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ObjectiveTo analyze the clinical features， treatment and prognosis of patients with respiratory depression caused by glufosinate poisoning. MethodsThe clinical data of patients with respiratory depression caused by glufosinate poisoning admitted to the ICU of Xiangshan first people’s hospital medical and health group from March 2018 to January 2022 were retrospectively analyzed. ResultsA total of 21 patients with respiratory depression caused by glufosinate poisoning were included. The median （interquartile） intake of glufosinate was 30 （20， 40） g， and the median （interquartile） visit time was within 2.0 （1.0， 2.8） h. The initial symptoms were nausea and vomiting in 16 cases （76.2%）， and sore throat in 8 cases （38.1%）. Respiratory depression， convulsions and shock occurred 6‒48 hours after ingestion of glufosinate. Convulsion occurred in 13 cases （61.9%）， shock in 10 cases （47.6%） and bradycardia in 5 cases （23.8 %）. Among the patients with convulsion or shock， respiratory depression occurred earlier than convulsion and shock in 10 cases （76.9%） and 9 cases （90.0%）， respectively. All patients were treated with gastric lavage， catharsis， mechanical ventilation and symptomatic support. Blood purification was performed in 14 cases. The duration of mechanical ventilation was 5.0 （4.0， 7.0） d，and no patient died. The patients were divided into blood purification group and routine treatment group. There was no significant difference in complications and duration of mechanical ventilation between the blood purification group and the routine treatment group （P>0.05）. ConclusionRespiratory depression caused by glufosinate poisoning usually occurs earlier than convulsion and shock. The overall prognosis of patients with respiratory depression caused by glufosinate poisoning is good， which mainly depends on the early recognition and intervention of respiratory depression.
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Tumor lysis syndrome (TLS) is a metabolic disorder that is caused by acute lysis of massive tumor cells. We report a case with opioids-related severe respiratory depression induced by TLS. A 39-year-old man received chemotherapy for mycosis fungoides. Two hours after administration of chemotherapeutic agents, his renal function worsened, and he was diagnosed with TLS by laboratory and clinical findings. Moreover, he showed severe respiratory depression and pinpoint pupils, and become drowsy. These symptoms were attributed to oxycodone that had been administered to treat his tumor-related cutaneous pain, and were improved by injection of anti-opioids agent naloxone. In this case, we consider that the clearance of oxycodone was disrupted by renal dysfunction caused by TLS, leading to enhancement of the effects of oxycodone.
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Introduction: A low Apgar score at one minute is a clinical problem that contributes to neonatal morbidity and mortality. Objective: To identify adverse perinatal results of newborns with low Apgar score. Design: Retrospective, analytical, case-control study. Institution: Hipolito Unanue Hospital in Tacna, Peru. Participants: 2 176 live births with Apgar score below 7 at one minute, single pregnancy, born between 2002 and 2016, compared with 4 352 live births with Apgar score 7-10 selected by simple random sampling. We used the SIP2000 Perinatal Computer System database. Main outcome measures: Absolute and relative frequencies, averages, standard deviation, bivariate analysis, odds ratio with 95% confidence intervals. Results: The frequency of newborns with low Apgar score was 4.1 per 100 live births. Low Apgar score was associated with male sex, prematurity, low weight, small and large for gestational age, and birth by cesarean section. Adverse perinatal results were associated with higher risk of morbidity (OR=5.8), neonatal mortality (OR=41.1), perinatal infection (OR=9.4), respiratory distress syndrome (OR=7.6), congenital malformations (OR=7), birth trauma (OR=5,4), and hyperbilirubinemia (OR=4.9), Conclusion: In our hospital, newborns with a low Apgar score at one minute were at high risk of neonatal morbidity and mortality.
Introducción. El Apgar bajo al minuto de nacimiento es un problema clínico que contribuye a la morbimortalidad neonatal. Objetivo. Conocer los resultados perinatales adversos del recién nacido con Apgar bajo. Diseño. Estudio retrospectivo, analítico, de casos y controles. Institución. Hospital Hipólito Unanue de Tacna, Perú. Participantes. Se estudió 2 176 recién nacidos vivos durante los años 2002 a 2016, con Apgar al minuto menor de 7, de embarazo único, comparados con 4 352 nacidos vivos con Apgar 7 a 10 seleccionados por muestreo aleatorio simple. Se utilizó la base de datos del sistema informático perinatal SIP2000. Principales medidas de resultados. Frecuencias absolutas y relativas, promedios, desviación estándar, análisis bivariado, odds ratio con intervalos de confianza al 95%. Resultados. La frecuencia de recién nacidos con Apgar bajo fue 4,1 por 100 nacidos vivos. Se asociaron al Apgar bajo los recién nacidos de sexo masculino, prematuros, peso bajo, pequeños y grandes para la edad gestacional y nacidos por cesárea. Los resultados perinatales adversos fueron riesgo de morbilidad (OR=5,8), mortalidad neonatal (OR=41,1), infección perinatal (OR=9,4), síndrome de dificultad respiratoria (OR=7,6), malformaciones congénitas (OR=7), traumatismo al nacer (OR=5,4) e hiperbilirrubinemia (OR=4,9). Los fallecidos fueron 79,4% prematuros y 78,7% de peso bajo. Conclusión. El recién nacido con Apgar bajo al minuto en el hospital Hipólito Unanue de Tacna tiene riesgo alto de morbilidad y mortalidad neonatal.
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Humans , Infant, Newborn , Apgar Score , Infant Mortality , MorbidityABSTRACT
OBJECTIVE To evaluate plasma pharmacokinetics, distribution of target organs, sedative effect and respiratory depression of sufentanil (SFTN), and dexmedetomidine (DEM) in rats, and to explore the potential drug-drug interactions between the two drugs. METHODS Rats were intravenously injected with SFTN 20.0 μg•kg-1, DEM 25.2 μg•kg-1 and SFTN+DEM (SFTN 20.0 μg•kg-1, DEM 25.2 μg•kg-1), respectively. Plasma samples were taken at different time points (2, 5, 15, 30 min and 1, 2, 4, 6, 8 h) to determine the concentrations of SFTN and DEM using the liquid chromatography-mass spectrometry (LC-MS/MS) quantitative method established in this study. The same method was used to determine the concentrations of SFTN and DEM in plasma and brain samples taken at different time points (5, 15, 30, 60 and 120 min). Pharmacokinetic parameters were obtained by noncompartmental analysis performed using Phoenix WinNonlin 7.0 (Pharsight, California). The duration of drug-induced loss of right reflex (LORR) and respiratory function were also measured using instrument monitoring. RESULTS An LC-MS/MS method for quantitative analysis of plasma SFTN and DEM was established and validated. The Cmax,;t1/2, and Cl ;of SFTN in SFTN group were (22.2±2.6) ug•L-1, (2.13±0.69) h and (2288±446) mL•h-1•kg-1, respectively, compared with (15.9±9.4) μg•L-1, (1.22±0.13) h and (3565±743) mL•h-1 •kg-1 in SFTN+DEM group. The Cmax, t1/2, and Cl of DEM in DEM group were (14.0±8.9) μg•L-1, (1.21±0.15) h and (4235±752) mL•h-1•kg-1, compared with (9.4±3.5) μg•L-1, (1.08±0.26) h and (4796±744) mL•h-1•kg-1 in SFTN+DEM group. The Cmax ratio of SFTN in brain and plasma of SFTN+DEM group was 0.49, which was 1.3-fold that of SFTN group (0.45). The Cmax ratio of DEM in brain and plasma of SFTN + DEM group was 16.9, which was 12-fold that of DEM group (1.42). The duration of LORR of SFTN, DEM, and SFTN+DEM groups was 370±13, 41±5 and (104±24) min, respectively, and that of SFTN+DEM group was more significantly extended than those in SFTN and DEM groups (P<0.01). Respiratory depression of SFTN+DEM group was not further aggravated compared with SFTN group, but the duration of inhibition was extended (P<0.05, P<0.01). CONCLUSION The combination of SFTN and DEM can cause drug-drug interactions, which may promote the sedation and prolong the respiratory depression by increasing the exposure level of DEM brain tissue. In clinical application, attention should be paid to the possible drug-drug interactions or adverse reactions caused by the combination of these two drugs.
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Ampakines are a class of pharmacological agents acting as positive modulators of AMPA receptors. Currently, clinical indications studied for ampakines involve many diseases including the respiratory depression and psychoneurosis, etc. The studies using CX516 and CX546 as tool compounds have shown that ampakines could be classified into "high impact ampakines"and "low impact ampakines". The two subclasses of ampakines differ in the chemical structures, influences on receptor dynamics, receptor-ligand bindings, synaptic transmissions, neurotrophin regulations and side effects. According to the available literature, the low impact ampakines have better clinical application prospects than high impact ampakines because of their high safety and good tolerance. The above different characteristics of the two subclasses of ampakines are reviewed in this paper.
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OBJECTIVE Respiratory depression hinders the use of anaesthetics and sedative hyp-notics.To explore the mechanism of LCX001 on protection against respiratory depression,a novel AMPA receptor modulator LCX001,synthesized by our Institute of Medicinal Chemistry,is expected to relieve suppressed respiration. METHODS LCX001 was tested to alleviate respiratory depression triggered by opioid(fentanyl and TH-030418),propofol and pentobarbital in the plethysmography recording.The acetic acid writhing and hot-plate tests were conducted to evaluate analgesic effect of LCX001.Binding assay and whole-cell recording were used to analyze the property of LCX001 on positive modulation. The function of AMPA receptors were determined by location of receptors in the membrane and state of channel opening, and both processes were impressed by AMPA receptor regulatory proteins. Ac-cording to the theory,the effect of LCX001 on the expression of stargazin was measured firstly by west-ern blotting. The variation of receptor surface location was observed by live cell imaging. The regula-tion on neuronal Ca2+and cell function was investigated intensively by Ca2+imaging to clarify mecha-nism of LCX001. RESULTS LCX001 effectively rescued and prevented opioid (fentanyl and TH-030418), propofol, and pentobarbital-induced respiratory depression by strengthening respiratory fre-quency and minute ventilation in rats. The acetic acid writhing test and hot-plate test revealed potent anti-nociceptive efficacy of LCX001,in contrast to some ampakines that did not affect analgesia. Fur-thermore,LCX001 potentiated[3H]AMPA and L-glutamate binding affinity to AMPA receptors,and facili-tated glutamate-evoked inward currents in HEK293 cells stably expressing GluA2(R).Importantly,appli-cation of LCX001 generated a significant increase in GluA2(R) surface expression in a mechanism of stargazin up-regulation,and restrained opioid-induced abnormal intracellular Ca2+load,which might par-ticipate in breathing modulation. CONCLUSION The novel pharmacological effect and potential new mechanism of LCX001 might promote ampakines to be a therapeutic option for protection against respi-ratory depression.
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Objective To compare the effect of ketamine and sufentanyl on respiratory depression induced by propofol in pediatric patients.Methods Sixty children with taplipes equines in the Department of Pediatric Orthopedics,the Third Affiliated Hospital of Zhengzhou University from February 2014 to August 2015 were selected and divided into ketamine group,sufentanil group and control group,with 20 patients in each group.The patients in ketamine group were given ketamine 1.50 mg· kg-1 by intravenous injection and maintained with ketamine 0.75 mg · kg-1 · h-1 by pump infusion;the patients in sufentanil group were given sufentanil 0.2 μg · kg-1 by intravenous injection and maintained with sufentanil 0.1 μg · kg-1 · h-1 by pump infusion;the patients in control group were given the same volume of saline.The initial plasma concentration of propofol in ketamine group,sufentanil group and control group was 1.1 mg · L-1,and the ratio between the two successive concentration gradients was 1.1.It was defined as positive when patients developed respiration depression.The bispectral index (BIS) and the observer's assessment of alertness/sedation (OAA/S) score of patients in the three groups were recorded at the time point of intravenous infusion ketamine or sufentanil (T1),3 min after propofol target controlled infusion (TCI) (T2),5 min after propofol TCI (T3) and after the target effect-site and plasma concentrations were balanced(T4).The target effect-site concentration was recorded when the BIS dropped to 65 or OAA/S score was 3.The median effective concentration(EC50) and its 95％ confidence interval (CI) of propofol inducing respiratory depression were calculated.Results There was no statistic difference in BIS and OAA/S scores of patients at the time point of T1 among the three group(P ＞ 0.05);the BIS and OAA/S scores of patients in ketamine group and sufentanil group were significantly lower than those in the control group at the time point of T2,T3 and T4 (P ＜ 0.05);the BIS and OAA/S scores of patients in ketamine group were significantly lower than those in the sufentanil group at the time point of T2,T3,T4 (P ＜ 0.05).The EC50 and its 95 ％ CI of respiratory depression induced by propofol in ketamine group,sufentanil group and the control group were 1.75 (1.56-2.34),1.86 (1.47-2.23),2.82 (2.56-3.02) mg · L-1 respectively.The EC50 of patients in ketamine group and sufentanil group was significantly lower than that in control group (P ＜ 0.05),but there was no statistic difference in EC50 of patients between the ketamine group and sufentanil group (P ＞ 0.05).Conclusion Both ketamine and sufentanil can increase the EC50 of respiratory depression induced by propofol in pediatric patients,but the effects of both drugs are the same.Ketamine and sufentanil can reduce the BIS and OAA/S scores of patients,enhance the sedation efficacy of propofol,and the effect of ketamine is better than sufentanil.
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Tidal volume by sevoflurane in small amounts is stable due to the increase in the breathing rate. But alveolus ventilation decreases due to sevoflurane as the degree of sedation increases; this ultimately causes PaCO2 to rise. The occurrence of suppression of breath increases the risk of severe hypoxia and hypercapnia in deeply sedated patients with disabilities. Sevoflurane inhalation anesthesia has a number of risks and may have unexpected problems with hemodynamic changes depending on the underlying state of the body. This study was conducted to examine the stability of internal acid-base system caused by respiratory depression occurring when patients with disabilities are induced by sevoflurane.Anesthetic induction was carried out by placing a mask on top of the patient's face and through voluntary breathing with 4 vol% of sevoflurane, 4 L/min of nitrous oxide, and 4 L/min of oxygen. After the patient's loss of consciousness and muscle relaxation, IV line was inserted by an expert and intravenous blood gas was analyzed by extracting blood from vein.In a deeply sedated state, the average amount of pH of the entire patients was measured as 7.36 ± 0.06. The average amount of PvCO₂ of the entire patients was measured as 48.8 ± 8.50 mmHg. The average amount of HCO₃₋ of the entire patients was measured as 27.2 ± 3.0 mmol/L.In conclusion, in dental treatment of patients with disabilities, the internal acid base response to inhalation sedation using sevoflurane is relatively stable.
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Humans , Anesthesia, General , Anesthesia, Inhalation , Hypoxia , Blood Gas Analysis , Hemodynamics , Hydrogen-Ion Concentration , Hypercapnia , Inhalation , Masks , Muscle Relaxation , Nitrous Oxide , Oxygen , Respiration , Respiratory Insufficiency , Tidal Volume , Unconsciousness , Veins , VentilationABSTRACT
ABSTRACT Objective: To analyze the safety degree of drugs used in colonoscopy during conscious sedation in patients developing respiratory depression. Methods: Cross-sectional observational study that evaluated 1120 patients who underwent colonoscopy between February 2015 and February 2016. Physical characteristics, surgical history and previous colonoscopies, indication and conditions of the current examination, fentanyl and midazolam doses and subsequent complications were analyzed. Level of significance: p < 0.05. Chi-square test was used for association of categorical variables, whereas Student's t test was used to compare means and Spearman's coefficient for correlation. Results: There were 661 female (59%) and 459 (41%) male patients, with a mean age of 54.90 (20-87) years and BMI of 27.00 (14.5-45.4). Of the 1120 patients, only 2 (0.2%) had respiratory depression, reversed with lanexat. Patients who had complications were of both genders, with a body mass index of 21.25 and 28.7. There was a correlation between the required dose of fentanyl and age (p < 0.001 to −0.121 Spearman's coefficient), as well as midazolam (p < 0.001 - Spearman's coefficient −0.452) and increasing age was associated with a lower dose of the drug. Conclusion: The number of patients with complications was 0.17%. The age of the patient showed an inverse association, i.e., the older the patient, the lower the required dose of medication. The drugs used in colonoscopy show a high degree of safety, corroborating their frequent use for superficial/conscious sedation in this procedure.
RESUMO Objetivo: Analisar o grau de segurança dos fármacos utilizados na colonoscopia sob sedação superficial em pacientes que desencadeiam depressão respiratória. Métodos: Estudo observacional transversal, que avaliou 1.120 pacientes que realizaram colonoscopia entre Fevereiro de 2015 e Fevereiro de 2016. Analisaram-se características físicas, histórico cirúrgico e colonoscopias prévias, indicação e condições do exame atual, dose de fentanil e midazolam e complicações apresentadas. Nível de significância adotado: p < 0,05. Utilizou-se teste Qui-quadrado para associação de variáveis categóricas, teste t de Student para comparação de médias e coeficiente de Spearman para correlação. Resultados: Foram 661 pacientes do sexo feminino (59%) e 459 (41%) do sexo masculino, com média de idade de 54,90 (20-87) anos e IMC de 27,00 (14,5-45,4). Dos 1120 pacientes, apenas 2 (0,2%) exibiram depressão respiratória revertida com lanexate. Os pacientes que apresentaram complicação eram de sexos diferentes, com índices de massa corpórea de 21,25 e 28,7. Houve correlação entre a dose necessária de fentanil e a idade (p < 0,001 - coef Spearmann - 0.121), assim como a de midazolam (p < 0,001 - coef Spearmann - 0.452), sendo que com o aumento da idade se correlacionou com uma menor dose utilizada de medicamento. Conclusão: O número de pacientes que apresentaram alguma complicação foi 0,17%. A idade do paciente tem associação inversa, quanto maior a idade do paciente, menor é a dose necessária de medicamentos. Verifica-se alto grau de segurança dos medicamentos utilizados na colonoscopia, corroborando sua utilização frequente para a sedação superficial/consciente neste procedimento.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Respiratory Insufficiency/etiology , Midazolam/adverse effects , Fentanyl/adverse effects , Conscious Sedation , Colonoscopy/methods , Hypnotics and Sedatives/adverse effects , Midazolam/administration & dosage , Fentanyl/administration & dosageABSTRACT
Objective To analyze the risk factors of respiratory depression occurring during recovery period in patients after having undergone general anesthesia and laparoscopic operation.Methods A total of 374 patients after general anesthesia and laparoscopic surgery admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2015 to June 2016 were enrolled, they were divided into with or without the incidence of respiratory depression two groups by whether or not respiratorydepression, with the incidence of respiratory depression group 52 cases, without the incidence of respiratory depression group 322 cases. The patients' gender, age, body mass index (BMI), operation time, anesthesia maintenance mode, artificial airway mode, operative type and medication used in operation, intra-operative hypotension presence or absence, and type of operation were recorded. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors of respiratory depression occurring in the recovery period after general anesthesia; receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of age, intraoperative medication, and age combine with intraoperative medication respectively in the occurrence of respiratory depression during recovery period after general anesthesia and lapatoscopic operation.Results Univariate analyses showed that there were no statistical significant differences in gender, BMI, operation time, anesthesia maintenance mode, artificial airway mode, intra-operative hypotension presence or absence, type of operation, etc. compared between patients with and without the incidence of respiratory depression groups (allP > 0.05); while the differences were statistically significant in age and drug used in the operation (dezocine, flurbiprofen, dexmedetomidine or dezocine combined with dexmedetomidine, allP < 0.05). Multivariate analyses showed that age and medication used in operation were the independent risk factors for the occurrence of respiratory depression during the anesthesia recovery stage (P values being 0.000, 0.002 respectively). ROC curve showed that age, intra-operative medication and age combine with intraoperative medication respectively had certain predictive value for the occurrence of respiratory depression during the recovery period after general anesthesia and laparoscopic surgery, the area under the ROC curve (AUC) of age combine with intraoperative medicationfor prediction of occurrence of respiratory depression during recovery period after anesthesia and laparoscopic surgery was significantly larger than that of single age or single intraoperative medication (0.826 vs. 0.668, 0.750,P < 0.01), 95% confidence interval (95%CI) of age, intraoperative medication and age combined with intraoperative medication were 0.598-0.738, 0.670-0.830, 0.764-0.888, the sensitivity, specificity and accuracy rate of age combine with intraoperative medication were 53.8%, 94.4% and 88.8%, respectively.Conclusion Elderly patients undergoing general anesthesia and laparoscopic operation and dezocine, dexmedetomidine or dezocine combined with dexmedetomidine being applied in the laparoscopic operation are more easily associated with incidence of respiratory depression during recovery period of anesthesia.
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Respiratory depression is a common adverse effect of opioids .Currently, the mechanisms and manage-ment of opioid-induced respiratory depression ( OIRD) are one of the research foci .OIRD arises from stimulation ofμ-opioid receptors in the pre-Botzinger complex and the Kolliker-Fuse neurons .Adenylyl cyclase , calcium chan-nels, and G-protein-gated inwardly rectifying potassium (GIRK) channels may be the key cellular signaling mecha-nisms of OIRD .
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Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.
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Anesthesia, General , Deep Sedation , Hemostasis , Insufflation , Pneumoperitoneum , Respiratory Insufficiency , Stomach NeoplasmsABSTRACT
Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.
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Anesthesia, General , Deep Sedation , Hemostasis , Insufflation , Pneumoperitoneum , Respiratory Insufficiency , Stomach NeoplasmsABSTRACT
A tese desenvolvida neste estudo é que a depressão respiratória em pacientes queimados que utilizam opiódes como terapeutica farmacológica da dor, pode ser prevenida por meio de ações de enfermagem que identifiquem os fatores predisponentes para a depressão respiratória, que considerem na rotina de aprazamento da terapeutica farmacológica da dor, as características farmacológicas dos medicamentos, para evitar interações medicamentosas e que monitorem adequadamente o paciente queimado para identificar precocemente sinais de depressão respiratória. Para tanto, este estudo teve como objetivo desenvolver barreiras de segurança com foco em ações de enfermagem, para prevenção de depressão respiratória em pacientes queimados em uso de opióides. Trata-se de um estudo restrospectivo, em que foram analisados 272 prontuários de pacientes queimados internados em um Centro de Tratamento de Queimados (CTQ), de um hospital público federal de grande porte, no município do Rio de Janeiro. nos anos de 2011 a 2013. Dentre os 272 prontuários 42 atenderam os critérios de seleção da pesquisa, e destes, em 28,58% (n=12) foi identificada a ocorrência de depressão respiratória. Predominaram pacientes adultos jovens do sexo masculino. O óbito predominou no grupo com DR, assim como, queimaduras de 2º e 3º graus, e superfície corporal queimada com mediana de 50%. Os fatores predominantes para depressão respiratória foram insuficiencia renal, hipoalbuminemia e hipertensão arterial. Na terapia medicamentosa dos pacientes queimados, os analgésicos opióides são os mais utilizados, predominando o tramadol (45,49%) e a metadona (18,45%). Diazepam é o benzodiazepínico de escolha, entre os antidepressivos a imipramina é o mais utilizado, apesar de classificada como anticonvulsivantes a gabapentina, nos queimados é utilizada em dose analgésica...
The thesis developed in this study considers that the respiratory depression (RD) in burned patients using opioids as pharmacological therapeutic for pain can be prevented through nursing actions that identify its predisposing factors; also, nurses should consider the pharmacological characteristics of drugs during the routine schedule to apply pharmacological therapeutic for pain, aiming to prevent drug interactions; and adequately they should monitor the burned patient to identify early signs of respiratory depression. Therefore, this study had as general objective to develop safety barriers with a focus on nursing actions to prevent respiratory depression in burned patients in use of opioids; those barriers were related to the pharmacology of opioids, to the predisposing factors for respiratory depression by opioid, and to the monitoring of respiratory depression. This is a retrospective study that analyzed 272 medical records of burned patients admitted into a Burn Treatment Center (BTC) of large federal public hospital in the city of Rio de Janeiro, Brazil, from 2011 to 2013. Among those records, 42 records met the selection criteria of this research; and the occurrence of respiratory depression was identified in 28.58% (n=12) of them. Young adult male patients were prevalent. The death predominated in the group with RD, as well as, in the group with burns of 2nd and 3rd degrees and about 50% burned body surface. The prevalent factors for respiratory depression were renal failure, hypoalbuminemia, and high blood pressure. In drug therapy of burn patients, opioid analgesics are the most used, predominantly tramadol (45.49%) and methadone (18.45%). Diazepam is the chosen benzodiazepine; and among antidepressants, imipramine is the most used, although gabapentin is classified as anticonvulsant; in burned patients, it is used in analgesic dose...
Subject(s)
Humans , Male , Young Adult , Analgesics, Opioid , Burns , Respiratory Insufficiency/nursing , Nursing , Nursing Care , Respiratory Insufficiency , Brazil , Cohort Studies , Nursing Methodology Research , Retrospective StudiesABSTRACT
Objective To investigate the effect of nalmefene on sufentanil and propofol anesthesia for abortion and its impact on BIS. Methods One hundred and twenty patients undergoing abortion patients were randomly divided into group A, B, C, and D (n = 30 each). Patients in group A and B received 0.2 μg/kg or 0.3 μg/kg sufentanil, respectively, followed with 1.5 mg/kg propofol for induction of anesthesia post-pretreatment with 0.2 μg/kg nalmefene. Patients in group C and D received induction of anesthesia as patients in group A and B. According to the BIS and fluctuation of hemodynamic , the amount of propofol was adjusted. If necessary, additional single intravenous injection of 0.5 mg/kg propofol. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and respiratory rate (RR) in patient before injection (T1), the eyelash reflex (T2), dilatation (T3), curettage (T4) and surgery awake (T5) were detected. The additional amount of propofol , operation time , recovery time of surgery , the steward score of orientation recovery after 1min of surgery , body movement reaction , cough , respiratory depression , postoperative visual analog digital score (VAS) 15 min later were also recorded in each group. Results Compared with group A, propofol could reduce the intraoperative body movement reaction rate , with lower postoperative VAS in group B and group D (P 0.05). The rapid recovery, surgery within 1 min orientation recovery were higher in group B, C, D compared with group A (P <0.05). However, orientation recovery score in group D was higher than that in group B (P < 0.05); The respiratory depression and choking were higher in group A and B than those in group C , D (P < 0.05, respectively). Conclusion The doses of 0.2 μg/kg nalmefene can effectively antagonize the respiratory depression , delay recovery and other adverse reactions in painless which induced by sufentanil , and the dose of nalmefene in this study failed to enhance the effect of analgesic and change the BIS values.
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Patient-controlled analgesia (PCA) provides excellent pain control and high stability, thereby minimizing the incidence of adverse effects. However, one of our patients experienced respiratory depression and hypotension within 30 minutes of initiation of PCA therapy. We discovered that machine malfunction caused continuous activation of the PCA button, resulting in a drug overdose. The PCA machine was sent to the manufacturer, who found an electrical short in the PCA button. All PCA units of the same make and model were immediately removed from hospitals and replaced with redesigned units without defects in the PCA button. We have used the improved machines without any problems. The purpose of this report is to raise awareness of this type of malfunction in PCA units in order to help prevent adverse events in the future.
Subject(s)
Humans , Analgesia, Patient-Controlled , Drug Overdose , Hypotension , Incidence , Passive Cutaneous Anaphylaxis , Respiratory InsufficiencyABSTRACT
Los efectos adversos de los opioides son el resultado de interacciones con sus receptores a nivel cerebral. Cuando se administran por vía intratecal se ha descrito depresión respiratoria, aunque con menor frecuencia que en uso endovenoso. Objetivo: describir la ocurrencia de efectos adversos en pacientes llevados a cirugía en el Hospital de San José de Bogotá D.C. que recibieron fentanyl intratecal como adición a bupivacaína hiperbárica. Materiales y métodos: estudio descriptivo de una cohorte de pacientes llevados a cirugía en el Hospital de San José entre 1º de octubre de 2007 y 30 de septiembre de 2009, que recibieron anestesia subaracnoidea aplicando fentanyl intratecal y bupivacaína hiperbárica. Se incluyeron los pacientes de 18 a 65 años, las no gestantes y aquellos sin conversión a anestesia general. Resultados: se estudiaron 313 pacientes, 39,9% mujeres con edad promedio de 42 años (DE:12,7), clasificación ASA distribuida en ASA I, 60,7%; ASA II, 33,3%; ASA III, 5,7% y ASA IV, 0,3%. Los efectos adversos más comunes fueron náuseas 8,6% (n:27), prurito 6,7%(n:21), vómito 2,2% (n:7) y bradicardia 2,2% (n:7). La depresión respiratoria se presentó en 1,3% (n:4). Conclusiones: la frecuencia de depresión respiratoria que reportamos se encuentra en el rango de la literatura; sin embargo, hay que considerar que no existe consenso en la manera como se mide. Los demás eventos adversos fueron menos que los reportados.
Adverse effects of opioids result of their interactions with opioid brain receptors. Intrathecal administration of fentanyl may induce respiratory depression but less frequently than when intravenously administered. Objective: to describe the frequency of adverse side effects in surgical patients at Hospital de San José who received intrathecal fentanyl plus hyperbaric bupivacaine. Materials and Methods: descriptive study of a cohort of patients who underwent surgery at Hospital de San José between October 1 2007 and September 30 2009, who received intratecal fentanyl plus hyperbaric bupivacaine. Patients aged 18 to 65 years, nonpregnant women and those who were not converted into general anesthesia were included. Results: 313 patients were studied, 39.9% women with mean age 42 years (SD: 12.7), classified as: ASA I 60.7%; ASA II, 33.3%; ASA III, 5.7% and ASA IV, 0.3%. The most common adverse side effects were, nausea 8.6% (n: 27), pruritus 6.7% (n: 21), vomiting 2.2% (n: 7) and bradycardia 2.2% (n: 7). Respiratory depression presented in 1.3% (n: 4). Conclusions: our report of the frequency of respiratory depression is within that described in literature; however, it must be considered that the measuring methods were not consistent. Other adverse events were lower than those reported.
Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Young Adult , Fentanyl/adverse effects , Anesthesia/adverse effects , Apnea , Pruritus , Respiratory Insufficiency , Vomiting , Nausea , Analgesics, Opioid , Bupivacaine/adverse effectsABSTRACT
Objective: To assess the clinical effect of modified Mapleson D breathing system in intravenous anesthesia for minor surgical procedures. Methods: A total of 112 patients (ASA I-II) scheduled for minor outpatient surgery were randomly divided into two groups, with 56 in each group. Patients in Group A inhaled oxygen using common face mask, and were transferred to artificial ventilation by emergency ventilator when respiratory depression occurred; those in Group B were subjected to modified Mapleson D breathing system, and were transferred to artificial ventilation using the present breathing system when respiratory depression occurred. The respiratory rate (RR), oxygen saturation (SpO 2), Partial end-tidal CO2 pressure (PETCO 2), occurrence (T1) and rectification time (T2) of respiratory depression were all recorded in the two groups. Results: The incidence of respiratory depression in Group B was lower than that in Group A; moreover, Group B also had a higher incidence of hyoxemia and shorter rectification time compared with Group A. Conclusion: Compared with conventional face mask, our modified Mapleson D breathing system is easy and convenient to use, and it leads to lower incidence and quick rectification of respiratory depression, showing a potential in the airway management of patients undergoing minor intravenous anesthesia.
ABSTRACT
Buprenorphine is a semisynthetic opioid derived from thebaine. It has been shown to nteract in vivo and in vitro with multiple opioid receptors with slow receptor binding kinetics. It can act as an agonist and/or antagonist when interacting with different classes of opioid receptors, which contributes to the distinctive pharmacological feature of buprenorphine. This review summarizes the recent research data on the pharmacology of buprenorphine, aiming to accurately understand the efficacy and safety of its clinical use.
ABSTRACT
OBJECTIVE:To test the efficacy and safety of PhilVent, a pressure limited, time cycled, Philippine ventilator through animal and clinical studies. METHODS AND RESULTS: Animal study: Term, newborn piglets (N=8) were intubated and alternately cycled to the PhilVent or to a pressure limited, time cycled, commercial ventilator (Sechrist) at peak inspiratory pressures of 10, 13 and 15 cm H20 and rates of 15, 20, 25 breaths per min and constant FiO2 (0.40) and positive end expiratory pressure (+4). Blood gases and adverse events (pneumothorax, sudden deterioration, death) were monitored. Results show no significant difference in blood gases on either machine at the various ventilator settings. No adverse events occurred. Clinical study: Prospective, randomized, controlled trial of 90 preterm infants with respiratory distress, randomized either to PhilVent (N=45) or Sechrist (N=45). Ventilator settings were adjusted to achieve predetermined range of blood gases. Arterial blood gases and any adverse events e.g., pneumothorax, pulmonary hemorrhage were monitored. There were no clinically significant differences in the ventilator settings or blood gases of the infants on the PhilVent or Sechrist. No increase in adverse events were noted with the PhilVent. CONCLUSION: In animal and clinical studies, the efficacy and safety of the PhilVent were comparable to the Sechrist. The PhilVent is an effective, alternative ventilator for the treatment of respiratory insufficiency in newborn infants.