ABSTRACT
In patients undergoing spine surgery postoperative pain management can often be complicated with side effects associated with high dose narcotic such as respiratory depression and those associated with non-steroidal anti-inflammatory drugs such as interference with bone healing process. Local anesthetics can help in both decreasing postoperative pain and minimizing side effects associated with systematically administered analgesics. This report describes the use of preoperative ultrasound guided dorsal ramus nerve block to reduce postoperative pain in six patients undergoing lumbar spine surgery under general anesthesia.
Subject(s)
Lumbar Vertebrae/surgery , Nerve Block/methods , Pain, Postoperative/prevention & control , Spinal Nerves/diagnostic imaging , Ultrasonography, Interventional , Adult , Aged , Female , Humans , Male , Middle AgedSubject(s)
Amides/adverse effects , Anesthetics, Local/adverse effects , Attention Deficit Disorder with Hyperactivity/complications , Intraoperative Complications/chemically induced , Nerve Block/adverse effects , Phospholipids/therapeutic use , Soybean Oil/therapeutic use , Adolescent , Anesthesia, General , Arthroscopy , Atomoxetine Hydrochloride , Attention Deficit Disorder with Hyperactivity/drug therapy , Confusion/chemically induced , Emulsions/therapeutic use , Hallucinations/chemically induced , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/therapeutic use , Intraoperative Complications/psychology , Male , Midazolam/administration & dosage , Midazolam/therapeutic use , Propylamines/adverse effects , Propylamines/therapeutic use , Ropivacaine , Shoulder/surgery , Speech Disorders/chemically inducedSubject(s)
Airway Obstruction/therapy , Thorax/physiology , Tracheal Stenosis/therapy , Airway Obstruction/pathology , Airway Obstruction/surgery , Exhalation , Female , Humans , Infant , Lung/abnormalities , Pressure , Plastic Surgery Procedures , Trachea/pathology , Tracheal Stenosis/pathology , Tracheal Stenosis/surgery , TracheostomyABSTRACT
PURPOSE OF REVIEW: The purpose of this review is to discuss the risk factors associated with laryngospasm and the techniques used for prevention and treatment. We also summarize the prevention and treatment modalities in organized algorithms. RECENT FINDINGS: According to recent endoscopic studies, laryngospasm is always complete, thus airway management and intravenous therapy are indicated. Parental history of children having upper respiratory infection is associated with increased risk of laryngospasm. Anesthesia administered by a pediatric anesthesiologist is associated with lower incidence of laryngospasm. Intravenous anesthesia is associated with lower incidence of laryngospasm than inhalational anesthesia. In tracheal intubation, the use of muscle relaxants decreases laryngospasm. Deep laryngeal mask airway removal is associated with lower incidence of laryngospasm in sevoflurane or isoflurane anesthesia. In no intravenous line situation, laryngospasm can be treated with succinylcholine administration by intramuscular, intraosseous and intralingual routes. SUMMARY: Identifying the risk factors and taking the necessary precautions are the key points in prevention of laryngospasm. An experienced anesthesiologist is associated with lower incidence of laryngospasm. Airway management is the most essential part of treatment of laryngospasm. Drugs can be used as an adjunct in treatment of laryngospasm, especially when anesthesia is administered by beginners.
Subject(s)
Intraoperative Complications/prevention & control , Intraoperative Complications/therapy , Laryngismus/prevention & control , Laryngismus/therapy , Child , Humans , Intraoperative Complications/epidemiology , Laryngismus/epidemiology , Risk FactorsABSTRACT
PURPOSE: The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg . kg(-1)) with intubating conditions 60 s after administering succinylcholine 1.5 mg . kg(-1). METHODS: The randomized double-blind study included 184 healthy adult patients scheduled for elective surgery. Anesthesia was induced in all patients with lidocaine 1.5 mg . kg(-1), remifentanil 2 microg . kg(-1), and propofol 2 mg . kg(-1) administered over 30 s. In one group, rocuronium 0.3 mg . kg(-1) was administered before the induction sequence, and in the other group, succinylcholine 1.5 mg . kg(-1) was administered after the induction sequence. Laryngoscopy was attempted 90 s after rocuronium administration and 60 s after succinylcholine administration. Intubating conditions were assessed as excellent, good, or poor on the basis of ease of laryngoscopy, position of the vocal cords, and reaction to insertion of the tracheal tube and cuff inflation. RESULTS: There were 92 patients per group. In the rocuronium group, intubating conditions were excellent in 83 patients (90%), good in 8 (9%), and poor in 1 (1%), not significantly different from the intubating conditions in the succinylcholine group, which were excellent in 88 patients (96%), good in 3 (3%), and poor in 1 (1%) (P = 0.3). CONCLUSION: During a lidocaine-remifentanil-propofol induction of anesthesia, rocuronium 0.3 mg . kg(-1) administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg . kg(-1) administered after the induction sequence.
Subject(s)
Androstanols/therapeutic use , Intubation, Intratracheal/methods , Neuromuscular Depolarizing Agents/therapeutic use , Neuromuscular Nondepolarizing Agents/therapeutic use , Succinylcholine/therapeutic use , Adolescent , Adult , Androstanols/administration & dosage , Anesthetics, Intravenous/therapeutic use , Anesthetics, Local/therapeutic use , Dose-Response Relationship, Drug , Double-Blind Method , Elective Surgical Procedures/methods , Female , Humans , Laryngoscopy/methods , Lidocaine/therapeutic use , Male , Middle Aged , Neuromuscular Depolarizing Agents/administration & dosage , Neuromuscular Nondepolarizing Agents/administration & dosage , Piperidines/therapeutic use , Propofol/therapeutic use , Prospective Studies , Remifentanil , Rocuronium , Succinylcholine/administration & dosage , Vocal Cords/metabolism , Young AdultSubject(s)
Abdominal Wall/surgery , Anesthesia, Epidural , Anesthesia, Spinal , Asthma , Female , Humans , Middle Aged , Plastic Surgery Procedures/methods , Risk FactorsABSTRACT
BACKGROUND: Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. METHODS: In a prospective, double-blind, randomized trial, we enrolled 60 adult patients undergoing nasal surgery using remifentanil-based anesthesia. During the emergence phase, the remifentanil group had remifentanil reduced to one tenth of the maintenance rate, whereas the control group had remifentanil discontinued. RESULTS: Times to awakening and tracheal extubation were similar between the two groups. During emergence, the remifentanil group (infusion rate 0.014 +/- 0.011 microg x kg(-1) x min(-1)) had a significantly lower incidence (40% vs 80%, P = 0.002) and less severe coughing compared with the control group, as well as a lower incidence of nonpurposeful movement (3.3% vs 30%, P = 0.006) and slower heart rates. CONCLUSIONS: Low-dose remifentanil during emergence did not prolong wake-up but reduced the incidence and severity of coughing from the endotracheal tube.
Subject(s)
Analgesics, Opioid/administration & dosage , Anesthesia Recovery Period , Anesthesia, General , Intubation, Intratracheal , Piperidines/administration & dosage , Adolescent , Adult , Blood Pressure/drug effects , Cough/etiology , Cough/prevention & control , Double-Blind Method , Drug Administration Schedule , Female , Heart Rate/drug effects , Humans , Hypotension/etiology , Hypotension/prevention & control , Infusions, Intravenous , Intubation, Intratracheal/adverse effects , Male , Middle Aged , Nose/surgery , Prospective Studies , Psychomotor Agitation/etiology , Psychomotor Agitation/prevention & control , Remifentanil , Severity of Illness Index , Tachycardia/etiology , Tachycardia/prevention & control , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The intubating laryngeal mask airway (ILMA) is used in the management of difficult intubation. Usually, a silicone wire-reinforced tube is inserted for tracheal intubation. Because the silicone wire-reinforced tube is expensive, alternatives, such as polyvinyl chloride (PVC) and posterior beveled Parker tubes, are worth considering. We compared the blind intubation success rates among the silicone wire-reinforced tube, the Parker tube, and the PVC tube, and identified laryngeal structures preventing tracheal intubations through the ILMA. METHODS: Sixty-three adult patients were randomized into three groups: Group I (n = 20) silicone wire-reinforced tube, Group II (n = 21) Parker tube, and Group III (n = 22) PVC tube. Demographic and clinical continuous data were compared with the analysis of variance with the Scheffé test for post hoc analysis. Frequencies and percentages were compared with the chi(2) test. RESULTS: Tracheal intubation was successful from the first attempt in 18 of 20 patients in Group I (silicone wire-reinforced tube), which was significantly higher than the success rate in either Group II (12 of 22 patients) (Parker tube) or Group III (10 of 21 patients) (PVC tube). With clockwise or anticlockwise rotation of the tracheal tube, the number of successful intubations did not change in Group I, but it increased to 19 of 22 patients in Group II and to 12 of 21 patients in Group III. The rate of successful intubation between patients in Group I (90%) and Group II (86%) was not significantly different after manipulation of the tracheal tube (P = 0.72). However, the rate of successful tracheal intubations in patients of Group III (57%) was significantly lower in comparison to patients in both Group I (P = 0.02) and Group II (P = 0.03). In 3 of the 22 patients of Group II and in 9 of the 21 patients of Group III in whom blind intubation was not possible, the obstruction was due to the epiglottis tubercule. CONCLUSIONS: Manipulation improved the success rate of intubation with the Parker tube through the ILMA rendering it a possible alternative to the silicone wire-reinforced tube.
Subject(s)
Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Laryngeal Masks , Polyvinyl Chloride/chemistry , Silicones/pharmacology , Adult , Anesthesia, General/instrumentation , Anesthesia, General/methods , Equipment Design , Female , Humans , Male , Middle Aged , Silicones/chemistry , Trachea , Treatment OutcomeABSTRACT
We report a 38 year old male patient who underwent a craniotomy for jugular foramen tumor resection. In the postoperative care unit, the patient developed aspiration accompanied with oxyhemoglobin desaturation. Subsequently, he had several episodes of recurrent aspiration which were attributed to cranial nerves (IX, X) palsy as a complication of the surgery at the jugular foramen. It is suggested that aspiration prophylactic measures should be taken and early assessment of lower cranial nerves function should be done prior to tracheal extubation to decrease post-operative aspiration in patients undergoing base of skull surgery.
Subject(s)
Glomus Jugulare Tumor/surgery , Neurilemmoma/surgery , Respiratory Aspiration/etiology , Adult , Humans , Lung/diagnostic imaging , Male , Radiography , Recurrence , Respiratory Aspiration/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Propofol is well-known for its pain on injection. Premixture with lidocaine or pretreatment with remifentanil reduces injection pain. A multimodal approach might offer additional mitigation of propofol injection pain. METHODS: In a randomized, prospective, double-blind study of 156 patients, we compared the incidence and severity of propofol pain among three groups. Patients in the lidocaine group (n = 54) received 2% lidocaine premixed with propofol (40 mg lidocaine in 180 mg propofol). Patients in the remifentanil group (n = 50), received pretreatment with remifentanil 2 microg x kg(-1) IV over 30 s. Patients in the combination group (n = 52) received both lidocaine and remifentanil. RESULTS: A significant decrease in the overall incidence of propofol pain at induction was achieved in the combination group (9.6%) compared with that in the remifentanil group (36%) and the lidocaine group (35%) (P = 0.003). The incidence of severe and moderate pain was also significantly different in the combination group (0%), compared with that in the remifentanil (18%) and lidocaine groups (12.9%) (P < 0.02). Similar, statistically significant differences among the three groups were achieved concerning recalled pain in the postanesthesia care unit. CONCLUSIONS: The combination of two different analgesic modalities, remifentanil and lidocaine completely abolishes moderate and severe pain associated with propofol injection, and significantly reduces the incidence of mild pain when compared with each drug used alone.