以咪唑安定、依托咪酯、顺式阿曲库铵和舒芬太尼麻醉诱导,以丙泊酚与瑞芬太尼,间断给予舒芬太尼、咪唑安定、顺式阿曲库铵及吸入七氟醚作麻醉维持。术前以经食道超声评价病变特征、确定手术类型,术中指导上腔静脉引流管的放置,术后监测心脏排气,评价手术效果。结果:24例患者均成功完成手术,其中行二尖瓣置换术者17例,二尖瓣成形术7例。2例患者食道超声术中监测二尖瓣成形不满意,改为瓣膜置换术成功。未出现瓣周漏、血肿、空气栓塞等并发症。结论:对胸腔镜直视下微创二尖瓣手术患者,选择合适的麻醉方式,并全程进行经食道超声监测,能为手术成功提供充分保障、避免并发症。%Objective :To discuss the experience of anesthesia and the clinical practice of transesophageal echocardio‐graphy (TEE) in thoracoscopy‐assisted mitral valve surgery .Methods :24 patients who underwent thoracoscopy‐assis‐ted mitral valve surgery were retrospectively analyzed .The induction of anesthesia was performed with midazolam , etomidate ,cis‐atracurium and sufentanil ,and the anesthesia was maintained with propofol and remifentanil .TEE was used to determine the lesion characteristics ,guide operation ,monitor the air exhaust and evaluate the effect of opera‐tion .Results:17 patients underwent mitral valve replacement and 7 patients underwent mitral valvuloplasty successful‐ly .2 patients underwent mitral valve replacement due to dissatisfied repair effect based on TEE evaluation .No compli‐cations were found in all patients .Conclusion:Appropriate anesthesia programs contributed to the process of operation and TEE guidance provided detailed information during

  1. Application of remifentanil combined with propofol of general anesthesia for cesarean section%丙泊酚联合瑞芬太尼在剖宫产全身麻醉中的应用

    Institute of Scientific and Technical Information of China (English)

    屈军; 刘晖; 刘锦

    2011-01-01

    group was given propofol 1.5 mg·kg-1,remifentanil 1.0 μg·kg-1 and atracurium amine0.8 mg·kg-1 through intravenous injection slowly,and remifentanil and propofol were given by target-controlled infusion to maintain during the operation;The control group was given propofol 1.5 mg·kg-1 ,fentanyl 1.0-2.0 μg·kg-1 .atracurium amine 0.8 mg·kg-1 intravenous injection slowly,and propofol was given by target-controlled infusion and fentanyl was given intermittently by intravenous injection. The two groups were given mask oxygen inhalation for three minutes, then endotracheal intubation was given for the patients. The changes of heart rate( HR) and mean arterial pressure( MAP) of expectant mother and the scores of neonatal Apgar were compared between two groups. Results Compared with the preoperative MAP,there was no statistically significant at the time of induction,after induction three minutes,the time of fetal disengagement and after fetal disengagement three minutes in observation group(P>0.05). In control group,the MAP at the time of fetal disengagement and after fetal disengagement five minutes was lower than that before surgery ( P <0.05 ). In observation group, the HR of puerpera increased than that before surgery(P<0.05) ;Compared with the preoperative HR,there was no statistically significant at the time of induction three minutes and after fetal disengagement five minutes(P >0.05). In control group,the HR at the time of induction and fetal disengagement and after fetal disengagement five minutes was faster than before surgery ( P < 0.05 ). The MAP at the time of fetal disengagement and after fetal disengagement five minutes in control group was lower than the observation group (P < 0.05 ). The HR in control group at the time of induction and fetal disengagement and after fetal disengagement five minutes was faster than the observation group (P < 0.05 ). The Apgar scores of fetal disengagement five minutes in observation were higher than the

  2. 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

  3. 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

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    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

  4. Remifentanil associado ao propofol ou sevoflurano para colecistectomia videolaparoscópica: estudo comparativo Remifentanil asociado al propofol o sevoflurano para colecistectomia videolaparoscópica Remifentanil associated to propofol or sevoflurane for videolaparoscopic cholecystectomy: a comparative study

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    Fernanda Fischer Estivalet

    2002-07-01

    medidas en los siguientes momentos: M1, antes de la inducción anestésica; M2, 1 minuto antes de la IOT; M3, 1 minuto después IOT; M4, 5 minutos después IOT; M5, 5 minutos después de la incisión quirúrgica; M6 y M7,10 y 30 minutos, respectivamente, después el pneumoperitonio. Después del término del procedimiento fueron analizados los tiempos, en minutos, para abertura ocular, ventilación espontanea, extubación, hablar el nombre completo y el aprieto de la mano del anestesiologista, sobre comando. También fueron estudiada la frecuencia del uso de atropina y efedrina y la ocurrencia de náuseas, vómitos y dolor. RESULTADOS: Las alteraciones hemodinámicas (PAS, PAD, PAM y FC y el despertar de los pacientes no tuvieron diferencias significativas entre los grupos. El uso de efedrina y atropina fueron semejantes. Entre las complicaciones solamente los vómitos tuvieron mayor incidencia en el Grupo 2. CONCLUSIONES: Ambas técnicas promovieron diminución de la presión arterial y de la frecuencia cardíaca. La recuperación anestésica es semejante para las dos técnicas. La incidencia de vómitos es mayor cuando el remifentanil fue asociado al sevoflurano.BACKGROUND AND OBJECTIVES: Different intravenous, inhalational or combined anesthetic techniques have been used for videolaparoscopic cholecystectomy. This study aimed at comparing hemodynamic parameters, anesthetic recovery and side-effects of remifentanil associated to propofol or sevoflurane. METHODS: Participated in this study 40 patients, who were divided in two groups: Group 1 (G1 - induced with 3 µg.ml-1 propofol and a 0.3 µg.kg-1.min-1 remifentanil infusion. Atracurium (0.5 mg.kg-1 was administered for tracheal intubation. Anesthesia was maintained with 2.5 to 3 µg.ml-1 propofol in target controlled infusion and 100% oxygen, and remifentanil by continuous infusion (0.3 µg.kg-1.min-1; Group 2 (G2 - induced with 6% sevoflurane and 100% oxygen at a 4 L.min-1 flow and a 0.3 µg.kg-1.min-1 remifentanil

  5. Agreement between cardiac index measured with FloTrac-Vigileo system and pulmonary artery catheter in patients undergoing off-pump coronary artery bypass grafting%非体外循环冠状动脉旁路移植术患者FloTrac-Vigileo系统与肺动脉导管技术监测心指数的一致性

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    杜伯祥; 史宏伟; 宋杰; 葛亚力

    2011-01-01

    目的 评价非体外循环冠状动脉旁路移植术患者FloTrac- Vigileo( FV)系统与肺动脉导管(PAC)技术监测心指数(CI)的一致性.方法 拟行非体外循环冠状动脉旁路移植术患者43例,年龄53~75岁,身高150~ 183 cm,体重46~100 kg,ASA分级Ⅱ或Ⅲ级.静脉注射咪达唑仑、舒芬太尼、异丙酚和罗库溴铵行麻醉诱导,麻醉维持:静脉输注异丙酚和瑞芬太尼,间断静脉注射阿曲库铵.于锯胸骨后至搭桥开始前和搭桥完成后至闭合胸骨前,吸入1 MAC七氟醚,其余时间不吸入七氟醚.采用FV系统和PAC技术监测CI.于锯胸骨后未吸入七氟醚时、吸入七氟醚5、15 min时,冠状动脉搭桥完成后未吸入七氟醚时、吸人七氟醚5、15 min时记录两种方法监测的CI数据对,进行一致性分析.结果 FV系统和PAC技术测定CI共计258次配对数据,配对数据平均值的均数(2.8±0.6)L·min- ·m-2.配对数据差值的均数(平均偏差)为0.23 L· min-1·m-2,一致性限度(- 0.57,1.02)L·min-1·m-2,百分误差为28.6%,Kappa系数为0.546.结论 FV系统与PAC技术监测CI的一致性尚可,可替代PAC技术用于非体外循环冠状动脉旁路移植术患者CI的监测.%Objective To determine ff the cardiac index (CI) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midasolam,sufentunil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.CI was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison

  6. 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

  7. 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

  8. 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

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    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

  9. Effect of Dexmedetomidine on Emergency Delirium in the Elderly Patients Undergoing Laparoscopic Surgery%右美托咪定对老年腹腔镜手术患者苏醒期谵妄的影响

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    龚建平; 刘卫华; 李恒

    2014-01-01

    the same volume of normal saline was infused in group A .Facilitated with 0.15mg/kg cisatracurium besylate and the patients were mechanicallv .Ventilated Load infusion 3min after anesthesia induction ,two groups were intravenous fentanyl 2~5μg/kg ,1~2mg/kg propofol and atracurium 0 .2mg/kg ,endotra‐cheal intubation after mechanical ventilation .Maintain anesthesia :sevoflurane by target controlled inhalation (TCI) (end‐tidal concentration set at 1% ~3% ) and intravenous injection pump ,ruifentanyl 0 .05~0 .1ng/(kg · min) ,intra‐operative maintain the BIS value of 40~60 .According to the BIS values to adjust the Sevoflurane and dosage of ruifent‐anyl ,the consumption of propofol ,ruifentanyl ,and sevoflurane ,agitation during emergenee from anesthesia ,and postop‐erative delirium within 6h after operation were recorded .Results:Compared with group A ,group B propofol ,ruifenta‐nyl and sevoflurane was significantly reduced ,and the incidences of agitation during emergence from anesthesia and postoperative delirium within 6h after operation were significantly decreased in group B (P<0.05) .Conclusion:Dexme‐detomidine can reduce the incidence of elderly patients with laparoscopic surgery postoperative emergency delirium ,for prevention and control of the occurrence of postoperative cognitive dysfunction has certain effect .

  10. 七氟烷和丙泊酚麻醉下阻塞性黄疸患者术后恢复的比较%The difference on anesthesia recovery period in obstructive jaundice patients under general anesthesia with sevoflurane of intravenous propofol

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    李廷坤; 卢锡华; 吕帅国; 章云飞; 王根生; 冯艳平

    2008-01-01

    Objective To investigate the effect of general anesthesia with sevoflurane or intravenous propofol on anesthesia recovery period in obstructive jaundice patients. Methods Thirty ASA Ⅰ or Ⅱ and Child A obstructive jaundice patients were randomly divided into two equal groups (n=15 each). The patients in group S received inhalation anesthesia with sevoflurane and those in group P intravenous anesthesia with propofol during operation for obstructive jaundice. The patients were premedicated with intramuscular phenobarbital 100mg and atropine 0.5mg, anesthesia was induced with midazolam 0.05mg/kg, atracurium 0.5mg/kg, propofol 1.5-2.5mg/kg and fentanyl 4μg/kg. Maintained with TCI of propofol (target plasmaconcentration was set at 3.5mg/L) or sevoflurane inhalation (end-tidal sevoflurane concentration was 2%-3%) and intermittent i. v. boluses of fentanyl. EGG, HR, MAP, SpO and end-tidal sevoflurane concentration were continuously monitored during operation. Duration of anesthesia, the volume of infusion and fentanyl were recorded, awaking time, extubation and regained consciousness after operation were recorded. Results There were no significant differences between the two groups in average age, sex, body-weight, duration of anesthesia, the parameters of MAP and HR (P>0.05). The awaking time was (7.9±1.5) minutes in group S and (26.1±8.8) minutes in group P. The extubation time was (8.5±2.5) minutes in group S and (27.8±11.2) minutes in group P. The regained consciousness time was (13.1±4.4) minutes in group S and (33.7±12.5) minutes in group P. The incidence of lethargy, fidget were higher in group P than those in group S. Conclusion Both sevoflurane and propofol can provide satisfactory anesthesia for the operation of obstructive jaundice, but the recovery of influence caused by sevoflurane is faster and more steady than that caused by propofol.%目的 比较阻塞性黄疽患者在七氟烷和丙泊酚麻醉后恢复的差异.方法 择期

  11. 30例重症甲型H1N1流感孕妇剖腹产麻醉分析%Anesthesia analysis on cesarean section of 30 pregnant women with severe H1N1 influenza

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    赵佳平; 胡海立; 侯米莎; 王娓

    2013-01-01

    目的 观察分析并发重症甲型H1N1流感及伴有急性呼吸窘迫综合征(ARDS)孕妇患者的麻醉方法,探讨全麻用药对其呼吸功能及新生儿Apgar评分情况的影响.方法 8例重症患者采用连续硬膜外麻醉,22例甲型H1N1流感伴ARDS患者采用全身麻醉.血浆靶控(TCI)浓度瑞芬太尼为2.0 ng/ml、丙泊酚为1.5 μg/ml、单次静脉注射咪达唑仑0.03~0.04 mg/kg、顺式阿曲库铵0.06~0.08 mg/kg麻醉诱导完成气管插管.以2.5 ng/ml瑞芬太尼和3 μg/ml丙泊酚血浆靶控,维持麻醉深度.比较其术前、术后血气检测结果及插管前、插管时、切皮、术中、术毕的脉搏-血氧饱和度(SPO2)情况.记录新生儿出生后1 min和5 min的Apgar评分.结果 30例全麻患者麻醉前、后血气检查结果差异无统计学意义(P均> 0.05).插管时、切皮、术中的脉搏-血氧饱和度(SPO2)与术前基础值相比SPO2有显著改善,差异具有统计学意义(P均= 0.000);术后与术中SPO2值均低于插管时SPO2水平,但差异无统计学意义(P = 0.543、0.715).新生儿1 min和5 min Apgar评分无显著变化.结论 麻醉方法、药物对经过术前治疗的重症甲型H1N1流感患者及伴有ARDS患者的呼吸功能、新生儿Apgar评分无显著影响.术后除2例危重症患者因原发病治疗无效死亡,余患者均痊愈出院.%Objective To observe and analyze the anesthesia method of pregnant women complicated with severe H1N1 influenza and acute respiratory distress syndrome (ARDS). To investigate the anesthesia medication on respiratory function and the effect on the Apgar score of newborns. Methods Eight patients with severe symptoms received continuous epidural anesthesia, while 22 cases with H1N1 influenza and acute respiratory distress syndrome (ARDS) received general anesthesia. Infusion of remifentanil as 2.0 ng/ml, propofol as 1.5 μg/ml, single intravenous injection of midazolam as 0.03-0.04 mg/kg, cis-atracurium as 0.06-0.08 mg

  12. Effect comparision of propofol and sevoflurane applied in neurosurgery%丙泊酚和七氟醚应用于神经外科手术麻醉的效果比较

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    韩宇; 郝洪钟; 张玮玮; 郭永清

    2015-01-01

    Objective To evaluate the anaesthetic effectiveness in neurosurgery between the remifentanil combined with propofol infusion in total intravenous anesthesia and the sevoflurane combined with remifentanil intravenous inhalation anesthesia. Methods 40 patients with ASA Ⅰ-II,scheduled for neurosurgery operation in our hospital from March to October 2014 were selected,and were randomly divided into propofol-remifentanil group (group P) and sevoflurane-remifentanil group (group S),20 cases in each group.Midazolam,fentanyl,cis-atracurium,and propofol were used in the induction of anesthesia.The mechanical ventilatione were applied after conventional trachea cannula.Then remifentanil were infused consistently by venous to malntaln intraoperative analgesia.While patients in group S were received sevoflurane instead,patients in group P were received propofol by continuous intravenous infusion for depth of anesthe-sia until the operation finished.Once patients were anesthetized steadily,systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) at different time [after anesthesia induction (T1),cut the skin (T2),incision (T3),intracranial dural placeholder to remove about half (T4),close the dura (T5),sewing leather end (T6)] was collected.When operation completed,Anesthesia waking time,extubation time,adverse reactions was observed. Results The recovery time and extubation time in group S was longer than that in group P (P0.05). Conclusion Propofol and sevoflurane are suitable to anesthetic malntenance in neurosurgery,but patients who underwent the remifentanil combined with infusion in total intravenous anesthesia wake more quickly.%目的:对比丙泊酚复合瑞芬太尼全凭静脉麻醉和七氟醚复合瑞芬太尼静脉吸入复合麻醉在神经外科手术中的麻醉效果。方法选择本院2014年3~10月择期神经外科手术全麻患者40例,ASAⅠ~Ⅱ级,将其随机分为丙泊

  13. 七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较%Comparison of cerebral blood flow and intracranial pressure during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia

    Institute of Scientific and Technical Information of China (English)

    田复波; 黄绍强; 梁伟民

    2010-01-01

    Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly

  14. 喉罩通气全凭吸入七氟醚麻醉在乳腺癌根治术中的应用研究%Application study of laryngeal mask airway dependent on sevoflurane inhalation anesthesia in radical mastectomy

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    李英娜; 刘志建; 侴伟平

    2013-01-01

    Objective To study the application of laryngeal mask airway dependent on sevoflurane inhalation anesthesia in patients underwent radical mastectomy. Methods 63 patients underwent elective modified radical mastectomy in tumor hospital of Liaoning Provirce from May 2009 to June 2012 were studied, and divided into observation group with 32 cases and control group with 31 cases. Patients in the observation group were inducted with Sevoflurane, and laryngeal mask successfully implanted, maintained by sevoflurane anesthesia alone. Patients in the control group were anesthesiaed with traditional intravenous induction, and laryngeal mask successfully implanted, maintained by continuous inhalation of sevoflurane and intermittent injection with benzenesulfonate atracurium. The information of anesthesia were studied. Results The time unplug the laryngeal mask in the observation group was significantly shorter than that in the control group, there was statistically significant (P < 0.05). Mean arterial blood pressure (MAP) values in T2 time point in the two groups were significantly lower than that in T1, the differences were significant (P < 0.05). MAP in the T2 time point in the control group was lower than that in observation group, the difference was significant (P < 0.05). The HR in the T2 time point in the control group was significantly slower than the T1 time point, the difference was significant (P < 0.05). Oxygen saturation values in each time point between the two groups had no significant differences. Conclusion The laryngeal mask airway dependent on sevoflurane inhalation anesthesia in modified radical mastectomy is a safe, effective and worthy of clinical application method.%目的 研究喉罩通气全凭吸入七氟醚麻醉在乳腺癌根治术中的应用.方法 以2009年5月~2012年6月于辽宁省肿瘤医院住院的63例乳腺癌根治术患者为研究对象,分为观察组32例和对照组31例.观察组采用七氟醚进行诱导,待成功置入喉

  15. 无肌松药全身麻醉下进行骨科手术的临床对照试验%Controlled clinical trials of orthopedic surgery under general anesthesia without muscle relaxants

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    徐成明; 李玉兰; 刘映龙; 吕兴华; 万占海

    2012-01-01

    目的 比较使用和不使用神经肌肉阻滞药全身麻醉下进行部分骨科手术的优缺点.方法 76例ASAⅠ或Ⅱ级骨科手术患者,随机分为试验组(T组)、对照组(C组)各38例.使用琥珀酰胆碱诱导后,T组只用丙泊酚、瑞芬太尼维持麻醉,C组按常规使用阿曲库铵.术中维持脑电双频指数(BIS值)在30~60之间,记录两组患者麻醉前,诱导后,切皮时,术后30、60 min和拔管后的BIS值和四个成串刺激比(T4/T1,TOFr),比较两组丙泊酚和瑞芬太尼用量、睁眼时间、拔管时间、术后20 min警觉与镇静评分(OAA/S)及不良反应,术后请外科医师评价肌松效果.结果 两组患者瑞芬太尼用量、外科肌松评价、术中体动次数、血管活性药使用次数无显著差异;T组插管后各时点TOFr均显著高于C组(P < 0.01),丙泊酚用量多于C组(P < 0.05),睁眼时间、拔管时间明显短于C组(P < 0.05),拔管后BIS值显著高于C组(P < 0.05),术后20 min OAA/S评分明显低于C 组(P < 0.05).结论 无肌松药全身麻醉下进行骨科手术比使用者呼吸恢复早,拔管快,清醒程度好,具有显著优势.%Objective To compare the efficacy of general anesthesia with and without muscle relaxant on orthopedic surgery. Methods 76 ASA I or II adults underwent elective orthopedic surgery were randomly divided into 2 groups: trial group (group T) and control group (group C), with 38 cases in each group. General anesthesia was induced with Midazolam, Fentanyl, Propofol and Succinylcholine, and maintained with Propofol and Remifentanil at BIS level 30 to 60. After induction, Atracurium was used in group C but not in group T. BIS and TOFr at baseline, after induction, at skin incision, 30 min and 60 min after skin incision and at extubation were recorded. The dosage of Propofol and Remifentanil, eye-opening time, extubation time and OAA/S scale 20 min after extubation and possible adverse reaction were compared. The muscle relaxation

  16. 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.

  17. 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

  18. 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

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    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

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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