ABSTRACT
BACKGROUND: Laryngeal microscopic surgery directly stimulates an airway via endotracheal intubation and insertion of a suspension laryngoscope, and this can result in acute elevation of the blood pressure and heart rate. Therefore, an anesthesia that can maintain a sufficient depth of anesthesia and simultaneously makes awakening and recovery possible in a short period is required. We wanted to present the effect site concentration of remifentanil for achieving the best anesthesia by observing the hemodynamic changes according to the effect site concentration of remifentanil. METHODS: 36 patients, who corresponded with the ASA physical status classification 1 and 2 and who were from 20 to 70 years old, were the subjects of this study. They were randomly classified into three groups according to the effect site concentration of remifentanil. Propofol 4microgram/ml was infused continuously, and remifentanil was continuously infused for each group to achieve an effect site concentration of 4 ng/ml, 6 ng/ml, and 8 ng/ml, respectively. Rocuronium 0.5 mg/kg was used. The arterial blood pressures and heart rates were measured before induction of anesthesia, before endotracheal intubation, after endotracheal intubation and after insertion of a suspension laryngoscope. RESULTS: In comparison with the other groups, the 4 ng/ml remifentanil group was able to prevent acute elevation of blood pressure and heart rate. CONCLUSIONS: For total intravenous anesthesia using propofol and remifentanil, 4 ng/ml of remifentanil is proposed to be the effect site concentration that is able to stably maintain blood pressure and heart rate during laryngeal microscopic surgery.
Subject(s)
Aged , Humans , Anesthesia , Anesthesia, Intravenous , Arterial Pressure , Blood Pressure , Classification , Heart Rate , Hemodynamics , Intubation, Intratracheal , Laryngoscopes , PropofolABSTRACT
BACKGROUND: This study examined the cardiovascular responses to double-lumen endobronchial intubation during rapid sequence induction of anesthesia, and compared the effect of remifentanil and alfentanil in a randomized, double-blind, placebo-controlled study in three groups of 20 elderly patients each. METHODS: Anesthesia was induced with intravenous thiopental (4-6 mg/kg) immediately followed by either remifentanil 2 microgram/kg, alfentanil 30microgram/kg, or saline (placebo) given over 30 sec. Succinylcholine 1.5 mg/kg was given for neuromuscular block. The laryngoscopy and intubation were performed 60 sec later. RESULTS: The intubation significantly increased systolic arterial pressure (SAP) and heart rate (HR) in all groups. The maximum pressure changes in the remifentanil and alfentanil groups (36 +/- 26 and 33 +/- 30 mmHg, respectively) were significantly lower than the 83 +/- 35 mmHg in the control group. The maximum HR in the remifentanil (77 +/- 13 bpm) and alfentanil (80 +/- 13 bpm) groups was lower when compared to controls (93 +/- 11 bpm). The norepinephrine and epinephrine concentrations increased after intubation in the control group but remained unaltered in both the alfentanil and remifentanil groups. There were no significant differences between the remifentanil and alfentanil groups in HR, SAP or catecholamines at any time. Five patients in the remifentanil group and three in the alfentanil group received ephedrine for hypotension. CONCLUSIONS: Endobronchial intubation elicited a significant pressor response, and that both remifentanil and alfentanil similarly attenuated the pressor response. However, the incidence of hypotension confirms that both drugs should be used with caution in elderly patients.
Subject(s)
Aged , Humans , Alfentanil , Anesthesia , Arterial Pressure , Catecholamines , Ephedrine , Epinephrine , Heart Rate , Hypertension , Hypotension , Incidence , Intubation , Laryngoscopy , Neuromuscular Blockade , Norepinephrine , Succinylcholine , Tachycardia , ThiopentalABSTRACT
Hemolytic uremic syndrome is an unusual and uncommon disease in adults but more common in children, which is defined by the triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. We report a 64-year-old man who developed hemolytic uremic syndrome after esophagectomy and esophagogastrostomy due to esophageal cancer. We treated him using continuous renal replacement therapy and plasmapheresis with large volume fresh frozen plasma transfusion for 9 days. We could not find the cause of hemolytic uremic syndrome, and so finally concluded that it is idiopathic. Bleeding continuously without a particular reason after an operation, it needs an early diagnosis and treatment with considering a possibility of the hemolytic uremic syndrome.