ABSTRACT
BACKGROUND: Opioids are the most widely used drugs to minimize the increase of blood pressure and heart rate in endotracheal intubation during the induction of anesthesia. The purpose of this study was to compare the effects of fentanyl, alfentanil, and remifentanil on the cardiovascular response to laryngoscopic endotracheal intubation. METHODS: Eighty ASA I-II patients were randomly allocated to four groups. The patients received 10 ml intravenous saline (control group), 3microgram/kg fentanyl (fentanyl group), 10microgram/kg alfentanil (alfentanil group) or 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min remifentanil (remifentanil group). Anesthesia was induced with propofol and rocuronium and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. The noninvasive blood pressure and heart rate were recorded before induction (baseline), after induction, before intubation, and at 1 min intervals until 5 min after endotracheal intubation. RESULTS: Arterial pressure and heart rate after endotracheal intubation were lower in the fentanyl, alfentanil, and remifentanil groups than in the control group (P < 0.05). There were no significant differences for arterial pressure or heart rate in the fentanyl, alfentanil, and remifentanil groups at any time. There were no significant differences for the incidence of hypotension and bradycardia among the four groups. CONCLUSIONS: Administration of 3microgram/kg fentanyl, 10microgram/kg alfentanil and 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg /min remifentanil have a similar effect in the suppression of the cardiovascular response to laryngoscopic endotracheal intubation during the induction of general anesthesia.
Subject(s)
Humans , Alfentanil , Analgesics, Opioid , Androstanols , Anesthesia , Anesthesia, General , Arterial Pressure , Blood Pressure , Bradycardia , Fentanyl , Heart Rate , Hypotension , Incidence , Intubation , Intubation, Intratracheal , Methyl Ethers , Nitrous Oxide , Oxygen , Piperidines , PropofolABSTRACT
BACKGROUND: After induction of anesthesia with propofol or thiopental, rocuronium causes hand or limb withdrawal or generalized movements, suggesting the presence of intense pain even under anaesthesia. We evaluated the effect of diluting rocuronium 10 mg/ml solution to 5 mg/ml or 3.3 mg/ml with 0.9% NaCl solution on the withdrawal movements associated with IV administration of rocuronium given at intubating doses after thiopental administration. METHODS: Sixty three patients undergoing surgical procedures that required general anesthesia were randomized into three groups. Group 1 received rocuronium 0.9 mg/kg in 10 mg/ml solution, while Group 2 and 3 received the same dose of rocuronium in 5 mg/ml and 3.3 mg/ml solutions with 0.9% NaCl solution after thiopental IV administration, respectively. RESULTS: We observed that the incidence of withdrawal movements was 71.4% in the Group 1, 47.6% in the Group 2 and 14.3% in the Group 3. Intense withdrawal movements involving elbow or shoulder and generalized movements were observed in 42.8% of patients in Group 1, but they were seen in 23.8% of patients in Group 2 and 4.8% of patients in Group 3. There were significant differences in incidence and degree of withdrawal movements between Group 1 and 3 (P < 0.05). The pH values and osmolalities of study solutions were not significantly different between the groups. CONCLUSIONS: Dilution of rocuronium with 0.9% NaCl solution given at intubating doses after thiopental administration is a simple and cost-effective strategy for preventing withdrawal movements during IV rocuronium injection.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Elbow , Extremities , Hand , Hydrogen-Ion Concentration , Incidence , Osmolar Concentration , Propofol , Shoulder , ThiopentalABSTRACT
PURPOSE: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. METHOD: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). RESULTS: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M= 61.61 mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). CONCLUSION: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a 50cc syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.
Subject(s)
Humans , Catheters , Critical Illness , Enteral Nutrition , Feeding Methods , Glucose , Infusion Pumps , Suction , Syringes , Tracheostomy , Surveys and QuestionnairesABSTRACT
PURPOSE: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. METHOD: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). RESULTS: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M= 61.61 mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). CONCLUSION: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a 50cc syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.
Subject(s)
Humans , Catheters , Critical Illness , Enteral Nutrition , Feeding Methods , Glucose , Infusion Pumps , Suction , Syringes , Tracheostomy , Surveys and QuestionnairesABSTRACT
BACKGROUND: Two hundred seventy-eight patients undergoing thoracic surgery were retrospectively analyzed to determine whether which variable can predict the identification of patients at risk of arterial hypoxemia developing during one-lung ventilation (OLV). METHODS: According to the value of SpO2, the patients were divided two groups. Group L (n = 62) had SpO2 values of less than 95%, whereas group H (n = 216) those of more than 95%. Preoperative and intraoperative data, including past medical history, current therapy, and usual preoperative and intraoperative tests, were collected and used as predictable variables for arterial hypoxemia during OLV by binary logistic regression (forward conditional method) subsequent to independent t-test and Chi-square test, as appropriate. RESULTS: Preoperative (past medical history with pulmonary resection of a lobectomy in dependent lung, hypertension, arrhythmias, and predicted diffusion capacity for carbon monoxide < or = 70%) and intraoperative (arterial oxygen tension/inspiratory oxygen fraction during two-lung ventilation <528 mmHg, right thoracotomy) variables were considered as predictable factors that identified patients at risk of arterial hypoxemia during OLV. CONCLUSION: Caution to the increased risk of arterial hypoxemia during OLV is needed in patients that have aforementioned preoperative and intraoperative variables.
Subject(s)
Humans , Hypoxia , Arrhythmias, Cardiac , Carbon Monoxide , Diffusion , Hypertension , Logistic Models , Lung , One-Lung Ventilation , Oxygen , Retrospective Studies , Thoracic Surgery , VentilationABSTRACT
BACKGROUND: Phantom limb sensation is an unusual position sense of the extremity during nerve block that the position of extremity is misinterpreted as being flexed, or elevated, when actually they are in neutral position. Whether it is from the fixation of proprioceptive input at the time of motor blockade or from unmasking of the pattern which has been already present in the CNS is still controversial. We perfomed this study under the assumption that phantom limb sensation can still be reproduced without the influence of position at the time of nerve blockade. METHODS: Thirty-six patients scheduled for elective orthopedic surgery were randomly assigned. For 26 patients, spinal anesthesia was performed with hyperbaric 0.5% tetracaine or bupivacaine at lateral decubitus position and the position was changed to supine immediately. Existence of phantom limb sensation and the level of anesthesia was recorded at 10 and 20 minutes after injection of local anesthetics. For 10 patients, same local anesthetics were injected after patient's legs were straightened in lateral decubitus position. RESULTS: Forteen out of 26 patients whose position were changed to supine immediately after the injection of local anesthetics experienced phantom limb sensations. Five out of 10 patients whose legs were kept straight before the injection of local anesthetics experienced phantom limb sensations. Previous history of trauma was positively related to the expression of phantom limb sensation. CONCLUSION: Our data showed that the expression of phantom limb sensation is reproducible. And this was not related to the position at the time of spinal anesthesia. Trauma seems to be an important factor related to the expression of phantom limb sensation.
Subject(s)
Humans , Anesthesia , Anesthesia, Spinal , Anesthetics, Local , Bupivacaine , Extremities , Leg , Nerve Block , Orthopedics , Phantom Limb , Proprioception , Sensation , TetracaineABSTRACT
No abstract available.