ABSTRACT
UNLABELLED: Colonoscopy is one of the most frequently performed outpatient procedures in the United States. This study was designed to test the hypothesis that a remifentanil infusion would be superior to boluses of meperidine in older patients undergoing ambulatory colonoscopy. One hundred ASA physical status I-IV patients undergoing colonoscopy were randomized in this double-blinded study to receive either remifentanil infusions (n = 49) or titrated boluses of meperidine (n = 51). Patient tolerance was assessed using physiologic variables and side effects associated with opioid analgesia. Verbal pain/anxiety and patient/operator satisfaction were also assessed. As a group, the physiologic characteristics demonstrated no significant differences in the response to the colonoscopy procedure. Although the patient and operator satisfaction surveys were similar between groups, the incidences of tachycardia, hypotension, and nausea were less and the adjusted verbal pain and anxiety scores were more in the Remifentanil group compared with the Meperidine group. This study demonstrates that remifentanil and meperidine were equally well tolerated in older patients undergoing ambulatory colonoscopy when administered by an anesthesia provider. The differences in the pharmakinetics of remifentanil and meperidine most likely account for the differences noted between the two treatment groups. IMPLICATIONS: Remifentanil infusions and meperidine boluses are equally well tolerated in older patients undergoing ambulatory colonoscopy when administered by an anesthesia provider.
Subject(s)
Adjuvants, Anesthesia/administration & dosage , Analgesics, Opioid/administration & dosage , Anesthetics, Intravenous/administration & dosage , Colonoscopy/methods , Meperidine/administration & dosage , Piperidines/administration & dosage , Adjuvants, Anesthesia/adverse effects , Aged , Ambulatory Care , Analgesics, Opioid/adverse effects , Anesthetics, Intravenous/adverse effects , Anxiety/drug therapy , Anxiety/etiology , Colonoscopy/adverse effects , Double-Blind Method , Female , Humans , Infusions, Intravenous , Injections, Intravenous , Male , Meperidine/adverse effects , Middle Aged , Pain/drug therapy , Pain/etiology , Pain Measurement/drug effects , Piperidines/adverse effects , RemifentanilSubject(s)
Anesthesia, Conduction , Bradycardia/chemically induced , Fenfluramine/adverse effects , Fluoxetine/adverse effects , Hypotension/chemically induced , Intraoperative Complications/chemically induced , Phentermine/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Sympathomimetics/adverse effects , Anesthetics, Intravenous , Appetite Depressants/adverse effects , Drug Interactions , Fentanyl , Humans , Male , Middle AgedABSTRACT
A 70-year-old man required prolonged ventilation after surgery to remove a rectal neoplasm. The cause of the slow recovery from the effects of neuromuscular blocking agents used during his anesthetic was the Lambert-Eaton myasthenic syndrome (LEMS). Before surgery, he had no neuromuscular symptoms, even in retrospect. LEMS should be considered in the diagnosis of prolonged recovery from neuromuscular blockade, even in previously asymptomatic patients.
Subject(s)
Anesthesia Recovery Period , Lambert-Eaton Myasthenic Syndrome/physiopathology , Postoperative Complications/physiopathology , Adenocarcinoma/surgery , Aged , Humans , Male , Rectal Neoplasms/surgerySubject(s)
Catheterization , Forearm/blood supply , Ultrasonography , Arteries , Humans , Male , Middle Aged , Regional Blood Flow , RheologyABSTRACT
The recovery of patients following neurolept or fentanyl/nitrous oxide anesthesia is extremely variable due to variations in drug dosage, biotransformation and excretion idiosyncracies among individuals. The respiratory depressant effects of fentanyl or fentanyl/droperidol can far outlast the analgesic duration and can recur after having dissipated. The level of consciousness and the quality of breathing can be misleading indicators of complete recovery from neurolept anesthesia. Respiratory rate has been observed to return to control levels when simultaneous response to CO2 rebreathing was reduced and resting PeCO2 was increased. Naloxone can be used in dosages which will help ensure adequate ventilation without attenuating postoperative analgesia.
Subject(s)
Fentanyl/adverse effects , Neuroleptanalgesia/adverse effects , Respiratory Insufficiency/chemically induced , Adult , Droperidol/adverse effects , Humans , Male , Naloxone/therapeutic use , Nitrous Oxide/adverse effects , Respiratory Insufficiency/drug therapyABSTRACT
Experience with 648 consecutive percutaneous transfemoral coronary arteriograms and left ventriculograms performed in a teaching laboratory without the use of systemic anticoagulation during the procedure was reviewed. Only 1 death was felt to be related to a procedure, and this occurred 3 weeks after a myocardial infarction. There were 10 myocardial infarctions or emboli, 8 cerebral vascular accidents, and 7 femoral artery complications. Only 1 patient experienced a residual neurologic change following a procedure-related cerebral vascular accident, and this was a mild visual field defect. Clotting of the catheter without sequelae but necessitating procedural changes occurred in 10 instances. The transient nature of the neurologic deficits and the low mortality suggest that the emboli which occurred in these patients were small, possibly platelet-fibrin accumulations. It is postulated that with the use of careful technic larger emboli capable of producing myocardial infarction with shock or disabling cerebral vascular accidents can be prevented, even in a training situation. However, smaller embolic phenomena probably cannot be completely avoided by the use of careful technic, and it is for prevention of small emboli that systemic anticoagulation with heparin may be of value.
