RESUMEN
This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were >40 years. The Mini-Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge. The anaesthetic protocol was the same for all patients, except for the neuromuscular block reversal, which was administered by random allocation using either sugammadex or neostigmine/atropine after the reappearance of T2 in the train-of-four sequence. POCD was defined as a decline ≥1 standard deviation in ≥2 cognitive tests. The incidence of POCD was similar in both groups at one hour postoperatively and at discharge (28% and 10%, in the neostigmine group, 23% and 5.4% in the sugammadex group, P=0.55 and 0.27 respectively). In relation to individual tests, a significant decline of clock-drawing test in the neostigmine group was observed at one hour postoperatively and at discharge. For the Isaacs Set test, a greater decline was found in the sugammadex group. These findings suggest that there are no clinically important differences in the incidence of POCD after neostigmine or sugammadex administration.
Asunto(s)
Atropina/administración & dosificación , Disfunción Cognitiva/epidemiología , Neostigmina/administración & dosificación , Complicaciones Posoperatorias/epidemiología , gamma-Ciclodextrinas/administración & dosificación , Adulto , Disfunción Cognitiva/etiología , Método Doble Ciego , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas Muscarínicos/administración & dosificación , Bloqueo Neuromuscular/métodos , Parasimpaticomiméticos/administración & dosificación , SugammadexRESUMEN
BACKGROUND: This study aimed to translate and culturally adapt a Greek version of the Shoulder Pain and Disability Index (SPADI) questionnaire and to validate its usage in Greek patients. MATERIALS AND METHODS: A forward and backward translation was performed, and the final version of the Greek questionnaire was administered to 134 outpatients (mean age 47.4 ± 14.5) with rotator cuff tear under conservative treatment. The questionnaire was re-administered 2-5 days later to assess test-retest reliability. Patients completed the Greek SPADI, the Greek version of the Quick DASH (Disability of the Arm, Shoulder and Hand Questionnaire) and the EuroQoL EQ-5D. 102 of the 134 questionnaires were considered valid. RESULTS: The internal consistencies of the SPADI total and its subscales measured with Cronbach's alpha coefficient were high (0.932 for SPADI-Total, 0.899 for SPADI-Disability, 0.905 for SPADI-Pain). Intraclass correlation coefficients showed excellent test-retest reliability (0.899 for Disability, 0.902 for Pain, and 0.929 for total SPADI). A significantly high positive correlation was found between the SPADI total score and its subscales, and Quick DASH for Pain and Disability. Significant correlations were also found between SPADI scales and EQ-5D variables. There was a moderate positive correlation with the variables "self-reliance" (r = 0.66), "common activities" (r = 0.58), and "pain/discomfort" (r = 0.49), and a weaker correlation with the "mobility" variable (r = 0.20). Factor analysis (PAF method) revealed a bidimensional formation of the SPADI. Eight items (five pain/three disability) weighted the first factor by >0.5, and five disability items weighted the second factor. CONCLUSIONS: The Greek SPADI represents a valid and reliable tool for measuring pain and disability in patients with painful shoulder disorders. LEVEL OF EVIDENCE: Level 3.
Asunto(s)
Evaluación de la Discapacidad , Lesiones del Manguito de los Rotadores/clasificación , Lesiones del Manguito de los Rotadores/fisiopatología , Dolor de Hombro/clasificación , Dolor de Hombro/fisiopatología , Femenino , Grecia , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Psicometría , Reproducibilidad de los Resultados , Lesiones del Manguito de los Rotadores/terapia , Dolor de Hombro/terapia , TraducciónAsunto(s)
Ecocardiografía/instrumentación , Pruebas de Función Cardíaca/instrumentación , Monitoreo Intraoperatorio/instrumentación , Anciano , Anciano de 80 o más Años , Ecocardiografía/métodos , Femenino , Humanos , Masculino , Monitoreo Intraoperatorio/métodos , Procedimientos Ortopédicos , Estudios Prospectivos , Reproducibilidad de los Resultados , Mecánica Respiratoria , Volumen Sistólico , Vena Cava InferiorRESUMEN
BACKGROUND: Sevoflurane exerts effects on pulmonary cells that could protect against lung injury. We evaluated the potential of pretreatment with sevoflurane to attenuate lipopolysaccharide (LPS)-induced lung injury. METHODS: LPS was administered intratracheally in Wistar rats to induce lung injury. Sevoflurane was administered for 30 min at 0.25, 0.5 or 1.0 MAC 15 min before LPS or for 30 min at 0.5 MAC 24 hours before LPS. After initial analysis of bronchoalveolar lavage fluid (BALF) cells and total protein, the group of 0.5 MAC 15 min before LPS was further analyzed for surfactant aggregates subfractions, plasma malondialdehyde levels and lung histology. RESULTS: LPS instillation resulted in neutrophils sequestration in the lungs, loss of alveolar macrophages, increased BALF total protein and decreased large surfactant aggregates. Only inhalation of sevoflurane for 30 min at 0.5 MAC 15 min before LPS installation effectively reduced neutrophil accumulation, preserved alveolar epithelial cells and reduced total protein content in BALF. This regimen also reduced plasma malondialdehyde levels and increased large surfactant aggregates, despite the application of mechanical ventilation. This effect was preserved after LPS instillation and the favorable composition of surfactant was maintained. CONCLUSION: Pretreatment with sevoflurane effectively attenuates direct severe lung injury, possibly by inhibition of neutrophil accumulation and alteration of the surfactant composition.
Asunto(s)
Lesión Pulmonar Aguda/prevención & control , Anestésicos por Inhalación/uso terapéutico , Éteres Metílicos/uso terapéutico , Lesión Pulmonar Aguda/inducido químicamente , Animales , Líquido del Lavado Bronquioalveolar , Lipopolisacáridos , Masculino , Ratas , Ratas Wistar , Sevoflurano , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismoRESUMEN
Venous thromboembolism is an important complication after general and cardiac surgery. Using transthoracic echocardiography, this study assessed the incidence of inferior vena cava (IVC) thrombosis among a total of 395 and 289 cardiac surgical and major surgical patients in the immediate postoperative period after cardiac and major surgery, respectively. All transthoracic echocardiography was performed by a specialist intensivist within 24 hours after surgery with special emphasis on using the subcostal view in the supine position to visualise the IVC. Of the 395 cardiac surgical patients studied, the IVC was successfully visualised using the subcostal view in 315 patients (79.8%) and eight of these patients (2.5%) had a partially obstructive thrombosis in the IVC. In 250 out of 289 (85%) general surgical patients, the IVC was also clearly visualised, but only one patient (0.4%) had an IVC thrombosis (2.5 vs 0.4%, P <0.05). In summary, visualisation of the IVC was feasible in most patients in the immediate postoperative period after both adult cardiac and major surgery. IVC thrombosis appeared to be more common after adult cardiac surgery than general surgery. A large prospective cohort study is needed to define the risk factors for IVC thrombus and whether early thromboprophylaxis can reduce the incidence of IVC thrombus after adult cardiac surgery.
Asunto(s)
Complicaciones Posoperatorias/diagnóstico por imagen , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Trombosis/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Periodo Posoperatorio , Factores de Riesgo , Posición Supina , UltrasonografíaRESUMEN
OBJECTIVES: We examined the application of an ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in patients undergoing oral and maxillofacial surgery. METHODS: A total of 19 patients receiving ultrasound-guided combined intermediate and deep cervical plexus anaesthesia followed by neck surgery were examined prospectively. The sternocleidomastoid and the levator of the scapula muscles as well as the cervical transverse processes were used as easily depicted ultrasound landmarks for the injection of local anaesthetics. Under ultrasound guidance, a needle was advanced in the fascial band between the sternocleidomastoid and the levator of the scapula muscles and 15 ml of ropivacaine 0.75% was injected. Afterwards, the needle was advanced between the levator of the scapula and the hyperechoic contour of the cervical transverse processes and a further 15 ml of ropivacaine 0.75% was injected. The sensory block of the cervical nerve plexus, the analgesic efficacy of the block within 24 h after injection and potential block-related complications were assessed. RESULTS: All patients showed a complete cervical plexus nerve block. No patient required analgesics within the first 24 h after anaesthesia. Two cases of blood aspiration were recorded. No further cervical plexus block-related complications were observed. CONCLUSIONS: Ultrasound-guided combined intermediate and deep cervical plexus block is a feasible, effective and safe method for oral and maxillofacial surgical procedures.
Asunto(s)
Plexo Cervical/efectos de los fármacos , Escisión del Ganglio Linfático/métodos , Músculos del Cuello/cirugía , Bloqueo Nervioso/métodos , Ultrasonografía Intervencional , Absceso/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amidas/administración & dosificación , Analgésicos/administración & dosificación , Puntos Anatómicos de Referencia/diagnóstico por imagen , Anestésicos Locales/administración & dosificación , Sangre , Estudios de Cohortes , Drenaje , Procedimientos Quirúrgicos Electivos , Fascia/diagnóstico por imagen , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Músculos del Cuello/diagnóstico por imagen , Bloqueo Nervioso/instrumentación , Estudios Prospectivos , Ropivacaína , Enfermedades de la Glándula Submandibular/cirugía , Adulto JovenAsunto(s)
Androstanoles/farmacología , Potenciales Evocados Motores/efectos de los fármacos , Fármacos Neuromusculares no Despolarizantes/farmacología , gamma-Ciclodextrinas/farmacología , Adulto , Anciano , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Rocuronio , SugammadexAsunto(s)
Androstanoles/antagonistas & inhibidores , Hepatopatías/complicaciones , Fármacos Neuromusculares no Despolarizantes/antagonistas & inhibidores , Derivación Portosistémica Intrahepática Transyugular/métodos , gamma-Ciclodextrinas , Adulto , Androstanoles/metabolismo , Periodo de Recuperación de la Anestesia , Síndrome de Budd-Chiari/complicaciones , Femenino , Hepatitis C/complicaciones , Humanos , Cirrosis Hepática/complicaciones , Hepatopatías/metabolismo , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Fármacos Neuromusculares no Despolarizantes/metabolismo , Rocuronio , SugammadexAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Hemotórax/diagnóstico por imagen , Complicaciones Intraoperatorias/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Anciano , Coagulación Sanguínea , Puente de Arteria Coronaria , Ecocardiografía , Femenino , Hemotórax/terapia , Humanos , Complicaciones Intraoperatorias/terapia , Masculino , Pleura/cirugíaRESUMEN
BACKGROUND: The immunomodulatory effects of volatile anaesthetics in vitro and the protective effect of propofol in lung injury spurred us to study the effects of volatile anaesthetics and propofol on lung tissue in vivo. METHODS: Twenty-seven pigs were randomized to 4-h general anaesthesia with propofol (8 mg/kg/h, group P, n=9), sevoflurane [minimum alveolar concentration (MAC)=1.0, group S, n=9) or desflurane (MAC=1.0, group D, n=9). Four healthy animals served as the no-ventilation group. Bronchoalveolar lavage fluid (BALF) was obtained to measure the cell counts, platelet-activating factor acetylhydrolase (PAF-AcH), phospholipase A(2) (PLA(2)) and superoxide dismutase (SOD) activity. Lung tissues were evaluated histologically and for caspase-3 expression. RESULTS: Volatile anaesthetics reduced PAF-AcH levels without affecting PLA(2) activity and resulted in decreased alveolar macrophage and increased lymphocyte counts in BALF (sevoflurane: 29 ± 23%; desflurane: 26 ± 6%, both P<0.05 compared with 4 ± 2% in the no-ventilation group). These findings were accompanied by atelectasis and inflammatory cells' infiltration in the inhalational anaesthetics groups. Also, sevoflurane reduced SOD activity and both sevoflurane and desflurane induced significant caspase-3 expression. In contrast, propofol resulted in a minor degree of inflammation and preserved BALF cells' composition without triggering apoptosis. CONCLUSION: Halogenated anaesthetics seem to trigger an immune lymphocytic response in the lung, inducing significant apoptosis and impairment of PAF-AcH. In contrast, propofol preserves anti-inflammatory and anti-oxidant defences during mechanical ventilation, thus preventing the emergence of apoptosis.
Asunto(s)
Anestésicos por Inhalación/farmacología , Anestésicos Intravenosos/farmacología , Pulmón/efectos de los fármacos , Propofol/farmacología , Respiración Artificial , 1-Alquil-2-acetilglicerofosfocolina Esterasa/fisiología , Animales , Antiinflamatorios/farmacología , Apoptosis , Líquido del Lavado Bronquioalveolar/química , Líquido del Lavado Bronquioalveolar/citología , Caspasa 3/análisis , Hemodinámica , Pulmón/inmunología , Oxígeno/sangre , Mecánica Respiratoria , Superóxido Dismutasa/metabolismo , PorcinosRESUMEN
Venous thrombosis of the upper extremities is becoming increasingly prevalent in the intensive care unit as a result of chronic in-dwelling central venous catheters. We report two rare cases in which combined transoesophageal echocardiography and vascular ultrasound examination aided in the identification of catheter-related thrombosis in two patients suffering from splenectomy-induced thrombocytosis and antiphospholipid syndrome respectively.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Cateterismo Venoso Central/efectos adversos , Ecocardiografía Transesofágica/métodos , Esplenectomía/efectos adversos , Trombosis Venosa Profunda de la Extremidad Superior/diagnóstico por imagen , Adulto , Humanos , Unidades de Cuidados Intensivos , MasculinoRESUMEN
AIM: Prolonged cardio-pulmonary bypass (CPB) time, usually necessary for reoperations, is known to increase mortality in coronary bypass procedures and aortic reoperations. We investigated if prolonged CPB time and arch reconstruction in reoperations of the thoracic aorta affect in-hospital outcome. METHODS: Twenty-nine patients underwent reoperations on the thoracic aorta. The reoperations performed were aortic root replacement with composite graft without aortic arch involvement in ten patients, isolated ascending aorta replacement in six patients, aortic arch replacement as a primary procedure in two patients, and aortic arch in conjunction with ascending or descending aorta replacement in 11 patients. RESULTS: Fourteen patients had aortic reoperation with deep hypothermic circulatory arrest (DHCA) and 15 without DHCA. The in-hospital mortality rate was 13.8%. The use deep hypothermic circulatory arrest or CPB time did not affect early outcome. Previous coronary artery bypass procedure was independent predictor of in-hospital mortality. Seven patients required re-exploration for bleeding. One patient suffered from stroke and finally five patients had prolonged ventilation, two requiring tracheostomy. There have been no deaths in the follow-up period. None of the patients has required repeat surgical intervention on the heart or the aorta. CONCLUSION: The use of DHCA or prolonged CPB time do not affect early outcome in reoperations of the thoracic aorta.
Asunto(s)
Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Puente Cardiopulmonar , Paro Circulatorio Inducido por Hipotermia Profunda , Adulto , Anciano , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/mortalidad , Distribución de Chi-Cuadrado , Paro Circulatorio Inducido por Hipotermia Profunda/efectos adversos , Paro Circulatorio Inducido por Hipotermia Profunda/mortalidad , Puente de Arteria Coronaria/mortalidad , Grecia , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Intrathecal baclofen therapy using implantable pumps is an established treatment for spasticity. The pumps occasionally experience serious malfunction. CASE REPORT: A 12-year-old girl suffering from spastic diplegia was implanted with a Medtronic SynchroMed II pump (Medtronic Inc., Minneapolis, Minn., USA). During a refill at 3 months 19 ml of baclofen were still in the pump. It was assumed that there was a lumbar catheter obstruction and a revision was performed. At 11 months she was receiving 180 microg/day. When she presented for refill, there were again 19 ml of baclofen in the reservoir. The pump was refilled, stopped and restarted at a lower dose. Ten minutes after restart the patient was complaining that she could not move her legs. Within the next 50 min she lapsed into coma, from a presumed baclofen overdose. She was intubated and ventilated. The reservoir was emptied of baclofen and the pump stopped. Seventeen hours after the baclofen overdose, the patient woke up gradually with no new neurological deficits. The pump was removed a week later. Medtronic laboratories examined the pump and reported no technical fault. DISCUSSION: The implanted Medtronic SynchroMed II pump suffered an unusual malfunction. It is postulated that the pump had suffered a motor stall, and when it was restarted, it gave an unusually high, potentially lethal, dose to the patient. CONCLUSION: Physicians who implant pumps for intrathecal baclofen administration need to be aware that these devices may suffer unheralded catastrophic failure that can lead to potentially lethal overdose administration.
Asunto(s)
Baclofeno/envenenamiento , Parálisis Cerebral/tratamiento farmacológico , Falla de Equipo , Bombas de Infusión Implantables/efectos adversos , Relajantes Musculares Centrales/envenenamiento , Baclofeno/administración & dosificación , Niño , Sobredosis de Droga , Femenino , Humanos , Inyecciones Espinales , Relajantes Musculares Centrales/administración & dosificación , Espasticidad Muscular/tratamiento farmacológicoRESUMEN
AIM: The ability of the thyroid hormone to increase cardiac output and to lower systemic vascular resistance may provide a novel treatment for cardiovascular diseases. Therefore, understanding the mechanisms of thyroid hormone action on the heart and peripheral vasculature could be of clinical importance. We previously found that thyroid hormone modulates the alpha1-adrenergic effect on vascular reactivity of rat aortas. In the present study we further investigated possible mechanisms of this response. METHODS: Hyperthyroidism was induced on Wistar-Kyoto male rats with L-Thyroxine, (THYR) treatment for two weeks, N.=18 while untreated rats used as controls (NORM), N.=16. The thoracic aorta was dissected and cut into rings that were suspended in an isolated organ bath with Krebs-Henseleit buffer. Maximal tension, Tmax, in g was measured in response to Potassium Chloride (KCl) and Phenylephrine (PE) in rings in the presence of Ritodrine, a beta-2 agonist (NORM-RITO, N:=8, THYR-RITO, N.=9), or in the absence of Ritodrine (THYR, N.=9, NORM, N.=8). RESULTS: With KCL, Tmax was not different between the THYR, NORM, NORM-RITO, and THYR-RITO groups. With PE, there was a difference in Tmax between NORM-RITO and NORM, 0.66 (0.056) g vs 1.00 (0.066) g, P<0.05 and THYR and NORM, 0.75 (0.055) g vs 1.00 (0.066) g, P<0.05. No significant difference was observed between THYR-RITO AND THYR. Furthermore, Relax % was not significantly different between the NORM and the THYR, NORM-RITO, and THYR-RITO groups, 64.5%(3.7) vs 67.3%(6.7), 73.5% (4.3) and 81.8 %(4.7), P>0.05. CONCLUSIONS: PE induced vasoconstriction in isolated rat aortic rings was reduced after both ritodrine and thyroxine treatment. However, co-administration of thyroid hormone and ritodrine did not result in a synergistic reduction of PE induced vasoconstriction. Thus, thyroxine may modulate the alpha1-adrenergic vascular responsiveness by enhancing beta2-adrenergic stimulation.