Remifentanil-propofol versus fentanyl-propofol for monitored anesthesia care during hysteroscopy.

STUDY OBJECTIVE: To compare the efficacy of remifentanil-propofol with that of fentanyl-propofol for monitored anesthesia care during hysteroscopy. DESIGN: Prospective, randomized study. SETTING: Operating room and postanesthesia care unit of a university hospital. PATIENTS: 30 ASA physical status I and II adult patients undergoing hysteroscopic procedures. INTERVENTIONS: After propofol infusion, patients received a bolus of remifentanil (group R, 0.5 microg/kg) or fentanyl (group F, 1 microg/kg) 4 minutes before starting the procedure and then received a continuous infusion of remifentanil (group R, 0.05 microg/kg per min) or bolus doses of fentanyl (group F, 0.5 microg/kg). MEASUREMENTS AND MAIN RESULTS: Patients in group R had lower pain scores than patients in group F (0-0 vs 0-7, P < 0.05) and more stable blood pressures (74 +/- 15 vs 85 +/- 9 mmHg, P < 0.05) one minute after the start of the procedure. However, no differences were observed in other variables (recovery profiles and satisfaction scores). CONCLUSION: Remifentanil seems to be a safe and effective analgesic adjunct for monitored anesthesia care of hysteroscopic surgery.

Propofol reverses oxidative stress-attenuated glutamate transporter EAAT3 activity: evidence of protein kinase C involvement.

The authors investigated the effects of propofol on EAAT3 (excitatory amino acid transporter 3) activity under oxidative stress induced by tert-butyl hydroperoxide (t-BHP), and the mediation of these effects by protein kinase C (PKC). Rat EAAT3 was expressed in Xenopus oocytes and L-glutamate (30 microM)-induced membrane currents were measured using the two-electrode voltage clamp technique. Exposure of these oocytes to t-BHP (1-20 mM) for 10 min dose-dependently decreased EAAT3 activity, and t-BHP (5 mM) significantly decreased the Vmax, but not the Km of EAAT3 for glutamate, and propofol (1-100 microM) dose-dependently reversed this t-BHP-attenuated EAAT3 activity. Phorbol-12-myristate-13-acetate (a PKC activator), also abolished this t-BHP-induced reduction in EAAT3 activity, whereas staurosporine (a PKC inhibitor), significantly decreased EAAT3 activity. However, as compared with staurosporine or t-BHP alone, t-BHP and staurosporine in combination did not further reduce EAAT3 activity. A similar pattern was observed for chelerythrine (also a PKC inhibitor). In oocytes pretreated with combinations of t-BHP and PMA (or staurosporine), propofol failed to change EAAT3 activity. Our results suggest that propofol restores oxidative stress-reduced EAAT3 activity and that these effects of propofol may be PKC-mediated.

The influence of endotracheal tube tip design on nasal trauma during nasotracheal intubation: magill-tip versus murphy-tip.

UNLABELLED: We performed this study to assess the influence of endotracheal tube (ETT) tip design (Murphy-tip versus Magill-tip) on nasal trauma during nasotracheal intubation with a conventional polyvinyl chloride ETT. Patients were randomly allocated to one of four groups (n = 25 each): Magill-tipped ETT and Murphy-tipped ETT with or without thermosoftening. After preparation with a vasoconstrictor, the selected, well-lubricated ETT was advanced blindly into the nasopharynx, and intubation was completed under direct laryngoscopy. The severity of epistaxis was estimated based on the distance that blood had traveled up the suction catheter and tubing. Without thermosoftening, the Murphy-tipped ETT produced more severe epistaxis than the Magill-tipped ETT (P < 0.05). Thermosoftening effectively reduced the severity of epistaxis for both conventional types of ETT (P < 0.05). However, there was no difference in the severity of epistaxis and the incidence of nasal injury and pain between the Magill-tipped, non-thermosoftened ETT and Murphy-tipped, thermosoftened ETT. Thermosoftening is recommended because it decreases the trauma during nasotracheal intubation. However, if one chooses to use a normal ETT, the Magill-tipped ETT will cause fewer traumas than the Murphy-tipped ETT. IMPLICATIONS: During nasotracheal intubation with conventional endotracheal tubes, Magill-tipped, non-thermosoftened tubes seem to be comparable to Murphy-tipped, thermosoftened tubes with regard to trauma on the nasal mucosa.