Laparoscopic cholecystectomy for cholelithiasis in a patient with myotonic dystrophy.

Myotonic dystrophy (DM) is a rare autosomal dominant inherited neuromuscular disease involving several systems. The anesthetic method of choice remains uncertain. The risk of perioperative complications, particularly pulmonary and cardiac complications, in these patients is of major concern. We report on a 16-year-old female patient with DM type 1 undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis, who had a smooth, uncomplicated recovery. Laparoscopic cholecystectomy is feasible and safe in patients with DM but requires individual multidisciplinary perioperative management.

Administration of esmolol in microlaryngeal surgery for blunting the hemodynamic response during laryngoscopy and tracheal intubation in cigarette smokers.

OBJECTIVES: Cigarette smokers constitute a group of patients with an increased hemodynamic response to tracheal intubation. We studied the dose-response and side effects of bolus administration of esmolol hydrochloride in cigarette smokers undergoing elective microlaryngeal surgery, when esmolol was used for reducing the intense hemodynamic response to laryngoscopy and tracheal intubation. METHODS: We randomly allocated 165 patients (American Society of Anesthesiologists physical status classes I to III) to receive placebo (Eplac) or esmolol 1 mg/kg (E1) or 2 mg/kg (E2). The esmolol was given 2 minutes before laryngoscopy and tracheal intubation. The same anesthetic technique was used in all patients. Cardiovascular parameters were recorded every minute for the first 5 minutes and thereafter every 3 minutes. Bronchospasm, other side effects, and rescue esmolol treatment were noted during anesthesia. RESULTS: In group Eplac, significant increases (p < .05) in arterial blood pressure and heart rate were observed in the first 3 minutes after tracheal intubation. In group E1, significant increases (p < .05) in diastolic blood pressure were observed in the first 2 minutes after intubation. In group E2, no significant fluctuations were recorded in cardiovascular parameters after intubation. During surgery, 17% of the patients in group Eplac showed an increase in blood pressure and tachycardia. CONCLUSIONS: We conclude that esmolol administration of 2 mg/kg during induction of anesthesia in smokers provides hemodynamic stability after laryngoscopy and tracheal intubation with no severe side effects.

Preoperative administration of rofecoxib versus ketoprofen for pain relief after tonsillectomy.

OBJECTIVES: We evaluated the analgesic efficacy and the opioid-sparing effect of oral rofecoxib compared with intramuscular (IM) ketoprofen in tonsillectomy. METHODS: Seventy-seven adult patients were randomized into 2 groups: group R (n = 39), which received a single oral preoperative dose of rofecoxib 50 mg, and group K (n = 38), which received 2 IM doses of ketoprofen 100 mg (before surgery and after 12 hours). In both groups, additional IM meperidine hydrochloride 1 mg/kg was given. All patients received general anesthesia. A pain score (visual analog scale, 0 to 100) was assessed both at rest and during swallowing at 30 minutes and at 4, 8, 12, 16, and 24 hours after operation. If the pain score exceeded 40, patients were given meperidine as rescue analgesia. RESULTS: The pain scores during rest and swallowing in group R were significantly lower (p < .05) than those of group K at 4, 8, and 12 hours after operation. Meperidine was given as rescue medication in significantly more patients of group K (76%) than of group R (38%; p < .05). CONCLUSIONS: Oral premedication with rofecoxib seems to be more effective than use of ketoprofen in decreasing postoperative pain and the need for opioid rescue medication after elective tonsillectomy. Both drugs seem to be relatively safe as far as postoperative bleeding is concerned.

Inhalational anesthetic technique in microlaryngeal surgery: a comparison between sevoflurane-remifentanil and sevoflurane-alfentanil anesthesia.

We studied the effects of sevoflurane, remifentanil hydrochloride, and alfentanil anesthesia in terms of the hemodynamic responses and emergence characteristics of patients scheduled for elective microlaryngeal surgery. Sixty patients (ASA I to III) were randomly allocated into 2 groups: group S-R (sevoflurane-remifentanil) and group S-A (sevoflurane-alfentanil; 1:20 and 1:4 ratios of remifentanil to alfentanil for induction and maintenance of anesthesia, respectively; doses not strictly equipotent). The mean arterial pressure and heart rate were measured before and after induction of anesthesia, 1 and 3 minutes after endotracheal intubation, at the insertion of the operating laryngoscope, and every 3 minutes during surgery. The emergence times and side effects during the first 30 minutes after surgery were also recorded. The mean arterial pressure values at the insertion of the operating laryngoscope and throughout the procedure were significantly greater (p < .05) in group S-A than in group S-R. The emergence times and postoperative side effects did not differ, except for the greater pain score (p < .05) in group S-R. In conclusion, sevoflurane with remifentanil seems to maintain cardiovascular stability during microlaryngeal surgery more effectively than sevoflurane with alfentanil. Both anesthetic regimens seem to provide rapid and uneventful emergence.