RESUMO
BACKGROUND: The use of sevoflurane without muscle relaxant for tracheal intubation has been widely investigated in children. Non-depolarizing neuromuscular blockers have long duration of action and do not provide rapid return of spontaneous ventilation. Use of suc-cinylcholine has been found to be associated with various side-effects especially in children. Therefore, we aim to evaluate the effect of propofol 1.5 mg/kg without muscle relaxant, on intubating conditions in children 2-8 yrs of age and we compare them with those achieved with rocuronium 0.6 mg/kg, at moderate sevoflurane concentration. METHODS: Fifty children between 2-8 yrs, ASA I or II scheduled for elective surgery were randomly allocated to either Group P (propofol) or group R (rocuronium). After premedication with oral midazolam 0.5 mg/kg 30 min before surgery, anaesthesia was induced with 8% sevoflurane in oxygen. Intravenous fentanyl 1 µg/kg was administered after securing intravenous access and dial concentration of sevoflurane was reduced to 4%. At one minute with regards to time T0, the patients received the drug which was either intravenous rocuronium 0.6 mg/kg or an equal volume of 0.9% saline (D) and at three minutes (two minutes after D1), second drug (D2) was given, which was either propofol 1.5 mg/kg or an equal volume of 0.9% saline according to the group allocated. At four minutes, laryngoscopy was done and intubation performed with appropriate sized uncuffed endotracheal tube. Incidence of acceptable and excellent intubating conditions, time to intubation and hemodynamic parameters were recorded. RESULTS: Incidence of acceptable or excellent intubating conditions was similar in both groups (p = 1.00). The difference in time to intubation was statistically not significant (25.03 ± 6.05s in Group P and 24.38 ?5.58s in Group R, p = 0.694), at similar end-tidal concentration of sevoflurane (3.2 ± 0.20% in Group P and 3.1 ± 0.20% in Group R, p = 0.12). CONCLUSION: Propofol (1.5 mg/kg) and rocuronium (0.6 mg/kg) produced similar intubating conditions in children induced with sevoflurane.
Assuntos
Androstanóis/farmacologia , Intubação Intratraqueal/estatística & dados numéricos , Éteres Metílicos/farmacologia , Propofol/farmacologia , Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Fármacos Neuromusculares não Despolarizantes/farmacologia , Estudos Prospectivos , Rocurônio , SevofluranoRESUMO
A child with cretinism poses multiple anaesthetic challenges due to the associated mental and physical disability, deranged metabolic and physiologic functions, difficult airway and propensity to perioperative cardiorespiratory complications. Spinal anaesthesia in children is associated with remarkable cardiorespiratory stability and provides complete surgical anaesthesia. Here, we report a case that describes the first successful anaesthetic management of a child who was an unevaluated case of cretinism under subarachnoid block.
RESUMO
The Proseal Laryngeal Mask Airway (PLMA) is routinely inserted by the digital and introducer tool techniques but a newer Gum Elastic Bougie (GEB) guided insertion technique has been described. The aims and objectives were to compare the ease of PLMA insertion and fibreoptic view of PLMA after placement using GEB and conventional techniques. Ninety-six ASA I or II patients of either gender aged 18 to 60 years, scheduled for elective surgery under general anaesthesia in the supine position were included in this study. Following induction of anaesthesia, a PLMA was inserted using a GEB, introducer tool or digital technique in Groups G, I and D respectively (n = 32). Correct placement of the PLMA was confirmed by using clinical tests along with fibreoptic assessment. Ease of PLMA insertion was assessed by the number of attempts, time taken and number of patients requiring lateral approach for insertion. The fibreoptic view of PLMA placement through the airway tube was graded on a scale from 4 (best view) to 1 (worst view). GEB-guided PLMA insertion was more successful both after the first attempt (G 100%, I 69%, D 72%, P < 0.01) and after two attempts (G 100%, I 78%, D 84%, P < 0.05). Time taken for successful placement was significantly shorter in the GEB-guided group after two attempts (G 22 +/- 2 seconds, I 31.9 +/- 18.8 seconds, D 29.5 +/- 18.6 seconds, P < 0.05). The fibreoptic view through the airway tube was significantly better in the GEB-guided group (P < 0.01). Incidence of trauma was significantly less in the GEB-guided group (P < 0.05).
Assuntos
Anestesia Geral , Tecnologia de Fibra Óptica , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Adolescente , Adulto , Procedimentos Cirúrgicos Eletivos/métodos , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Decúbito Dorsal , Adulto JovemRESUMO
Several additives have been combined with local anaesthetics for intravenous regional anaesthesia to improve block quality, analgesia and to decrease tourniquet pain. Magnesium sulphate is one potential additive. This prospective, randomised, double-blinded study was conducted in 30 ASA physical status I or II patients undergoing upper limb surgery under tourniquet. In group L, patients received intravenous regional anaesthesia with lignocaine alone (9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Patients in group M received intravenous regional anaesthesia with lignocaine plus magnesium sulphate (6 ml of 25% magnesium sulphate plus 9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Assessment was by observing the response to injection of drug; sensory and motor block and tourniquet pain. The mean time of onset of sensory block was 12.40 and 3.47 minutes in groups L and M respectively (P < 0.001). The average times of onset of motor block in groups L and M were 17 and six minutes respectively (P < 0.001). Of the patients in group M, 66.7% reported moderate to severe pain while the drug was being injected, compared to 20% in group L (P=0.011). There was a statistically significant difference in visual analogue scale for tourniquet pain at 10 and 30 minutes after tourniquet inflation (lower in group M). These findings indicate that magnesium sulphate added as an adjuvant to lignocaine hastens the onset of sensory and motor block and decreases tourniquet pain. However there is increased incidence of transient pain on injection if magnesium sulphate is added.
Assuntos
Adjuvantes Anestésicos/uso terapêutico , Anestesia por Condução/métodos , Anestesia Intravenosa/métodos , Lidocaína/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Extremidade Superior/cirurgia , Adulto , Anestésicos/uso terapêutico , Anestésicos Combinados/uso terapêutico , Anestésicos Locais/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Bloqueio Nervoso/métodos , Dor/prevenção & controle , Medição da Dor/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Torniquetes/efeitos adversos , Resultado do TratamentoRESUMO
Here is reported an unusual case of substance dependence with buprenorphine, mephentermine, & promethazine. This combination taken through intramuscular route produced a relatively mild & delayed abstinence syndrome with features viz. increased sleep and appetite in the patients. The neurophysiological basis for use of this rare form of additive (mephentermine) with buprenorphine is speculated.