Anesthesia for craniotomy in a patient with previous paralytic polio.

Poliomyelitis remains endemic in many developing nations. Patients may develop residual muscle weakness in one or more limbs after an attack of poliomyelitis in childhood. We report an adult patient who presented for right temporal cortical grid placement. He had childhood poliomyelitis and, while showing no evidence of postpolio syndrome, demonstrated excessive sensitivity to nondepolarizing muscle relaxants and developed prolonged muscle weakness during the postoperative period.

Remifentanil vs fentanyl with a target controlled propofol infusion in patients undergoing craniotomy for supratentorial lesions.

AIM: Remifentanil hydrochloride is an ultra-short acting m-opioid receptor agonist. This study compared the use of remifentanil with that of fentanyl during elective supratentorial craniotomy in a target controlled infusion (TCI)-propofol anesthesia regimen and evaluated the quality of recovery from anesthesia. METHODS: After written informed consent for this prospective study, 40 adult patients were randomly divided into 2 groups: in group F analgesia was provided with fentanyl 2-3 mg kg(-1) h(-1) and in group R with remifentanil 0.25 mg kg(-1) h(-1). Anesthesia was induced with thiopental and pancuronium bromide, and maintained with propofol-TCI, pancuronium, air and oxygen and fentanyl (group F) or remifentanil (group R), respectively. After tracheal intubation, infusion rate of remifentanil was reduced and then adjusted to maintain stable hemodynamics. Hemodynamics and recovery time were monitored for 60 min after surgery. Analgesic requirements, propofol intraoperative consumption, nausea and vomiting in postoperative period were monitored. Recovery was evaluated according to a modified Aldrete score. RESULTS: Baseline hemodynamics were similar in both groups. Mean arterial pressure differed between the 2 groups (P<0.05) with the greatest decrease in group R during dura opening (P<0.001). Postoperative mean arterial pressure was higher in group R. Patients in group R exhibited a faster recovery. The incidence of nausea and vomiting was similar in the 2 groups. Noteworthy, there was a reduction in the amount of propofol used in group R. CONCLUSIONS: Remifentanil appears to be a reasonable alternative to fentanyl during elective surgery of supratentorial lesions.

Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade.

Whether succinylcholine causes an increase in intracranial pressure (ICP) in patients with brain lesions is uncertain and, if increased ICP does occur, its pathophysiology remains unknown. The authors investigated both the effect of succinylcholine on ICP and its modification with prior neuromuscular blockade by measuring ICP (subarachnoid bolt) in 13 consecutive patients with brain tumors who received succinylcholine both before and after complete neuromuscular blockade with vecuronium. Anesthesia was induced with thiopental, 6 mg X kg-1 iv, and nitrous oxide, 70% in oxygen, while ventilation was controlled (PaCO2 = 37.2 mmHg +/- 1.7 SE). Succinylcholine, 1 mg X kg-1 iv, was administered and ICP, heart rate (HR), and blood pressure (BP) were recorded until normal twitch tension was restored. Complete neuromuscular blockade was then established with vecuronium, 0.14 mg X kg-1 iv; 3 min later, succinylcholine, 1 mg X kg-1 iv, was repeated. The resulting changes in ICP, HR, and BP were recorded for 3 min. Following the first dose of succinylcholine, mean ICP increased from 15.2 mmHg +/- 1.3 SE to 20.1 mmHg +/- 2.0 SE (P less than 0.05), with five of the patients sustaining increases in ICP of 9 mmHg or greater. In contrast, when succinylcholine was given after vecuronium-induced paralysis, no patient developed an increase in ICP greater than 3 mmHg (P less than 0.05 compared with the incidence of ICP greater than or equal to 9 mmHg observed after the first dose of succinylcholine). A second group of six patients received two doses of succinylcholine according to the same protocol but without an intervening dose of vecuronium.(ABSTRACT TRUNCATED AT 250 WORDS)

Lubrificaçäo do tubo traqueal para prevenir comprometimento da garganta após intubaçäo orotraqueal / Lubrification of the tracheal tube to prevent throat complaints after orotracheal intubation

Justificativa e objetivos - O comprometimento da garganta após a intubaçäo traqueal tem sido diferentemente referido, sendo relacionados ao sexo, idade, tipo de tubo e balonete traqueal, e uso de lubrificantes. O uso de lubrificantes é controverso. O objetivo deste estudo foi avaliar a incidência e o comprometimento da garganta com dois tipos de lubrificantes aplicados no tubo traqueal e que säo muito utilizados quando na intubaçäo orotraqueal. Métodos - Foram avaliados 40 pacientes de ambos os sexos, com idade entre 15 e 63 anos, peso de 50 a 88 kg, estado físico ASA I ou II, escalados para procedimento cirúrgico eletivo. Todos foram submetidos ao mesmo tipo de anestesia, sendo introduzidos com a administraçäo venosa de midzolam (2,5 a 3,0 mg), fentanil (3,0 a 3,5 µg.kg elevado a menos um), etomidato (0,2 a 0,3 mg.kg elevado a menos um) e relaxamento muscular de pancurônio (0,08 a 0,1 mg.kg elevado a menos um). A manutençäo da anestesia foi feita com isoflurano e oxigênio. Na IOT os balonetes dos tubos foram lubrificados com a aplicaçäo de 2ml de lidocaína viscosa 2 por cento para o grupo I e 2ml de pomada oftálmica para garganta quando a tosse, secura, rouquidäo e dor no período de 6 e 24 horas após a intubaçäo orotraqueal. Resultados - Ocorreu comprometimento da garganta em todos o pacientes estudados. Houve melhora da secura entre os tempos avaliados. Näo foi possível identificar diferença significante entre os grupos quanto aos ítens avaliados de secura, tosse, rouquidäo e dor. Conclusöes - Ao que parece, a única justificativa plausível para a utilizaçäo de lubrificantes para a IOT é a facilitaçäo mecânica, näo havendo vantagem quanto ao comprometimento da garganta na amostra estudada