RESUMEN
PURPOSE: Both ketamine and priming may shorten the onset time of rocuronium. This study investigates the effects of ketamine and priming as components of a propofol induction on intubating conditions and onset of neuromuscular block. METHODS: This prospective randomized double-blind study was performed in 120 American Society of Anesthesiologists (ASA) I-II patients who were assigned to one of four groups of 30 patients each: control, priming, ketamine, and ketamine-priming. Ketamine 0.5 mg x kg(-1) or saline was given before priming and induction. Rocuronium 0.06 mg x kg(-1) or saline was injected 2 min before propofol 2.5 mg x kg(-1). This was followed by rocuronium 0.6 mg x kg(-1) or by rocuronium 0.54 mg x kg(-1) if priming was given. Intubation was performed one minute later. Intubating conditions were graded as excellent, good, or poor. Heart rate, noninvasive blood pressure, and train-of-four (TOF) response were monitored. RESULTS: Intubating conditions were graded excellent in 20% of the control group, 30% of the priming group, 47% of the ketamine group, and 57% of the ketamine-priming group. Analysis using forward stepwise regression indicated that ketamine improved intubating conditions (P = 0.001) but priming did not (P = 0.35). Time to reach a TOF count of zero was shortened by ketamine (P = 0.001) but not by priming (P = 0.94): 216 +/- 20 s in the control group, 212 +/- 27 s in the priming group, 162 +/- 18 s in the ketamine group, and 168 +/- 22 s in the ketamine-priming group. CONCLUSION: A low-dose ketamine used with a propofol-rocuronium induction improved intubating conditions and shortened onset time. Priming did not influence intubating conditions or onset time.
Asunto(s)
Androstanoles/uso terapéutico , Intubación Intratraqueal/métodos , Ketamina/uso terapéutico , Propofol/uso terapéutico , Adulto , Analgésicos/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares no Despolarizantes/uso terapéutico , Estudios Prospectivos , Análisis de Regresión , Rocuronio , Factores de Tiempo , Adulto JovenRESUMEN
PURPOSE: To evaluate the procedural and follow-up results of radiologic central venous port placement in pediatric patients. MATERIALS AND METHODS: Between July 2002 and July 2006, 127 chest ports were placed in 122 pediatric patients (80 boys, 42 girls). Five patients underwent port implantation twice. The mean age of the patients was 8.5 years (range, 4 months to 18 years). The most common underlying disease was leukemia (66%). Internal jugular vein access was used in all patients. All types of anesthesia or sedation for the procedures were applied by anesthetists in the angiography suite. Retrospective evaluation of an electronic database and hospital charts was performed for the detailed follow-up. RESULTS: Technical success rate was 100%. The mean catheter life was 459 days (total, 51,373 d; range, 16-1,297 catheter-days). Overall, 82 ports are still in use, 10 patients are deceased, and eight (7.1%) and 12 (10.7%) ports were removed at the end of treatment or as a result of complications, respectively. One patient (0.9%) died 167 days after port implantation as a result of unconfirmed port-related sepsis. Eight ports (7.1%) were explanted as a result of infectious complications, three (2.7%) required removal for skin erosion, and one (0.9%) was explanted as a result of a broken catheter. The rate of confirmed overall port-related infection was 14.3%, or 0.31 infections per 1,000 catheter days. Fifteen patients were lost to follow-up. CONCLUSIONS: Chest port placement by interventional radiologists in pediatric patients is safe, with a high rate of technical success and low rate of complications.
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Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Neoplasias/diagnóstico por imagen , Neoplasias/cirugía , Radiografía Intervencional/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the long-term outcomes of radiologically inserted dual-lumen hemodialysis and infusion catheters in pediatric patients. MATERIALS AND METHODS: The authors retrospectively reviewed the outcomes of 114 tunneled internal jugular catheters in 71 consecutive pediatric patients between March 2003 and May 2006. Forty hemodialysis catheters were placed in 23 patients (11 girls, 12 boys), and 74 infusion catheters were placed in 48 patients (14 girls, 34 boys). The mean patient age was 11.2 years (range, 1-16 years) in the hemodialysis group and 7.86 years (range, 4 months to 16 years) in the infusion group. RESULTS: The technical success rate was 100%. The mean duration of catheter use was 84 days (range, 5-730 days) in the hemodialysis group and 58 days (range, 3-206 days) in the infusion group. Nine hemodialysis (22%) and 29 infusion (39%) catheters were electively removed. The most common reasons for catheter removal were malfunction (22%) in the hemodialysis group and completion of therapy (39%) in the infusion group. Revisions were performed at a rate of 0.6 and 0.4 per 100 catheters days in the hemodialysis and infusion groups, respectively. Total infection rates were 0.15 and 0.38 episodes per 100 catheter days in hemodialysis and infusion catheters, respectively. Mean primary device service intervals were 86 and 60 days for hemodialysis and infusion catheters, respectively, with total access site service intervals of 140 and 71 days. CONCLUSION: Radiologically placed tunneled internal jugular catheters appear to be safe and effective, with very low complication rates for both hemodialysis and long-term infusion therapies. Higher infection rates were seen in patients with cancer.
Asunto(s)
Cateterismo Venoso Central , Catéteres de Permanencia , Venas Yugulares , Fallo Renal Crónico/terapia , Radiografía Intervencional , Diálisis Renal/instrumentación , Adolescente , Niño , Preescolar , Remoción de Dispositivos , Femenino , Humanos , Lactante , Infusiones Intravenosas , Venas Yugulares/diagnóstico por imagen , Fallo Renal Crónico/mortalidad , Masculino , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
OBJECT: The aim of this study was to report on a novel technique in which metallic embolization coils were combined with the Onyx liquid embolic agent in the aneurysm sac to achieve a more durable result after endovascular treatment. This therapeutic procedure was performed in selected cases in which, based on the authors' experiences, either coil embolization or Onyx alone would likely have failed. The authors report long-term clinical and angiographic follow-up results in 20 consecutive intracranial aneurysms treated using this combination for defined indications. METHODS: Twenty aneurysms in 20 patients were treated with a combination of embolic coils and Onyx. Four aneurysms were giant; 13, large; and three, small. This new technique was used when standard Onyx or coil treatment with balloon assistance was determined to involve a higher possibility of recanalization, because either an adjunctive stent insertion could not be performed or the Onyx technique could not be used due to an unsuccessful seal test or intraaneurysm balloon prolapse. In one case, an adjunctive stent was placed before coil placement and Onyx deposition to control the material in the sac of the aneurysm, which had a fusiform neck. All aneurysms were completely occluded after using this technique. No clinical or technical adverse events occurred in any of the cases. Follow-up angiography was performed in all patients: 3-year studies in six patients, 2-year studies in five, and 1-year studies in nine. None of these studies demonstrated aneurysm regrowth or parent artery occlusion. CONCLUSIONS: The combination of the embolic coils and the Onyx liquid embolic agent provides very durable aneurysm occlusion for defined indications.
Asunto(s)
Oclusión con Balón , Dimetilsulfóxido/administración & dosificación , Embolización Terapéutica/métodos , Aneurisma Intracraneal/terapia , Polivinilos/administración & dosificación , Adolescente , Adulto , Embolización Terapéutica/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Metales , Persona de Mediana Edad , Radiografía , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Pulmonary arteriovenous malformation (AVM) is a rare vascular malformation of the lung that carries a considerable risk of serious complications such as cerebral embolism, brain abscess, and pulmonary hemorrhage. Embolization with coils or detachable balloons is currently the preferred treatment. Paradoxical embolization of coils and balloons may occur, especially in patients with large feeding arteries. This report describes an initial experience with the use of the Amplatzer Vascular Plug used for endovascular treatment of bilateral multiple pulmonary AVMs in an adult patient.