Anaphylactic shock during hyperbaric oxygen therapy.

A case of a 38-year-old woman is reported who was treated with hyperbaric oxygen therapy to cure a dehiscent wound. She suffered from "oral-allergy syndrome" (OAS) while eating certain fruits, and from itching when wearing latex gloves to handle hair dyes. Fifteen minutes after the start of compression, malaise, anxiety, dyspnoea, tachycardia, cold sweating and laryngeal stridor occurred. Despite intensive care treatment, face angioedema persisted for several days. On the basis of history, radioallergosorbent test (RAST) and prick tests, latex was assumed to be responsible for the anaphylactic reaction. To our knowledge, this is the first extensive report of an anaphylactic reaction to latex in a hyperbaric chamber. The lesson drawn from this case record can be summarized as follows: 1) never fail to collect a thorough history; 2) set up a latex-safe hyperbaric chamber when needed; 3) have an emergency kit always near at hand.

QT interval and QT dispersion during the induction of anesthesia and tracheal intubation: a comparison of remifentanil and fentanyl.

BACKGROUND: The aim of this paper was to determine if there were any significant differences between the effects of fentanyl delivered as a bolus or remifentanil delivered as a continuous infusion on the QT interval and QT dispersion (QTD) during the induction of anesthesia and tracheal intubation. METHODS: This was a prospective, randomized and single blind study. A total of 50 ASA I-II patients scheduled to undergo elective minor abdominal surgery were divided into two groups. In the remifentanil group (N=25), patients received a continuous infusion (c.i.) of remifentanil (0.25 mcg/kg · min). In the fentanyl group (N=25), a bolus dose of fentanyl (2.0 mcg/kg) was administered. The QT interval, the difference between QTmax and QTmin (QTD), the heart rate-corrected QT (QTc) and the QT dispersion (QTcD) were calculated using a 12-lead computerized electrocardiogram (ECG). RESULTS: In both groups, there was no significant change in QT or QTc intervals during the study period. In the remifentanil group, a significant decrease in QTD and QTcD was observed during induction compared with baseline values (P<0.05). There was a significant increase in QTD at 1 min and in QTcD at 1 and 3 min after intubation in the fentanyl group (P<0.05). CONCLUSION: Both remifentanil and fentanyl did not prolong the QT interval. QTD decreased after the induction of anesthesia and did not increase after tracheal intubation in patients receiving c.i. remifentanil in comparison with fentanyl. Overall, remifentanil infusion may be the opioid-based treatment regimen of choice in patients at risk of dysrhythmias.

The effects of pneumoperitoneum and head-up position on heart rate variability and QT interval dispersion during laparoscopic cholecystectomy.

BACKGROUND: The aim of the study was to evaluate the effects of pneumoperitoneum and head-up position on autonomic cardiac function changes during inhalational or total intravenous anesthesia by using the analysis of QT dispersion and heart rate variability (HRV). METHODS: In this prospective, single-blind study, 30 patients scheduled for elective laparoscopic cholecystectomy were randomly divided in two groups: a sevoflurane-based inhalational anesthesia group (N=15) and an intravenous anesthesia group with propofol (N=15). Propofol 2.0 mg/kg-1 and cisatracurium 0.15 mg/kg-1 during induction of anesthesia and Remifentanil as titrated infusion for analgesia were used in both groups. Pneumoperitoneum was established at 12 mmHg with patients in the supine position. ECG was recorded before the induction of anesthesia; 1 and 3 min after pneumoperitoneum (supine position); 1 and 3 min after shifting the patient to a head-up position (HUP) of 60 degrees; after abdominal deflation; and after awakening. RR interval, QT interval, corrected QT interval (QTc), QT interval dispersion (QTD), corrected QT interval dispersion (QTcD), low-frequency power (LF), high-frequency power (HF) and LF/HF ratio were recorded. RESULTS: The LF/HF ratio increased significantly after 3 min HUP in the SEVO group (P<0.05). QTD and QTcD increased significantly at 3 min after abdominal insufflation and at 1 and 3 min after HUP in both groups (P<0.05). CONCLUSION: Statistically significant increases of QTD and QTcD occurred during pneumoperitoneum and HUP, regardless of the anesthetic techniques used. In patients receiving inhalational anesthesia, the LF/HF ratio increased significantly after HUP.

Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy.

AIM: The aim of this study was to evaluate the haemodynamic changes in patients undergoing cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) using an echo-Doppler device (Hemosonic 100). EXPERIMENTAL DESIGN: haemodynamic and cardiac function variables during IPHC, using a closed abdomen technique, were measured with the use of a non-invasive esophageal echo-Doppler monitor. SETTING: operating room in an oncologic surgery department in hospital. Fifteen patients, ASA II or III with age ranging from 59 to 66 years were successively studied. All patients were under general anaesthesia with sevoflurane, remifentanil as titrated infusion, and cisatracurium for muscle relaxation. The standard monitoring included ECG, capnometry, invasive measurement of blood pressure and central venous pressure, pulsoximetry, diuresis, esophageal and tympanic temperature. Haemodynamic changes evaluated by an echo-Doppler device were recorded at predetermined times. RESULTS: A significant reduction in stroke volume (SV) and aortic blood flow (ABF) values was recorded (P<0.05) during the abdominal cavity filling, followed by a significant increase in total systemic vascular resistance values (P<0.05). A significant increase in SV, ABF and left ventricular ejection time was recorded 90 min after the start of IPHC procedure (P<0.05) when the body temperature increased. Peak velocity and acceleration values increased significantly at the same time. CONCLUSIONS: These results suggest that the echo-Doppler device (Hemosonic 100) provided an easy-to-handle, non-invasive and reliable tool to monitor changes in cardiac parameters during IPHC.

Immediate postoperative pain management in patients undergoing major abdominal surgery after remifentanil-based anesthesia: sufentanil vs tramadol.

AIM: The transition from intraoperative analgesia to postoperative analgesia must be planned carefully after remifentanil-based anesthesia, due to the short duration of action of remifentanil. The aim of this study is to compare the efficacy and safety of 2 transition strategies using sufentanil or tramadol for early postoperative pain relief in patients who had major abdominal surgery under general anesthesia with remifentanil/sevoflurane. METHODS: Sixty patients participated in this double-blind, prospective study and were randomly assigned to either sufentanil (S) group or tramadol (T) group. Twenty minutes before the end of surgery the patients received either a bolus of 0.15 microg kg(-1) sufentanil (group S) or tramadol 100 mg (group T). Mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP=systolic arterial pressure (SAP)xHR), analgesia by a verbal rating score (VRS) and sedation by a sedation score (SS) were evaluated at emergence from anesthesia. RESULTS: A statistically significant difference in HR between the 2 groups was recorded at extubation (78+/-13 in group S vs 86+/-24 in group T). A significant decrease of RPP values at extubation and 5 minutes later were found in group S in comparison with group T. VRS values were significantly lower in sufentanil group at 5 and 10 minutes after awakening. CONCLUSIONS: Sufentanil provided more effective transition analgesia in comparison with tramadol. The effects of remifentanil dissipated rapidly and analgesia with major opioids was required. A bolus dose of sufentanil 0.15 microg kg(-1) was efficacious in controlling the hemodynamic parameters at awakening from anesthesia. The lower HR values and, consequently the lower RPP values are of utmost importance especially in the aged cardiovascular risk patient.