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Sample records for atracurium

  1. Interaction between atracurium and drugs used in anaesthesia.

    Science.gov (United States)

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

    1983-01-01

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

  2. 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.

  3. Acute quadriparesis in an asthmatic treated with atracurium.

    Science.gov (United States)

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

    1995-03-01

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

  4. 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.

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

    Science.gov (United States)

    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.

  6. 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

  7. 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.

  8. 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.

  9. The Comparison of Priming with Pancrunium and Atracurium in the Speed of Providing Adequate Neuromuscular Blockade for Tracheal Intubating

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    S. Sanaie, M.D

    Full Text Available Abstract Background and purpose: Neuromuscular relaxants are one group of the important drugs in providing good condition for tracheal intubation and operation. Rapid intubation is needed in most situations. Also, most of non- depolarizing relaxants almost have long onset time. We compared the priming with pancrunium and atracurium in providing good and rapid relaxation for tracheal intubation.Materials and Methods: In this prospective study, 65 patients with ASA class I, II were randomized into two groups. Group A received pancrunium and group B received atracurium. Primimg dose was injected as 20% of total dose of relaxant. Twitching response was measured with peripheral nerve stimulator. Intubation was done when % 80 of the twitching response disappeared. The time of total disappearance of twitching response was also recorded.Results: The mean time for the injection of the first dose of relaxant until the time of intubation was 94.47 seconds in group A and 142.9 seconds in group B, which were significantly different (P<0/01. If intubation until the time of twitch response is detained, the time gap of group A will again be less than group B (P<0/01.Conclusion: In priming technique, the time of tracheal intubation with pancrunium is significantly less than atracurium. So, considering the patient's condition and the need for rapid relaxation, pancrunium could be is a better relaxant than atracurium.

  10. 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.

  11. 全身热疗对全凭静脉麻醉下阿曲库铵肌松效应的影响%The effects of whole -body hyperthermiaon pharmacodynamics of atracurium under total intravenous anesthesia TA NG

    Institute of Scientific and Technical Information of China (English)

    唐刚; 程伟; 梁斯; 齐敦益; 张跃; 卢杰

    2011-01-01

    Objective To observe the effects of whole-body hyperthermia (WBH)on pharmacodynamics of atracurium in patients with malignant tumor under total intravenous anesthesia. Methods Fifty patients with advanced cancer were randomly assigned into two groups, hyperthermia group (n=24)and non-hyperthermia group (n=26). Parameters such as body temperature, electrocardiogram(ECG), central venous pressure(CVP), pulse oxygen saturation(SpO2)and endridal CO2(PeiCO2) were monitored during the operation. The train of four (TOF) mode of stimulation was used to monitor neuromuscular blocking. The dosages of atracurium were recored. The TOF on the time of atracurium withdrawal and the time of 25 %, 50 %, 75 % recovery from 10% of TOF were recorded. Results The dosage of atracurium in hyperthermia group was higher than that of non hyperthermia group (123.8±15.7) mg/kg vs (73.2±9.5) mg/kg(P<0.01). The infusion speed of atracurium in hyperthermia group was faster than that of non hyperthermia froup (12.5±1.7) μg·kg-1·min-1 vs (5.1±0.9) μg·kg-1·min-1( P<0.01). The 25%, 50%, 75% of TOF recovery from 10% of TOF in non-hyperthermia group were (8.2±2.5), (13.8±2.3), (24.1±3.7) min, respectively. The 25% ,50% ,75% of TOF recovery from 10% of TOF in hyperthermia group were(4.8±1.38),(6±1.7),(l4.1±3.2), respectively. Conclusion WBH increases the consumption and infusion speed of atracurium and shortens the acting time of atracurium.%目的 观察全身热疗(whole body hyperthhermia,WBH)对晚期癌症患者全凭静脉麻醉(total intravenous anesthesia,TIVA)中阿曲库铵用量和作用时间的影响.方法 晚期癌症TIVA患者,分非高温组(24例),高温组(26例).监测两组患者的体温、心电图(ECG)、中心静脉压(CVP)、脉搏血氧饱和度(SpO2)、pH值,呼气末二氧化碳分压(PETCO2)等;记录各组阿曲库铵用量.监测停止输注阿曲库铵时,4个成串刺激(train of four,TOF)从10%恢复至25%、50%、75%平均时间.结果 与

  12. 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.

  13. 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.

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

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    袁晓红; 郭建荣; 金孝岠

    2014-01-01

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

  15. 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

  16. 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

  17. 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

  18. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    费胜琪; 唐京军

    2013-01-01

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

  1. 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%.

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

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    Alexandre da Silva Polydoro

    1996-08-01

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

  3. 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

  4. 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

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    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

  5. 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

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    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

  6. 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

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    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.

  7. 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.

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

    OpenAIRE

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

    2007-01-01

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

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

    OpenAIRE

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

    2002-01-01

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

  10. 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.

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

    Science.gov (United States)

    Moneret-Vautrin, D A; Kanny, G

    2002-09-01

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

  12. 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.

  13. 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.

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

    Institute of Scientific and Technical Information of China (English)

    李商庚; 厉小丽; 叶永青

    2012-01-01

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

  15. 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

  16. 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....

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

    Directory of Open Access Journals (Sweden)

    MR Safavi

    2007-11-01

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

  18. 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

  19. 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.

  20. 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.

  1. 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 ...

  2. 氨甲环酸对老年全髋关节置换术患者的血液保护效果%Blood-saving effect of tranexamic acid in elderly patients undergoing total hip replacement

    Institute of Scientific and Technical Information of China (English)

    潘宁; 熊鹰; 熊君宇

    2012-01-01

    目的 评价氨甲环酸对老年全髋关节置换术患者的血液保护效果.方法 择期全髋关节置换术患者160例,性别不限,年龄65-70岁,体重指数16-22 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组(n=80):对照组(C组)和氨甲环酸组(T组).切皮前T组经15 m in静脉输注氨甲环酸15 mg/kg,C组给予等容量生理盐水.术中监测Hb、PIt、PT和APTT指导输血.记录术中出血量、术后12 h和48 h出血量,术中、术后异体血输注情况.记录术后并发症的发生情况.结果 两组术中出血量比较差异无统计学意义(P>0.05).与C组比较,T组术后出血量、异体红细胞使用率降低(p<0.05),两组末见术后并发症的发生.结论 氨甲环酸对老年全髋关节置换术患者具有一定血液保护效应,但是临床价值有限.%Objective To evaluate the blood-saving effect of tranexamic acid in elderly patients undergoing total hip replacement.Methods One hundred and sixty ASA Ⅱ or Ⅲ patientss of both sexes,aged 65-70 yr,with a body mass index of 16-22kg/m2,undergoing total hip replacement,were randomly divided into 2 groups(n =80,each):control group(group C)and tranexamic acid group(group T).Anesthesia was induced with midazolam,fentanyl,etomidate and atracurium.The patients were tracheal intubated and mechanically ventilated.PEr CO2 was maintained at 35-45 mm Hg.Aneslhesia was maintained with propofol,remifentanil and atracurium.Before the skin incision,tranexamic acid 15 mg/kg was infused over 15 m in in group T,while the equal volume of normal saline was given instead in group C.Hemoglobin(Hb),platelet count(PLT),prothrombin time(PT),and activated partial thromboplastin time(APTT)were monitored during operation to guide blood transfusion.Intraoperative and postoperative blood loss and allogeneic blood transfusion were recorded.Postoperative complications were also recorded.Results There was no significant difference in the amount of intraoperative

  3. 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

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

    Directory of Open Access Journals (Sweden)

    Waleed Riad

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

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

    Science.gov (United States)

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

    2004-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  11. 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

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

    Science.gov (United States)

    Alipour, Mohammad; Tabari, Masoomeh; Alipour, Masoomeh

    2014-01-01

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

  13. Postoperative pain management after supratentorial craniotomy.

    Science.gov (United States)

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

    2002-04-01

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

  14. Effects of preoperative sleep disturbance on efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery%术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响

    Institute of Scientific and Technical Information of China (English)

    王丽; 裴凌; 苏帆

    2014-01-01

    Objective To investigate the effects of preoperative sleep disturbance on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.Methods Ninety-six ASA Ⅰ or Ⅱ patients of both sexes (aged 20-60 years and weighing 50-80 kg) undergoing endoscopic nasal surgery were enrolled in this study.Pittsburg sleep quality index was used to evaluate the long-term sleep quality before hospitalization and Athens sleep quality index was used to evaluate the short-term sleep quality in hospital.The patients were divided into four groups according to the types of preoperative sleep disturbance (n =24 each):no sleep disturbance (group Ⅰ),long-term sleep disturbance (group Ⅱ),acute short-term sleep disturbance (group Ⅲ),and long-term + acute short-term sleep disturbance (group Ⅳ).Anesthesia was induced with sufentanil,propofol and cis-atracurium and maintained with intravenous infusion of remifentanil and propofol.Then the patients received endotracheal intubation and mechanical ventilation.The end-tidal pressure of carbon dioxide was maintained at 30-35 mm Hg.Controlled hypotension was performed with nicardipine,and the mean arterial blood pressure was maintained at 50-70 mm Hg and heart rate at 60-90 bpm during operation.The patients received intravenous injection of flurbiprofen 50 mg 15 minutes before the end of operation for postoperative analgesia.When the visual analogue scale score was more than 3 during the first 6 hours after operation,flurbiprofen 50 mg was given intravenously as rescue analgesia.Results The incidence of rescue analgesia administered after operation was significantly greater in groups Ⅱ,Ⅲ and Ⅳ than in group Ⅰ,and greater in group Ⅳ than in groups Ⅱ and Ⅲ.There was no significant difference in the incidence of rescue analgesia administered during the first 6 hours after operation between groups Ⅱ and Ⅲ.Conclusion Preoperative sleep disturbance has adverse effects on the efficacy

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

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    邓军; 韦克(通讯作者); 李明良; 左朝晖; 赵兰花

    2014-01-01

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

  16. 妇科腹腔镜手术患者右美托咪啶或瑞芬太尼复合七氟醚麻醉效果的比较%Dexmedetomidine versus remifentanil in combination with sevoflurane for gynecological laparoscopy

    Institute of Scientific and Technical Information of China (English)

    贺秋兰; 徐辉; 李梅娜; 李扬; 孙来保; 黄文起

    2011-01-01

    ): dexmedetomidine group (group D) and remifentanil group (group R). Starting from 5 min before induction of anesthesia, dexmedetomidine was infused at 0.05 μg · kg - 1 · min- 1 in group D and remifentanil at 0.1 μg· kg- 1· min-1 in group R for 10 min, then dexmedetomidine infusion rate was increased to 0. 3 μg· kg-1 · h-1 and remifentanil infusion rate was increased to 0.15 μg· kg-1 · min-1 . Anesthesia was induced with propofol 1.5-2.0 mg/kg and fentanyl 2 μg/kg. Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg. Anesthesia was maintained with sevoflurane and fentanyl 1 μg/kg and intermittent iv boluses of cis-atracurium. Narcotrend index was maintained at 40-50. Blood sample was taken from external jugular vein for blood gas analysis and determination of serum concentrations of corticosteroid, norepinephrine and epinephrine before administration, at 5 min after intubation, at 10 min of aeroperitoneum and at 5 min after extubation. The pH value and concentrations of lactic acid and glucose were recorded. The time for recovery of spontaneous breathing, eye-opening time, extubation time, orientation time and perioperative side-effects were recorded. Numeric rating scale was used to assess the intensity of pain during 2 h after operation. The analgesics used were also recorded. Results The serum concentrations of norepinephrine and epinephrine were significanfly lower at 10 min of aeroperitoneum, the time for recovery of spontaneous breathing was shorter, eye-opening time longer and the incidence of shivering and nausea and vomiting lower, the percentage of patients requiring rescue opioids lower in group D than in group R ( P < 0.05). Conclusion The efficacy of dexmedetomidine combined with sevoflurane anesthesia is better than remifentanil combined with sevoflurane anesthesia for gynecological laparoscopy.

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

    Institute of Scientific and Technical Information of China (English)

    韩梅; 聂宇; 熊君宇

    2011-01-01

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

  18. 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

  19. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  20. 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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Institute of Scientific and Technical Information of China (English)

    王志; 刘风

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王合梅; 贾慧群; 雍芳芳; 李超; 王勇; 赵伟

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    赵占志; 吴慧; 胡松; 许大伟

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    郭雄; 李雪刚

    2014-01-01

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

  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. 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

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

    Directory of Open Access Journals (Sweden)

    Pan SD

    2016-04-01

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

  10. 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

  11. 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.

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

    Institute of Scientific and Technical Information of China (English)

    张学康; 赵为禄; 徐琳; 闵佳

    2011-01-01

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

  13. [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

  14. 依托咪酯不同输注速度对全麻诱导期肌阵挛的影响%Effects of different infusion rates of etomidate on myoclonus during general anesthe-sia induction period

    Institute of Scientific and Technical Information of China (English)

    魏宇; 董有静

    2014-01-01

    目的:研究依托咪酯不同输注速度对全麻患者肌阵挛的影响。方法选取妇科全麻手术的患者90例,平均分成3组,每组30例,记录患者的入室平均动脉压( MAP)、心率( HR)。开通静脉后,在诱导期以不同的速度静脉输注总量为0.3 mg/kg的依托咪酯。输注速度:A组0.9 mg/(kg·min),B组0.45 mg/(kg·min),C组0.23 mg/( kg·min)。患者入睡后,记录肌阵挛的发生情况,然后给予0.1 mg芬太尼,0.15 mg/kg顺苯,并吸入6%七氟醚,2 min后给予插管。记录输注依托咪酯结束后1、5、8 min的MAP、HR。结果 B组肌阵挛的发生率低于A组,但B组与C组比较差异无统计学意义,其中B组发生肌阵挛的程度以1、2级为主,而A组和C组均以2、3级为主。给药后5 min,三组患者MAP升高,给药后8 min有所下降。三组心率比较差异无统计学意义。结论依托咪酯以一定的速度推注,可以减少肌阵挛的发生率并减轻其发生程度,本实验的最适速度是0.45 mg/( kg·min)。%Objective To study the effect of different infusion rates of etomidate on myoclonus during general anesthesia. Methods 90 patients with general anesthesia gynecological surgery were divided into three groups. The mean arterial pressure (MAP),heart rate (HR) were recorded. After opening veins,patients of the three groups re-ceived intravenous infusion of 0. 3 mg/kg etomidate by different speeds. The infusion speed of group A,group B and group C were 0. 9 mg/( kg·min) ,0. 45 mg/( kg·min) and 0. 23 mg/( kg·min) . The patients′ myoclonus occurrences were recorded after falling asleep,then 0. 1 mg fentanyl and 0. 15 mg/kg cis-atracurium was injected,and 6%sevoflu-rane was inhaled. The intubation was done after 2 min. The blood pressure,mean arterial pressure ( MAP) and heart rate ( HR) at 1 min,5 min,8 min after injecting etomidate were recorded. Results The incidence of myoclonus in group B was lower than that of group A,no significant

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

    Institute of Scientific and Technical Information of China (English)

    高光洁; 徐迎阳; 王兵,; 吕红梅; 杨闻宇; 尚宇

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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

  17. 多模式镇痛用于小儿唇腭裂修补术全麻苏醒期的镇痛镇静效果%Analgesic and sedative effects of muitimodal analgesia in stage of emergence after general anesthesia for cleft lip and/or palate prosthesis

    Institute of Scientific and Technical Information of China (English)

    唐岩峰; 陈芳; 王本福; 李海飞; Gennadiy Fuzaylov; 李军; 连庆泉

    2009-01-01

    目的 观察联合应用芬太尼、对乙酰氨基酚栓剂及局部浸润麻醉对唇腭裂修补术小儿全麻苏醒期镇静镇痛的效果.方法 择期行唇腭裂修补术的患儿54例,随机分为2组,对照组(C组,n=28)和多模式镇痛组(M组,n=26).均采用全身麻醉气管插管的方法,七氟烷麻醉诱导与维持.手术开始前由术者对两组患儿行局部浸润麻醉;M组患儿气管插管后即予对乙酰氨基酚栓剂塞肛;手术结束前10 min,静脉注射静脉注射芬太尼0.5μg/kg,C组不给药.观察两组患儿停止吸入七氟烷至拔除气管导管的时间、PACU内镇静镇痛评分、PACU的滞留时间及不良反应的发生情况.结果 两组患儿从停止吸入麻醉药至拔除气管导管时间无明显差异;PACU滞留时间M组[(25 ±4)min]较C组[(32±3)min]短(t=7.426,P<0.01);与C组比较,M组患儿镇痛满意(F=4.840,P=0.028),发生严重疼痛(F=5.333,P=0.021)及躁动(F=4.571,P=0.033)的例数少,差异具有统计学意义;两组患儿无一例发生呼吸抑制及瘙痒,过度镇静和恶心呕吐的发生率,两组间差异无统计学意义.结论 联合应用芬太尼、对乙酰氨基酚栓剂及局部浸润麻醉的多模式镇痛方法在苏醒期可为唇腭裂修补术小儿提供良好的镇痛镇静,减少躁动的发生率,加快PACU患者的转运速度,有利于苏醒期安全.%Objective To investigate the effects of multimodal analgesia on analgesia and sedation during emergence of general anesthesia for cleft lip and/or palate surgery pediatric patients. Methods Fifty-four pediatric patients with ASA Ⅰ and Ⅱ cleft lip and/or palate, aged 2 - 7, undergoing prosthesis were randomly allocated into 2 groups: control group (Group C, n = 28) inhaling nitrous oxide/oxygen (50%: 50%) and sevoflurane(5%) for general anesthesia, and multimodal group (Group M, n =26), injected intravenously with fentanyl and atracurium in addition to inhalation of nitrous oxide/oxygen (50%: 50%) and

  18. 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

    Directory of Open Access Journals (Sweden)

    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

  19. 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

  20. Effect of preoperative sleep disturbance on efficacy of flurbiprofen for postoperative analgesia in patientsundergoing endoscopic nasal surgery%术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响

    Institute of Scientific and Technical Information of China (English)

    王丽; 裴凌; 苏帆

    2011-01-01

    Objective To investigate the effect of preoperative sleep disturbance on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.Methods Ninety-six ASA Ⅰ or Ⅱ patients of both sexes aged 20-60 yr weighing 50-80 kg undergoing endoscopic nasal surgery were enrolled in this study.Pittsburg sleep quality index was used to evaluate long-term sleep quality before hospitalization and Athens sleep quality index was used to evaluate short-term sleep quality in hospital.The patients were divided into 4 groups according to the types of preoperative sleep disturbance ( n =24 each):group Ⅰ no sleep disturbance;group Ⅱ long-term sleep disturbance; group Ⅲ acute short-term sleep disturbance; group Ⅳ long-term + acute short-term sleep disturbance.Anesthesia was induced with sufentanil,propofol and cis-atracurium and maintained with iv infusion of remifentanil and propofol.The patients were intubated and mechanically ventilated.PETCO2 was maintained at 30-35 nun Hg.Controlled hypoteasion was performed with nicardipine,MAP was maintained at 50-70 mm Hg and HR at 60-90 bpm during operation.The patients received iv flurbiprofen 50 mg at 15 min before the end of operation for postoperative analgesia.When VAS score was more than 3 during the fnrst 6 h after operation,flurbiprofen 50 mg was given iv as rescue analgesic.Results The incidence of rescue analgesic administered after operation was significantly larger in groups Ⅱ,Ⅲ and Ⅳ than in group Ⅰ,and in group Ⅳ than in groups Ⅱ and Ⅲ.There was no significant difference in the incidence of rescue analgesic administered during the first 6 h after operation between groups Ⅱ and Ⅲ.Conclusion Preoperative sleep disturbance has adverse effect on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.%目的 评价术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响.方法

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

    Institute of Scientific and Technical Information of China (English)

    李晓宁; 张卫

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王灿琴; 王中云; 潘寅兵

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    孙梅杰; 边雯; 李刚; 章玉菊; 时光刚

    2011-01-01

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

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

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    Gabriela Rocha Lauretti

    2009-12-01

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

  5. 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

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

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    孙震; 卜亚男; 吕晶

    2016-01-01

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

  7. 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

    Institute of Scientific and Technical Information of China (English)

    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

  8. 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

  9. 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.

  10. 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.

  11. 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