Assuntos
Bacteriúria/diagnóstico , Infecções por Escherichia coli/diagnóstico , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , beta-Lactamases/genética , Idoso , Antibacterianos/farmacologia , Bacteriúria/microbiologia , Elementos de DNA Transponíveis , DNA Bacteriano/química , DNA Bacteriano/genética , Escherichia coli/genética , Infecções por Escherichia coli/microbiologia , Feminino , França , Ordem dos Genes , Humanos , Testes de Sensibilidade Microbiana , Análise de Sequência de DNARESUMO
BACKGROUND: The aim of this prospective study was to determine the risk factors of epileptiform discharge during induction with sevoflurane in healthy adult patients. METHODS: Forty adult patients with American Society of Anesthesiologists physical status I were randomly allocated to one of four groups. Group A: Patients breathed 8% sevoflurane in oxygen (8 l/min) via a prefilled circuit. End-tidal sevoflurane was maintained at 4%. Tracheal intubation was performed at the third minute after cisatracurium injection. Group B: The anesthesia protocol was similar, but a vital capacity technique was performed. Group C: Patients were anesthetized as in group A but were hyperventilated. Group D: Patients were anesthetized as in group A, but end-tidal sevoflurane was maintained at 2%. An electroencephalogram was recorded before and during induction up to 11 min after the start of induction. Statistical analysis was performed with Statview 5.0 (SAS Institute Inc., Cary, NC) for multivariate analysis. RESULTS: Twelve patients experienced epileptiform discharges. Risk factors were female sex (odds ratio, 12.60; 95% confidence interval, 1.46-135), delay to the occurrence of beta waves (odds ratio, 0.92; 95% confidence interval, 0.86-0.99), and end-tidal sevoflurane (odds ratio, 8.78; 95% confidence interval, 1.12-69). Epileptiform discharges were not associated with significant hemodynamic or Bispectral Index variations. CONCLUSION: Induction with sevoflurane may result in epileptiform electroencephalographic activity. Only electroencephalographic monitoring allows the diagnosis. Risk factors are mainly female sex, short delay to onset of anesthesia, and high alveolar sevoflurane concentration. Induction with high sevoflurane concentration is controversial mainly in women.
Assuntos
Anestésicos Inalatórios/efeitos adversos , Eletroencefalografia/efeitos dos fármacos , Éteres Metílicos/efeitos adversos , Adulto , Anestesia por Inalação , Dióxido de Carbono/sangue , Cognição/efeitos dos fármacos , Feminino , Humanos , Masculino , Fatores de Risco , Sevoflurano , Caracteres SexuaisRESUMO
Una causa común de morbilidad y mortalidad atribuible a la anestesia es la intubación dificultosa o fallida. Si se identifica previamente a los pacientes en condiciones de riesgo, un anestesista con un equipo preparado puede estar presente para enfrentarse a este problema. Los anestesistas deben tener el conocimiento y entrenamiento en seleccionar racionalmente los métodos de manejo de la vía aérea y realizarlos rápidamente y secuencialmente como sea requerido. Se desarrollan las distintas técnicas que se deben considerar en esta situación.
A common cause of morbidity and mortality attributable to anaesthesia is difficult or failed intubation. If those patients in whom intubation proves difficult could be identified in advanced, it could be arranged that an anesthetist properly equipped could be present to deal with the problem. Anesthetists are advised to become knowledgeable and skillful in selected rational methods of airway management and institute them sequentially and rapidly as required. The techniques to consider in this situation are reviewed.