RESUMEN

OBJECTIVE: To compare 2 different doses of intravenous nicardipine versus placebo to control heart rate and blood pressure responses to emergence and extubation. DESIGN: Prospective, randomized, double-blind, placebo-controlled. SETTING: University hospital, single-institutional. PARTICIPANTS: Forty-five American Society of Anesthesiologists (ASA) class I through III adult patients. INTERVENTIONS: General endotracheal anesthesia was with oxygen and isoflurane and muscle relaxation. At the end of surgery, with at least 2 twitches present by nerve stimulator and end-tidal isoflurane <0.4%, reversal was accomplished with neostigmine and glycopyrrolate. Two minutes post-reversal, the study drug (nicardipine, 0.015 mg/kg; nicardipine, 0.03 mg/kg; or a saline placebo) was given. Heart rate and blood pressure were measured for every minute up to 10 minutes and at 15 minutes postreversal. MEASUREMENTS AND MAIN RESULTS: There were no significant differences among groups in age, gender, ASA class, weight, or heart rate. The nicardipine groups, 0.015 and 0.03 mg/kg, had lower blood pressure values than the placebo group. There was a significant difference in blood pressure among groups, with greater and more consistent attenuation of blood pressure occurring with the larger nicardipine dose. There were no episodes of hypotension or adverse events. CONCLUSIONS: Compared with placebo, both nicardipine doses attenuated blood pressure but not heart rate responses during emergence and extubation. Greater blood pressure control occurred with the larger nicardipine dose of 0.03 mg/kg.

Asunto(s)

Periodo de Recuperación de la Anestesia , Anestesia General , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/uso terapéutico , Frecuencia Cardíaca/efectos de los fármacos , Intubación Intratraqueal , Nicardipino/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Remoción de Dispositivos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos

RESUMEN

STUDY OBJECTIVE: To identify the maximally effective dolasetron dose (i.e., maximum efficacy with minimum adverse events) for prevention of postoperative nausea and vomiting (PONV) using the statistical power generated in a pooled patient sample from three large, nearly identical clinical trials. DESIGN: Three randomized, multicenter, placebo-controlled, double-blinded trials. SETTING: Trials 1, 2, and 3 enrolled patients at 10, 25, and 17 hospitals and/or surgical centers, respectively. PATIENTS: A total of 1,946 ASA physical status, I, II, and III patients. Trials 1 and 2 enrolled only female patients (n = 916) undergoing gynecologic surgery. Trial three enrolled 722 females (approximately 70% gynecologic surgeries) and 308 males (approximately 46% orthopedic surgeries) undergoing a variety of surgical procedures. INTERVENTIONS: All surgical procedures used balanced general anesthesia. Patients received 12.5, 25, 50, or 100 mg of the antiemetic, dolasetron, near the end of anesthesia. MEASUREMENTS AND MAIN RESULTS: Efficacy endpoints were identical and measured for 24 hours: complete response (no vomiting or rescue medication) and maximum nausea, reported using a 100-mm visual analog scale (VAS). Safety was assessed using adverse event reports, laboratory and electrocardiographic data, and vital signs. All four dolasetron doses produced significant increases in complete response and decreases in maximum VAS nausea compared with placebo (p < 0.01). No increased efficacy was observed with dolasetron doses higher than 12.5 mg. Safety was similar between each dolasetron dose and placebo. CONCLUSION: Dolasetron 12.5 mg, given near the end of anesthesia, is the maximally effective dose studied for preventing postoperative nausea and vomiting.

Asunto(s)

Antieméticos/administración & dosificación , Indoles/administración & dosificación , Náusea y Vómito Posoperatorios/prevención & control , Quinolizinas/administración & dosificación , Adulto , Análisis de Varianza , Anestesia General , Antieméticos/efectos adversos , Bradicardia/inducido químicamente , Distribución de Chi-Cuadrado , Método Doble Ciego , Electrocardiografía/efectos de los fármacos , Femenino , Estudios de Seguimiento , Cefalea/inducido químicamente , Humanos , Indoles/efectos adversos , Cuidados Intraoperatorios , Modelos Logísticos , Masculino , Placebos , Náusea y Vómito Posoperatorios/clasificación , Quinolizinas/efectos adversos , Seguridad , Factores Sexuales , Factores de Tiempo

RESUMEN

In a multicentre, randomized, double-blind, placebo-controlled dose-ranging study, 1030 patients undergoing outpatient surgery with general anaesthesia received i.v. dolasetron mesylate (12.5, 25, 50, or 100 mg) or placebo. The principal outcome measure was the proportion of patients who were free of emesis or rescue medication for the 24-h period after the study drug was given; the subsidiary outcome measure was survival time without rescue medication. Effects on nausea were quantified using a visual analogue scale. Compared with placebo, a complete response was significantly higher when all four dolasetron doses were combined (49% vs. 58%, P =0.025). In females, dolasetron, 12.5-mg, dolasetron provided maximum clinical benefit (effectiveness compared with adverse events), with no additional benefit in complete response rates or nausea visual analogue scale scores at higher doses. No significant differences were observed in complete response for any dolasetron dose in males compared with placebo. The majority of adverse events reported were mild or moderate. Dolasetron provided well-tolerated, safe, and effective prophylaxis for post-operative nausea and vomiting with maximum effectiveness observed at a dose of 12.5 mg.

Asunto(s)

Procedimientos Quirúrgicos Ambulatorios , Anestesia General , Antieméticos/uso terapéutico , Indoles/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Quinolizinas/uso terapéutico , Adulto , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Análisis de Varianza , Anestesia General/efectos adversos , Antieméticos/administración & dosificación , Antieméticos/efectos adversos , Distribución de Chi-Cuadrado , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Indoles/administración & dosificación , Indoles/efectos adversos , Inyecciones Intravenosas , Modelos Logísticos , Masculino , Placebos , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Quinolizinas/administración & dosificación , Quinolizinas/efectos adversos , Inducción de Remisión , Seguridad , Factores Sexuales , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

Pain, nausea and vomiting are frequently listed by patients as their most important perioperative concerns. With the change in emphasis from an inpatient to outpatient hospital and office-based medical/surgical environment, there has been increased interest in the 'big little problem' of postoperative nausea and vomiting (PONV). Currently, the overall incidence of PONV is estimated to be 25 to 30%, with severe, intractable PONV estimated to occur in approximately 0.18% of all patients undergoing surgery. PONV can lead to delayed postanaesthesia care unit (PACU) recovery room discharge and unanticipated hospital admission, thereby increasing medical costs. The aetiology and consequences of PONV are complex and multifactorial, with patient-, medical- and surgery-related factors. A thorough understanding of these factors, as well as the neuropharmacology of multiple emetic receptors [dopaminergic, muscarinic, cholinergic, opioid, histamine, serotonin (5-hydroxy-tryptamine; 5-HT)] and physiology [cranial nerves VIII (acoustic-vestibular), IX (glossopharyngeal) and X (vagus), gastrointestinal reflex] relating to PONV are necessary to most effectively manage PONV. Commonly used older, traditional antiemetics for PONV include the anticholinergics (scopolamine), phenothiazines (promethazine), antihistamines (diphenhydramine), butyrophenones (droperidol) and benzamides (metoclopramide). These antiemetics have adverse effects such as dry mouth, sedation, hypotension, extrapyramidal symptoms, dystonic effects and restlessness. The newest class of antiemetics used for the prevention and treatment of PONV are the serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron). These antiemetics do not have the adverse effects of the older, traditional antiemetics. Headache and dizziness are the main adverse effects of the serotonin receptor antagonists in the dosages used for PONV. The serotonin receptor antagonists have improved antiemetic effectiveness but are not as completely efficacious for PONV as they are for chemotherapy-induced nausea and vomiting. Older, traditional antiemetics (such as droperidol) compare favourably with the serotonin receptor antagonists regarding efficacy for PONV prevention. Combination antiemetic therapy improves efficacy for PONV prevention and treatment. In the difficult-to-treat PONV patient (as in the chemotherapy patient), suppression of numerous emetogenic peripheral stimuli and central neuroemetic receptors may be necessary. This multimodal PONV management approach includes use of: (i) multiple different antiemetic medications (double or triple combination antiemetic therapy acting at different neuroreceptor sites); (ii) less emetogenic anaesthesia techniques; (iii) adequate intravenous hydration; and (iv) adequate pain control.

Asunto(s)

Anestesia/efectos adversos , Antieméticos/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Antieméticos/farmacología , Análisis Costo-Beneficio , Quimioterapia Combinada , Humanos , Factores de Riesgo

RESUMEN

STUDY OBJECTIVES: To compare repeat intravenous (i.v.) dosing of ondansetron 4 mg with placebo for the treatment of postoperative nausea and vomiting (PONV) in patients for whom prophylactic, preoperative ondansetron 4 mg i.v. was inadequate DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Ten outpatient surgical centers in the United States. PATIENTS: 2,199 male and female ASA physical status I, II, and III patients > or = 12 years old scheduled to undergo outpatient surgical procedures and receive nitrous oxide-based general anesthesia. INTERVENTIONS: Ondansetron 4 mg i.v. was administered to all patients before induction of general anesthesia. Patients who experienced PONV or requested antiemetic therapy within 2 hours after discontinuation of inhaled anesthesia were randomized (1:1) to either a repeat i.v. ondansetron 4 mg dose or placebo. MEASUREMENTS AND MAIN RESULTS: Of the 2,199 patients prophylactically treated with ondansetron 4 mg before anesthesia induction, 1,771 (80.5%) did not experience PONV or request antiemetic therapy during the 2 hours following discontinuation of anesthesia. Of the 428 patients who experienced PONV or requested antiemetic therapy during the same period, and were randomized to additional treatment (214 randomized to ondansetron, 214 randomized to placebo), the incidence of complete response (no emesis, no rescue medication, no study withdrawal) was similar for both ondansetron-randomized and placebo-randomized groups for the 2-hour (34% and 43%, respectively, p = 0.074) and 24-hour (28% and 32%, respectively, p = 0.342) postrandomization study periods. Repeat ondansetron dosing was not more effective than placebo in controlling either postoperative emesis or the severity/duration of postoperative nausea. The administration of an additional dose of ondansetron 4 mg postoperatively did not result in an increased incidence of adverse effects. CONCLUSIONS: In patients for whom preoperative prophylaxis with ondansetron 4 mg i.v. is not successful, a repeat dose of ondansetron 4 mg i.v. in the postanesthesia care unit does not appear to offer additional control of PONV.

Asunto(s)

Antieméticos/administración & dosificación , Ondansetrón/administración & dosificación , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Adolescente , Adulto , Antieméticos/uso terapéutico , Niño , Método Doble Ciego , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Ondansetrón/uso terapéutico

RESUMEN

STUDY OBJECTIVES: To compare the intraoperative effects and recovery characteristics of remifentanil hydrochloride and alfentanil when administered as part of balanced anesthesia, and to assess the effects of an additional remifentanil infusion administered as analgesic pretreatment before removal of the uterus. DESIGN: Multicenter, double-blind, randomized, parallel-group study. SETTING: Two university hospitals. PATIENTS: 35 ASA physical status I, II, and III women scheduled for elective total abdominal hysterectomy with general endotracheal anesthesia. INTERVENTIONS: Patients were premedicated with midazolam 0.05 mg/kg intravenously (i.v.). Anesthesia was induced with thiopental 2 mg/kg, vecuronium 0.15 mg/kg, and a single dose of opioid over 60 seconds (Pump 1): remifentanil 2 micrograms/kg (Remi/Placebo and Remi/Remi groups) or alfentanil 50 micrograms/kg (Alf/Placebo group). Anesthesia was maintained with a nitrous oxide/oxygen mixture (66:34 ratio) and a continuous opioid infusion: remifentanil 0.25 microgram/kg/min (Remi/Placebo and Remi/Remi) or alfentanil 0.5 microgram/kg/min (Alf/Placebo). At skin incision, a second blinded drug infusion was also initiated (Pump 2): remifentanil 0.25 microgram/kg/min (Remi/Remi) or saline placebo (Remi/Placebo and Alf/Placebo). Intraoperative responses were controlled with single doses of opioid and/or rate titrations via Pump 1. Pump 2 was terminated on removal of the uterus. Pump 1 was terminated at skin closure. MEASUREMENTS AND MAIN RESULTS: The mean (+/- SD) opioid infusion rates administered for the duration of Pump 2 to suppress responses to removal of the uterus were 0.49 +/- 0.27 microgram/kg/min, 1.99 +/- 1.34 micrograms/kg/min, and 0.49 +/- 0.07 microgram/kg/min for the Remi/Placebo, Alf/Placebo, and Remi/Remi groups, respectively. At these rates, similar proportions of patients in the Remi/Placebo (67%) and the Alf/Placebo (60%) groups had responses. Fewer patients had responses in the Remi/Remi group (8%) compared with the Remi/Placebo and Alf/Placebo groups (p < 0.05). The mean total opioid doses used during maintenance were 84.6 micrograms/kg (Remi/Placebo), 393 micrograms/kg (Alf/Placebo), and 68.7 micrograms/kg (Remi/Remi). Awakening times were significantly shorter (p < 0.05) in the remifentanil population compared with the alfentanil population, but discharge times were similar. More patients received naloxone to reverse opioid effects in the alfentanil population (60%) than in the remifentanil population (20%) (p < 0.05). CONCLUSIONS: A mean remifentanil infusion of 0.49 microgram/kg/min is as effective as a mean alfentanil infusion of 1.99 micrograms/kg/min in suppressing intraoperative responses. Doubling of the remifentanil infusion to 0.5 microgram/kg/min before the major stress event improves suppression of responses and lowers intraoperative use of remifentanil without prolonging recovery times. Remifentanil allows faster awakening times than alfentanil, but preemptive administration of postoperative analgesics is recommended to facilitate discharge.

Asunto(s)

Alfentanilo , Anestesia Intravenosa , Anestésicos Intravenosos , Histerectomía , Piperidinas , Adulto , Alfentanilo/efectos adversos , Anestesia Intravenosa/efectos adversos , Anestésicos Intravenosos/efectos adversos , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Piperidinas/efectos adversos , Complicaciones Posoperatorias , Estudios Prospectivos , Remifentanilo , Resultado del Tratamiento

RESUMEN

UNLABELLED: This study was conducted to determine the efficacy and safety of four intravenous (I.V.) doses of dolasetron, an investigational 5-HT3 receptor antagonist, for the treatment of postoperative nausea and/or vomiting (PONV) after outpatient surgery under general anesthesia. This multicenter, randomized, double-blind trial compared the antiemetic efficacy of 12.5, 25, 50, or 100 mg I.V. dolasetron with placebo over 24 h using complete response (no emetic episodes and no rescue medication), time to first emetic episode or rescue medication, and patient nausea and satisfaction with antiemetic therapy as rated by visual analog scale (VAS). Of 1557 patients enrolled, 620 patients were eligible for treatment. Complete response rates for all dolasetron doses--12.5 mg (35%), 25 mg (28%), 50 mg (29%), and 100 mg (29%)--were significantly more effective than placebo (11%, P < 0.05). There was a significant gender interaction for complete response (P < 0.01). Of the patients in the 25-mg and 100-mg dose groups, 12% and 13%, respectively, experienced no nausea (VAS score < 5 mm) versus 5% in the placebo group (P < 0.05). There were no clinically relevant changes in vital signs or laboratory values and no trends with dose for adverse events. Dolasetron is effective for treating PONV and has an adverse event profile similar to that of placebo. The 12.5-mg dose was as effective as larger doses for complete response. IMPLICATIONS: Nausea and vomiting are common problems for postsurgical patients. In this study of 620 patients undergoing surgery, a 12.5-mg dose of intravenous dolasetron, a new serotonin-receptor blocker, was significantly more effective than placebo in treating established postoperative nausea and vomiting. Dolasetron 12.5 mg was as safe as placebo.

Asunto(s)

Antieméticos/administración & dosificación , Indoles/administración & dosificación , Náusea/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Quinolizinas/administración & dosificación , Vómitos/tratamiento farmacológico , Adulto , Procedimientos Quirúrgicos Ambulatorios , Anestesia General , Antieméticos/efectos adversos , Método Doble Ciego , Femenino , Humanos , Indoles/efectos adversos , Inyecciones Intravenosas , Modelos Logísticos , Masculino , Satisfacción del Paciente , Quinolizinas/efectos adversos

RESUMEN

STUDY OBJECTIVES: To determine (1) the efficacy and safety of ondansetron in the prevention of postoperative nausea and vomiting (PONV) in male outpatients; (2) prognostic factors for PONV in male outpatients; and (3) patients' perceptions of the debilitating effects of PONV in the ambulatory surgery setting. DESIGN: Prospective, randomized, stratified, double-blind study. SETTING: Multicenter-24 medical centers. PATIENTS: 468 ASA physical status I and II males at least 12 years of age scheduled for general anesthesia. INTERVENTIONS: All patients received intravenous ondansetron 4 mg or placebo prior to undergoing general balanced (opioid) anesthesia. MEASUREMENTS AND MAIN RESULTS: In the postanesthesia care unit (PACU), the number of emetic episodes, vital signs, adverse events, and nausea assessments were recorded by a blinded observer. After discharge, and until the end of the 24-hour study period, patients completed a diary that collected emetic episodes, adverse events, nausea, and pharmacoeconomic data. There were no differences in patient demographics or safety profiles between groups. The number of patients with no emesis and no nausea during the 24-hour study period was significantly greater (p < 0.05) with ondansetron 4 mg compared with placebo. Prognostic factors for an increased likelihood of developing PONV in males included a history of motion sickness or previous PONV, patients undergoing nonorthopedic procedures, and surgeries lasting longer than one hour. Finally, 38% of patients experiencing PONV perceived PONV to be as, or more debilitating than, the aftereffects of surgery itself. CONCLUSIONS: Ondansetron 4 mg was more effective than placebo in preventing PONV in male outpatients. Males at potential risk for developing PONV include: (1) those with a history of motion sickness and/or PONV; (2) patients undergoing nonorthopedic procedures; and (3) procedures lasting longer than one hour. Such patients may benefit from receipt of a prophylactic antiemetic. Postoperative nausea and vomiting has a debilitating effect that can be differentiated by patients from the effects of surgery itself.

Asunto(s)

Procedimientos Quirúrgicos Ambulatorios , Antieméticos/uso terapéutico , Ondansetrón/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Vómitos/prevención & control , Adulto , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/clasificación , Periodo de Recuperación de la Anestesia , Anestesia General , Antieméticos/administración & dosificación , Actitud Frente a la Salud , Niño , Método Doble Ciego , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Masculino , Registros Médicos , Mareo por Movimiento/complicaciones , Náusea/prevención & control , Ondansetrón/administración & dosificación , Alta del Paciente , Placebos , Premedicación , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo

RESUMEN

The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients. However, patients with cardiovascular or cerebral disease may be at increased risk of morbidity and mortality from the tachycardia and hypertension resulting from this stress. These hemodynamic effects gained notice after the introduction and use of muscle relaxants, such as curare and succinylcholine, for endotracheal intubation at the time of anesthesia induction. A variety of anesthetic techniques and drugs are available to control the hemodynamic response to laryngoscopy and intubation. The method or drug of choice depends on many factors, including the urgency and length of surgery, choice of anesthetic technique, route of administration, medical condition of the patient, and individual preference. The possible solutions number as many as the medications and techniques available and depend on the individual patient and anesthesia care provider. This paper reviews these medications and techniques to guide the clinician in choosing the best methods.

Asunto(s)

Hemodinámica/fisiología , Intubación Intratraqueal/efectos adversos , Laringoscopía/efectos adversos , Anestesia , Humanos , Complicaciones Intraoperatorias

RESUMEN

STUDY OBJECTIVE: To determine the hemodynamic response to airway manipulation and endotracheal intubation by comparing the direct oral method of the Macintosh laryngoscope to the blind oral method of the Augustine guide. DESIGN: Prospective, comparative, randomized study. SETTING: University medical center. PATIENTS: 24 ASA physical status I and II, nonpregnant female patients aged 18 years or older, undergoing outpatient gynecologic surgery with general anesthesia. INTERVENTIONS: Patients were preoxygenated and received alfentanil 10 mcg/kg five minutes prior to anesthesia induction with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg. Under random assignment, patients (n = 12 in each group) were intubated with the Macintosh laryngoscope or the Augustine guide. After intubation, 50% nitrous oxide and 50% oxygen and 1.5% inspired concentration of isoflurane were administered. MEASUREMENTS AND MAIN RESULTS: Oxygen saturation, heart rate (HR), and mean arterial pressure (MAP) were measured at baseline and at minutes 1 to 6 postinduction (time zero). Intubation time was defined as the interval between removal of the face mask from the patient's face and reconnection of the circle system airway connector after successful endotracheal intubation. The number of attempts and time to successful endotracheal intubation were noted. There was no difference between groups in age, weight, height, Mallampati airway class, oxygen saturation (at least 98%), or MAP. There was a significant difference (p < 0.01) between groups (percent change from baseline) in HR from minutes 1 to 4 postinduction. Time to successful endotracheal intubation was significantly longer (p < 0.05, mean +/- SEM) with the Augustine guide (91.0 +/- 15.9 seconds) than with the Macintosh laryngoscope (24.0 +/- 1.73 seconds). CONCLUSIONS: The Augustine guide, a new technique for orally intubating patients blindly and when head and neck manipulations are contraindicated, had less of an effect on HR compared with the Macintosh laryngoscope. Minimal lifting of the tongue and mandible required with the Augustine guide could account for the decreased HR response. The Augustine guide appears to be a promising new addition to the airway armamentarium and deserves further testing.

Asunto(s)

Presión Sanguínea , Frecuencia Cardíaca , Intubación Intratraqueal/métodos , Laringoscopía/métodos , Oxígeno/sangre , Adolescente , Adulto , Procedimientos Quirúrgicos Ambulatorios , Anestesia por Inhalación , Anestesia Intravenosa , Anestésicos Intravenosos/administración & dosificación , Diseño de Equipo , Femenino , Genitales Femeninos/cirugía , Humanos , Intubación Intratraqueal/instrumentación , Laringoscopios , Mandíbula/anatomía & histología , Estudios Prospectivos , Factores de Tiempo , Lengua/anatomía & histología

RESUMEN

STUDY OBJECTIVES: To determine (1) the general risk and outcome in the recovery room among 4 different anesthetic techniques associated with 2 different extracorporeal shock wave lithotripsy (ESWL) machines and (2) any gender-related differences among patients undergoing ESWL. DESIGN: Retrospective statistical analysis. SETTING: University medical center. PATIENTS: 2,203 ASA physical status I-IV patients undergoing ESWL over a 46-month period. INTERVENTIONS: A review of the chart records of patients who received 1 of 4 anesthetic techniques (general, spinal, epidural, or monitored anesthesia care) on 1 of 2 ESWL machines. MEASUREMENTS AND MAIN RESULTS: A positive finding was defined as a complication and/or side effect of such significance as to require a treatment order or recovery room note on the patient's chart. The main complications and/or side effects were nausea and/or vomiting, flank pain, and hypertension. Female patients experienced flank pain and nausea and/or vomiting with general anesthesia and monitored anesthesia care at approximately twice the frequency of males. CONCLUSIONS: (1) Overall, ESWL is relatively safe. Both machine types and all anesthetic techniques exhibited a low risk and good outcome. (2) There appear to be gender-related differences during ESWL. Female and male patients may have different pain and nausea and/or vomiting thresholds during ESWL.

Asunto(s)

Anestesia/efectos adversos , Cálculos Renales/terapia , Litotricia/efectos adversos , Adulto , Anciano , Periodo de Recuperación de la Anestesia , Anestesia Epidural/efectos adversos , Anestesia General/efectos adversos , Anestesia por Inhalación/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Riesgo

Asunto(s)

Intubación Intratraqueal/instrumentación , Laringoscopios , Anestesia Endotraqueal/instrumentación , Anestesia Endotraqueal/métodos , Diseño de Equipo , Humanos , Intubación Intratraqueal/métodos , Laringoscopía/métodos , Orofaringe

RESUMEN

Treacher-Collins syndrome is a familial and congenital condition often associated with a difficult airway. Although the condition is rare, the anesthesia care provider may encounter it on occasion. This report describes a patient with Treacher-Collins syndrome scheduled to undergo facial reconstruction (fore-head plasty, brow lift, and rhinoplasty) as the sixth of multiple operations. A nasotracheal intubation using the stylet component of a recently introduced airway device, the Augustine Guide, was successfully performed. This is believed to be the first reported use of this method using the Augustine stylet.

Asunto(s)

Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Disostosis Mandibulofacial/cirugía , Adulto , Anestesia por Inhalación , Diseño de Equipo , Humanos , Isoflurano , Laringe/patología , Masculino , Disostosis Mandibulofacial/patología , Orofaringe/patología , Tráquea/patología

RESUMEN

STUDY OBJECTIVE: To determine the effectiveness of esmolol hydrochloride (Brevibloc) as an additional adjunct to low-dose alfentanil premedication in controlling the hemodynamic response [heart rate (HR), mean arterial pressure (MAP), and intraocular pressure (IOP)] to succinylcholine and endotracheal intubation. DESIGN: Randomized, double-blind, placebo-controlled, prospective study. SETTING: Ambulatory gynecologic surgery at a university medical center. PATIENTS: Twenty ASA physical status I and II female patients scheduled for outpatient laparoscopy under general anesthesia. INTERVENTIONS: All patients received alfentanil 10 micrograms/kg as a preoperative medication 4 minutes prior to induction of anesthesia. Study patients (n = 10 in each group) received either esmolol 1.5 mg/kg or a placebo (normal saline) 30 seconds prior to induction (210 seconds after alfentanil and 90 seconds prior to endotracheal intubation). Anesthesia was induced with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg. Postintubation, 70% nitrous oxide, 30% oxygen, and 1% isoflurane were administered. MEASUREMENTS AND MAIN RESULTS: Time of study drug administration was defined as time zero. Measurements of HR, MAP, and IOP were made at baseline (patient awake) and at each minute from minutes 1 through 6 after administration of the study drug (time zero). Analysis of variance was used to analyze the data, with a value of p less than 0.05 considered significant. Esmolol 1.5 mg/kg was found to blunt the maximum increase in HR but not MAP or IOP following low-dose alfentanil premedication. CONCLUSIONS: In an eye patient with coronary artery disease, or in any patient in whom tachycardia may be detrimental, esmolol may be a useful adjunct in combination with low-dose alfentanil to attenuate the increase in HR due to laryngoscopy and endotracheal intubation.

Asunto(s)

Antagonistas Adrenérgicos beta/farmacología , Alfentanilo/farmacología , Anestesia Intravenosa , Presión Sanguínea/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Presión Intraocular/efectos de los fármacos , Intubación Intratraqueal , Medicación Preanestésica , Propanolaminas/farmacología , Succinilcolina/farmacología , Antagonistas Adrenérgicos beta/administración & dosificación , Adulto , Alfentanilo/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Placebos , Propanolaminas/administración & dosificación , Estudios Prospectivos , Succinilcolina/administración & dosificación , Factores de Tiempo

RESUMEN

Twelve ASA physical status I-III patients were enrolled in a double-blind, prospective, randomized, three-way, within-patient crossover study designed to determine the effect of two standard esmolol bolus doses (100 and 200 mg) on the haemodynamic response and seizure duration during electro-convulsive therapy (ECT). Esmolol or placebo was administered one minute prior to induction of anaesthesia and exactly two minutes before ECT. Both the 100 and 200 mg bolus doses significantly blunted the maximum increase in heart rate (HR) and mean arterial pressure (MAP) following ECT in comparison with placebo. Compared with placebo, esmolol 100 mg decreased maximum HR by 23 +/- 3%, maximum MAP by 17 +/- 7% and maximum rate-pressure product (RPP) by 40 +/- 9%. Esmolol 200 mg decreased maximum HR by 25 +/- 3%, maximum MAP by 19 +/- 3% and maximum RPP by 42 +/- 5%. No significant difference was found between the two esmolol doses at corresponding measurement points before and after ECT. Treatment with esmolol 200 mg resulted in a significantly shorter mean seizure duration than with placebo. As the 200 mg dose caused a shorter seizure duration and the haemodynamic effects of 100 mg and 200 mg doses were similar, it was concluded that the 100 mg esmolol bolus dose was the better dose for ECT.

Asunto(s)

Antagonistas Adrenérgicos beta/uso terapéutico , Terapia Electroconvulsiva , Hemodinámica/efectos de los fármacos , Propanolaminas/uso terapéutico , Adulto , Anciano , Depresión Química , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo

Asunto(s)

Anestesia/efectos adversos , Humanos , Complicaciones Intraoperatorias/prevención & control , Monitoreo Intraoperatorio

RESUMEN

To determine whether a standardized dose of esmolol can effectively attenuate the cardiovascular response to electroconvulsive therapy (ECT), 17 ASA physical status I-II patients were studied in a randomized within-patient, crossover design. Each patient received "no esmolol" during one ECT and three to five days later crossed over to the alternative treatment receiving an esmolol 80 mg bolus followed by 24 mg.min-1 infusion two minutes prior to induction of anaesthesia and continued for five minutes after induction. Esmolol blunted the maximum increases in heart rate (HR) by 26 per cent, mean arterial pressure (MAP) by 14 per cent, and rate pressure product by 37 per cent with significant differences (P less than 0.05) noted at one, two, three and four minutes after ECT (minutes five, six, seven, and eight of the esmolol infusion). There was no significant difference in seizure duration between the two groups and no adverse reactions occurred.

Asunto(s)

Antagonistas Adrenérgicos beta/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Terapia Electroconvulsiva , Frecuencia Cardíaca/efectos de los fármacos , Propanolaminas/uso terapéutico , Antagonistas Adrenérgicos beta/administración & dosificación , Adulto , Anciano , Depresión Química , Femenino , Humanos , Masculino , Persona de Mediana Edad , Propanolaminas/administración & dosificación

Asunto(s)

Inyecciones/instrumentación , Jeringas

Asunto(s)

Anestesia General/instrumentación , Niño , Gases , Humanos , Humedad , Lactante , Agua

Asunto(s)

Anestesia por Inhalación/instrumentación , Anestesia por Inhalación/efectos adversos , Falla de Equipo , Humanos