RESUMEN
Diabetic patients are known to have additional risks in surgery. We evaluated haemodynamic profiles, incidence of arrhythmias and post-operative recovery when remifentanil infusion was used for vitrectomies. We compared 22 diabetics with 22 age-matched controls undergoing vitrectomy. ECG Holter monitoring was continued throughout the operation and until 20 hours postoperatively. Autonomic tests including breathing and stand up were performed in the beginning of Holter-monitoring. Anaesthesia was induced with a bolus of remifentanil (1 microg/kg) and continued with 0.4 microg/kg/ h. Thereafter, propofol, 0.5 mg/kg, was given with additional doses of 0.25 mg/kg if needed. Anaesthesia was maintained with 40% oxygen in air and 0.5% isoflurane. After the operation time to obey commands, pain scores, nausea and vomiting, and haemodynamic parameters were registered. Both breathing and stand up tests differed statistically between the groups (p = 0.001 and p = 0.000, respectively). Diabetic patients needed less remifentanil (p = 0.039) than controls. Hypotensive periods were more frequent in diabetic patients (p = 0.013) and they needed more etilefrine than controls (p = 0.014). Holter recordings revealed no ischaemic episodes in either group. Periods of short ventricular and supraventricular extra beats occurred without any clinical relevance in both groups. Time to obey commands or need for pain medicine postoperatively did not differ between the groups. Diabetic patients were haemodynamically more instable with more frequent hypotensive periods during anaesthesia despite of less amount of remifentanil compared to controls. On the other hand, during remifentanil infusion no ischaemic or clinically significant arrhythmic episodes occurred in either group.
Asunto(s)
Anestesia General , Anestésicos Intravenosos/farmacología , Diabetes Mellitus , Piperidinas/farmacología , Vitrectomía , Anestésicos Intravenosos/efectos adversos , Estudios de Casos y Controles , Electrocardiografía Ambulatoria/métodos , Humanos , Persona de Mediana Edad , Piperidinas/efectos adversos , Remifentanilo , Método Simple Ciego , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Etoricoxib alleviates and prevents acute pain. The hypothesis of our study was that the pre-operative use of etoricoxib would reduce the post-operative need for additional pain treatment. METHODS: In this double-blind, randomized and active placebo-controlled study, 75 patients were pre-medicated 1.5 h before elective laparoscopic cholecystectomy with 120 mg of etoricoxib (E120 group), the same dose of etoricoxib combined with 1 g of paracetamol (E + P group) or placebo (Pla group). To alleviate post-operative pain, a patient-controlled analgesia (PCA) device was programmed to deliver 50 microg of fentanyl intravenously (lockout time, 5 min). The pain intensity and nausea were assessed using a visual analogue scale (VAS). The number of patients with post-operative nausea and vomiting was recorded. Blood loss was compared between the groups. Because the operations are almost blood-less, the operation time was also recorded to compare the possible effect on bleeding time. RESULTS: Pre-medication with etoricoxib or etoricoxib plus paracetamol had a statistically significant fentanyl-sparing effect 2-20 h post-operatively compared with placebo (P = 0.001). No significant differences were demonstrated in fentanyl-sparing effect between the E120 and E + P groups. No significant differences in pain intensity were found between the three study groups. No significant differences were observed between the groups with regard to nausea, blood loss, duration of anaesthesia or duration of surgery. CONCLUSION: Etoricoxib is suitable for pre-medication before laparoscopic cholecystectomy as it reduces the need for post-operative opioids. Opioid-related side-effects, however, were not reduced in the present study, despite the observed opioid-sparing effect of etoricoxib and combined etoricoxib and paracetamol.
Asunto(s)
Colecistectomía Laparoscópica , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Dolor Postoperatorio/prevención & control , Piridinas/uso terapéutico , Sulfonas/uso terapéutico , Acetaminofén/administración & dosificación , Acetaminofén/uso terapéutico , Adolescente , Adulto , Anciano , Analgesia Controlada por el Paciente , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Pérdida de Sangre Quirúrgica , Método Doble Ciego , Combinación de Medicamentos , Determinación de Punto Final , Etoricoxib , Fatiga/epidemiología , Femenino , Fentanilo/administración & dosificación , Fentanilo/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Náusea y Vómito Posoperatorios/epidemiología , Cuidados Preoperatorios , Tamaño de la MuestraRESUMEN
BACKGROUND: The cyclo-oxygenase-2 inhibitor, parecoxib, can be administered parenterally. The recommended dose for post-operative use is 40 mg twice daily, which may not be the appropriate dose for the treatment of visceral pain. We studied the effect of a single dose of parecoxib of either 40 or 80 mg in laparoscopic cholecystectomy, and its effect on opioid-induced side-effects. METHODS: Seventy-three patients scheduled for elective laparoscopic cholecystectomy were enrolled in this prospective, randomized, double-blind study. Patients were randomized into three groups: a placebo-treated control group, a 40-mg parecoxib-treated group (P40) and an 80-mg parecoxib-treated group (P80). We recorded the cumulative fentanyl consumption during the first 20 h post-operatively by patient-controlled analgesia equipment, the pain scores during rest, coughing and mobilization (visual analogue scale, 0-10), the worst pain during the first 2 h post-operatively and in the following 18 h, and the side-effects by questionnaire. RESULTS: No significant differences in fentanyl consumption between the three groups could be detected. The worst pain experienced between 2 and 20 h post-operatively on the ward was significantly lower in the P80 group than in the control group. CONCLUSION: The recommended dose of parecoxib, 40 mg, is not effective for the treatment of pain during the early post-operative period after laparoscopic cholecystectomy. Doubling the dose to 80 mg seems to improve the results.
Asunto(s)
Analgésicos no Narcóticos/administración & dosificación , Colecistectomía Laparoscópica , Isoxazoles/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Procedimientos Quirúrgicos Ambulatorios , Analgesia , Analgésicos Opioides/administración & dosificación , Método Doble Ciego , Femenino , Fentanilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND AND OBJECTIVE: Laparoscopic and open surgery have been compared with conflicting results regarding their systemic responses. The sensitivity of biochemical markers that are used to discriminate between the stress responses to different types of surgery varies from study to study. We wanted to evaluate the stress response and the sensitivity of clinical and biochemical stress markers in patients undergoing laparoscopically assisted vaginal or abdominal hysterectomy. METHODS: We performed a case-control study with patients undergoing laparoscopically assisted vaginal hysterectomy (n=20) or abdominal hysterectomy (n=20). Pain scores were assessed at rest and during coughing, and active leg elevation and fatigue scores using a visual analogue scale. In 10 patients of each group, haematocrit, white cell count, C-reactive protein, glucose, cortisol, adrenocorticotrophic hormone, beta-endorphin immunoreactivity, interleukin-6 and urine excretion of epinephrine and norepinephrine were measured preoperatively and during the first 44 postoperative hours. RESULTS: The most sensitive symptoms and markers of the systemic response were pain scores during mobilization, fatigue scores, C-reactive protein and interleukin-6 (P < 0.01 in all comparisons). Pain scores at rest, and all other laboratory markers of the systemic response, did not discriminate between the two types of surgery. CONCLUSION: Follow-up of postoperative pain scores during mobilization and fatigue levels might be an easy tool for the evaluation of postoperative recovery. Using an identical anaesthetic technique, the neuroendocrine response was of the same magnitude after both types of surgery.
Asunto(s)
Fatiga/etiología , Histerectomía Vaginal , Histerectomía , Complicaciones Posoperatorias/etiología , Adulto , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Fatiga/sangre , Femenino , Humanos , Interleucina-6/sangre , Laparoscopía , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/sangre , Estudios Prospectivos , Estrés Fisiológico/sangre , Estrés Fisiológico/etiologíaRESUMEN
BACKGROUND: Because pregnancy increases the sensitivity of nervous tissue to local anaesthetics, pregnant patients may be at higher risk of developing neurologic deficits after spinal block than non-pregnant patients. Therefore, we evaluated prospectively the incidence and type of neurologic symptoms after spinal anaesthesia with hyperbaric bupivacaine for caesarean section. METHODS: In this prospective follow-up study we recorded neurologic complications during anaesthesia and postoperatively until discharge from the hospital of 219 patients, who underwent caesarean section under spinal anaesthesia with hyperbaric bupivacaine (5 mg/ml, mean 13 mg). The patients filled in a questionnaire on the first and fifth postoperative days. In the case of complaints typical of neurologic symptoms they were checked first by the anaesthesiologist and, in the case of persistent symptoms, afterwards additionally by a neurologist. RESULTS: Twenty-six of 219 patients were not included in the further evaluation because of incomplete return of their questionnaires. Seventeen mothers (8.8%) complained of transient neurologic symptoms (TNSs), lasting mostly 1-2 days, in the buttocks and/or legs during the first three postoperative days. Eleven patients (5.7%) complained of postdural puncture headache. Two patients (emergency caesarean section because of protracted labour in one and elective caesarean section because of previous caesarean section in the other) complained of persisting pain or sensory abnormalities. Neither of them felt paraesthesia during lumbar puncture. CONCLUSION: Women after caesarean section under a spinal block seem to suffer more often from TNSs than non-pregnant women. The conclusions are, however, uncertain since we had no control group operated on under other than spinal anaesthesia. The persisting neurologic symptoms in two patients might also be due to the obstetric procedure itself. To find out about the validity and possible underlying causes of our results, we need randomised studies with control groups receiving epidural or general anaesthesia.
Asunto(s)
Anestesia Epidural/efectos adversos , Anestesia Obstétrica/efectos adversos , Cesárea/efectos adversos , Síndromes de Neurotoxicidad/fisiopatología , Complicaciones Posoperatorias/inducido químicamente , Adolescente , Adulto , Anestésicos Locales/efectos adversos , Bupivacaína/efectos adversos , Femenino , Estudios de Seguimiento , Cefalea , Humanos , Persona de Mediana Edad , Dolor Postoperatorio/inducido químicamente , Embarazo , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
Effective plasma concentrations of propofol, thiopentone and ketamine were determined at different endpoints in a study with randomized, crossover design in nine New Zealand White rabbits. A continuous infusion was used (30 ml/h) with concentrations of 10 mg/ml for propofol, 25 mg/ml for thiopentone and 20 mg/ml for ketamine. The endpoints were loss of the righting reflex, loss of purposeful reactions to tail clamping (as an example of a peripheral pain stimulus) or to intranostril insufflation of ammonia vapour (as an example of a central reflex stimulus), and the recovery of these reflexes and reactions. According to the ED50 values the potency ratios of propofol, thiopentone and ketamine were at the loss of righting reflex 1:1.8:1.2, at the loss of reaction to ammonia vapour 1:1.5:1.6, and at the loss of reaction to tail clamping 1:1.5:3.9, respectively. Recovery was significantly faster after propofol than after thiopentone and ketamine. Measuring the effective plasma concentrations of intravenous anaesthetics provides a method of relating dose to effect, but there still remains a variable gap between plasma concentration and effect.
Asunto(s)
Anestésicos Intravenosos/farmacología , Ketamina/farmacología , Dolor , Propofol/farmacología , Conejos/sangre , Tiopental/farmacología , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/sangre , Animales , Sistema Nervioso Central/efectos de los fármacos , Ketamina/administración & dosificación , Ketamina/sangre , Postura , Propofol/administración & dosificación , Propofol/sangre , Reflejo/efectos de los fármacos , Tiopental/administración & dosificación , Tiopental/sangreRESUMEN
BACKGROUND: Because of its pain-attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations. METHODS: One hundred children between 10 and 15 kg of body weight scheduled for day-case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 microg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1-9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well-being at home. RESULTS: The children of the K-groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D-groups; stridor scores > or = 6 were seen in one child of the D-groups (DS) and in six children of the K-groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home. CONCLUSION: Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.
Asunto(s)
Adenoidectomía , Procedimientos Quirúrgicos Ambulatorios , Anestésicos/administración & dosificación , Diazepam/administración & dosificación , Diclofenaco/administración & dosificación , Ketamina/administración & dosificación , Lidocaína/administración & dosificación , Prilocaína/administración & dosificación , Adyuvantes Anestésicos/administración & dosificación , Administración Oral , Administración Rectal , Anestésicos Combinados/administración & dosificación , Preescolar , Glicopirrolato/administración & dosificación , Humanos , Lactante , Combinación Lidocaína y Prilocaína , Medicación PreanestésicaRESUMEN
OBJECTIVE: Profound neuromuscular block (NMB) quantified by post-tetanic count (PTC) may prevent all muscle activity during anesthesia. We studied whether monitoring of PTC prevents airway pressure alarms or visible movements of the vocal cords and the abdomen during endolaryngeal procedures (ELPs). METHODS: In this prospective, double blind, study 50 healthy (ASA 1-3) patients scheduled for ELPs were randomized into five groups: atracurium, mivacurium, rocuronium, vecuronium and succinylcholine. During alfentanil-propofol anaesthesia, profound NMB was controlled by monitoring the PTC (target level PTC 0-2, 50 Hz tetanic stimulation) of the adductor pollicis muscle. The muscle relaxants were administered using bolus dosing in all groups but in the succinylcholine group. The early signs of recovery of NMB to be observed were: 1) airway pressure alarms, 2) movements of vocal cords on the laryngeal video monitor and 3) movements of the abdomen. The inference was based on 90% confidence interval tests. RESULTS: During 50 ELP:s following signs of early recovery of NMB were recognized: 2 alarms of airway pressure, 16 laryngeal movements and 11 movements of the abdomen. The proportion of airway pressure alarms was significantly lower than proportion of all detectable movements (95% confidence interval analysis). Twelve of the movements were recorded at PTC zero level. The signs of early recovery of NMB were detected in all groups. CONCLUSIONS: PTC-monitoring following 50 Hz stimulation does not ensure total inactivity of muscles during alfentanil-propofol anesthesia, regardless which relaxant has been chosen. During ELPs, simultaneous observation of the vocal cords and the abdomen is more sensitive in detecting early recovery of NMB compared to our method of airway pressure monitoring.
Asunto(s)
Laringe/fisiología , Contracción Muscular/fisiología , Relajantes Musculares Centrales/administración & dosificación , Relajantes Musculares Centrales/farmacología , Bloqueo Neuromuscular , Bloqueantes Neuromusculares/administración & dosificación , Respiración Artificial , Pliegues Vocales/fisiología , Abdomen , Adulto , Alfentanilo/administración & dosificación , Alfentanilo/farmacología , Anestesia General , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/farmacología , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Bloqueantes Neuromusculares/farmacología , Presión , Propofol/administración & dosificación , Propofol/farmacología , Ensayos Clínicos Controlados Aleatorios como Asunto , TráqueaRESUMEN
The cortical responses to auditory stimuli were studied in 12 patients during isoflurane anaesthesia producing burst suppression (ETisof (SD) 1.4 (0.2) vol.%). Earphones were used to give 3-s trains of auditory click stimuli (60 clicks, 20 clicks per second, 80 dB, 0.1 ms) at irregular intervals. In 10 patients, the electroencephalography (EEG) showed a burst suppression pattern consisting of high-amplitude activity intermingled with suppressed background activity. In eight patients with burst suppression patterns, there was a strong cortical reactivity to the termination, not to the beginning, of auditory stimuli: 80 (20)% of all stimuli presented during EEG suppression evoked high amplitude cortical response, offset-burst. The latency of these auditory offset evoked bursts was 540 (60) ms. Auditory offset evoked bursts suggest that in spite of cortical suppression during deep anaesthesia the brain retains its ability to respond to changes in the acoustic environment.
Asunto(s)
Anestésicos por Inhalación/farmacología , Electroencefalografía/efectos de los fármacos , Potenciales Evocados Auditivos/efectos de los fármacos , Isoflurano/farmacología , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Tiempo de Reacción/efectos de los fármacosRESUMEN
OBJECTIVE: The fade in train-of-four (TOF) monitoring is considered to be due to blocking of the prejunctional nicotinic acetylcholine receptors (AchRs). During onset of the neuromuscular block (NMB) tubocurarine (TC) causes more fade in the TOF responses than vecuronium (VEC). Therefore we wanted to investigate whether onset or duration of action of VEC or TC would be improved with a priming dose of an agent with different prejunctional activity. METHODS: The rates of NMB were measured following priming doses of 0.15 mg x kg(-1) of TC and 0.015 mg x kg(-1) of VEC with 6 min priming time. The individual time course of action of 0.6 mg x kg(-1) of TC (1.13 x ED 95) and 0.1-0.2 mg x kg(-1) of VEC (1.75-3.5 x ED95) were examined with a priming dose of the same agent or the other agent, by measurement of changes in the evoked compound EMG from the hypothenar muscle. RESULTS: Priming doses of TC decreased mean TOF ratio to 67% [95% confidence interval (CI) = 56-78] during priming time, which was significantly lower than after priming with VEC 87% (76-97; P < 0.001). Despite the higher TOF ratio, the priming dose of VEC accelerated the onset time of intubation dose of TC more than the priming dose of TC (P = 0.0018). Priming with TC prolonged the duration of VEC-induced NMB by 35-70 min compared with priming with VEC, which means that a small priming dose of TC changes VEC from a muscle relaxant with intermediate action to a long-acting agent. CONCLUSION: Priming with TC caused a lower TOF ratio; however, priming with TC did not accelerate the onset time of either agent as much as priming with VEC. It appears that potentiation of NMB after combination of VEC and TC is not dependent on "fade" receptors.
Asunto(s)
Bloqueo Neuromuscular , Fármacos Neuromusculares no Despolarizantes/farmacología , Antagonistas Nicotínicos/farmacología , Tubocurarina/farmacología , Bromuro de Vecuronio/farmacología , Adulto , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Sinergismo Farmacológico , Humanos , Persona de Mediana Edad , Fármacos Neuromusculares no Despolarizantes/administración & dosificación , Antagonistas Nicotínicos/administración & dosificación , Tubocurarina/administración & dosificación , Bromuro de Vecuronio/administración & dosificaciónRESUMEN
UNLABELLED: The goal of this double-blinded, prospective study was to compare the costs incurred by waiting time of intense neuromuscular block while posttetanic count (PTC) was maintained at 0-2 during jet ventilation. Fifty patients were randomized into five groups to receive atracurium (ATR), mivacurium (MIV), rocuronium (ROC), vecuronium (VEC), and succinylcholine (SUCC). PTC < or =2 was maintained until completion of laryngomicroscopy by administering additional doses of relaxants or by adjusting the speed of the infusion of SUCC. We compared waiting time, i.e., onset time and recovery time, and costs of intense neuromuscular block. The expenses due to waiting time were calculated based on the average costs in the otorhinolaryngological operating room in Tampere University Hospital: FIM 40 (approximately $8) per minute in 1997. MIV and SUCC differ favorably from ATR, ROC, and VEC when waiting time and costs are concerned. The recovery times with MIV and SUCC were considerably shorter than those with ATR, ROC, and VEC (P < 0.001 in all pairwise comparisons). Using the muscle relaxant with the longest waiting time instead of that with the shortest waiting time (difference 21.8 min) cost more than FIM 800 (approximately $160) extra per patient. IMPLICATIONS: In this randomized, double-blinded, prospective study, we evaluated the costs of intense neuromuscular block due to waiting time. Succinylcholine and mivacurium are the most economical muscle relaxants to use when intense neuromuscular block is mandatory. Using intermediate-acting muscle relaxants results in unduly prolonged recovery time and extra costs.
Asunto(s)
Anestesia/economía , Laringoscopía/economía , Bloqueo Neuromuscular , Fármacos Neuromusculares Despolarizantes/economía , Fármacos Neuromusculares no Despolarizantes/economía , Adulto , Citas y Horarios , Costos y Análisis de Costo , Método Doble Ciego , Estimulación Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
We studied the effect of anticholinergics on the incidence of cardiac arrhythmias during paediatric anaesthesia. ASA I-II children (n = 77) undergoing adenoidectomy were randomly allocated to three groups. Intravenous atropine 0.02 mg kg-1 was given in group A (n = 25), glycopyrrolate 0.004 mg kg-1 in group G (n = 27) and physiological saline in group P (n = 25) 3 min before the induction of anaesthesia. The children breathed spontaneously under halothane anaesthesia with 66% nitrous oxide in oxygen after induction with thiopentone and succinylcholine. Perioperative monitoring of the ECG (Holter recordings) and oxygen saturation was carried out. Ventricular tachycardia occurred in 16.0%, 18.5% and 12.0% of the children in groups A, G and P respectively (ns). The incidence of ventricular arrhythmias (ventricular tachycardia, ventricular bigeminy, ventricular premature beats > 10) was 20.0% in group A, 44.4% in group G and 36.0% in group P (ns). Bradycardia (< 70 beats min-1) was observed in 0.0%, 14.8% and 24.0% of patients in groups A, G and P respectively (A vs P, P < 0.05). The use of anticholinergics did not influence the incidence of ventricular arrhythmias during halothane anaesthesia in children. Bradycardia was more common in the placebo group than in the atropine group.
Asunto(s)
Adenoidectomía , Anestésicos por Inhalación/efectos adversos , Arritmias Cardíacas/prevención & control , Halotano/efectos adversos , Antagonistas Muscarínicos/uso terapéutico , Arritmias Cardíacas/inducido químicamente , Atropina/uso terapéutico , Bradicardia/prevención & control , Preescolar , Método Doble Ciego , Glicopirrolato/uso terapéutico , Humanos , Lactante , PremedicaciónRESUMEN
UNLABELLED: The purpose of the present study was to investigate the interaction of chronic smoking and the actions of atracurium (ATR). Twenty nonsmokers (NON-SMOK) were compared with 80 smokers, who were randomized into three groups: 30 patients received 21 mg/d transdermal nicotine system > or = 10 h before fentanyl/thiopental/N2O/O2/isoflurane anesthesia (TD-NICO), whereas the abstinent group received a placebo transdermal system (ABST, n = 30). The TD-NICO and ABST groups refrained from smoking for at least 10 h before the induction of anesthesia. A third group was allowed to smoke until 1-3 h before anesthesia (SMOK, n = 20). Neuromuscular block was monitored using a Relaxograph (Datex, Helsinki, Finland). The electromyographic response was recorded from the first dorsal interosseus muscle of the hand. The inspiratory isoflurane concentration was kept constant at 0.7 vol% in all patients. After an initial bolus dose of 0.5 mg/kg ATR, no significant difference was observed among the groups regarding onset time and maximal neuromuscular block. In Group ABST, the duration of block until 25% recovery of T1 was 48.2 +/- 10.1 min, which was significantly longer (analysis of variance post hoc tests) than in Groups TD-NICO, SMOK, and NON-SMOK (42.7 +/- 7.1, 41.4 +/- 10.4, and 42.8 +/- 7.3 min, respectively). The maintenance dose of ATR in Group ABST (0.23 +/- 0.03 mg x kg(-1) x h(-1)) was smaller than in Groups TD-NICO, SMOK, and NON-SMOK (0.30 +/- 0.07, 0.32 +/- 0.06, and 0.32 +/- 0.05 mg x kg(-1) x h(-1), respectively). We conclude that abstinence from smoking increases the duration of ATR-induced neuromuscular block and reduces the maintenance dose of ATR in smokers. Perioperative use of a transdermal nicotine system prevents these abstinence-induced changes in duration and maintenance-dose. IMPLICATIONS: The purpose of the present study was to investigate the interaction of chronic smoking and atracurium. Smokers who refrain from smoking for > 10 h require a smaller maintenance dose of atracurium than nonsmokers. However, using a transdermal nicotine system prevents the decrease in maintenance dose during abstinence.
Asunto(s)
Atracurio , Bloqueo Neuromuscular , Fármacos Neuromusculares no Despolarizantes , Nicotina/administración & dosificación , Cese del Hábito de Fumar , Administración Cutánea , Adulto , Anestésicos Combinados/administración & dosificación , Método Doble Ciego , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nicotina/farmacología , Estudios Prospectivos , Fumar , Factores de TiempoRESUMEN
We studied recovery from halothane anaesthesia in 93 children, aged 1-3 yr, undergoing day-case adenoidectomy. Children were allocated randomly to receive thiopental 5 mg kg-1 (group TH), alfentanil 10 micrograms kg-1 and propofol 3 mg kg-1 (group PAH) or 5% halothane (group HH) for induction of anaesthesia. In group TH, tracheal intubation was facilitated with succinylcholine (suxamethonium) 1.5 mg kg-1. In groups PAH and HH, tracheal intubation was performed without neuromuscular block, and succinylcholine was used only if required. Anaesthesia was maintained with 1-3% halothane during spontaneous respiration. Times to achieving predetermined recovery end-points were recorded. Quality of recovery was assessed using a score of 1-9 (best to worst) for sedation, crying, restlessness and agitation. A postoperative questionnaire was used to determine the well-being of the child at home, 24 h after operation. Emergence from anaesthesia (response to non-painful stimuli) occurred earlier in group HH (mean 9 (SD 6) min) than in groups PAH (13 (6) min, P < 0.01) and TH (18 (14) min, P < 0.01). Sitting up, walking and home readiness were achieved earlier in groups PAH and HH than in group TH (P < 0.05 for each variable). Children in group TH were more sedated during the first 30 min after anaesthesia than those in the two other groups (P < 0.05) while emergence-related delirium was more common in group HH than in group TH (P < 0.01). Well-being at home was similar in all groups. We conclude that induction of halothane anaesthesia with propofol-alfentanil or halothane provided more rapid recovery and earlier discharge than that with thiopental.
Asunto(s)
Adenoidectomía , Procedimientos Quirúrgicos Ambulatorios , Anestésicos Combinados , Anestésicos por Inhalación , Halotano , Alfentanilo , Periodo de Recuperación de la Anestesia , Anestésicos Intravenosos , Preescolar , Humanos , Lactante , Propofol , TiopentalRESUMEN
During isoflurane-induced electroencephalographic (EEG) suppression, external stimuli evoke high-amplitude cortical responses (bursts). We tested whether bursts evoked by somatosensory stimuli would reliably distinguish intact somatosensory pathways from pathways in which peripheral nerve conduction had been blocked by local anesthetic. Ten subjects were anesthetized with isoflurane until burst suppression was achieved. During EEG suppression, they were given somatosensory stimulation, consisting of 3-s episodes of 60 electric pulses (20 mA, 0.2 ms), to the tips of the left and right fifth fingers alternately for 10 min. One finger was then anesthetized at the base of the proximal phalanx with prilocaine and the other finger was injected with saline in a double-blind manner. The stimulation was continued for 20 min. In nine patients, the disappearance of bursts in response to stimuli applied to the anesthetized finger clearly indicated the side of the conduction block. After the injection of local anesthetic, there was a predominance of offset bursts over onset bursts in response to stimuli applied to the anesthetized finger (P < 0.05) before the responses disappeared. We conclude that evoked bursts merit further investigation for potential use in monitoring the integrity of neural pathways.
Asunto(s)
Electroencefalografía , Potenciales Evocados Somatosensoriales/fisiología , Monitoreo Intraoperatorio , Corteza Somatosensorial/fisiología , Anestesia por Inhalación , Anestésicos por Inhalación/administración & dosificación , Anestésicos Locales/administración & dosificación , Método Doble Ciego , Estimulación Eléctrica , Electroencefalografía/efectos de los fármacos , Potenciales Evocados Somatosensoriales/efectos de los fármacos , Femenino , Dedos/inervación , Humanos , Isoflurano/administración & dosificación , Conducción Nerviosa/efectos de los fármacos , Vías Nerviosas/efectos de los fármacos , Nervios Periféricos/efectos de los fármacos , Placebos , Prilocaína/administración & dosificación , Corteza Somatosensorial/efectos de los fármacosRESUMEN
We recorded visual evoked potentials (VEPs) to flash stimuli in moderately deep anaesthesia when EEG showed burst suppression pattern. Flash VEPs could consistently be recorded in all 8 test subjects during bursts but not during suppressions. We conclude that during isoflurane-induced EEG suppression VEPs to flash stimuli are also suppressed. This effect should be taken into account in evoked potential testing during anaesthesia.
Asunto(s)
Encéfalo/fisiología , Electroencefalografía/efectos de los fármacos , Potenciales Evocados Visuales/fisiología , Isoflurano/farmacología , Adulto , Femenino , Humanos , Persona de Mediana Edad , Tiempo de Reacción/efectos de los fármacosRESUMEN
We studied cortical reactivity to auditory, visual, and somatosensory stimuli during moderate and deep levels of isoflurane anesthesia at which the electroencephalogram (EEG) showed burst suppression patterns, defined as alternating high amplitude bursts and periods of suppressed background activity. Fifteen patients scheduled for gynecologic surgery were anesthetized with isoflurane until burst suppression appeared in the EEG. During steady state burst suppression at 1.5 end-tidal isoflurane concentration (ETisof), each patient was given a 5-min interval each of episodes of visual, auditory, and somatosensory stimulation. During the 5-min interval of visual stimulation the patient was given 3-s episodes of 60 flashes, 4 ms duration each, at a 20-Hz frequency via redlight-emitting diode goggles. Corresponding auditory and somatosensory stimulation consisted of 60 clicks (80 dB, 0.1 ms, 20 Hz) via earphones and 60 pulses to the median nerve at the wrist (20 mA, 0.2 ms, 20 Hz). The 3-s episodes of stimulation were given at irregular intervals ranging from 5 to 20 s. End-tidal isoflurane was then increased by 0.3 vol% and 15 min later the stimulation sequence was repeated. During anesthesia at 1.5 +/- 0.1 ETisof all stimulus modalities readily evoked bursts. One hundred percent of visual stimuli, 98% +/- 4% of somatosensory stimuli, and 94% +/- 9% of auditory stimuli, given during EEG suppression, evoked bursts. Somatosensory and visual stimulation evoked bursts at both onset and offset of the 3-s episodes of stimuli. The responses to auditory stimuli were related mainly to the ending of the 3-s episode of clicks.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anestesia por Inhalación , Anestésicos por Inhalación/administración & dosificación , Corteza Cerebral/efectos de los fármacos , Electroencefalografía/efectos de los fármacos , Isoflurano/administración & dosificación , Estimulación Acústica , Procedimientos Quirúrgicos Electivos , Estimulación Eléctrica , Potenciales Evocados Auditivos/efectos de los fármacos , Potenciales Evocados Somatosensoriales/efectos de los fármacos , Potenciales Evocados Visuales/efectos de los fármacos , Femenino , Genitales Femeninos/cirugía , Humanos , Nervio Mediano/efectos de los fármacos , Estimulación Luminosa , Tiempo de Reacción , Volumen de Ventilación Pulmonar , Muñeca/inervaciónRESUMEN
The aim of this study was to compare propofol produced EEG burst suppression with isoflurane produced burst suppression in rabbits and to see whether rabbits can serve as models in studying the effects of different anaesthetics on human EEG. We recorded EEG of eight rabbits anaesthetised with isoflurane and propofol. The isoflurane bursts had higher amplitude than propofol bursts (P < 0.005). Isoflurane bursts appeared on distinct DC-shifts while propofol bursts were on slow waves. The EEG patterns were, however, different from those seen in humans. Rabbits did not have the rhythms seen in humans. We conclude that rabbits can be used to study the EEG effects of anaesthetics, such as the timing properties and reactivity of burst suppression pattern. However, this model seems less promising in the study of rhythmic activity seen in human EEG during burst suppression.
Asunto(s)
Anestésicos por Inhalación/farmacología , Anestésicos Intravenosos/farmacología , Electroencefalografía/efectos de los fármacos , Isoflurano/farmacología , Propofol/farmacología , Anestesia , Animales , Frecuencia Cardíaca/efectos de los fármacos , Masculino , ConejosRESUMEN
We studied EEG reactivity to visual stimuli during deep isoflurane (1.5-2.05 vol% end-tidal concentration) anaesthesia. Twelve patients were anaesthetized with isoflurane until burst suppression occurred in the EEG. Red LED goggles were used to give visual stimulation of 60 flashes, 4-ms duration each, at a frequency of 20 Hz. The stimuli, 3-strains of flashes, were given at random intervals. Both onset and offset of stimulation evoked bursts. The latency of visually evoked bursts was comparable with long latency evoked potentials, which are known to be related to cognitive processing. Our data showed that the central nervous system reacts strongly to photic stimulation during deep anaesthesia.