ABSTRACT
BACKGROUND: During carotid endarterectomy (CEA), hemodynamic stability and adequate fluid management are crucial to prevent perioperative cerebral stroke, myocardial infarction and hyperperfusion syndrome. Both pulse pressure variation (PPV) and stroke volume variation (SVV), dynamic preload indices derived from the arterial waveform, are increasingly advocated as predictors of fluid responsiveness in mechanically ventilated patients. The aim of this study was to evaluate the accuracy of PPV and SVV for predicting fluid responsiveness in patients undergoing CEA. METHODS: Twenty seven patients undergoing CEA were enrolled in this study. PPV, SVV and cardiac output (CO) were measured before and after fluid loading of 500 ml of hydroxyethyl starch solution. Fluid responsiveness was defined as an increase in CO > or = 15%. The ability of PPV and SVV to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Both PPV and SVV measured before fluid loading are associated with changes in CO caused by fluid expansion. The ROC analysis showed that PPV and SVV predicted response to volume loading (area under the ROC curve = 0.854 and 0.841, respectively, P or = 9.5% identified responders (Rs) with a sensitivity of 71.4% and a specificity of 90.9%, and a SVV > or = 7.5% identified Rs with a sensitivity of 92.9% and a specificity of 63.6%. CONCLUSIONS: Both PPV and SVV values before volume loading are associated with increased CO in response to volume expansion. Therefore, PPV and SVV are useful predictors of fluid responsiveness in patients undergoing CEA.
Subject(s)
Humans , Arterial Pressure , Blood Pressure , Cardiac Output , Endarterectomy, Carotid , Fluid Therapy , Hemodynamics , Hydroxyethyl Starch Derivatives , Myocardial Infarction , ROC Curve , Sensitivity and Specificity , Stroke , Stroke VolumeABSTRACT
No abstract available.
Subject(s)
Arterial Pressure , Arteriovenous Malformations , Embolization, Therapeutic , Ethanol , Extremities , NitroglycerinABSTRACT
No abstract available.
Subject(s)
Arterial Pressure , Arteriovenous Malformations , Embolization, Therapeutic , Ethanol , Extremities , NitroglycerinABSTRACT
No abstract available.
Subject(s)
Coronary Artery Bypass, Off-Pump , Endarterectomy, Carotid , Hematoma , TransplantsABSTRACT
We report two cases of high-risked patients with cardiac dysfunction undergoing femoro-popliteal or tibial arterial bypass surgery anesthetized by ultrasound guided peripheral nerve blocks; femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block. We used an anesthetic solution consisting of 0.375% ropivacaine with epinephrine. We provided sufficient surgical anesthesia. These nerve blockades provided stable intraoperative and postoperative hemodynamic status, which is valuable knowledge from the perspective of postoperative pain control as well as satisfaction of both patients and surgeons. We believe that femorosciatic nerve block with concurrent femoral branch block of genitofemoral nerve could be an excellent anesthetic choice for patients receiving femoro-popliteal or tibial arterial bypass surgery, especially in patients with cardiac dysfunction.
Subject(s)
Humans , Amides , Anesthesia , Anesthesia, Conduction , Epinephrine , Femoral Nerve , Hemodynamics , Nerve Block , Pain, Postoperative , Peripheral Nerves , Peripheral Vascular Diseases , Sciatic Nerve , UltrasonographyABSTRACT
We report two cases of high-risked patients with cardiac dysfunction undergoing femoro-popliteal or tibial arterial bypass surgery anesthetized by ultrasound guided peripheral nerve blocks; femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block. We used an anesthetic solution consisting of 0.375% ropivacaine with epinephrine. We provided sufficient surgical anesthesia. These nerve blockades provided stable intraoperative and postoperative hemodynamic status, which is valuable knowledge from the perspective of postoperative pain control as well as satisfaction of both patients and surgeons. We believe that femorosciatic nerve block with concurrent femoral branch block of genitofemoral nerve could be an excellent anesthetic choice for patients receiving femoro-popliteal or tibial arterial bypass surgery, especially in patients with cardiac dysfunction.
Subject(s)
Humans , Amides , Anesthesia , Anesthesia, Conduction , Epinephrine , Femoral Nerve , Hemodynamics , Nerve Block , Pain, Postoperative , Peripheral Nerves , Peripheral Vascular Diseases , Sciatic Nerve , UltrasonographyABSTRACT
BACKGROUND: Cyclic guanosine monophosphate (cGMP) and opioid receptors are involved in the modulation of nociception. Although the opioid receptors agonists are active in pain, the effect of an phospodiesterase inhibitor (zaprinast) for increasing the level of cGMP has not been thoroughly investigated at the spinal level. This study examined the effects of intrathecal zaprinast and morphine in a nociceptive test and we also examined the nature of the pharmacological interaction after the coadministration of zaprinast with morphine. The role of the nitric oxide(NO)-cGMP-potassium channel pathway on the effect of zaprinast was further clarified. METHODS: Catheters were inserted into the intrathecal space of male SD rats. For the induction of pain, 50microliter of 5% formalin solution was applied to the hindpaw. Isobolographic analysis was used for the evaluation of the drug interaction between zaprinast and morphine. Furthermore, NO synthase inhibitor (L-NMMA), guanylyl cyclase inhibitor (ODQ) or a potassium channel blocker (glibenclamide) were intrathecally administered to verify the involvement of the NO-cGMP-potassium channel pathway on the antinociception effect of zaprinast. RESULTS: Both zaprinast and morphine produced an antinociceptive effect during phase 1 and phase 2 in the formalin test. Isobolographic analysis revealed a synergistic interaction after the intrathecal administration of the zaprinast-morphine mixture in both phases. Intrathecal L-NMMA, ODQ and glibenclamide did not reverse the antinociception of zaprinast in either phase. CONCLUSIONS: These results suggest that zaprinast, morphine and the mixture of the two drugs are effective against acute pain and they facilitated pain state at the spinal level. Thus, the spinal combination of zaprinast with morphine may be useful for the management of pain. However, the NO-sensitive cGMP-potassium channel pathway did not contribute to the antinocieptive mechanism of zaprinast in the spinal cord.
Subject(s)
Animals , Humans , Male , Rats , Acute Pain , Catheters , Drug Interactions , Formaldehyde , Glyburide , Guanosine Monophosphate , Guanylate Cyclase , Morphine , Nitric Oxide Synthase , Nociception , omega-N-Methylarginine , Pain Measurement , Potassium Channels , Receptors, Opioid , Spinal CordABSTRACT
Mucopolysaccharidosis is characterized by the progressive accumulation of glycosaminoglycans in multiple organs. Valve and coronary involvement, upper airway obstructive disease, joint stiffness, and mental retardation are associated perioperative anesthetic risks. Nineteen patients and 23 anesthetic cases were presented for elective surgery. The mean patient age was 10.8 years. General anesthesia was administered in 21 cases and intubation was failed in two. Mask ventilation without intubation was performed in two cases in day surgery unit. In one case, spinal anesthesia was performed. Otolaryngologic procedures, i.e., tonsillectomy and adenoidectomy, and ventilation tube insertion were most common. Percutaneous endoscopic gastrostomy and herniorrhaphy were also frequent. Dexamethasone was given to all intubated cases and all patients were extubated in the postanesthesia care unit or in the intensive care unit. There was no perioperative mortality. Cautious airway management until intubation is recommended and mask ventilation with short-acting inhalation or intravenous anesthetics is enough to manage relatively short procedures. For herniorrhaphy, a spinal block could be used.
Subject(s)
Humans , Adenoidectomy , Airway Management , Ambulatory Surgical Procedures , Anesthesia, General , Anesthesia, Spinal , Anesthetics, Intravenous , Dexamethasone , Gastrostomy , Glycosaminoglycans , Herniorrhaphy , Inhalation , Intellectual Disability , Intensive Care Units , Intubation , Joint Diseases , Masks , Mortality , Mucopolysaccharidoses , Mucopolysaccharidosis I , Tonsillectomy , VentilationABSTRACT
BACKGROUND: The opioid agonist fentanyl has been used at induction of anesthesia to stabilize hemodynamic parameters. But it can induce cough and in some patients, it can be hazardous. We investigated the effect of alpha2- agonist clonidine premedication on fentanyl induced cough reflex. METHODS: 83 patients (ASA class 1) were involved in this study and divided into two groups: Group 1 (no premedication group, n=43) and Group 2 (clonidine 300 microgram p .o. 1 hour prior to anesthesia, n=40). Before induction of anesthesia, in each group, fentanyl was injected within 1 second through a peripheral venous cannula in dorsum of hand and rapid fluid infusion was followed. We checked cough response, cough emerging time and it's duration. We graded the duration of cough into grade I and II (Grade I: shorter than 5 seconds, Grade II: longer than 5 seconds). RESULTS: There was no significant difference in the incidence of fentanyl induced cough reflex between Group 1 (34.9%) and Group 2 (25.6%). The incidence of Grade II is higher in Group 1 (18.3%) than in Group 2 (2.5%). CONCLUSIONS: Clonidine, as a premedication agent, couldn't reduce the incidence of fentanyl induced cough reflex. But it reduced the degree of cough response.