RESUMO
There is a lack of information on critical care in Korea. The aim of this study was to determine the current status of Korean intensive care units (ICUs), focusing on the organization, characteristics of admitted patients, and nurse and physician staffing. Critical care specialists in charge of all 105 critical care specialty training hospitals nationwide completed a questionnaire survey. Among the ICUs, 56.4% were located in or near the capital city. Only 38 ICUs (17.3%) had intensive care specialists with a 5-day work week. The average daytime nurse-to-patient ratio was 1:2.7. Elderly people > or = 65 yr of age comprised 53% of the adult patients. The most common reasons for admission to adult ICUs were respiratory insufficiency and postoperative management. Nurse and physician staffing was insufficient for the appropriate critical care in many ICUs. Staffing was worse in areas outside the capital city. Much effort, including enhanced reimbursement of critical care costs, must be made to improve the quality of critical care at the national level.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Cuidados Críticos/organização & administração , Hospitais , Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Médicos/estatística & dados numéricos , Inquéritos e Questionários , República da CoreiaRESUMO
BACKGROUND: Nitrous oxide (N2O) and remifentanil both have anesthetic-reducing and antinociceptive effects. We aimed to determine the anesthetic requirements and stress hormone responses in spinal cord-injured (SCI) patients undergoing surgery under sevoflurane anesthesia with or without pharmacodynamically equivalent doses of N2O or remifentanil. METHODS: Forty-five chronic, complete SCI patients undergoing surgery below the level of injury were randomly allocated to receive sevoflurane alone (control, n = 15), or in combination with 67% N2O (n = 15) or target-controlled infusion of 1.37 ng/ml remifentanil (n = 15). Sevoflurane concentrations were titrated to maintain a Bispectral Index (BIS) value between 40 and 50. Measurements included end-tidal sevoflurane concentrations, mean arterial blood pressure (MAP), heart rate (HR), and plasma catecholamine and cortisol concentrations. RESULTS: During surgery, MAP, HR, and BIS did not differ among the groups. Sevoflurane concentrations were lower in the N2O group (0.94 +/- 0.30%) and the remifentanil group (1.06 +/- 0.29%) than in the control group (1.55 +/- 0.34%) (P < 0.001, both). Plasma concentrations of norepinephrine remained unchanged compared to baseline values in each group, with no significant differences among groups throughout the study. Cortisol levels decreased during surgery as compared to baseline values, and returned to levels higher than baseline at 1 h after surgery (P < 0.05) without inter-group differences. CONCLUSIONS: Remifentanil (1.37 ng/ml) and N2O (67%) reduced the sevoflurane requirements similarly by 31-39%, with no significant differences in hemodynamic and neuroendocrine responses. Either remifentanil or N2O can be used as an anesthetic adjuvant during sevoflurane anesthesia in SCI patients undergoing surgery below the level of injury.
Assuntos
Humanos , Anestesia , Pressão Arterial , Catecolaminas , Frequência Cardíaca , Hemodinâmica , Hidrocortisona , Óxido Nitroso , Norepinefrina , Plasma , Traumatismos da Medula EspinalRESUMO
BACKGROUND: Elevated systemic levels of pro-inflammatory cytokines cause hypotension during septic shock and induce capillary leakage in acute lung injury. Manassantin B has anti-inflammatory and anti-plasmoidal properties. This study examined the effects of manassantin B on lipopolysaccharide (LPS)-induced inflammatory response in murine macrophages. METHODS: RAW 264.7 macrophage cells were incubated without or with (1, 3 and 10 microM) manassantin B and without or with (100 ng/ml) LPS. Manassantin B dissolved in phosphate buffered saline was added to the medium 1 h prior to the addition of LPS. The degree of activation of mitogen-activated protein kinase (MAPK) including extracellular signal-regulated kinases 1 and 2 (ERK1/2), c-Jun amino terminal kinases (JNK) and p38 MAPK, and the level of interleukin (IL)-1beta were determined 30 min and 24 h after the addition of LPS respectively. RESULTS: Manassantin B inhibited the production of IL-1beta and attenuated the phosphorylations of ERK1/2 and p38 MAPK, but not that of JNK, in RAW 264.7 cells treated with LPS. CONCLUSIONS: Manassantin B reduces LPS-induced IL-1beta expression through effects on ERK1/2- and p38 MAPK-mediated pathways. Manassantin B has potential as a potent anti-inflammatory drug for use in pathological processes such as sepsis or acute lung injury.
Assuntos
Lesão Pulmonar Aguda , Capilares , Citocinas , MAP Quinases Reguladas por Sinal Extracelular , Furanos , Hipotensão , Interleucina-1beta , Interleucinas , Lipopolissacarídeos , Macrófagos , Proteínas Quinases p38 Ativadas por Mitógeno , Processos Patológicos , Fosforilação , Fosfotransferases , Proteínas Quinases , Saururaceae , Sepse , Choque SépticoRESUMO
BACKGROUND: Urinary trypsin inhibitors (UTI) have been widely used for the treatment of diseases including disseminated intravascular coagulation, shock, and pancreatitis. Since UTI synthesis is likely to be reduced in patients who have undergone liver resection, the incidence of inflammatory reactions may be increasing accordingly. For such patients, the liver enzyme increases after the operation can reflect liver damage. The purpose of this study was to examine if ulinastatin can inhibit liver enzyme increases after liver resection. METHODS: After receiving Institutional Review Board approval, a retrospective chart review was performed on 201 patients who underwent hepatic resection from 2006 to 2010. We divided the records into the control (n = 69) and ulinastatin (n = 132) groups according to the use of intraoperative ulinastatin and compared the preoperative and postoperative laboratory test results. The number of patients who had > 400 U/L elevation of aspartate transaminase (AST) level after surgery was compared between the 2 groups. RESULTS: The mean AST, alanine transaminase (ALT), and total bilirubin levels after liver resection were significantly lower in the ulinastatin group than in the control group. The number of patients who showed an AST > 400 U/L after liver resection was significantly higher in the control group (odds ratio = 3.02). CONCLUSIONS: Ulinastatin attenuates the elevation of hepatic enzymes and bilirubin after liver resection.
Assuntos
Humanos , Alanina Transaminase , Aspartato Aminotransferases , Bilirrubina , Coagulação Intravascular Disseminada , Comitês de Ética em Pesquisa , Glicoproteínas , Hepatectomia , Incidência , Fígado , Testes de Função Hepática , Pancreatite , Estudos Retrospectivos , Choque , Tripsina , Inibidores da TripsinaRESUMO
Sauchinone has been known to have anti-inflammatory and antioxidant effects. We determined whether sauchinone is beneficial in regional myocardial ischemia/reperfusion (I/R) injury. Rats were subjected to 20 min occlusion of the left anterior descending coronary artery, followed by 2 hr reperfusion. Sauchinone (10 mg/kg) was administered intraperitoneally 30 min before the onset of ischemia. The infarct size was measured 2 hr after resuming the perfusion. The expression of cell death kinases (p38 and JNK) and reperfusion injury salvage kinases (phosphatidylinositol-3-OH kinases-Akt, extra-cellular signal-regulated kinases [ERK1/2])/glycogen synthase kinase (GSK)-3beta was determined 5 min after resuming the perfusion. Sauchinone significantly reduced the infarct size (29.0% +/- 5.3% in the sauchinone group vs 44.4% +/- 6.1% in the control, P < 0.05). Accordingly, the phosphorylation of JNK and p38 was significantly attenuated, while that of ERK1/2, Akt and GSK-3beta was not affected. It is suggested that sauchinone protects against regional myocardial I/R injury through inhibition of phosphorylation of p38 and JNK death signaling pathways.
Assuntos
Animais , Ratos , Benzopiranos/farmacologia , Dioxóis/farmacologia , Quinase 3 da Glicogênio Sintase/metabolismo , Proteínas Quinases JNK Ativadas por Mitógeno/metabolismo , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Fosforilação , Substâncias Protetoras/farmacologia , Transdução de Sinais/efeitos dos fármacos , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
PURPOSE: Anesthesia and surgery commonly cause hypothermia, and this caused by a combination of anesthetic-induced impairment of thermoregulatory control, a cold operation room environment and other factors that promote heat loss. All the general anesthetics markedly impair normal autonomic thermoregulatory control. The aim of this study is to evaluate the effect of two different types of propofol versus inhalation anesthetic on the body temperature. MATERIALS AND METHODS: In this randomized controlled study, 36 patients scheduled for elective laparoscopic gastrectomy were allocated into three groups; group S (sevoflurane, n=12), group L (lipid-emulsion propofol, n=12) and group M (micro-emulsion propofol, n=12). Anesthesia was maintained with typical doses of the study drugs and all the groups received continuous remifentanil infusion. The body temperature was continuously monitored after the induction of general anesthesia until the end of surgery. RESULTS: The body temperature was decreased in all the groups. The temperature gradient of each group (group S, group L and group M) at 180 minutes from induction of anesthesia was 2.5+/-0.6degrees C, 1.6+/-0.5degrees C and 2.3+/-0.6degrees C, respectively. The body temperature of group L was significantly higher than that of group S and group M at 30 minutes and 75 minute after induction of anesthesia, respectively. There were no temperature differences between group S and group M. CONCLUSION: The body temperature is maintained at a higher level in elderly patients anesthetized with lipid-emulsion propofol.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envelhecimento , Anestesia Geral/métodos , Anestésicos Combinados/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Temperatura Corporal/efeitos dos fármacos , Regulação da Temperatura Corporal/efeitos dos fármacos , Emulsões Gordurosas Intravenosas , Éteres Metílicos/administração & dosagem , Propofol/administração & dosagemRESUMO
BACKGROUND: A low fraction of inspired oxygen (FiO2) increases venous deoxygenated hemoglobin concentrations, making the color of the blood darker. The present study was aimed to determine the effects of FiO2 on the ability to discriminate venous from arterial blood. METHODS: One-hundred and sixty surgical patients undergoing percutaneous central venous access of the internal jugular vein were randomly assigned to receive an FiO2 of 0.2, 0.4, 0.6, or 1.0 (n = 40 each) for at least 20 min prior to central line placement under general anesthesia. Vascular access was achieved with a 22-gauge needle; 2 ml of blood was withdrawn and shown to three physicians including the operator. Each of them was asked to identify the blood as 'arterial', 'venous' or 'not sure'. Simultaneous blood gas analysis of the samples was performed on blood taken from the puncture site and the artery after visual comparison to confirm blood's origin and hemodynamic measurements. RESULTS: Lowering FiO2 progressively increased venous deoxygenated hemoglobin concentrations (2.24 +/- 1.12, 3.30 +/- 1.08, 3.66 +/- 1.15, and 3.71 +/- 1.33 g/dl) in groups having an FiO2 of 1.0, 0.6, 0.4 and 0.2, respectively (P < 0.001), thereby facilitating the 'venous' blood identification (P < 0.001). Neither heart rate nor mean arterial pressure differed among the groups. None developed hypoxemia (percutaneous hemoglobin oxygen saturation < 90%) in any group during the study period. CONCLUSIONS: A low FiO2 increases venous deoxygenated hemoglobin levels, thereby facilitating the recognition by clinicians of its venous origin in percutaneous central venous catheterization under general anesthesia.
Assuntos
Humanos , Anestesia Geral , Hipóxia , Pressão Arterial , Artérias , Gasometria , Cateterismo Venoso Central , Cateteres Venosos Centrais , Frequência Cardíaca , Hemodinâmica , Hemoglobinas , Veias Jugulares , Oxigênio , PunçõesRESUMO
BACKGROUND: Caffeic acid phenethyl ester (CAPE) is an active component of propolis and is known to have anti-inflammatory properties. This study was performed to evaluate the effects of CAPE on lipopolysaccharide (LPS)-induced murine macrophage activation. METHODS: Raw 264.7 cells were incubated with varying concentrations of CAPE with or without LPS. The production of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta and macrophage inflammatory protein-2 (MIP-2) and activation of extracellular signal-regulated kinases 1/2 (ERK1/2), c-Jun amino terminal kinases (JNK) and p38 were measured. RESULTS: CAPE inhibited the production of TNF-alpha, IL-1beta and MIP-2 and attenuated phosphorylation levels of ERK1/2 and p38, but not JNK in RAW264.7 cells stimulated with LPS. CONCLUSIONS: CAPE can attenuate LPS-induced macrophage responses and we suggest that these effects may play an important role in modulating macrophage-mediated inflammatory responses in vivo.
Assuntos
Ácidos Cafeicos , Citocinas , MAP Quinases Reguladas por Sinal Extracelular , Interleucinas , Ativação de Macrófagos , Macrófagos , Proteínas Quinases Ativadas por Mitógeno , Álcool Feniletílico , Fosforilação , Fosfotransferases , Própole , Fator de Necrose Tumoral alfaRESUMO
BACKGROUND: The analgesic mechanisms of cyclooxygenase (COX)-2 inhibitors have been explained mainly on the basis of the inhibition of prostaglandin biosynthesis. However, several lines of evidence suggest that their analgesic effects are mediated through serotonergic or adrenergic transmissions. We investigated the roles of these neurotransmitters in the antinociception of a selective COX-2 inhibitor at the spinal level. METHODS: DUP-697, a selective COX-2 inhibitor, was delivered through an intrathecal catheter to male Sprague-Dawley rats to examine its effect on the flinching responses evoked by formalin injection into the hindpaw. Subsequently, the effects of intrathecal pretreatment with dihydroergocristine, prazosin, and yohimbine, which are serotonergic, alpha1 adrenergic and alpha2 adrenergic receptor antagonists, respectively, on the analgesia induced by DUP-697 were assessed. RESULTS: Intrathecal DUP-697 reduced the flinching response evoked by formalin injection during phase 1 and 2. But, intrathecal dihydroergocristine, prazosin, and yohimbine had little effect on the antinociception of intrathecal DUP-697 during both phases of the formalin test. CONCLUSIONS: Intrathecal DUP-697, a selective COX-2 inhibitor, effectively relieved inflammatory pain in rats. Either the serotonergic or adrenergic transmissions might not be involved in the analgesic activity of COX-2 inhibitors at the spinal level.
Assuntos
Animais , Humanos , Masculino , Ratos , Antagonistas Adrenérgicos , Analgesia , Catéteres , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Di-Hidroergocristina , Formaldeído , Neurotransmissores , Prazosina , Prostaglandina-Endoperóxido Sintases , Ratos Sprague-Dawley , Receptores Adrenérgicos , Medula Espinal , Tiofenos , IoimbinaRESUMO
BACKGROUND: Endotracheal intubation usually causes transient hypertension and tachycardia. The cardiovascular and arousal responses to endotracheal and endobronchial intubation were determined during rapid-sequence induction of anesthesia in normotensive and hypertensive elderly patients. METHODS: Patients requiring endotracheal intubation with (HT, n = 30) or without hypertension (NT, n = 30) and those requiring endobronchial intubation with (HB, n = 30) or without hypertension (NB, n = 30) were included in the study. Anesthesia was induced with intravenous thiopental 5 mg/kg followed by succinylcholine 1.5 mg/kg. After intubation, all subjects received 2% sevoflurane in 50% nitrous oxide and oxygen. Mean arterial pressure (MAP), heart rate (HR), plasma catecholamine concentration, and Bispectral Index (BIS) values, were measured before and after intubation. RESULTS: The intubation significantly increased MAP, HR, BIS values and plasma catecholamine concentrations in all groups, the peak value of increases was comparable between endotracheal and endobronchial intubation. However, pressor response persisted longer in the HB group than in the HT group (5.1 +/- 1.6 vs. 3.2 +/- 0.9 min, P < 0.05). The magnitude of increases in MAP and norepinephrine from pre-intubation values was greater in the hypertensive than in the normotensive group (P < 0.05), while there were no differences in those of HR and BIS between the hypertensive and normotensive groups. CONCLUSIONS: Cardiovascular response and arousal response, as measured by BIS, were similar in endobronchial and endotracheal intubation groups regardless of the presence or absence of hypertension except for prolonged pressor response in the HB group. However, the hypertensive patients showed enhanced cardiovascular responses than the normotensive patients.
Assuntos
Idoso , Humanos , Anestesia , Nível de Alerta , Pressão Arterial , Frequência Cardíaca , Hipertensão , Intubação , Intubação Intratraqueal , Éteres Metílicos , Óxido Nitroso , Norepinefrina , Oxigênio , Plasma , Succinilcolina , Taquicardia , TiopentalRESUMO
BACKGROUND: The injection pain of microemulsion propofol is frequent and difficult to prevent. This study examined the prevention of pain during microemulsion propofol injection by pretreatment with different doses of remifentanil or saline, and premixing of lidocaine. METHODS: One hundred sixty ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into one of four groups (n = 40, in each). The patients received saline (group LS), remifentanil 0.3 microg/kg (group LR 0.3), remifentanil 0.5 microg/kg (group LR 0.5), or remifentanil 1.0 microg/kg (group LR 1.0), and after 90 seconds received an injection of 2 mg/kg microemulsion propofol premixed with lidocaine 40 mg. Pain was assessed on a four-point scale during microemulsion propofol injection. RESULTS: The incidence of microemulsion propofol-induced pain was significantly lower in the LR 0.3, LR 0.5 and LR 1.0 groups than in the LS group (37.5%, 12.5% and 10% vs 65%, respectively). The LR 0.5 and LR 1.0 groups showed significantly less frequent and intense pain than the LR 0.3 group. However, both incidence and severity of pain were not different between LR 0.5 and LR 1.0 groups. CONCLUSIONS: The combination of remifentanil and lidocaine is effective in alleviating pain associated with a microemulsion propofol injection compared with just lidocaine. Remifentanil 0.5 microg/kg had a similar analgesic effect compared to the 1.0 microg/kg dose.
Assuntos
Adulto , Humanos , Incidência , Lidocaína , Piperidinas , PropofolRESUMO
BACKGROUND: Selective inhibitors of cyclooxygenase (COX)-2 are commonly used analgesics in various pain conditions. Although their actions are largely thought to be mediated by the blockade of prostaglandin (PG) biosynthesis, evidences suggesting endogenous opioid peptide link in spinal antinociception of COX inhibitor have been reported. We investigated the roles of opioid receptor subtypes in the spinal antinociception of selective COX-2 inhibitor. METHODS: To examine the antinociception of a selective COX-2 inhibitor, DUP-697 was delivered through an intrathecal catheter, 10 minutes before the formalin test in male Sprague-Dawley rats. Then, the effect of intrathecal pretreatment with CTOP, naltrindole and GNTI, which are micro, delta and kappa opioid receptor antagonist, respectively, on the analgesia induced by DUP-697 was assessed. RESULTS: Intrathecal DUP-697 reduced the flinching response evoked by formalin injection during phase 1 and 2. Naltrindole and GNTI attenuated the antinociceptive effect of intrathecal DUP-697 during both phases of the formalin test. CTOP reversed the antinociception of DUP-697 during phase 2, but not during phase 1. CONCLUSIONS: Intrathecal DUP-697, a selective COX-2 inhibitor, effectively relieved inflammatory pain in rats. The delta and kappa opioid receptors are involved in the activity of COX-2 inhibitor on the facilitated state as well as acute pain at the spinal level, whereas the micro opioid receptor is related only to facilitated pain.
Assuntos
Animais , Humanos , Masculino , Ratos , Dor Aguda , Hidróxido de Alumínio , Analgesia , Analgésicos , Carbonatos , Catéteres , Ciclo-Oxigenase 2 , Formaldeído , Naltrexona , Peptídeos Opioides , Medição da Dor , Prostaglandina-Endoperóxido Sintases , Ratos Sprague-Dawley , Receptores Opioides , Receptores Opioides kappa , Somatostatina , TiofenosRESUMO
BACKGROUND: Pain upon the injection of propofol is a common adverse effect. This study was conducted to evaluate the analgesic effect of remifentanil and cold propofol during propofol injection for the induction of anesthesia and to determine if a combination of cold propofol and remifentanil produced additional analgesic efficacy. METHODS: A total of 160 patients aged 20-65 years old were randomly allocated into one of four groups (n = 40, in each). Control and remifentanil group patients received 2 mg/kg propofol that had been stored at room temperature (20-23degrees C), while the cold and combination group received cold (4degrees C) propofol. The patients received remifentanil 0.5 microg/kg IV in the remifentanil and combination groups or saline in the control and cold groups. Ninety seconds after administration the patients were administered propofol over a 30 second period. The pain intensity and incidence were then evaluated using a 4-point verbal rating scale. RESULTS: The incidence of pain was significantly reduced in groups that received remifentanil in the cold and combination groups when compared with the control group (27.5%, 30%, and 2.5% vs. 70%, respectively). Moreover, the severity of pain was significantly lower in groups that received remifentanil in the cold and combination groups when compared with the control group. The incidence and severity of pain from the propofol injection in the combination group was significantly lower than that in the remifentanil and cold groups. CONCLUSIONS: The combination of cold propofol and pretreatment with remifentanil more effectively reduced the incidence of pain upon the injection of propofol than either treatment alone.
Assuntos
Idoso , Humanos , Anestesia , Temperatura Baixa , Incidência , Piperidinas , PropofolRESUMO
A clinically apparent thromboembolism associated with arthroscopic shoulder surgery is extremely rare. We report a case of a fatal pulmonary embolism developed after an arthroscopic rotator cuff repair in a 45-year-old woman. On the first day after surgery, she experienced syncope that was complicated by cardiac arrest. No hemostasis impairment was noted. A computed tomography scan revealed a pulmonary embolism, and Doppler ultrasound revealed thrombosis of the axillary vein on the contralateral shoulder. She died from multiple organ failure 13 days after surgery. This case shows that clinicians must be aware of the potential occurrence of a pulmonary thromboembolism in patients undergoing prolonged arthroscopic shoulder surgery.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Veia Axilar , Parada Cardíaca , Hemostasia , Insuficiência de Múltiplos Órgãos , Embolia Pulmonar , Manguito Rotador , Ombro , Síncope , Tromboembolia , Trombose , Trombose VenosaRESUMO
BACKGROUND: Inflammation plays an important role in the postoperative morbidity of organs, which is related to the activation of pro-inflammatory and anti-inflammatory cytokines. Ulinastatin (Urinary trypsin inhibitor, UTI) is a serine protease inhibitor found in human urine or serum that inhibits the activation of human leukocyte elastase. This study examined the effect of UTI on the inflammation response in patients undergoing a gastrectomy. METHODS: Thirty patients scheduled to undergo a gastrectomy were divided into two groups as follows: Control group (untreated, n = 15) and UTI group (100,000 units of UTI were continuously injected intravenously for 2 hours, n = 15). Arterial blood was sampled before surgery (T0), 10 minutes after its onset (T1), at its end (T2), and 1 hour after surgery (T3) to measure the level of cytokines. RESULTS: Both the control and treatment groups had higher interleukin (IL)-6 levels at T2 and T3 than T0, and the level increased with time. However, the increase was smaller in the treatment group. The IL-8 levels were not activated significantly in any of the groups. CONCLUSIONS: UTI inhibits the secretion of IL-6, which is an inflammatory cytokine produced after a gastrectomy. This shows that UTI can decrease the inflammation reaction caused by surgical stress.
Assuntos
Humanos , Citocinas , Gastrectomia , Glicoproteínas , Inflamação , Interleucina-6 , Interleucina-8 , Interleucinas , Elastase de Leucócito , Serina Proteases , TripsinaRESUMO
BACKGROUND: Microemulsion propofol produces more frequent and severe pain upon injection than lipid emulsion propofol. This study examined the analgesic effect of lidocaine-premixed microemulsion propofol in patients pretreated with remifentanil. The induction of anesthesia with this combination was compared with microemulsion propofol accompanied with either remifentanil or lidocaine. METHODS: One hundred twenty patients aged between 20-65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the remifentanil group received remifentanil 0.5 microgram/kg IV for 30 seconds before a microemulsion propofol injection. The patients in the lidocaine group received propofol 2 mg/kg premixed with 40 mg lidocaine over a 60 second period. The patients in the combination group received both remifentanil and lidocaine. RESULTS: There was a significantly lower incidence of microemulsion propofol injection pain (severity 2 or more) in the combination group (12.5%) than in the remifentanil and lidocaine groups (90% and 65%, respectively, P < 0.05). The incidence of moderate pain disappeared completely in the combination group (0%) compared to that in the remifentanil and lidocaine group (32.5% and 20%, respectively, P < 0.05). Severe pain did not appear in any of the three groups. There were no complications on the injection site in the lidocaine alone and combination groups. CONCLUSIONS: The combination of microemulsion propofol premixed with lidocaine after a pretreatment with remifentanil was more effective in reducing the incidence of pain upon the injection of microemulsion propofol than either treatment alone.
Assuntos
Idoso , Humanos , Anestesia , Anestésicos Intravenosos , Incidência , Lidocaína , Piperidinas , PropofolRESUMO
BACKGROUND: Endotracheal intubation elicits cardiovascular and arousal responses. The present study was aimed to determine whether remifentanil affects these responses in patients with preeclampsia. METHODS: Thirty preeclamptic women who were scheduled to undergo cesarean delivery under general anesthesia were randomly assigned to receive either remifentanil 1 microgram/kg (n = 15) or saline (n = 15) before induction of anesthesia. Systolic arterial pressure (SBP), heart rate (HR) and bispectral index (BIS) value as well as plasma catecholamine concentrations were measured. Neonatal effects were assessed using Apgar score and umbilical cord blood gas analysis. RESULTS: Induction with thiopental caused a reduction in SBP and BIS (P < 0.01) in both groups. Following the tracheal intubation SBP and HR increased in both groups, the magnitude of which was lower in the remifentanil group. BIS values also increased, of which magnitude did not differ between the groups. Norepinephrine concentrations increased significantly following the intubation in the control, while remained unaltered in the remifentanil group. The neonatal Apgar scores (5 min), and umbilical gas values were similar in the two groups except for higher incidence of Apgar score < 7 at 1 min in the remifentanil group. CONCLUSIONS: Remifentanil 1 microgram/kg effectively attenuates hemodynamic and catecholamine but not BIS responses to tracheal intubation in preeclamptic patients undergoing cesarean delivery. However, remifentanil may cause mild neonatal depression and thus should be used when adequate facilities for neonatal resuscitation are available.
Assuntos
Feminino , Humanos , Anestesia , Anestesia Geral , Índice de Apgar , Nível de Alerta , Pressão Arterial , Depressão , Sangue Fetal , Frequência Cardíaca , Hemodinâmica , Hipertensão , Incidência , Intubação , Intubação Intratraqueal , Laringoscopia , Norepinefrina , Piperidinas , Plasma , Pré-Eclâmpsia , Ressuscitação , TiopentalRESUMO
BACKGROUND: We compared the effects of different remifentanil effect-site concentrations on intubating conditions, and cardiovascular and bispectral index score (BIS) responses to intubation at a fixed effect-site concentration of propofol without muscle relaxants. METHODS: Sixty-four patients were randomly assigned to one of three groups: remifentanil 2 (group R2, n = 22), 4 (group R4, n = 21), or 6 ng/ml (group R6, n = 21). Anesthesia was induced using target-controlled infusion of propofol 5 microgram/ml and each concentration of remifentanil. Laryngoscopy and intubation was attempted at 2.5 min following induction. Intubating conditions were assessed as excellent, good or poor using a standard scoring system. Mean arterial pressure (MAP), heart rate (HR), and BIS values were assessed. RESULTS: Excellent or good intubating conditions were obtained in 91% of group R4 and 95% of R6, both of which are higher compared with 32% of R2 (P < 0.01). MAP and HR decreased significantly after induction in all groups. After intubation, they recovered to baseline value in group R2 and R4 but were significantly less than baseline values in R6. BIS response to intubation was attenuated in group R4 and R6 but not R2. Hypotension was more frequent in group R6 than R2. CONCLUSIONS: Remifentanil target concentrations of 4 or 6 ng/ml combined with 5 microgram/ml propofol provided good or excellent conditions for tracheal intubation and prevented cardiovascular and BIS response during induction without muscle relaxants. However, the use of 6 ng/ml dose was associated with frequent occurrence of hypotension and bradycardia requiring treatment.
Assuntos
Humanos , Anestesia , Pressão Arterial , Bradicardia , Frequência Cardíaca , Hemodinâmica , Hipotensão , Intubação , Laringoscopia , Músculos , Piperidinas , PropofolRESUMO
BACKGROUND: We investigated whether the intubating condition change acoording to the methods of administration of propofol and rocuronium. METHODS: Ninety adult patients (ASA physical status I or II) undergoing elective surgery were randomly assigned to one of three groups; Group I (n = 30) received rocuronium (0.6 mg/kg) after administration of propofol (2 mg/kg), Group II (n = 30) received propofol and rocuronium simultaneously via different intravenous routes, and Group III (n = 30) received a mixture of propofol and rocuronium via same intravenous route. Intubation was attempted at 60 seconds after administration of rocuronium. Hemodynamic parameters (mean blood pressure, heart rate) were measured before and after propofol administration with 20 seconds interval. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. Train of four counts were recorded at 60 seconds after administration of rocuronium. RESULTS: Excellent intubating conditions were obtained in 13% in group I, 60% in group II, 77% in group III. Mean train of four counts were 3.7 in group I, 3.4 in group II, and 3.5 in group III. Mean blood pressures were decreased gradually after propofol administration in all groups. However, heart rates were not changed in all groups. CONCLUSIONS: At induction of anesthesia, simultaneous or mixed administration of propofol and rocuronium provides excellent or good intubating conditions 60 seconds after rocuronium administration. It could be an effective alternative to succinylcholine for rapid sequence induction of anesthesia.
Assuntos
Adulto , Humanos , Androstanóis , Anestesia , Pressão Sanguínea , Coração , Frequência Cardíaca , Hemodinâmica , Intubação , Propofol , Relaxamento , Succinilcolina , Prega VocalRESUMO
Pheochromocytoma is an uncommon tumor that originates in the adrenal medulla or in other paraganglia of the sympathetic nervous system. If a hypertensive crisis occurs during general anesthesia in incidental or untreated pheochromocytoma, it is a life-threatening event with a mortality rate of about 80%. Anesthetic drugs such as pancuronium, atracurium, and metoclopromide can exacerbate the potentially lethal cardiovascular effects of catecholamines. We report a case of a patient with pheochromocytoma who display abrupt increases in systolic arterial pressure and plasma norepinephrine following rocuronium administration. This case indicates the possible involvement of elevated sympathetic nervous system to a catecholamine crisis triggered by rocuronium in pheochromocytoma.