An epidemiologic analysis of Candida spp. urinary infections in intensive care unit / Uma análise epidemiológica das infecções urinárias por Candida spp. em unidade de terapia intensiva / Un análisis epidemiológico de las infecciones urinarias por Candida spp. en la unidad de cuidados intensivos

Background and objectives: The finding of Candida species in urine is an usual finding and is called candiduria. There is an increase in the frequency of urinary tract infections (UTI) caused by Candida especially in critically ill patients. This study aimed to determine the epidemiological, clinical, and mycological characteristics of Candida urinary infections in intensive care unit (ICU) and antifungal susceptibilities. Methods: Urine cultures of 394 ICU patients with clinical suspicion of UTI were evaluated. After 24-48 hours of incubation, colonies appeared to grow as yeast, were morphologically examined by Gram staining. Candida strains that grew 104 ≥ CFU/mL in urine cultures were accepted as candiduria. The susceptibilities of the Candida strains to amphotericin B, itraconazole, fluconazole, voriconazole, flucytosine, and caspofungin were investigated with broth microdilution method. Results: The distribution of the isolated 100 urinary Candida strains were as, 54 Candida albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae, and 1 as C. parapsilosis. Among 100 Candida species isolated in our study susceptibility rates of amphotericin B, flucytosine, caspofungin, fluconazole, itraconazole, and voriconazole were 100%, 100%, 91%, 23%, 13%, 25.8%, respectively. Conclusion: Accurate identification of Candida spp., as well as the investigating the antifungal susceptibility, will be beneficial in terms of the effectiveness of the treatment and the prevention of resistance development.(AU)

Justificativa e objetivos: O achado de espécies de Candida na urina é um achado comum e é chamado de candidúria. Há um aumento na frequência de infecções do trato urinário (ITU) causadas por Candida, principalmente em pacientes críticos. Este estudo teve como objetivo determinar as características epidemiológicas, clínicas e micológicas das infecções urinárias por Candida em unidade de terapia intensiva (UTI) e a susceptibilidade aos antifúngicos. Métodos: Foram avaliadas culturas de urina de 394 pacientes de UTI com suspeita clínica de ITU. Após 24-48 horas de incubação, as colônias pareceram crescer como leveduras, foram morfologicamente examinadas por coloração de Gram. As cepas de Candida que cresceram ≥104 UFC/mL em culturas de urina foram aceitas como candidúria. As suscetibilidades das cepas de Candida à anfotericina B, itraconazol, fluconazol, voriconazol, flucitosina e caspofungina foram investigadas com o método de microdiluição em caldo. Resultados: A distribuição das cepas 100 isoladas de Candida urinária foi de 54 Candida albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae e 1 como C. parapsilosis. Entre 100 espécies de Candida isoladas em nosso estudo, as taxas de susceptibilidade de anfotericina B, flucitosina, caspofungina, fluconazol, itraconazol e voriconazol foram de 100%, 100%, 91%, 23%, 13%, 25,8%, respectivamente. Conclusão: A identificação precisa de Candida spp., bem como a investigação da susceptibilidade aos antifúngicos, será benéfica em termos de eficácia do tratamento e prevenção do desenvolvimento de resistência.(AU)

Justificación y objetivos: El hallazgo de especies de Candida en la orina es un hallazgo habitual y se denomina candiduria. Hay un aumento en la frecuencia de infecciones del tracto urinario (ITU) causadas por Candida, especialmente en pacientes críticamente enfermos. Este estudio tuvo como objetivo determinar las características epidemiológicas, clínicas y micológicas de las infecciones urinarias por Candida en la unidad de cuidados intensivos (UCI) y la susceptibilidad antifúngica. Métodos: Se evaluaron urocultivos de 394 pacientes de UCI con sospecha clínica de ITU. Después de 24-48 horas de incubación, las colonias parecían crecer como levadura, se examinaron morfológicamente mediante tinción de Gram. Las cepas de Candida que crecieron 104 ≥ UFC / ml en urocultivos se aceptaron como candiduria. Las susceptibilidades de las cepas de Candida a la anfotericina B, itraconazol, fluconazol, voriconazol, flucitosina y caspofungina se investigaron con el método de microdilución en caldo. Resultados: La distribución de las cepas 100 urinarias aisladas de Candida fue de, 54 C. albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae y 1 como C. parapsilosis. Entre las 100 especies de Candida aisladas en nuestro estudio, las tasas de susceptibilidad de anfotericina B, flucitosina, caspofungina, fluconazol, itraconazol y voriconazol fueron 100%, 100%, 91%, 23%, 13%, 25,8%, respectivamente. Conclusión: La identificación precisa de Candida spp., así como la investigación de la susceptibilidad antifúngica, será beneficiosa en términos de la eficacia del tratamiento y la prevención del desarrollo de resistencias.(AU)

Evaluation of affecting factors and the effectiveness of treatment in cases with post-dural puncture headache who underwent epidural blood patch.

OBJECTIVES: We evaluated post dural puncture headache (PDPH) cases and the contributing factors and monitored the treatment response with epidural blood patch (EBP), and other therapies. METHODS: In this retrospective study, 77 PDPH cases treated with EBP were included. Patients were evaluated in terms of age, gender, type of surgery, type and diameter of the needle used for dural puncture, number(s) of dural puncture, onset of punctural headache, any conservative therapies for PDPH, number(s) of EBP application, analgesia quality at the 10th minute and 2nd hour after EBP application, and radicular pain during procedure. RESULTS: The mean age of 77 patients (46 female, 31 male) was 31.5 ± 11.3, and the most common surgery performed was cesarean section. More than one attempt was applied in 48 patients. In 37 cases, a 22G spinal needle was used, while a 25 G spinal needle was used in 20 cases. The mean duration of the headache was 3.1 ± 1.3 days for female patients and 4.6 ± 2.3 days for male patients (p=0.020). VAS significantly decreased and patient satisfaction significantly increased after the 10th minute in patients who had EBP (p=0.001). In only one case (2%), the second EBP was needed for pain relief. Transient radicular pain was observed in 17 cases (22.07%) at administration of EBP. CONCLUSION: In PDPH cases, EBP is an effective and relatively safe method, especially in obstetric patients. We reported that the PDPH symptoms presented earlier in female patients. A preference of a small diameter needle (less than 22 G) and avoidance of multiple attempts is important for spinal anesthesia.

The effects of DEX premedication on volatile induction of mask anesthesia (VIMA) and sevoflurane requirements.

We investigated the effect of intravenous premedication with single dose of dexmedetomidine (DEX) on volatile anesthetic induction time and sevoflurane requirements of anesthesia maintenance in adults by monitoring the bispectral index (BIS). Sixty adult patients with status of ASA I-II undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: The first group; a control group (group C, n = 30) and the second group; DEX group (group D, n = 30). Each patient in group D was premedicated with intravenous DEX 0.5 µg/kg or placebo 10 min before the induction of anesthesia. Anesthesia was induced by fentanyl 1 µg/kg, 1:1 ratio of nitrous oxide and oxygen and sevoflurane of 5-8 % and rocuronium bromur (Esmeron) 0.5 mg/kg keeping BIS values at 40-50. Time to induction of anesthesia, BIS, End-tidal sevoflurane concentration (Etsevoflurane), End-tidal CO2 concentration, duration of surgery, recovery time, hemodynamic variables, adverse effects were recorded intraoperatively. Analgesic requirement was noted in postoperative 24 h-period. The time to induction of anesthesia (p < 0.0001) and Etsevoflurane at 1 min (p < 0.05) were significantly lower in group D than in group C. Intravenous premedication with 0.5 µg/kg of DEX decreased the induction time by almost 75 % and provided a significant decrease in Etsevoflurane.

Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery.

BACKGROUND: The purpose of this study was to investigate endotracheal tube cuff pressure alteration in patients during laparoscopic cholecystectomy surgery. METHODS: Forty patients with ASA I-II physical status, who were scheduled for elective laparoscopic (group I) or open abdominal surgery (group II) were enrolled in the study. Tracheal intubation was always performed by an experienced anesthesiologist. The endotracheal tube cuff was inflated with air through a 10-ml syringe. The cuff was connected to a manometer. The endotracheal cuff pressure was registered every 5 min after tracheal intubation. At the time of discharge from the Post-Anesthesia Care Unit (PACU) and 12 h after tracheal extubation, patients were asked about their laryngotracheal condition by an independent observer who was uninformed of the patient allocation groups. We investigated laryngotracheal complaints such as sore throat, dysphasia, and hoarseness. RESULTS: The endotracheal cuff pressures in group I were significantly higher than those in the group II at all time points studied (P < 0.05). The endotracheal cuff pressures exceeded the critical pressure of 30 cmH(2)O after 5 min in the group I (intra-abdominal pneumoperitoneum was started). The incidence of sore throat was higher in group I than in group II in the PACU and at 12 h. CONCLUSION: This study indicates that the CO(2) pneumoperitoneum and Trendelenburg position used during laparoscopy increase endotracheal cuff pressure and lead to discomfort in the postoperative patient. Measurement of endotracheal cuff pressure is a simple and inexpensive procedure and should be applied in patients under going laparoscopic surgery.

Dexmedetomidine use in direct laryngoscopic biopsy under TIVA.

BACKGROUND: The purpose of this study is to investigate the suitability of dexmedetomidine as a helpful sedative agent in direct laryngoscopic biopsy (DLB), under total intravenous anesthesia (TIVA). METHODS: In this double blind randomised study, patients were allocated to receive dexmedetomidine 0.5 microg/kg (group D, n = 20) or saline placebo (group P, n = 20) intravenously. Forty ASA I-III patients were infused propofol and administered rocuronium bromur. They were intubated and performed biopsy. Aldrete scores, intraoperative propofol and postoperative analgesic requirements, satisfaction scores, recovery time, Ramsay sedation scale (RSS), haemodynamic changes and side effects were recorded. RESULTS: Postoperative analgesic requirement in group D was significantly lower and satisfaction scores and RSS were significantly higher than in group P. Additionally, MAP (mean arterial blood pressure) significantly decreased at post-extubation time in group D. CONCLUSION: The premedication with a single dose of dexmedetomidine decreases intraoperative propofol and postoperative analgesic requirements, increases the postoperative satisfaction and RSS considerably in patients undergoing DLB under TIVA.

Dexmedetomidine premedication of outpatients under IVRA.

PURPOSE: Dexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It induces analgesia in patients and decreases anesthetic requirements by up to 90%. The current study aimed to evaluate the effects of dexmedetomidine premedication on tourniquet pain, intraoperative - postoperative analgesic requirements, sedation levels, quality of anesthesia, and the hemodynamic parameters when used as a single dose before intravenous regional anesthesia (IVRA). MATERIAL AND METHODS: Fifty-four patients undergoing hand surgery (carpal tunnel and tendon release) were randomly divided into 2 groups for IVRA. IVRA was performed with 40 mL of 0.5 % lidocaine in both groups. A single dose of dexmedetomidine 0.5 microg/kg in 20 mL saline was administered to group D (n = 27) and placebo solution 20 mL to group C (n = 27) through the non-IVRA catheter 15 minutes before IVRA. Sensory and motor block onset and recovery time, hemodynamic variables, tourniquet pain, analgesic requirements according to verbal rating scale (VRS) and visual analog scale(VAS), sedation score, and anesthesia quality were recorded in the intraoperative and postoperative period. RESULTS: Improved quality of anesthesia, reduced postoperative pain scores, and total analgesic requirements were found in group D during postoperative period. Additionally, the patients experienced a higher degree of sedation during intraoperative and postoperative period. CONCLUSION: The premedication of 0.5 microg/kg low dose dexmedetomidine before IVRA improves the quality of anesthesia and decreases the postoperative analgesic requirement of outpatients undergoing hand surgery without any serious side effects.

Dexmedetomidine use during strabismus surgery in agitated children.

OBJECTIVE: We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. SUBJECTS AND METHODS: We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 µg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 µg/kg and rocuronium bromide 0.5 mg/kg. RESULTS: 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0-4.0) in group D and 0.0 (IQR 1.0-2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5-3.0) in group D and 2.0 (IQR 1.5-3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0-2.0) in group D and 4.5 (4.0-5.0) in group P] (p = 0.0001). CONCLUSION: Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery.

How is electrocardiogram influenced by electroconvulsive therapy in males and females?

OBJECTIVES: We aimed to investigate and compare the P duration and P dispersion (Pd) between male and female patients with a primary diagnosis of chronic schizophrenia disorder before and after the electroconvulsive therapy (ECT) period. METHODS: We obtained electrocardiograms of 50 healthy young volunteers which included 25 female (group F, n = 25) and 25 male patients (group M, n = 25). We measured minimum and maximum P wave durations (Pmin, Pmax) and Pd in milliseconds. Electrocardiography was performed before electroconvulsive therapy (ECT) and immediately after the ECT period after awakening. A 12-lead surface electrocardiogram was obtained from each subject in the supine position. RESULTS: The post-ECT P duration was significantly longer than the pre-ECT P duration in groups F and M (P = 0.01 and P = 0.008, respectively). The post-ECT Pd was significantly longer than the pre-ECT Pd in groups F and M (P = 0.0001 in both groups). A higher correlation (r) in group M was observed between the pre-ECT Pd and post-ECT P duration than in group F (r = 0.538, P = 006 in group M; r = 0.349, P = 08 in group F). There was no significant difference between the groups regarding hemodynamics. CONCLUSIONS: Electroconvulsive therapy in both sexes may influence atrial conduction as evidenced by the significantly prolonged Pmax and Pd in patients with a primary diagnosis of schizophrenia disorder.

Comparison of the coaxial circle circuit with the conventional circle circuit.

OBJECTIVE: The coaxial circle system helps prevent heat loss during surgery, and it also acts as a humidifier. This study aimed to compare the coaxial breathing system and the conventional system in their ability to warm and moisturize inhaled gases, and we also analyzed lung function protection and saccharin clearance time in patients who underwent tympanomastoidectomy (TMT) with the aid of these two systems. MATERIALS AND METHODS: Forty adult patients of ASA physical status I-II were scheduled for elective TMT. A standard volume-dependent ventilator setting was used to establish normocapnia. The coaxial circle system was used in the treated group (n=20), whereas the conventional circuit system was used in the control group (n=20). Saccharin clearance, VC (vital capacity), FRC (functional residual capacity), FEV1 (forced expiratory volume in 1 second), airway pressure, relative humidity and temperature of inspired gas, body temperature and adverse and hemodynamic effects were measured at different perioperative periods. RESULTS: The relative humidity (mg H2O Lt -1) of inspired gas in the treated group was higher than in the control group at 5, 15, 30, 45, 60 and 90 minutes after anesthesia induction. The temperature of inspired gas (Centigrade) in the treated group was higher than in the control group (p<0.05) after 5, 10, 15, 30, 45, and 90 minutes of anesthesia. Postoperative saccharin clearance time was lower than before the operation in the treated group (p<0.05). Postoperative FRC was lower than preoperative FRC in the study and control groups (p<0.05). CONCLUSION: The coaxial circle system decreased postoperative saccharin clearance time and increased postoperative FRC, relative humidity and the temperature of inspired fresh gas, without any adverse perioperative effects in patients who underwent TMT.

Ketamine versus propofol for strabismus surgery in children.

PURPOSE: To compare the effects of intravenous infusion of ketamine and propofol anesthesia in children undergoing strabismus surgery. METHODS: Sixty pediatric patients aged 4-11 years were enrolled for the study. Patients in Group K were infused ketamine 1-3 mg/kg/hr (n = 30) and patients in Group P were infused with propofol 6-9 mg/kg/hr (n = 30). After giving fentanyl 1 mug/kg and rocuronium bromide 0.5 mg/kg, patients were intubated. RESULTS: The consumption of anesthetics (P = 0.0001) and antiemetics (P = 0.004), the incidence of oculocardiac reflex (P = 0.02) in Group K were significantly lower than in Group P. The recovery time (P = 0.008), postoperative agitation score (P = 0.005), Face Pain Scale (P = 0.001), Ramsay Sedation Score (P = 0.01) during awakening and at postoperative 30th min (P = 0.02) in Group K were significantly lower than in Group P. The postoperative agitation score during awakening was significantly lower than the preoperative values in Group K (P = 0.0001). CONCLUSIONS: The infusion of ketamine is more advantageous than the infusion of propofol in children for use in strabismus surgery.

Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate: a randomized, double-blind controlled trial.

BACKGROUND: Myoclonic movements are common problems during induction of anesthesia with etomidate. The aim of this study was to compare the effect of pretreatment with dexmedetomidine (0.5 microg/kg) and thiopental (1 mg/kg) on the incidence of etomidate-induced myoclonus and postoperative pain. MATERIALS AND METHODS: A prospective double-blind study was conducted at a university hospital. Ninety patients (ASA physical status I-II) were randomly assigned to one of three groups: patients were pretreated with either dexmedetomidine (0.5 microg/kg), thiopental (1 mg/kg), or saline before induction of anesthesia with etomidate. One minute after the injection of study drugs, etomidate, 0.3 mg/kg was given. Myoclonus was assessed on a scale of 0 to 3. Recovery time, postoperative pain score, and hemodynamic variables were recorded during the intraoperative and postoperative period. Headache, nausea, vomiting, and coughing were noted during the study. RESULTS: The incidence and the intensity of myoclonus was significantly lower in the dexmedetomidine and thiopental groups (34%, 36%) than in the control group (64%) (P<0.05). The postoperative pain score at 30 min in the thiopental group was significantly higher than in the dexmedetomidine and control groups (63%) (P<0.05). CONCLUSIONS: We concluded that pretreatment with dexmedetomidine or thiopental is effective in reducing the incidence and severity of etomidate-induced myoclonic muscle movements and pretreatment with thiopental increases the postoperative pain.

Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy.

PURPOSE: This study was designed to compare the effects of premedication with dexmedetomidine and midazolam on post-electroconvulsive therapy (ECT) agitation (which patients had experienced previously and had been resistant to treatment). In addition, we aimed to evaluate the duration of convulsion, the propofol requirement, the recovery time, and patients' satisfaction during and after ECT. METHODS: Fifteen patients with depressive episodes of bipolar disorder and nonbipolar recurrent depression and patients who underwent a series of three consecutive ECT treatments were studied as a crossover design. In this double-blind and placebo-controlled study, patients were randomly allocated to receive either dexmedetomidine, 0.5 microg x kg(-1) (group Dex), midazolam, 0.025 mg x kg(-1) (group Dor), or saline (group C) in a total volume of 20 ml given intravenously 10 min before the induction of anesthesia. Propofol was administered until the patients did not respond to a verbal command. RESULTS: The mean duration of convulsive activity was longer in group Dex than in group C and group Dor (P < 0.05). The total dose of propofol requirement in group Dor and group Dex was lower than that in group C (P < 0.05). Agitation scores in both groups Dor and Dex were significantly lower than scores in group C (P < 0.05) at 10 and 15 min after ECT. CONCLUSION: Premedication with low-dose intravenous dexmedetomidine, 0.5 microg x kg(-1) or midazolam, 0.025 mg x kg(-1) before ECT may be useful in managing treatment-resistant agitation after ECT, without adverse effects.

Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging.

BACKGROUND: The purpose of this study was to compare the safety and efficacy of oral midazolam and midazolam-diphenhydramine combination to sedate children undergoing magnetic resonance imaging (MRI). METHODS: We performed a prospective randomized double-blind study in 96 children who were randomly allocated into two groups. Group D received oral diphenhydramine (1.25 mg x kg(-1)) with midazolam (0.5 mg x kg(-1)), and Group P received oral placebo with midazolam (0.5 mg x kg(-1)) alone. Sedation scores, onset and duration of sleep were evaluated. Adverse effects, including hypoxemia, failed sedation, and the return of baseline activity, were documented. RESULTS: Diphenhydramine facilitated an earlier onset of midazolam sedation (P < 0.01), and higher sedation scores (P < 0.01). In children who received midazolam alone, 20 (41%) were inadequately sedated, compared with 9 (18%) children who received midazolam and diphenhydramine combination (P < 0.01). Time to complete recovery was not significantly different between the two groups. CONCLUSIONS: Our study indicates that the combination of oral diphenhydramine with oral midazolam resulted in safe and effective sedation for children undergoing MRI. The use of this combination might be more advantageous compared with midazolam alone, resulting in less sedation failure during MRI.

Characteristics of poisoning cases in adult intensive care unit in Sanliurfa, Turkey.

OBJECTIVE: The aim of this prospective study was to analyze the rate and characteristics of acute poisoning cases admitted to adult intensive care unit (ICU). METHODS: All cases of acute poisoning admitted to ICU of the Harran University Hospital, Turkey, between July 2002 and May 2005, were included in this study. Clinical, laboratory, and demographic characteristics, type of poison and patient's outcomes were recorded. RESULTS: There were 86 poisoning cases among 844 patients admitted to the ICU. The mean age was 26 +/- 9 years and the majority of the patients (56.9%) were 15-24 years of ages. Eighty percent of acute poisonings were self-inflicted and 65.2% of these patients were singles. Medical drugs overdose were the major cause (51.2%) of intoxication followed by agricultural chemicals (37.2%). The most frequently involved medicinal drugs were benzodiazepines, antidepressants and analgesics. Eleven patients in pesticides-rodenticides and 9 patients in other medical drugs poisoning have required mechanical ventilation between 1-12 days. The duration of the intensive care stay was 6.4 +/- 4.3 days. Five cases (5.8%) with acute poisonings were fatal. CONCLUSION: There was a high rate of suicides attempt in young singles, predominantly female population. These data were the highest agricultural activity of the country that provide important information about the characteristics of poisoning at the city.

The effect of music on preoperative sedation and the bispectral index.

We assessed the effect of music on the level of sedation and the electroencephalograph bispectral index (BIS) during the preoperative period. Fifty-four ASA physical status I-II patients, scheduled for elective septo-rhinoplastic surgery, were included in the study. Subjects were assigned to receive either music (music group; n = 28) or no music (control group; n = 26) during the preoperative period. Sedative premedication was provided with midazolam 0.08 mg/kg IM. Observer's Assessment of Alertness/Sedation Scales (OAAS) scores and BIS values were recorded at specific time intervals. In the control group, there were more patients with an OAAS score of 1 than in the music group at 30 min after midazolam injection. In addition, there were more patients with an OAAS score of 2 in the control group than in the music group at 30-50 min. However, there were significantly more patients with an OAAS score of 3 in the music group than in the control group at 20-50 min. BIS values of the music group were also smaller than the control group at 30 and 40 min. BIS values were significantly decreased from baseline values at 10-50 min in the music group, whereas BIS values decreased at 30-50 min in the control group. In conclusion, listening to music during midazolam premedication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value.

The effects of remifentanil and alfentanil-based total intravenous anesthesia (TIVA) on the endocrine response to abdominal hysterectomy.

STUDY OBJECTIVE: To compare the effects of remifentanil with alfentanil as a part of total intravenous anesthesia (TIVA) on plasma concentrations of cortisol, insulin, and glucose, and hemodynamic responses in patients undergoing abdominal hysterectomy. DESIGN: Randomized, double-blind study. SETTING: University hospital. PATIENTS: 24 ASA physical status I female patients scheduled for abdominal hysterectomy. INTERVENTIONS: Premedicated patients were randomly allocated to receive either remifentanil-propofol (Group R) or alfentanil-propofol (Group A). The loading dose of the study drug was administered over 60 seconds (remifentanil l microg kg(-l) or alfentanil 10 microg kg(-l)) followed by a continuous infusion (remifentanil 0.2 microg kg(-l) min(-l) or alfentanil 0.5 microg kg(-l) min(-l)). In both groups, propofol was administered until loss of consciousness and maintained with a propofol infusion rate of 100 microg kg(-l) min(-l). After induction of anesthesia, all patients were manually ventilated by mask with O2-air mixture for 20 minutes. Then rocuronium 0.6 mg kg(-l) was given for tracheal intubation. MEASUREMENTS: Mean arterial pressure (MAP) and heart rate (HR) were recorded. Plasma concentrations of cortisol, insulin, and glucose were measured during anesthesia and in the recovery room. MAIN RESULTS: In Group R, MAP and HR were lower after tracheal intubation and skin incision than in Group A (p < 0.05). Plasma cortisol concentrations decreased from baseline values at 20 minutes after induction, after tracheal intubation, and skin incision in Group R (p < 0.001). Plasma concentrations of cortisol and glucose increased from baseline values at 30 minutes after skin incision and continued to increase in both groups (p = 0.001). Plasma concentrations of cortisol, insulin, and glucose did not differ between groups at all sampling times. CONCLUSION: Remifentanil provided better hemodynamic stability than alfentanil during anesthesia and surgery. However, both remifentanil and alfentanil had similar effects on the stress endocrine response to abdominal hysterectomy.

Remifentanil vs alfentanil in the total intravenous anaesthesia for paediatric abdominal surgery.

BACKGROUND: Our aim was to investigate whether total intravenous anaesthesia (TIVA) with remifentanil and alfentanil would ensure appropriate analgesia and recovery conditions in anaesthesia for children undergoing abdominal surgery. METHODS: Sixty children, scheduled for abdominal operations were randomized to receive, in a double-blind manner, either remifentanil (loading dose 1 microg x kg(-1); maintenance infusion, 0.25 microg x kg(-1) min(-1)) or alfentanil (loading dose 50 microg x kg(-1); maintenance infusion, 1 microg x kg(-1) min(-1)) as the analgesic component of TIVA. They were combined with propofol (loading dose, 2 mg x kg(-1); step 1 maintenance infusion, 10 mg x kg(-1) h(-1); step 2 maintenance infusion, 8 mg x kg(-1) h(-1); step 3 maintenance infusion, 6 mg x kg(-1) h(-1)) neuromuscular blockade was with mivacurium. Dose changes of the drugs, the times from cessation of anaesthesia to extubation, verbal responses, recovery of ventilation, orientation, and qualification for discharge from the postanaesthetic care unit (PACU) were recorded. RESULTS: Demographics, duration of surgery and anaesthesia were similar between the two groups. Times to extubation and stay in the PACU were significantly shorter in the remifentanil group compared with the alfentanil group. Quality of emergence (QE) from anaesthesia scale scores were higher in the remifentanil group compared with the alfentanil group. CONCLUSIONS: Remifentanil provides a more rapid recovery and adequate postoperative analgesia after TIVA for paediatric abdominal surgery, compared with alfentanil.