Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 268
Filter
1.
Article in English | WPRIM | ID: wpr-762272

ABSTRACT

BACKGROUND: New complications associated with sugammadex have been increased since its widespread use. We report a case of an 80-year-old male who experienced profound bradycardia and sustained hypotension after administration of sugammadex. CASE: Following administration of 200 mg sugammadex after laparoscopic cholecystectomy, sudden bradycardia (29 beats/min) developed for 10 seconds and his train-of-four (TOF) ratio remained at 0.2 for 5 min. An additional 200 mg sugammadex was administered and profound bradycardia (21–30 beats/min) and hypotension (60/40 mmHg) developed. Atropine at 0.5 mg was administered, but the effect lasted only 30 s. Profound bradycardia occurred four more times at 30 s intervals, and ephedrine and phenylephrine were injected intermittently to increase the patient's heart rate and blood pressure. The TOF ratio became 0.9 about 10 min after administration of additional sugammadex. CONCLUSIONS: Awareness must be heightened regarding the possibility of sugammadexinduced bradycardia and hypotension, and more attention should be paid to patients with slow recovery times following muscle relaxation, despite the use of sugammadex.


Subject(s)
Aged, 80 and over , Atropine , Blood Pressure , Bradycardia , Cholecystectomy, Laparoscopic , Ephedrine , Heart Rate , Humans , Hypotension , Male , Muscle Relaxation , Neuromuscular Blockade , Phenylephrine , Postoperative Complications
2.
Article in English | WPRIM | ID: wpr-759516

ABSTRACT

BACKGROUND: Previous studies have shown that sequential intrathecal injection of fentanyl and hyperbaric bupivacaine for cesarean section (CS) anesthesia provides a superior anesthetic effect than use of bupivacaine alone, and prolongs postoperative analgesia. Herein, we investigated whether rapid intrathecal injection of fentanyl followed by slow injection of hyperbaric bupivacaine affects the duration of postoperative analgesia, the effectiveness of anesthesia, and hemodynamic status. METHODS: Fifty-six parturients with American Society of Anesthesiologists physical status I or II, aged 18–40 years, and scheduled to undergo elective CS were randomly assigned to 2 groups of 28 patients each. The normal sequential group received sequential intrathecal injections of fentanyl and hyperbaric bupivacaine at the same rate, each with a 5 ml syringe. The rapid sequential group received a rapid intrathecal injection of fentanyl with an insulin syringe, followed by a slow injection of hyperbaric bupivacaine with a 5 ml syringe. The onset of sensory block, the timing of the first rescue analgesia, the doses of rescue analgesics, the degree of postoperative pain, the onset and duration of motor block, the incidence and duration of hypotension, and spinal anesthesia-related complications were recorded. RESULTS: While both approaches had comparable spinal anesthesia-related complications, incidence and duration of hypotension, and doses of ephedrine, the rapid sequential group exhibited a more rapid onset of sensory block, a higher sensory level, and more prolonged postoperative analgesia. CONCLUSIONS: Rapid sequential injection of fentanyl and hyperbaric bupivacaine produced superior anesthesia and more prolonged postoperative analgesia than sequential injections of both at the same rate.


Subject(s)
Analgesia , Analgesics , Anesthesia , Anesthesia, Spinal , Anesthetics , Bupivacaine , Cesarean Section , Ephedrine , Female , Fentanyl , Hemodynamics , Humans , Hypotension , Incidence , Injections, Spinal , Insulin , Pain, Postoperative , Pregnancy , Syringes
3.
Rev. bras. anestesiol ; 68(1): 69-74, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-897807

ABSTRACT

Abstract Introduction Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. Material and method The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24 h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL-1 at 0, 2, 4, 6, 8, 10 and 12th hours. Results Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium, or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512 mcg.mL-1 concentration and significantly decreased bacterial growth rate. Conclusion Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections.


Resumo Introdução Propofol e efedrina são fármacos comumente usados durante a manutenção da anestesia, o primeiro como agente hipnótico e o segundo como vasopressor. A adição de propofol à efedrina ou a administração de efedrina antes da injeção de propofol é útil para diminuir ou prevenir alterações hemodinâmicas e dor vascular relacionadas ao propofol. Este estudo in vitro avaliou o efeito antibacteriano de efedrina, isolada ou em combinação com propofol, em patógenos comuns implicados em infecção hospitalar. Material e método O estudo foi feito em duas etapas. Na primeira, a concentração inibitória mínima (CIM) de propofol e de efedrina isolada e em combinação foi calculada para Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa e um isolado clínico de Acinetobacter spp às 0, 6, 12 e 24 horas, com o método de microdiluição. Na segunda etapa, o mesmo fármaco e sua combinação foram usados para determinar seus efeitos no crescimento bacteriano. As soluções bacterianas foram preparadas em soro fisiológico a 0,9% em 0,5 McFarland e diluídas a uma concentração de 1/100. Os números das colônias foram medidos como ufc.mL-1 às 0, 2, 4, 6, 8, 10 e 12 horas. Resultados Efedrina isolada ou em combinação com propofol não apresentou efeito antimicrobiano sobre E. coli, E. faecium ou P. aeruginosa, um resultado semelhante ao de propofol. Porém, efedrina isolada e em combinação com propofol apresentou efeito antimicrobiano sobre Staphylococcus aureus e Acinetobacter spp, em concentração de 512 mcg.mL-1, e redução significativa da taxa de crescimento bacteriano. Conclusão Efedrina tem atividade antimicrobiana em S. aureus e Acinetobacter spp, patógenos frequentemente identificados como causa de infecções nosocomiais.


Subject(s)
Pseudomonas aeruginosa/drug effects , Staphylococcus aureus/drug effects , Vasoconstrictor Agents/pharmacology , Acinetobacter/drug effects , Propofol/pharmacology , Enterococcus faecium/drug effects , Ephedrine/pharmacology , Hypnotics and Sedatives/pharmacology , Vasoconstrictor Agents/administration & dosage , Microbial Sensitivity Tests , Propofol/administration & dosage , Ephedrine/administration & dosage , Escherichia coli/drug effects , Hypnotics and Sedatives/administration & dosage , Anti-Bacterial Agents
4.
Article in English | WPRIM | ID: wpr-759489

ABSTRACT

BACKGROUND: Propofol is used for supraglottic airway device insertion, often with the i-gel. However, the propofol requirement for i-gel insertion has not been explored in paralyzed patients. This study was performed to explore hemodynamic changes and sedation level with different propofol doses in healthy paralyzed patients when the i-gel was inserted. METHODS: A total of 141 patients undergoing a urologic operation were randomly allocated to three groups depending on the propofol dose (1.5, 2, and 2.5 mg/kg; Groups P1.5, P2, and P2.5, respectively). After patients had been administered each propofol dose and rocuronium, the i-gel was inserted and changes in hemodynamic parameters and bispectral index were evaluated. RESULTS: Group P2 showed a lower incidence of complications (17%) such as hemodynamic instability and inadequate sedation than Group P1.5 (55.3%, P < 0.001) or Group P2.5 (40.4%, P = 0.012). The incidence and dose of additional propofol increased in Group P1.5 (51%, median [range]; 20 [0–50]) compared with those in the other groups (0%, 0 [0–0] in Group P2 and 8.5%, 0 [0–50] in Group P2.5, all P < 0.001), and the incidence and dose of additional ephedrine were significantly higher in Group P2.5 (31.9%; 0 [0–20]) than in Group P1.5 (10.6%, P = 0.012; 0 [0–5], P = 0.007, respectively). CONCLUSIONS: For the stable maintenance of hemodynamic parameters and proper sedation level during i-gel insertion, 2 mg/kg propofol has an advantage over 1.5 mg/kg or 2.5 mg/kg propofol in healthy paralyzed patients.


Subject(s)
Ephedrine , Hemodynamics , Humans , Incidence , Propofol
5.
Article in Chinese | WPRIM | ID: wpr-775324

ABSTRACT

Based on the nanofiltration mass transfer model, the enhanced separation behavior of ephedrine in organic solution was studied. In the experiment, the sensitive region of ethanol concentration and pH on the rejection of ephedrine was screened out by Box-Behnken central composite experiment design. Furthermore, to analyze the separation regularity of ephedrine and organic solution, the correlation between mass transfer coefficient and concentration of organic solvent was fitted with the changed organic solution by nanofiltration mass transfer mathematical model. Experiments showed the enhanced separation behavior, the decrease in the mass transfer coefficient while the increase in ethanol concentration from 20% to 40%, MWCO at 450 and pH 6.0. Under the same conditions, the enhanced separation behavior was appeared as the solvent changed into methanol and acetonitrile, the enhanced effect was positively correlated with the concentration of the three common organic solvents, and the effect order was acetonitrile>ethanol>methanol. This study took ephedrine as an example, and explored the mechanism of nanofiltration separation in the environment of organic solution, so as to provide references for nanofiltration separation for heat-sensitive traditional Chinese medicine of alkaloid.


Subject(s)
Ephedrine , Chemistry , Ethanol , Methanol , Molecular Weight , Solvents
6.
Rev. chil. obstet. ginecol. (En línea) ; 82(3): 298-303, jun. 2017.
Article in Spanish | LILACS | ID: biblio-899908

ABSTRACT

Afortunadamente, las arritmias malignas en un embarazo de curso normal son raras y la mayoría de las quejas por palpitaciones se deben a arritmias benignas. Dentro de ellas las taquicardias supraventriculares paroxísticas (TSP) se describen en la literatura con relativa frecuencia y pueden ocurrir sólo, o incluso exacerbarse, durante el embarazo, debido a un efecto pro-arritmogénico de la gestación. Así en pacientes gestantes la carga hemodinámica y los cambios del tono autonómico facilitan la aparición de arritmias, más frecuentemente en mujeres con limitada reserva cardíaca y pueden llegar a comprometer la supervivencia del feto y de la madre debido a las consecuencias hemodinámicas o los efectos adversos de los tratamientos farmacológicos y no farmacológicos. Presentamos el caso de una gestante a término que durante el trabajo de parto, posterior a la administración de analgesia epidural con ropivacaína y fentanilo, sufre un cuadro de hipotensión materna y bradicardia materna/fetal mantenida que requiere ser medicada con efedrina y atropina intravenosa. Inmediatamente presenta palpitaciones y dolor torácico sostenido, diagnosticándosele TSP que cede con la administración de adenosina intravenosa, no repitiendo nuevos episodios durante el trabajo de parto ni puerperio. En nuestro caso la arritmia ocurrió como efecto adverso de la efedrina y administradas para recuperar el cuadro de hipotensión causada por la analgesia epidural.


Subject(s)
Humans , Female , Pregnancy , Adult , Tachycardia, Supraventricular/chemically induced , Tachycardia, Supraventricular/drug therapy , Adenosine/therapeutic use , Obstetric Labor Complications/chemically induced , Anti-Arrhythmia Agents/therapeutic use , Ephedrine/adverse effects , Obstetric Labor Complications/drug therapy
7.
Pakistan Journal of Pharmaceutical Sciences. 2017; 30 (4): 1305-1308
in English | IMEMR | ID: emr-189697

ABSTRACT

In the present research work novel ephedrine based thiourea derivative, 3-benzothioyl-l-[3-hydroxy-3-phenyl -3-propyl]-l-methylthiourea 4is synthesized and then characterized elemental analyzed via various techniques i.e., Proton NMR, carbon13 NMR and fatherly confirmed via X-ray crystallography. Compound 4 was then screened for their possible antioxidant and cytotoxic potentials. Benzoyl chloride was treated with an equimolar potassium thiocyanate in acetone to achieve benzoyl isothiocyantes. It was then treated with an equimolar [1R, 2*S]-[-]-Ephedrine to obtain the 3-benzothioyl-l-[3-hydroxy-3-phenyl-3-propyl]-l-methyl thiourea4. It was then screened for antioxidant and cytotoxic potentials. The compound 4 showed excellent antioxidant activity almost comparable to ascorbic acid [standard] and have significant cytotoxic activity with LC[50] value 05+/-0.58 ppm


Subject(s)
Antioxidants , Ephedrine , Thiourea/analogs & derivatives
8.
Article in English | WPRIM | ID: wpr-189579

ABSTRACT

Palonosetron is a 5-hydroxytryptamine-3 (5-HT-3) receptor antagonist used for preventing postoperative nausea and vomiting. Compared with ondansetron and granisetron, it is a better drug because of prolonged action and minimal side effects. Some adverse effects of palonosetron have been reported. In this report, we describe a 37-year-old male who developed severe hypersensitivity reactions to palonosetron during surgery for kidney donation. His medical history was unremarkable, except for inguinal hernia with herniorrhaphy 8 years ago. The surgery was uneventful until 2 hours 20 minutes. After palonosetron injection, his blood pressure dropped to 80/50 mm Hg, and facial edema, rash, conjunctival swelling, and wheezing developed. The patient was resuscitated by administration of ephedrine, hydrocortisone, and peniramine. Following the surgery, the patient was monitored for 3 days, and there were no subsequent anaphylactic reactions or other complications. The skin test on postoperative day 54 was positive for hypersensitivity to palonosetron. Although palonosetron is known for its safety, other hypersensitivity events have been reported. Ondansetron is another widely used 5-HT-3 antagonist, which has been reported to cause anaphylaxis. Therefore, clinicians should be aware of the possibility of patients experiencing severe adverse reactions to palonosetron.


Subject(s)
Adult , Anaphylaxis , Anesthesia, General , Blood Pressure , Drug Hypersensitivity , Edema , Ephedrine , Exanthema , Granisetron , Hernia, Inguinal , Herniorrhaphy , Humans , Hydrocortisone , Hypersensitivity , Kidney , Male , Ondansetron , Postoperative Nausea and Vomiting , Respiratory Sounds , Skin Tests
9.
Article in Korean | WPRIM | ID: wpr-28781

ABSTRACT

Spinal anesthesia is widely used for parturients undergoing scheduled elective caesarean section. Hypotension associated with spinal anesthesia is a major concern in obstetrics. Preventive methods for post-spinal hypotension include intravenous fluid preloading, bolus or continuous injection of vasopressors. Intravenous fluid preloading reduces the incidence and severity of maternal hypotension during spinal anesthesia administered for cesarean section. Although fluid preloading prevents maternal hypotension, it is not advisable to delay spinal anesthesia for preloading a fixed volume of intravenous fluid. Ephedrine, the drug of choice to prevent maternal hypotension during spinal anesthesia for caesarean delivery, acts by maintaining the uteroplacental blood flow. Phenylephrine is also effective in reducing maternal hypotension during this procedure. Both the vasopressors are acceptable for preventing hypotension. However, in the absence of maternal bradycardia, phenylephrine is the preferred drug for the management of hypotension during regional anesthesia for caesarean section, because of its improved fetal acid-base status.


Subject(s)
Anesthesia, Conduction , Anesthesia, Spinal , Bradycardia , Cesarean Section , Ephedrine , Female , Hypotension , Incidence , Obstetrics , Phenylephrine , Pregnancy
10.
The Ewha Medical Journal ; : 143-148, 2017.
Article in Korean | WPRIM | ID: wpr-18837

ABSTRACT

OBJECTIVES: Liver transplantation (LT) is the only treatment for end stage of liver failure. In Korea, annually it has been performed 1,300 cases. Most of LTs are performed in large volumes centers. More than half of centers performing LT in Korea are low volume hospital and started a LT program recently. We present our four-year experiences and outcomes of anesthesia for LT since 2013. METHODS: Anesthetic and surgical outcomes of 49 consecutive patients who received LT (living donor LT, 21 cases; deceased donor LT, 28 cases) between April 2013 and April 2017 were analyzed retrospectively. RESULTS: All patients were adult, with the mean age of 53.5±9.2 years. The most common cause of original liver diseases was hepatitis B virus-related liver cirrhosis (40.8%). The mean MELD (Model for End-stage Liver Disease) score was 18.8±10.7. Postreperfusion syndrome was observed in 34.7%, which were all controlled by calcium, norepinephrine, ephedrine and epinephrine. The mean postoperative intensive care unit stay of deceased donor LT recipients (13.6±9.0 days) was significantly longer than that of living donor LT recipients (8.0±3.3 days). There was no intraoperative mortality in patients receiving LT. Thirty-day post-transplant survival rate was 93.8% and 3-year survival rate was 88.6 %. The most common postoperative complication was pneumonia. CONCLUSION: We have started LT successfully with multidisciplinary team's steady effort. Adaptation and setting up LT protocol, adequate equipment, proper training at established transplant centers are essential to begin a successful LT program.


Subject(s)
Adult , Anesthesia , Calcium , Ephedrine , Epinephrine , Female , Hepatitis B , Hospitals, Low-Volume , Humans , Intensive Care Units , Korea , Liver Cirrhosis , Liver Diseases , Liver Failure , Liver Transplantation , Liver , Living Donors , Mortality , Norepinephrine , Pneumonia , Postoperative Complications , Retrospective Studies , Survival Rate , Tissue Donors
11.
Braz. j. pharm. sci ; 52(1): 59-68, Jan.-Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-789072

ABSTRACT

ABSTRACT The association of p-synephrine, ephedrine, salicin, and caffeine in dietary supplements and weight loss products is very common worldwide, even though ephedrine has been prohibited in many countries. The aim of this study was to evaluate a 28-day oral exposure toxicity profile of p-synephrine, ephedrine, salicin, and caffeine mixture (10:4:6:80 w/w respectively) in male and female Wistar rats. Body weight and signs of toxicity, morbidity, and mortality were observed daily. After 28 days, animals were euthanized and blood collected for hematological, biochemical, and oxidative stress evaluation. No clinical signs of toxicity, significant weight loss or deaths occurred, nor were there any significant alterations in hematological parameters. Biochemical and oxidative stress biomarkers showed lipid peroxidation, and hepatic and renal damage (p < 0.05; ANOVA/Bonferroni) in male rats (100 and 150 mg/kg) and a reduction (p < 0.05; ANOVA/Bonferroni) in glutathione (GSH) levels in all male groups. Female groups displayed no indications of oxidative stress or biochemical alterations. The different toxicity profile displayed by male and female rats suggests a hormonal influence on mixture effects. Results demonstrated that the tested mixture can alter oxidative status and promote renal and hepatic damages.


RESUMO A associação de p-sinefrina, efedrina, salicina, e cafeína em suplementos alimentares e produtos para perda de peso é muito utilizada em todo o mundo, embora a efedrina tenha sido proibida em muitos países. O objetivo deste estudo foi avaliar o perfil de toxicidade à exposição oral de 28 dias à associação de p-sinefrina, efedrina, salicina e cafeína (na proporção de 10:4:6:80 m/m respectivamente) em ratos Wistar machos e fêmeas. Diariamente, os animais foram observados quanto ao peso corporal, sinais de toxicidade, morbidade e mortalidade. Após 28 dias, os animais foram sacrificados e o sangue coletado para avaliações hematológicas, bioquímicas e de estresse oxidativo. Não se observaram sinais clínicos de toxicidade, tampouco perda significativa de peso, mortes, ou quaisquer alterações significativas nos parâmetros hematológicos. Biomarcadores do estresse oxidativo e bioquímicos mostraram peroxidação lipídica, danos renais e hepáticos (p < 0,05; ANOVA/Bonferroni) em ratos machos (100 e 150 mg/kg) e a redução (p < 0,05; ANOVA/Bonferroni) nos níveis de glutationa reduzida (GSH) em todos os grupos de machos tratados. Nas fêmeas, não houve indícios de estresse oxidativo, nem alterações bioquímicas. O diferente perfil de toxicidade entre os gêneros sugere influência hormonal nos efeitos de mistura administrada. A associação testada pode alterar o estado oxidativo e promover danos renais e hepáticos.


Subject(s)
Rats , Biomarkers/analysis , Caffeine/toxicity , Ephedrine/toxicity , Oxidative Stress , Salicinum/toxicity , Synephrine/toxicity , Dietary Supplements/analysis , Weight Loss/drug effects
12.
Article in English | WPRIM | ID: wpr-229063

ABSTRACT

BACKGROUND: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens. METHODS: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted according to height and weight, and in the other, the dose was adjusted according to height only. RESULTS: Sixty women with a singleton pregnancy were included. Of the factors that could affect dose and blood pressure, including age, weight, height, and dose, only height differed between the groups. Mean heart rate was similar between the groups. Hypotension was significantly more frequent with dosage based on height alone than with two-factor dose calculation (56.7% vs. 26.7%; P = 0.018). CONCLUSIONS: Adjusting the dose of isobaric bupivacaine to a patient's height and weight provides adequate anesthesia for elective cesarean section and is associated with a decreased incidence and severity of maternal hypotension and less use of ephedrine.


Subject(s)
Advisory Committees , Anesthesia , Anesthesia, Spinal , Anesthetics, Local , Blood Pressure , Body Height , Body Weight , Bupivacaine , Cesarean Section , Emergencies , Ephedrine , Ethics, Institutional , Female , Heart Rate , Humans , Hypotension , Incidence , Pregnancy
13.
Article in English | WPRIM | ID: wpr-157506

ABSTRACT

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.


Subject(s)
Acetylcholine , Amitriptyline , Antipsychotic Agents , Cholinergic Antagonists , Compliance , Deamino Arginine Vasopressin , Dopamine , Ephedrine , Epinephrine , Follow-Up Studies , Humans , Mass Screening , Neural Pathways , Neurotransmitter Agents , Schizophrenia , Serotonin , Trihexyphenidyl , Urinary Incontinence , Paliperidone Palmitate
14.
Article in Korean | WPRIM | ID: wpr-177912

ABSTRACT

BACKGROUND: During cesarean delivery, hypotension is a frequently occurring adverse effect following spinal anesthesia. Our hypothesis was that hypotension could be avoided or delayed with a lateral decubitus position for 10 minutes after intrathecal injection, by reducing the detrimental effects of the aortocaval compression. METHODS: Spinal anesthesia was performed in the lateral decubitus position with 8 mg of 0.5% hyperbaric bupivacaine and 15 µg of fentanyl. Forty-one patients undergoing elective cesarean delivery were randomly assigned to one of two groups. In the experimental group, patients were maintained in the lateral position for 10 minutes following intrathecal injection (group Decubitus). In the control group, patients were repositioned to supine immediately after the injection (group Supine). Incidence of hypotension, the required dose of ephedrine, and characteristics of the sensory blockade, were subsequently investigated. RESULTS: The incidence of hypotension, the incidence of nausea, and total amount of ephedrine, were not statistically different between the two groups. In group Decubitus, the onset of hypotension was delayed significantly (5.6 ± 1.7 min vs. 13.8 ± 1.7 min, P < 0.001), and the maximal blockade level was more cephalad (T3 [T1–T4] vs. T4 [T3–T5], P < 0.001) when compared to that of group Supine. Apgar scores were comparable in both groups. CONCLUSIONS: Maintaining the lateral position for 10 min following intrathecal injection during cesarean delivery did not influence the incidence of maternal hypotension. However, it caused delayed onset of hypotension and higher cephalad spread of sensory block.


Subject(s)
Anesthesia, Spinal , Bupivacaine , Ephedrine , Fentanyl , Humans , Hypotension , Incidence , Injections, Spinal , Nausea
15.
Article in English | WPRIM | ID: wpr-52555

ABSTRACT

BACKGROUND: 5-Hydroxytryptamine3 (5-HT3) receptor antagonists have been reported to attenuate spinal anesthesia-induced hemodynamic changes. This study was conducted to determine whether the second generation 5-HT3, antagonist palonosetron attenuates hypotension and bradycardia during spinal anesthesia. METHODS: Sixty adult patients scheduled for lower limb surgery were enrolled in this study. Patients were randomly assigned to receive either normal saline (Control group, N = 30) or palonosetron (0.075 mg, i.v.) (Palonosetron group, N = 30) prior to spinal anesthesia. Hemodynamic variables were recorded during anesthesia. RESULTS: The mean blood pressure (MBP) were 89.2 ± 11.4 mmHg in the control group and 87.6 ± 12.1 mmHg in the palonosetron group at 10 min after intrathecal injection (P = 0.609). The median blocked levels of the control group and the palonosetron group were T10 (interquartile range, 9-10) and T10 (8-10) at 20 min after intrathecal injection (P = 0.939). Requirements for ephedrine, phenylephrine, and atropine were similar (P = 0.652, 0.533 and 0.417, respectively). The incidences of hypotension (40% vs. 41%) and bradycardia (7% vs. 17%) were comparable (P = 0.562, P = 0.198, respectively) between the control and the palonosetron group. There were no significances in the changes of systolic blood pressure, diastolic blood pressure, MBP and heart rate by the group (P = 0.632, 0.287, 0.556, 0.733, respectively). CONCLUSIONS: Intravenous palonosetron (0.075 mg) prior to spinal anesthesia might not attenuate spinal anesthesia-induced hypotension during low level of neuroaxial block for lower limb surgery.


Subject(s)
Adult , Anesthesia , Anesthesia, Spinal , Atropine , Blood Pressure , Bradycardia , Ephedrine , Heart Rate , Hemodynamics , Humans , Hypotension , Incidence , Injections, Spinal , Lower Extremity , Orthopedics , Phenylephrine
16.
Article in English | WPRIM | ID: wpr-149865

ABSTRACT

We describe a case involving a 69-year-old woman who developed anaphylatic shock caused by a clinical dose of sugammadex (2 mg/kg, 100 mg intravenously) 5 minutes after its administration. She developed redness and welts all over her body, and complained of an oropharyngeal itching sensation with dyspnea and dizziness. Her vital signs were closely monitored. She also experienced a sudden onset of hypotension (from 110/70 to 49/40 mmHg) and tachycardia (from 75 to 120 bpm). We diagnosed anaphylactic shock on the basis of these clinical manifestations. After 20 min of traditional treatment (hydration, ephedrine, cortisol, and phenylephrine), her vital signs returned to normal. No postoperative complications were evident, and the patient was discharged from the hospital. Although the prevalence of anaphylactic reactions to sugammadex is rare, physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.


Subject(s)
Aged , Anaphylaxis , Dizziness , Dyspnea , Ephedrine , Female , Humans , Hydrocortisone , Hypersensitivity , Hypotension , Postoperative Complications , Prevalence , Pruritus , Sensation , Shock , Tachycardia , Vital Signs
17.
Article in English | WPRIM | ID: wpr-73842

ABSTRACT

BACKGROUND: The old age population, including the very old aged (> or = 85 years), is rapidly increasing, and femur neck fracture from accidents is commonly seen in the elderly. Use of bone cement during bipolar hemiarthroplasty can cause bone cement implantation syndrome. METHODS: This study was prospectively conducted on the elderly who were scheduled to undergo elective cemented bipolar hemiarthroplasty under spinal anesthesia. Patients were divided into 2 groups: the old age (65-84 years) and very old age groups (> or = 85 years). Hemodynamic parameters were recorded at the following time points: the start of the operation, femoral reaming, cement insertion, every 2 minutes after cement insertion for 10 minutes, femoral joint reduction, and the end of operation. When hypotension occurred, ephedrine was given. RESULTS: Sixty-five patients in the old age group and 32 patients in the very old age group were enrolled. Mean ages were 78.9 and 89.4 years, respectively, in the old age and very old age groups. The very old age group showed constantly decreased levels of cardiac index and stroke volume from cementing until the end of the operation compared to the old age group. To maintain hemodynamic stability after cement insertion, the requirement of ephedrine was higher in the very old age group than in the old age group (13.52 +/- 7.76 vs 8.65 +/- 6.38 mg, P = 0.001). CONCLUSIONS: Bone cement implantation during bipolar hemiarthroplasty may cause more prominent hemodynamic changes in very elderly patients. Careful hemodynamic monitoring and management are warranted in very elderly patients undergoing cemented bipolar hemiarthroplasty.


Subject(s)
Aged , Anesthesia, Spinal , Bone Cements , Ephedrine , Femoral Neck Fractures , Hemiarthroplasty , Hemodynamics , Humans , Hypotension , Joints , Prospective Studies , Stroke Volume
18.
Article in English | WPRIM | ID: wpr-173270

ABSTRACT

BACKGROUND: The aim of this randomized, double-blind, placebo-controlled study was to evaluate dose effects of ephedrine pretreatment on the onset time and intubating conditions after cisatracurium administration. METHODS: A total of 140 adult patients were randomized into 4 groups to receive either 30 microg/kg ephedrine (Group 30, n = 35), 70 microg/kg ephedrine (Group 70, n = 35), 110 microg/kg ephedrine (Group 110, n = 35), 3 ml normal saline (Group C, n = 35) as pretreatment given 30 s before anesthetic induction. Neuromuscular block was achieved with 0.15 mg/kg cisatracurium, evaluated accelomyographically with train-of-four stimulation. An anesthesiologist blinded to patient grouping assessed the intubating conditions 1.5 min after cisatracurium administration. RESULTS: An onset time of 70 s was obtained in the ephedrine groups (Group 30: 155.4 +/- 44.7 s, Group 70: 152.6 +/- 40.3 s, Group 110: 151.2 +/- 51.6 s) compared to Group C (224.6 +/- 56.9 s) after 0.15 mg/kg of cisatracurium (P 200/100 mmHg) 1 min after tracheal intubation with no patients in other groups. CONCLUSIONS: We conclude that pre-treatment with ephedrine 70 microg/kg improved intubating conditions 1.5 min after cisatracurium administration and facilitated the onset of neuromuscular block (70 s) without adverse hemodynamic effects.


Subject(s)
Adult , Blood Pressure , Ephedrine , Heart Rate , Hemodynamics , Humans , Hypertension , Intubation , Neuromuscular Blockade
19.
Article in English | WPRIM | ID: wpr-173268

ABSTRACT

BACKGROUND: Ephedrine, unlike phenylephrine, has a dose-related propensity to depress fetal pH during spinal anesthesia during cesarean section. A low arterial umbilical cord pH has a strong association with neonatal mortality and morbidity. The purpose of this retrospective study was to investigate influences of vasopressor change on Apgar scores and adverse neonatal outcomes in cesarean section. METHODS: In obstetric anesthesia, we changed the prophylactic vasopressor from a combination of phenylephrine and ephedrine to phenylephrine alone in 2000. We evaluated the impact of vasopressor change on Apgar scores (1 and 5 min), incidence of Apgar score < 7 (1 and 5 min), neonatal seizure, continuous positive airway pressure (CPAP), intermittent positive pressure ventilation (IPPV), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), and hypoxic ischemic encephalopathy (HIE) in low-risk elective cesarean sections during a period when the combination of phenylephrine and ephedrine was used (2008-2009, two years) and the period of phenylephrine use alone (2011-2012, two years). RESULTS: There were no differences in Apgar scores (1 and 5 min), the incidence of 5 min Apgar score < 7, neonatal seizure, CPAP, IPPV, IVH, PVL, and HIE between the two time periods. However, the incidence of 1 min Apgar < 7 was decreased during the period of phenylephrine use compared with the period of phenylephrine and ephedrine use (P = 0.002). CONCLUSIONS: Conversion from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic anti-hypotensive drug during spinal anesthesia for cesarean section in low-risk pregnancy may be associated with a significant decrease in the incidence of 1 min Apgar < 7.


Subject(s)
Anesthesia, Obstetrical , Anesthesia, Spinal , Apgar Score , Cesarean Section , Continuous Positive Airway Pressure , Ephedrine , Female , Hemorrhage , Humans , Hydrogen-Ion Concentration , Hypoxia-Ischemia, Brain , Incidence , Infant , Infant Mortality , Infant, Newborn , Intermittent Positive-Pressure Ventilation , Leukomalacia, Periventricular , Phenylephrine , Pregnancy , Retrospective Studies , Seizures , Umbilical Cord
20.
Article in English | WPRIM | ID: wpr-56304

ABSTRACT

BACKGROUND: Various regimens have been studied in extension of a preexisting labor epidural for emergency cesarean section. Lumbar epidural analgesia for delivery is safe and efficient. We compared retrospectively 0.5% ropivacaine with fentanyl and 0.75% ropivacaine in extension of a preexisting labor epidural for emergency cesarean section. METHODS: We investigated medical records of 61 parturients in extension of a preexisting labor epidural for emergency cesarean section. There were two regimens which was 0.5% ropivacaine with fentanyl (group 1) and 0.75% ropivacaine (group 2). We recorded demographic data, local anesthetic dose, surgical readiness time, maximum level of sensory block, surgery time, intravenous supplementation, number of hypotension and total dose of ephedrine between two groups. RESULTS: There were no differences between the study groups in demographic data, surgical readiness time, maximum sensory block level, intravenous supplementation, incidence of hypotension and total dose of ephedrine. Local anesthetic volume was larger in group 1 than group 2, but local anesthetic doses were lower in group 1 than group 2. CONCLUSIONS: 0.5% Ropivacaine with fentanyl regimen is as fast and efficacious as 0.75% ropivacaine in extension of a preexisting labor epidural for cesarean section and reduces the requiring total local anesthetic dose.


Subject(s)
Analgesia, Epidural , Cesarean Section , Emergencies , Ephedrine , Female , Fentanyl , Hypotension , Incidence , Medical Records , Pregnancy , Retrospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL