ABSTRACT
STUDY OBJECTIVE: To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen. DESIGN: This is a non-randomized prospective cohort study. SETTING: Operating room of a university-affiliated teaching hospital. PATIENTS: Out of a total of 50 patients who had undergone mastectomy, 22 patients were allocated to the "Chemo group" and 28 patients to the "Non-Chemo group", based on a valid history of recent chemotherapy. INTERVENTION: After induction of anesthesia with thiopental and cisatracurium, neuromuscular monitoring was started for all patients. MEASUREMENTS: Initially the time to 100% single-twitch (ST) suppression was measured. Then, the time for the appearance of the first response to post-tetanic count (PTC) stimulation, Train-of-Four (TOF) stimulation, and TOF50% were measured consequently. MAIN RESULTS: Time to get STzero was significantly longer in the Chemo group than in the Non-chemo group. Time for the appearance of the first response of PTC and TOF and TOF50% was significantly shorter in the Chemo group than the other group. The mean duration of intense block was 27.66 minutes in the Chemo group versus 42.47 minutes in the Non-chemo group. CONCLUSION: This research demonstrated that in patients having undergone chemotherapy, the effect of NDMRs starts with a longer lag time and finishes earlier too. Thus, these patients are ready for intubation after a longer time. Moreover, we have to repeat cisatracurium injections after shorter intervals to maintain the desired level of blockade.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/pharmacology , Atracurium/analogs & derivatives , Neuromuscular Blockade/methods , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Adult , Anesthesia, General/methods , Atracurium/administration & dosage , Atracurium/antagonists & inhibitors , Atracurium/pharmacology , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Cyclophosphamide/pharmacology , Doxorubicin/pharmacology , Drug Administration Schedule , Female , Fluorouracil/pharmacology , Humans , Mastectomy , Middle Aged , Monitoring, Intraoperative/methods , Neoadjuvant Therapy/methods , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents/administration & dosage , Neuromuscular Nondepolarizing Agents/pharmacology , Prospective StudiesABSTRACT
General anesthesia (GA) is associated with serious concerns in advanced cases of Charcot-Marie-Tooth (CMT). Despite several benefits of applying regional anesthesia (RA), recommendation for RA is controversial in CMT due to insufficient supporting documents and trials. We report combined epidural/general anesthesia for a 12-year-old boy with CMT disease undergoing major spine corrective surgery. This manuscript is presented not only to evaluate the costs and benefits of RA, but also to highlight the safety of neuraxial anesthesia and emphasis on the broad potential role of RA to reduce risks of GA in CMT patients.
ABSTRACT
Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team's experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.
ABSTRACT
OBJECTIVE: Arterial blood gas analysis is an iatric component factor in the clinical evaluation of patients, but arterial puncture has many complications. Our study aimed to determine a correlation between arterial and venous blood gas values. METHODS: A prospective comparison of 200 samples from 100 patients undergoing lumbar disc surgery was conducted. Arterial and venous samples were obtained simultaneously from each patient. The samples were analyzed and compared using SPSS version 16 software, with Pearson's correlation and 95% confidence intervals (CIs) of the difference. RESULTS: Arterial and venous values for pH, bicarbonate (HCO(3)), base excess (BE), buffer base (BB) and partial pressure of carbon dioxide (PCO(2)) showed close and direct correlation. The comparison showed the following: pH, r = 0.938, p <0.001 (95% CI, 0.019 to 0.032); HCO(3), r = 0.884, p <0.001 (95% CI, -2.65 to -1.99); BE, r = 0.861, p <0.001 (95% CI, -1.89 to -1.17); BB, r = 0.849, p < 0.001 (95% CI, -2.35 to -1.60); and PCO(2), r = 0.899, p < 0.001 (95% CI, -5.97 to -4.66). Pearson's correlation coefficients for partial pressure of oxygen and oxygen saturation were 0.092 and 0.345, respectively. The mean difference between arterial and venous values for pH was 0.025 pH units, for HCO(3) was 2.327 mmol/L, for PCO(2) was 5.32 mmHg, for BE was 1.533 mmol/L, and for BB was 1.983 mmol/L. CONCLUSION: Venous blood gas values are an acceptable alternative to arterial blood gas values in patients undergoing lumbar disc surgery.
