RESUMO
BACKGROUND: Laryngoscopy and tracheal intubation may cause undesirable increases in blood pressure, heart rate (HR) and intraocular pressure (IOP). Gabapentin has been used effectively to attenuate the pressor response to laryngoscopy and tracheal intubation. We investigated whether the pre-treatment with gabapentin attenuates the IOP in addition to a haemodynamic response to tracheal intubation. METHODS: Sixty ASA I-II patients were randomly allocated into two groups who received either gabapentin (800 mg) or placebo 2 h before surgery. IOP, mean arterial pressure (MAP) and HR were measured before and after the induction of anaesthesia as well as at 0, 1, 3, 5, 10 and 15 min following intubation. RESULTS: IOP and MAP increased from baseline immediately after intubation in the placebo group (P=0.001 and 0.002, respectively). When compared with the placebo group, IOP values of the gabapentin group were significantly lower for the first 15 min after tracheal intubation (P=0.002 at 0 min, P=0.006 at 1 min, P<0.001 at 3 min, P<0.001 at 5 min, P<0.001 at 10 min and P=0.003 at 15 min) while MAP was lower in the first 10 min (P=0.001 at 0 min, P=0.002 at 1 min, P<0.001 at 3 min, P<0.001 at 5 min and P=0.028 at 10 min). These results showed that gabapentin effectively suppresses the increase in IOP secondary to endotracheal intubation and attenuates the increases in MAP. CONCLUSION: It is suggested that gabapentin is a useful adjuvant in order to prevent an increase in the IOP in response to laryngoscopy and tracheal intubation.
Assuntos
Aminas/administração & dosagem , Aminas/farmacologia , Ácidos Cicloexanocarboxílicos/administração & dosagem , Ácidos Cicloexanocarboxílicos/farmacologia , Hemodinâmica/efeitos dos fármacos , Pressão Intraocular/efeitos dos fármacos , Intubação Intratraqueal , Ácido gama-Aminobutírico/administração & dosagem , Ácido gama-Aminobutírico/farmacologia , Administração Oral , Adulto , Feminino , Gabapentina , Humanos , MasculinoAssuntos
Agonistas alfa-Adrenérgicos/farmacologia , Antagonistas Adrenérgicos beta/farmacologia , Dexmedetomidina/farmacologia , Pressão Intraocular/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Propanolaminas/farmacologia , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.
Assuntos
Anti-Infecciosos Locais/administração & dosagem , Bacteriemia/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Unidades de Terapia Intensiva , Anti-Infecciosos Locais/uso terapêutico , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Contaminação de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sulfadiazina de Prata/administração & dosagem , Sulfadiazina de Prata/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: To compare the application of the cuffed oropharyngeal airway and the laryngeal mask airway on anaesthetized adult patients undergoing minor outpatient surgery. METHODS: One hundred patients received intravenous fentanyl, propofol and N20 for the induction and maintenance of anaesthesia. The patients were randomly divided into two groups: a cuffed oropharyngeal airway group (n = 50) and a laryngeal mask airway group (n = 50). After insertion of the device, fibreoptic laryngoscopy was attempted and the degree of success scored. We then compared the first application success rate of both procedures while judging airway intervention requirement, fibreoptic scores, adverse airway events and haemodynamic tolerance. RESULTS: Both devices had an almost similar first-time placement rate (cuffed oropharyngeal airway 84% versus laryngeal mask airway 96%). The cuffed oropharyngeal airway required a higher number of airway interventions (P < 0.001). The laryngeal mask airway had a significantly better fibreoptic view compared with the cuffed oropharyngeal airway (P < 0.001). However, the number of adverse airway events was lower in the cuffed oropharyngeal airway group; there were no significant differences in adverse events and haemodynamic variables between the said two groups. CONCLUSIONS: The results suggest that the cuffed oropharyngeal airway was an effective alternative airway in spontaneously breathing patients during short procedures.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia por Inalação/métodos , Máscaras Laríngeas , Adulto , Idoso , Anestesia por Inalação/efeitos adversos , Feminino , Tecnologia de Fibra Óptica , Glote/fisiologia , Procedimentos Cirúrgicos em Ginecologia , Hemodinâmica/fisiologia , Humanos , Máscaras Laríngeas/efeitos adversos , Laringoscopia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial , Mecânica Respiratória , Prega Vocal/anatomia & histologiaRESUMO
Patients with tracheal stenosis have a high incidence of difficult or failed tracheal intubation. Airway management with the laryngeal mask airway during fibreoptic laryngoscopy was used in two children with acquired subglottic stenosis during spontaneous breathing. The laryngeal mask airway may be superior to tracheal intubation or use of a face mask during anaesthesia management in severe subglottic stenosis. Ventilation may be improved and the use of a laryngeal mask airway can reduce or eliminate some of the problems associated with the other methods of airway management, such as further damage to stenotic tissue and gastric distention.