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1.
Korean Journal of Anesthesiology ; : 12-18, 2013.
Artículo en Inglés | WPRIM | ID: wpr-82936

RESUMEN

BACKGROUND: Etomidate has a stable hemodynamic profile after induction, but hypertension and tachycardia are frequent after intubation as well as myoclonus. We compared the effects of fentanyl and remifentanil on the hemodynamic response to intubation and myoclonus during etomidate induction in elderly patients. METHODS: Ninety ASA I or II patients aged over 65 were randomly assigned to 3 groups. Group C received normal saline 10 ml (n = 30), group F and R were pretreated with fentanyl 1.0 microgram/kg (n = 30) or remifentanil 1.0 microgram/kg with continuous infusion of 0.1 microgram/kg/min (n = 30) 1 min before induction with etomidate 0.2 mg/kg. Endotracheal intubation was performed after administration of rocuronium 0.8 mg/kg. Systolic blood pressure (SBP), mean arterial pressure, diastolic blood pressure (DBP), heart rate (HR), and the incidence and intensity of myoclonus were recorded. RESULTS: After intubation, group R showed significant decreases compared with groups C and F for all of the hemodynamic variables measured. The incidences of increases in SBP and HR of more than 30% of the baseline levels, SBP of > 200 mmHg, and HR of > 120 beats/min were significantly lower in group R (0%, 10%, 0%, and 0%, respectively) compared with groups C (83%, 83%, 30%, and 13%, respectively) and F (63%, 77%, 13%, and 7%, respectively). The frequency and intensity of myoclonus were significantly decreased in both groups F and R compared with group C. CONCLUSIONS: Pretreatment with remifentanil suppressed cardiovascular reactions to endotracheal intubation more effectively than that of fentanyl during etomidate induction. Both opioids reduced the incidence of myoclonus.


Asunto(s)
Anciano , Humanos , Analgésicos Opioides , Androstanoles , Presión Arterial , Presión Sanguínea , Etomidato , Fentanilo , Frecuencia Cardíaca , Hemodinámica , Hipertensión , Incidencia , Intubación , Intubación Intratraqueal , Mioclonía , Piperidinas , Taquicardia
2.
The Korean Journal of Critical Care Medicine ; : 173-178, 2012.
Artículo en Coreano | WPRIM | ID: wpr-654895

RESUMEN

Pulmonary alveolar proteinosis (PAP) is characterized by the progressive accumulation of phospholipids and proteins within the alveolar sacs without producing an inflammatory response. Whole-lung lavage (WLL) is performed as the standard therapy for this disease because it serves to wash out the proteinaceous material from the alveoli. In this case, we performed sequential WLL using propofol-remifentanil, which is not related to hypoxic pulmonary vasoconstriction during one-lung ventilation. The patient's symptoms and radiologic findings showed improvement without the occurrence of any specific complications. Therefore, we report a case of anesthetic management of WLL performed repeatedly for a patient with recurrent PAP.


Asunto(s)
Humanos , Ventilación Unipulmonar , Fosfolípidos , Proteínas , Proteinosis Alveolar Pulmonar , Irrigación Terapéutica , Vasoconstricción
3.
Anesthesia and Pain Medicine ; : 80-86, 2012.
Artículo en Coreano | WPRIM | ID: wpr-227698

RESUMEN

BACKGROUND: Perioperative respiratory adverse events remain a major cause of postoperative morbidity and mortality during pediatric anesthesia. This multicenter study was designed to evaluate the incidence of perioperative respiratory adverse events during elective pediatric surgery and to identify the risk factors for these events. METHODS: Pediatric patients undergoing elective surgery under general anesthesia in 11 hospitals were randomly selected for this prospective, multicenter study. Preanesthetic assessments, anesthetic and surgical conditions were recorded by anesthesiologists in charge. Adverse respiratory events were registered. RESULTS: Eight hundred and twenty-three patients were included. The overall incidence of any perioperative respiratory adverse respiratory event was 15.1%. The incidences of perioperative bronchospasm, laryngospasm, coughing, desaturatioin (oxygen saturation or =2, OR 1.62. CONCLUSIONS: Multiple attempts for airway device insertion, recent URI, induction with intravenous anesthetics, airway related surgery and ASA class > or =2 were associated with increased risk for perioperative respiratory adverse events.


Asunto(s)
Niño , Humanos , Obstrucción de las Vías Aéreas , Anestesia , Anestesia General , Anestésicos Intravenosos , Espasmo Bronquial , Tos , Honorarios y Precios , Incidencia , Laringismo , Análisis Multivariante , Oportunidad Relativa , Estudios Prospectivos , Factores de Riesgo
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