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1.
Paediatr Anaesth ; 12(7): 585-8, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12358652

RESUMO

BACKGROUND: A retrospective survey of 339 infants who had undergone primary plastic surgery for cleft lip and palate was performed to evaluate the concomitant preoperative assessment based on severity grading of the common cold and the correlation of cleft type with the incidence of perioperative respiratory complications. METHODS: We assessed the severity of common cold symptoms in the preoperative period using the Common Cold Score, which comprises 10 symptoms and findings. We then determined the association of the incidence of perioperative respiratory complications with the increasing severity of common cold symptoms and also compared the complication incidence in the three cleft types in healthy infants without a common cold. RESULTS: The incidence of perioperative respiratory complications was greater in the group with a suspected presence of a common cold. Infants with severer cleft, who had bilateral cleft lip and palate, even without common cold symptoms, had a significantly higher incidence of perioperative respiratory complications (8.9%) than infants with simple cleft lip (1.7%, P < 0.05). CONCLUSIONS: Clinicians should consider postponing primary plastic surgery for cleft lip and palate in infants with a suspected presence of a common cold. Our results also suggest that the presence of a wide cleft is a risk factor for causing perioperative respiratory complications in infants with cleft lip and palate. We believe that a careful preoperative assessment of common cold symptoms in these infants can decrease the incidence of perioperative respiratory complications.


Assuntos
Anestesia/efeitos adversos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Complicações Pós-Operatórias , Doenças Respiratórias/etiologia , Fenda Labial/complicações , Fissura Palatina/complicações , Resfriado Comum/complicações , Resfriado Comum/diagnóstico , Humanos , Lactente , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
2.
Anesth Analg ; 95(1): 163-8, table of contents, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12088962

RESUMO

UNLABELLED: We attempted to determine which monoamine receptor subtypes are predominantly involved in antidepressant-induced antinociception. Antinociceptive effects were evaluated by using formalin tests with rats. Antidepressants acting as potent inhibitors of norepinephrine reuptake (nisoxetine, nortriptyline, and maprotiline) or inhibiting reuptake of both norepinephrine and serotonin (5-HT) (imipramine and milnacipran) induced dose-dependent antinociception. Simultaneous intraperitoneal administration of antidepressants and either prazosin (alpha(1) antagonist) or ketanserin (5-HT(2) antagonist) significantly antagonized antinociceptive effects. Fluvoxamine (selective serotonin reuptake inhibitor) induced antinociception less potently than other antidepressants and was significantly antagonized by ketanserin, but not prazosin. Ondansetron (5-HT(3) antagonist) significantly antagonized antinociception by 10 mg/kg of imipramine. In contrast, SDZ-205,557 (5-HT(4) antagonist) markedly enhanced antinociception by small-dose (2.5 mg/kg) imipramine. Imipramine-induced antinociception was significantly antagonized by intracerebroventricular administration of prazosin or ketanserin, but not by yohimbine (alpha(2) antagonist) or ondansetron, and was significantly enhanced by intracerebroventricularly administered SDZ-205,557. These findings suggest that alpha(1) adrenoceptors and 5-HT(2) receptors in the brain are involved in antidepressant-induced antinociception. In addition, the results suggested functional interactions between noradrenergic and serotonergic neurons as mechanisms for antidepressant-induced antinociception. IMPLICATIONS: Formalin tests of rats treated with antidepressants and antagonists of monoamine receptors indicate that alpha(1) adrenoceptors, serotonin (5-HT)(2) receptors, and 5-HT(3) receptors are involved in antidepressant-induced antinociception, suggesting functional interactions between noradrenergic and serotonergic neurons as mechanisms of antidepressant-induced antinociception.


Assuntos
Analgésicos , Antidepressivos/farmacologia , Receptores de Amina Biogênica/efeitos dos fármacos , Antagonistas de Receptores Adrenérgicos alfa 1 , Antagonistas de Receptores Adrenérgicos alfa 2 , Antagonistas Adrenérgicos alfa/farmacologia , Animais , Antidepressivos/antagonistas & inibidores , Relação Dose-Resposta a Droga , Formaldeído , Injeções Intraperitoneais , Injeções Intraventriculares , Masculino , Atividade Motora/efeitos dos fármacos , Norepinefrina/fisiologia , Medição da Dor/efeitos dos fármacos , Ratos , Ratos Wistar , Receptor 5-HT2A de Serotonina , Receptores Adrenérgicos alfa 1/efeitos dos fármacos , Receptores Adrenérgicos alfa 2/efeitos dos fármacos , Receptores de Amina Biogênica/antagonistas & inibidores , Receptores de Serotonina/efeitos dos fármacos , Receptores 5-HT3 de Serotonina , Receptores 5-HT4 de Serotonina , Antagonistas da Serotonina/farmacologia
3.
Reg Anesth Pain Med ; 27(3): 313-5, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12016607

RESUMO

BACKGROUND AND OBJECTIVES: We describe the use of mandibular nerve block for the management of bilateral trismus associated with hypoxic-ischemic encephalopathy. CASE REPORT: The patient was a 65-year-old man with bilateral trismus due to hypoxic-ischemic encephalopathy. Despite his impaired consciousness, we performed fluoroscopically guided bilateral mandibular nerve block. The bilateral symptoms were sufficiently improved, without obvious side effects, by injecting a local anesthetic near the right mandibular nerve and a neurolytic near the left mandibular nerve. CONCLUSIONS: Mandibular nerve block may be an effective treatment for patients with bilateral trismus due to ischemic-encephalopathy, even when consciousness is impaired.


Assuntos
Hipóxia-Isquemia Encefálica/complicações , Nervo Mandibular , Bloqueio Nervoso , Trismo/etiologia , Trismo/terapia , Idoso , Evolução Fatal , Parada Cardíaca/complicações , Insuficiência Cardíaca/complicações , Hepatite Crônica/complicações , Humanos , Masculino , Espectrometria de Fluorescência
4.
Masui ; 51(3): 289-92, 2002 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-11925897

RESUMO

A 46-year-old female with relapsing polychondritis (RP) was scheduled for surgical repair of saddle-nose and peri-chondritic ear. RP is a rare systemic, inflammatory, and destructive disease of the cartilaginous structures leading to multiple functional disorders in the affected organs. Preoperatively, her chest radiogram of the trachea showed narrowing in diameters which altered about 2 mm with expiration and inspiration. Propofol administered intravenously was given as induction and anesthesia was maintained with nitrous oxide-oxygen-sevoflurane with spontaneous ventilation using laryngeal mask airway. The operation was over uneventfully. Anesthesiologic management requires careful preoperative evaluation of vital organ functions, in particular, respiration.


Assuntos
Anestesia por Inalação , Policondrite Recidivante/cirurgia , Anestésicos Inalatórios , Anestésicos Intravenosos , Orelha/cirurgia , Feminino , Humanos , Éteres Metílicos , Pessoa de Meia-Idade , Óxido Nitroso , Nariz/cirurgia , Oxigênio , Propofol , Sevoflurano
5.
Masui ; 51(1): 61-3, 2002 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-11840667

RESUMO

A 57-year-old male with prostatic cancer was scheduled for a radical prostatectomy under general anesthesia combined with epidural anesthesia. An epidural catheter was introduced at the L 1-2 interspace without problem. The patient was placed in a hyperlordotic supine position with a bolster under his lower back for the seven and a half hour operation. Upon emergence from anesthesia, he complained of severe low back pain in addition to incisional pain. On the second postoperative day, the epidural catheter was removed. After residural analgesic effects had fully disappeared, he experienced muscular weakness in the left thigh and could not walk. Regional sensory loss and edema were also observed where pressure had been applied by the bolster, although spinal cord magnetic resonance imaging studies were almost normal. It took him seven weeks to walk without the support of a brace after surgery. Hyperextension of the lumbar spine could increase the pressure on the inferior vena cava which is transmitted to the intraspinal vein, and could lead to the disci intervertebrales compression and the stress on the facet joint. We believe that the primary cause of the presented symptoms was related to this position. Prolonged and/or excessive hyperlordosis during surgery should be avoided.


Assuntos
Dor Lombar/etiologia , Debilidade Muscular/etiologia , Complicações Pós-Operatórias , Prostatectomia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/cirurgia , Decúbito Dorsal , Coxa da Perna
6.
Masui ; 51(12): 1368-70, 2002 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-12607276

RESUMO

Hydrogen peroxide is widely used for irrigation of surgical wounds. However, its administration has been associated with gas embolism. We report a case of gas embolism after wound irrigation with hydrogen peroxide in a 11-year-old boy undergoing extraction of the extra-traumatic splint under general anesthesia. When 3% hydrogen peroxide 12 ml was applied to wound of the left femur after extraction of the splint, the patient showed clinical signs of pulmonary embolism. Symptomatic treatment was initiated immediately. When the patient awoke from anesthesia, he showed tonic convulsion. But he recovered without any complications. The administration of hydrogen peroxide into a closed tissue is contraindicated during surgery.


Assuntos
Embolia Aérea/etiologia , Peróxido de Hidrogênio/efeitos adversos , Cuidados Intraoperatórios , Oxigênio , Embolia Pulmonar/etiologia , Anestesia Geral , Criança , Contraindicações , Epilepsia Tônico-Clônica/etiologia , Fêmur/lesões , Fêmur/cirurgia , Humanos , Masculino , Irrigação Terapêutica/efeitos adversos
7.
J Anesth ; 16(1): 4-8, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-14566488

RESUMO

PURPOSE: Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS). METHODS: The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40 degrees; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure. RESULTS: The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 +/- 18 to 14 +/- 11 beats.min(-1); P < 0.001), but not in the control group (from 23 +/- 18 to 22 +/- 12 beats.min(-1); P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery. CONCLUSIONS: ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.

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