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Background@#Few studies have evaluated the use of automated artificial intelligence (AI)-based pain recognition in postoperative settings or the correlation with pain intensity. In this study, various machine learning (ML)-based models using facial expressions, the analgesia nociception index (ANI), and vital signs were developed to predict postoperative pain intensity, and their performances for predicting severe postoperative pain were compared. @*Methods@#In total, 155 facial expressions from patients who underwent gastrectomy were recorded postoperatively; one blinded anesthesiologist simultaneously recorded the ANI score, vital signs, and patient self-assessed pain intensity based on the 11-point numerical rating scale (NRS). The ML models’ area under the receiver operating characteristic curves (AUROCs) were calculated and compared using DeLong’s test. @*Results@#ML models were constructed using facial expressions, ANI, vital signs, and different combinations of the three datasets. The ML model constructed using facial expressions best predicted an NRS ≥ 7 (AUROC 0.93) followed by the ML model combining facial expressions and vital signs (AUROC 0.84) in the test-set. ML models constructed using combined physiological signals (vital signs, ANI) performed better than models based on individual parameters for predicting NRS ≥ 7, although the AUROCs were inferior to those of the ML model based on facial expressions (all P < 0.050). Among these parameters, absolute and relative ANI had the worst AUROCs (0.69 and 0.68, respectively) for predicting NRS ≥ 7. @*Conclusions@#The ML model constructed using facial expressions best predicted severe postoperative pain (NRS ≥ 7) and outperformed models constructed from physiological signals.
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Background@#A combination of opioids and adjunctive drugs can be used for intravenous patient-controlled analgesia (PCA) to minimize opioid-related side effects. We investigated whether two different analgesics administered separately via a dual-chamber PCA have fewer side effects with adequate analgesia than a single fentanyl PCA in gynecologic pelviscopic surgery. @*Methods@#This prospective, double-blind, randomized, and controlled study included 68 patients who underwent pelviscopic gynecological surgery. Patients were allocated to either the dual (ketorolac and fentanyl delivered by a dual-chamber PCA) or the single (fentanyl alone) group. Postoperative nausea and vomiting (PONV) and analgesic quality were compared between the two groups at 2, 6, 12, and 24 h postoperatively. @*Results@#The dual group showed a significantly lower incidence of PONV during postoperative 2–6 h (P = 0.011) and 6–12 h (P = 0.009). Finally, only two patients (5.7%) in the dual group and 18 (54.5%) in the single group experienced PONV during the entire postoperative 24 h and could not maintain intravenous PCA (odds ratio: 0.056, 95% CI [0.007, 0.229], P < 0.001). Despite the administration of less fentanyl via intravenous PCA during the postoperative 24 h in the dual group than in the single group (66.0 ± 77.8 vs. 383.6 ± 70.1 μg, P < 0.001), postoperative pain had no significant intergroup difference. @*Conclusions@#Two different analgesics, continuous ketorolac and intermittent fentanyl bolus, administered via dual-chamber intravenous PCA, showed fewer side effects with adequate analgesia than conventional intravenous fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.
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Background@#The anti-oxidative, anti-inflammatory, and anti-apoptotic effects of erythropoietin may provide neuroprotective effects. Erythropoietin also modulates autophagy signaling that may play a role in anesthesia-induced neurotoxicity (AIN). Herein, we investigated whether AIN can be attenuated by the neuroprotective effect of erythropoietin in the Caenorhabditis elegans (C. elegans). @*Methods@#Synchronized worms were divided into the control, Iso, EPO, and EPO-Iso groups. The chemotaxis index (CI) was evaluated when they reached the young adult stage. The lgg-1::GFP-positive puncta per seam cell were used to determine the autophagic events. The erythropoietin-mediated pathway of autophagy was determined by measuring the genetic expression level of let-363, bec-1, atg-7, atg-5, and lgg-3. @*Results@#Increased lgg-1::GFP puncta were observed in the Iso, EPO, and EPO-Iso groups. In the Iso group, only the let-363 level decreased significantly as compared to that in the control group (P = 0.009). bec-1 (P < 0.001), atg-5 (P = 0.012), and lgg-3 (P < 0.001) were expressed significantly more in the EPO-Iso group than in the Iso groups. Repeated isoflurane exposure during development decreased the CI. Erythropoietin could restore the decreased CI by isoflurane significantly in the EPO-Iso group. @*Conclusions@#Erythropoietin showed neuroprotective effects against AIN and modulated the autophagic pathway in C. elegans. This experimental evidence of erythropoietin-related neuroprotection against AIN may be correlated with the induced autophagic degradation process that was sufficient for handling enhanced autophagy induction in erythropoietin-treated worms.
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Background@#Remimazolam, a new benzodiazepine, is known for its quick onset of effects and recovery time. Recently, it has been licensed for general anesthesia and sedation in Korea and its use is increasing in other countries. However, less is known about its effect on postoperative recovery. We used a patient-reported outcome questionnaire to examine the effect of remimazolam on postoperative recovery. @*Methods@#Patients who underwent hysteroscopy on day surgery basis were administered an induction dose of remimazolam 6 mg/kg/h followed by a maintenance dose of 1–2 mg/kg/h. After surgery, the translated Korean version of 15-item Quality of Recovery scale (QoR-15K) including post-discharge nausea and vomiting (PDNV) and/or pain, was surveyed 24 h after surgery to evaluate patient recovery. @*Results@#Total of 38 patients were enrolled in this prospective, observational study. All patients successfully completed QoR-15K. Only one patient scored low for moderate pain and PDNV. On average, patients scored 9 and above for all QoR-15K items except for moderate pain (8.66 ± 1.68). When QoR-15K items were grouped into dimensions, all dimensions scored an average of 9 or higher on a 10-point scale. In addition, 19 out of 38 patients gave score range of 148 to 150 out of possible 150. @*Conclusions@#Psychometric evaluation based on postoperative QoR-15K among patients receiving remimazolam shows satisfactory patient recovery profiles without significant pain or PDNV. Considering its effectiveness and safety, remimazolam could be one of useful agents for general anesthesia of day surgery in terms of postoperative recovery.
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Background@#We compared preoperative residual gastric volume (GV) between the first and second stages of total knee arthroplasty (TKA) in older adults after drinking carbohydrate-containing fluid 2 h prior to surgery. @*Methods@#In this study, 36 patients, aged > 65 years, scheduled for staged bilateral TKA with one-week interval, were enrolled. The patients consumed 400 ml of carbohydrate-containing fluid 2 h prior to surgery. Before the induction of spinal anesthesia, the gastric antral cross-sectional area was measured at the first and second TKA using ultrasound, and the residual GV was calculated. The primary outcome was the residual GV. Qualitative GV (grades 0, 1, and 2) and analgesic consumption after the first TKA were assessed as secondary outcomes. @*Results@#The GV (median [Q1, Q3]) was greater in the second-stage TKA (41.1 [22.5, 62.8] ml) than in the first-stage TKA (10.3 [0.0, 27.1] ml) (P < 0.001). In the qualitative assessment, the distribution was not different between the two stages of TKA (P = 0.219) and only one patient showed grade 2 gastric content in the second TKA. When opioid consumption was converted to an equivalent dose of morphine, an average of 53.9 mg of morphine was required after the first TKA. @*Conclusions@#Residual GV after drinking carbohydrate-containing fluid differed according to the stage of TKA, showing a larger residual GV in the second TKA than in the first one. In older adults scheduled to undergo bilateral staged TKA, caution is required in preoperative fasting practice, especially in second-stage surgery.
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Background@#Tranexamic acid (TXA) is the most widely used hemostatic agent in surgical patients. However, when used in a high dose, it could cause a seizure in the postoperative period. The exact effector mechanism behind the seizure triggering remains unknown. Therefore, the authors investigated the effects of TXA on the activity of glutamate transporter type 3 (excitatory amino acid transporter 3; EAAT3), which is the main neuronal glutamate transporter type. @*Methods@#EAAT3 was expressed in Xenopus laevis oocytes through mRNA injection. Oocytes were incubated with diluted tranexamic acid for 72 h. Two-electrode voltage clamping was used to measure membrane currents before, during, and after applying 30 M L-glutamate. Responses were quantified by integrating the current traces and reported in microcoulombs (C). Results were presented as mean SEM. @*Results@#TXA (30 to 1,000 M) significantly decreased EAAT3 activity. Our kinetic study showed that Vmax was significantly decreased in the TXA group compared with the control group (1.1 0.1 vs. 1.4 0.1 C, n = 18–23, P = 0.043), but the Km did not significantly change (12.7 3.9 M for TXA vs. 12.8 3.8 for control, n = 18–23, P = 0.986). @*Conclusions@#Our results suggest that TXA attenuates EAAT3 activity, which may explain its proconvulsant effect.
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Objectives@#: Tianeptine is an antidepressant that has drawn attention recently. Unlike traditional monoaminergic antidepressants, tianeptine is known to affect glutamate neurotransmission like ketamine. However, there has been paucity of studies investigating the role of tianeptine on glutamate transporters, especially excitatory amino acid transporter type 3 (EAAT3). @*Methods@#: After expression of EAAT3 by intracellular injection of EAAT3 mRNA, we investigated the effect of tianeptine on the activity of EAAT3, by measuring membrane current in response to L-glutamate administration using Xenopus oocyte expression system and two-electrode voltage clamps.. @*Results@#: Tianeptine (1mM for 72h) significantly reduced Vmax (6.9±0.6 vs. 4.8±0.3mC, n=14-22, p<0.05) without changing Km (27.0±7.6 vs. 23.3±4.9mM, n=14-22, p=0.72). @*Conclusion@#: When tianeptine was exposed for 72h, it decreased the activity of EAAT3 in a concentration-dependent manner (1-100mM). Our results suggest that tianeptine decreases EAAT3 activity by reducing the available number or turnover rate of EAAT3.
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BACKGROUND: Obstetric patients with placenta previa are at risk for sever peripartum hemorrhage. Early detection of anemia and proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin (SpHb) monitoring in patients with placenta previa during cesarean section.METHODS: Parturients diagnosed with placenta previa and scheduled for cesarean section under spinal anesthesia were enrolled. SpHb and laboratory Hb (Lab-Hb) were measured during surgery as primary outcomes.RESULTS: Seventy-four pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between SpHb and Lab-Hb (P < 0.001). The Bland-Altman plot showed a mean difference ± SD of 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were −1.2 to 1.8 g/dl. The magnitude of the difference between SpHb and Lab-Hb was < 0.5 g/dl in 64.9%; however, it was > 1.5 g/dl in 10.8%.CONCLUSIONS: SpHb monitoring had a good correlation with Lab-Hb. A small mean difference between SpHb and lab-Hb might not be clinically significant; however, the limits of agreements were not narrow. In particular, SpHb could be overestimated in the anemic population. Based on our results, further studies investigating the accuracy and precision of SpHb monitoring should be performed in parturients presenting Hb below 10 g/dl.
Subject(s)
Female , Humans , Pregnancy , Anemia , Anesthesia, Spinal , Cesarean Section , Hemorrhage , Observational Study , Peripartum Period , Placenta Previa , Placenta , Prospective StudiesABSTRACT
BACKGROUND@#We investigated the effect of irrigation fluid on coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM).@*METHODS@#Venous blood was taken from 12 healthy volunteers and divided into four specimen tubes that were diluted to various levels (0%, 10%, 20%, and 40%) using an irrigation fluid composed of 2.7% sorbitol and 0.54% mannitol.@*RESULTS@#Significant prolongation of clotting time was observed in the 40% diluted sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, the clot formation time was prolonged significantly in the 10%, 20%, and 40% diluted samples using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. A significant decrease of α-angle of INTEM and EXTEM were observed in the 10% (P < 0.001), 20% (P < 0.001 and P = 0.001, respectively), and 40% (P < 0.001) groups compared with the 0% dilution group. The maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted samples. In the MCF of EXTEM and FIBTEM assays, 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) samples showed a significant decrease compared with the 0% sample. Nevertheless, most of the ROTEM values were within the reference range, except the 40% sample.@*CONCLUSIONS@#Blood became hypocoagulable when it was diluted in vitro with a fluid composed of 2.7% sorbitol and 0.54% mannitol.
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BACKGROUND: We investigated the effect of irrigation fluid on coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM). METHODS: Venous blood was taken from 12 healthy volunteers and divided into four specimen tubes that were diluted to various levels (0%, 10%, 20%, and 40%) using an irrigation fluid composed of 2.7% sorbitol and 0.54% mannitol. RESULTS: Significant prolongation of clotting time was observed in the 40% diluted sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, the clot formation time was prolonged significantly in the 10%, 20%, and 40% diluted samples using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. A significant decrease of α-angle of INTEM and EXTEM were observed in the 10% (P < 0.001), 20% (P < 0.001 and P = 0.001, respectively), and 40% (P < 0.001) groups compared with the 0% dilution group. The maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted samples. In the MCF of EXTEM and FIBTEM assays, 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) samples showed a significant decrease compared with the 0% sample. Nevertheless, most of the ROTEM values were within the reference range, except the 40% sample. CONCLUSIONS: Blood became hypocoagulable when it was diluted in vitro with a fluid composed of 2.7% sorbitol and 0.54% mannitol.
Subject(s)
Blood Coagulation , Healthy Volunteers , Hemodilution , In Vitro Techniques , Mannitol , Reference Values , Sorbitol , ThrombelastographyABSTRACT
Many sedatives are used clinically and include benzodiazepines, barbiturates, antihistamines, propofol, and alpha-2-agonist. Benzodiazepines activate GABA neuronal receptors in the brain and present sedating, hypnotic, anxiolytic, amnestic, and anticonvulsant effects, but low analgesic effects. Propofol induce sedative, anxiolytic, and amnestic effects but no analgesic effects. However, risks such as cardiopulmonary instability and hypotension must be considered during administration. Dexmedetomidine is a high selective alpha-2 agonist and has many advantages as a sedative. Patients under dexmedetomidine sedation awaken easily and are more likely to be cooperative. Risk of respiratory depression and cardiopulmonary instability is low as well. Additionally, dexmedetomidine decreases amount of analgesic needed during and after surgery, presenting analgesic effects. Dexmedetomidine also decreases risk of delirium. However, bradycardia may occur and biphasic effects on blood pressure may be observed during beginning of administration. Because of lengthy symptom onset and offset time, physicians should carefully control administration at the beginning and end of dexmedetomidine administration. The purpose of this review is to evaluate the efficacy and availability of dexmedetomidine in various clinical fields including sedation for critically ill patients, regional anesthesia, monitored anesthesia care for some invasive procedures, stabilization of heart in cardiac surgery or endoscopic procedures.
Subject(s)
Humans , Anesthesia , Anesthesia, Conduction , Barbiturates , Benzodiazepines , Blood Pressure , Bradycardia , Brain , Critical Illness , Delirium , Dexmedetomidine , GABAergic Neurons , Heart , Histamine Antagonists , Hypnotics and Sedatives , Hypotension , Propofol , Respiratory Insufficiency , Thoracic SurgeryABSTRACT
Many sedatives are used clinically and include benzodiazepines, barbiturates, antihistamines, propofol, and alpha-2-agonist. Benzodiazepines activate GABA neuronal receptors in the brain and present sedating, hypnotic, anxiolytic, amnestic, and anticonvulsant effects, but low analgesic effects. Propofol induce sedative, anxiolytic, and amnestic effects but no analgesic effects. However, risks such as cardiopulmonary instability and hypotension must be considered during administration. Dexmedetomidine is a high selective alpha-2 agonist and has many advantages as a sedative. Patients under dexmedetomidine sedation awaken easily and are more likely to be cooperative. Risk of respiratory depression and cardiopulmonary instability is low as well. Additionally, dexmedetomidine decreases amount of analgesic needed during and after surgery, presenting analgesic effects. Dexmedetomidine also decreases risk of delirium. However, bradycardia may occur and biphasic effects on blood pressure may be observed during beginning of administration. Because of lengthy symptom onset and offset time, physicians should carefully control administration at the beginning and end of dexmedetomidine administration. The purpose of this review is to evaluate the efficacy and availability of dexmedetomidine in various clinical fields including sedation for critically ill patients, regional anesthesia, monitored anesthesia care for some invasive procedures, stabilization of heart in cardiac surgery or endoscopic procedures.
Subject(s)
Humans , Anesthesia , Anesthesia, Conduction , Barbiturates , Benzodiazepines , Blood Pressure , Bradycardia , Brain , Critical Illness , Delirium , Dexmedetomidine , GABAergic Neurons , Heart , Histamine Antagonists , Hypnotics and Sedatives , Hypotension , Propofol , Respiratory Insufficiency , Thoracic SurgeryABSTRACT
BACKGROUND: Anesthetic agents used for general anesthesia are emerging possible influential factors for surgical site infection (SSI). In this retrospective study, we evaluated the incidence of SSI after colorectal surgery according to the main anesthetic agents: volatile anesthetics vs. propofol. METHODS: A total 1,934 adult patients, who underwent elective colorectal surgery under general anesthesia between January 2011 and December 2013, were surveyed to evaluate the incidence of SSI: 1,519 using volatile anesthetics and 415 using propofol for main anesthetic agents. Patient, surgery, and anesthesia-related factors were investigated from all patients. Propensity-score matching was performed to reduce the risk of confounding and produced 390 patients in each group. RESULTS: Within the propensity-score matched groups, the incidence of SSI was higher in the volatile group compared with the propofol group (10 [2.6%] vs. 2 [0.5%], OR = 5.0 [95% CI = 1.1-2.8]). C-reactive protein was higher in the volatile group than in the propofol group (8.4 ± 5.6 vs. 7.1 ± 5.3 mg/dl, P = 0.001), and postoperative white blood cells count was higher in the volatile group than in the propofol group (9.2 ± 3.2 × 10³/µl vs. 8.6 ± 3.4 × 10³/µl, P = 0.041). CONCLUSIONS: The results of this study suggest that intravenous anesthesia may have beneficial effects for reducing SSI in colorectal surgery compared to volatile anesthesia.
Subject(s)
Adult , Humans , Anesthesia , Anesthesia, General , Anesthesia, Inhalation , Anesthesia, Intravenous , Anesthetics , C-Reactive Protein , Colorectal Surgery , Incidence , Leukocytes , Propofol , Research Design , Retrospective Studies , Surgical Wound InfectionABSTRACT
BACKGROUND: Hydroxyethyl starch (HES) solutions are used as plasma expanders for correcting hypovolemia, but can lead to impaired coagulation. We evaluated the changes in hematological and hemostatic profiles with three types of HES. METHODS: Patients were randomized to receive volume replacement with 10% pentastarch 260/0.45 in 0.9% saline (Group-PEN, n = 25), 6% tetrastarch 130/0.4 in 0.9% saline (Group-TET(S), n = 25), or 6% tetrastarch 130/0.4 in a balanced electrolyte solution (Group-TET(B), n = 25). Coagulation was assessed using rotational thromboelastometry (ROTEM(R)) and other laboratory tests were performed, including measurements of hematological and hemostatic parameters and electrolytes. RESULTS: Post-operative ROTEM(R) parameters changed toward hypocoagulable states in all groups. The post-operative parameters of EXTEM and FIBTEM were more impaired in Group-PEN than in Group-TET(B). The percentage change in INTEM clot formation time (P = 0.004) and alpha-angle (P = 0.003) were smaller in Group-TET(S) and Group-TET(B) than in Group-PEN. The percentage change in the FIBTEM maximum clot firmness was greatest in Group-PEN (P = 0.011). The international normalized ratio of prothrombin time (P < 0.001) and the activated partial thromboplastin time (P < 0.001) were significantly prolonged in Group-PEN compared to those of Group-TET(B). CONCLUSIONS: The 6% HES 130/0.4 in a balanced electrolyte solution seemed to have less of an impact on blood coagulation than the 10% HES 260/0.45. No differences in hemostatic profile were observed between the balanced electrolyte and saline-based 6% HES 130/0.4.
Subject(s)
Humans , Arthroplasty, Replacement, Hip , Blood Coagulation , Colloids , Electrolytes , Hydroxyethyl Starch Derivatives , Hypovolemia , International Normalized Ratio , Partial Thromboplastin Time , Plasma , Prothrombin Time , Starch , ThrombelastographyABSTRACT
BACKGROUND: Using rotational thromboelastometry (ROTEM) analysis, we investigated the difference in blood hemostasis, based on the primary anesthetic agents used during general anesthesia. METHODS: Sixty-six adult patients scheduled for elective ophthalmic surgery under general anesthesia were evaluated with regard to changes in each parameter in INTEM, EXTEM, and FIBTEM analyses. The patients received intravenous anesthesia with propofol and remifentanil (TIVA group) or inhalation anesthesia with sevoflurane (SEVO group). The ROTEM tests were performed 10 min before starting anesthesia and 1 h after finishing anesthesia. The INTEM and EXTEM analyses included the clotting time (CT), clot firmness time (CFT), alpha angle (alpha), and maximum clot firmness (MCF). The FIBTEM analyzed only MCF. Maximum clot elasticity (MCE) was calculated by (MCF x 100) / (100 - MCF). The platelet component of clot strength was calculated as follows: MCE(platelet) = MCE(EXTEM) - MCE(FIBTEM). RESULTS: The preoperative and postoperative parameters (CT, CFT, alpha, and MCF) in the INTEM, EXTEM, and FIBTEM analyses were not significantly different between the two groups. The MCE(platelet) also did not show a significant difference. CONCLUSIONS: Presuming that the ophthalmic surgery had a minimal traumatic effect, we conclude that both anesthetic agents cause negligible changes in ROTEM analyses postoperatively.
Subject(s)
Adult , Humans , Anesthesia , Anesthesia, General , Anesthesia, Inhalation , Anesthesia, Intravenous , Anesthetics , Blood Platelets , Elasticity , Hemostasis , Propofol , ThrombelastographyABSTRACT
BACKGROUND: Magnesium sulfate (MgSO4) is a drug of choice for women with preeclampsia, with evidence that it reduces progression to eclampsia and maternal mortality. However, no previous studies have been conducted on the effect of magnesium sulfate on labor. This retrospective study investigated the effect of magnesium sulfate on the labor duration and the neonatal outcomes in parturients with preeclampsia. METHODS: We reviewed the medical records of 209 women who delivered vaginally with the diagnosis of preeclampsia from January 1, 2003 to June 30, 2013. They were divided into two groups, primipara (Primi group) and multipara (Multi group). Then, each group was subclassified as MgSO4-treated (Mg group) and MgSO4-untreated group (Cont group) again. Collected data included the duration of each stage of labor and neonatal outcomes. RESULTS: The duration of the 1st stage of labor was significantly longer in the Multi-Mg group, compared with the Multi-Cont group (138 +/- 149 min vs. 88 +/- 92 min, P = 0.025). However, the total labor durations were comparable between the two groups. Primi group had no difference in durations of any stage of labor and the total duration. Neonates showed worse outcomes (lower birth weight, lower Apgar, higher NICU admission rate) in the Primi-Mg group than the Primi-Cont group. CONCLUSIONS: Although preeclamptic multiparous parturients treated with MgSO4 showed longer 1st stage of labor than those untreated with MgSO4, the total labor durations were comparable between the groups.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Diagnosis , Eclampsia , Infant, Low Birth Weight , Magnesium Sulfate , Maternal Mortality , Medical Records , Pre-Eclampsia , Retrospective StudiesABSTRACT
BACKGROUND: We investigated the effects of a magnesium sulfate pretreatment on intubating conditions and cardiovascular responses during rapid sequence tracheal intubation (RSI) in this double-blind randomized study. METHODS: Adult patients (n = 154) were randomly allocated to a rocuronium-0.6, rocuronium-0.9, or magnesium group. The magnesium group was pretreated with 50 mg/kg MgSO4, and the other two groups received the same volume of isotonic saline. Anesthesia was induced with alfentanil, propofol, and either 0.6 mg/kg (rocuronium-0.6 and magnesium groups) or 0.9 mg/kg (rocuronium-0.9 group) rocuronium. An anesthesiologist, blinded to the group assignments, performed RSI and assessed the intubating conditions. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before the magnesium sulfate or normal saline was administered, before anesthesia induction, before intubation, and every minute after intubation for 5 min. RESULTS: Airway features were similar among the three groups. The intubating conditions were improved significantly in the magnesium group (P 0.05). No hypertensive episode occurred during the immediate post-intubation period in the magnesium group (P = 0.001), and tachycardia occurred most frequently in the rocuronium-0.6 group (P < 0.05). CONCLUSIONS: MgSO4 administered prior to RSI using alfentanil, propofol, and rocuronium may improve intubating conditions and prevent post-intubation hypertension.
Subject(s)
Adult , Humans , Alfentanil , Androstanols , Anesthesia , Arterial Pressure , Heart Rate , Hypertension , Intubation , Magnesium , Magnesium Sulfate , Propofol , TachycardiaABSTRACT
No abstract available.
Subject(s)
Blood Pressure , Pancreatectomy , Subclavian Artery , Subclavian Steal SyndromeABSTRACT
No abstract available.
Subject(s)
Delayed Emergence from Anesthesia , Embolization, Therapeutic , Infarction, Posterior Cerebral Artery , Posterior Cerebral ArteryABSTRACT
No abstract available.