RESUMO
BACKGROUND: In our study, we aimed to compare the endotracheal intubation conditions without muscle relaxants during induction with the combinations of dexmedotimidine-propofol, dexmedotimidine-thiopenthal and dexmedetomidine-etomidate. METHOD: Seventy-six patients, in ASA risk group I-II, between ages 20-60 years, with Mallampati Class 1 were included in the study. All patients were premedicated with midazolam. The patients were randomly divided into three groups as Group P (n=30, dexmedetomidine-propofol), Group T (n=30, dexmedetomidine-thiopenthal), Group E (n=16, dexmedetomidine-etomidate). All patients received dexmedetomidine 1 µg.kg-1 in 10 min. Then, the patients were administered 2.5 mg.kg-1 propofol for Group P, 5 mg.kg-1 thiopental for Group T and 0.3 mg.kg-1 etomidate for Group E during induction. Hemodynamic data of the patients were recorded before induction, after dexmedetomidine administration, immediately after intubation and 3, 5 and 10 minutes after intubation. RESULTS: There was no difference between the groups according to hemodynamic data. Sixteen patients in Group P and 10 patients in Group T had acceptable intubation conditions. Muscle relaxant was needed in 14, 20 and 16 patients in Groups P, T and E, respectively (p<0.05). CONCLUSION: In conclusion, we determined that best intubation conditions without muscle relaxants were achieved with propofol-dexmedetomidine combination. None of the patients receiving etomidate -dexmedetomidine combination could be intubated without muscle relaxants (Tab. 6, Ref. 29).
Assuntos
Anestésicos Intravenosos/farmacologia , Dexmedetomidina/farmacologia , Etomidato/farmacologia , Hipnóticos e Sedativos/farmacologia , Intubação Intratraqueal , Propofol/farmacologia , Tiopental/farmacologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: We aimed to investigate the effects of nitrous oxide on plasma total homocysteine and vitamin B12 levels in patients with or without methyltetrahydrofolate reductase (MTHRF) gene mutation. METHODS: After obtaining the ethics committee approval and written informed consents of patients, 93 patients between 18-70 years of age scheduled for surgery anticipated to last 1-4 hours were enrolled in the study. Patients with contraindications for nitrous oxide use were excluded. Preoperatively, blood samples were obtained from all patients for the determination of MTHFR gene mutation. Anesthesia induction was achieved with 3 mg.kg-1 of propofol and 1 µg.kg-1 of fentanyl. Anesthesia maintenance was performed with sevoflurane and with a carrier gas composed of 40 % O2 and 60 % N2O. Venous blood samples were obtained after venous canulation, and 24 hours after extubation for the analysis of plasma total homocysteine, vitamin B12 levels. RESULTS: Eighty-one patients were included in the study. Postoperative vitamin B12 levels were found to be significantly lower when compared with their preoperative levels (p<0.05). It was found that MTHRF gene polymorphism had no significant effect on postoperative plasma total homocysteine and serum vitamin B12 levels (p>0.05). Postoperative plasma total homocysteine levels were found to be significantly different between patients with operation times under and over 3 hours (p=0.028). CONCLUSIONS: We conclude that MTHRF gene polymorphism had no significant effects on postoperative plasma total homocysteine levels. However, we found that homocysteine levels might rise in patients who received general anesthesia with nitrous oxide for longer than 3 hours (Tab. 7, Ref. 26).
Assuntos
Homocisteína/sangue , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Mutação , Óxido Nitroso/farmacologia , Vitamina B 12/sangue , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Estudos ProspectivosRESUMO
This prospective, randomized, placebo-controlled study evaluated the effects of dexketoprofen as an adjunct to lidocaine in intravenous regional anaesthesia (IVRA) or as a supplemental intravenous (i.v.) analgesic. Patients scheduled for elective hand or forearm soft-tissue surgery were randomly divided into three groups. All 45 patients received 0.5% lidocaine as IVRA. Dexketoprofen was given either i.v. or added into the IVRA solution and the control group received an equal volume of saline both i.v. and as part of the IVRA. The times of sensory and motor block onset, recovery time and postoperative analgesic consumption were recorded. Compared with controls, the addition of dexketoprofen to the IVRA solution resulted in more rapid onset of sensory and motor block, longer recovery time, decreased intra- and postoperative pain scores and decreased paracetamol use. It is concluded that coadministration of dexketoprofen with lidocaine in IVRA improves anaesthetic block and decreases postoperative analgesic requirements.
Assuntos
Anestesia Intravenosa , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Cetoprofeno/análogos & derivados , Lidocaína/administração & dosagem , Trometamina/análogos & derivados , Adulto , Período de Recuperação da Anestesia , Braço/cirurgia , Pressão Sanguínea , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Mãos/cirurgia , Frequência Cardíaca , Humanos , Período Intraoperatório , Cetoprofeno/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Trometamina/administração & dosagemRESUMO
We present the successful use of perioperative non-invasive mechanical ventilation in a morbidly obese pregnant woman with bronchial asthma, severe preeclampsia and pulmonary edema undergoing an emergency cesarean delivery with spinal anesthesia. The combination of non-invasive mechanical ventilation with neuraxial anesthesia may be of value in selected parturients with acute or chronic respiratory insufficiency requiring surgery.
Assuntos
Anestesia Obstétrica , Raquianestesia , Cesárea/métodos , Respiração Artificial/métodos , Adulto , Manuseio das Vias Aéreas , Asma/complicações , Asma/terapia , Feminino , Humanos , Obesidade Mórbida/complicações , Pré-Eclâmpsia/terapia , Gravidez , Edema Pulmonar/complicações , Edema Pulmonar/terapia , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/terapiaRESUMO
The aim of our study was to investigate P wave dispersion (Pwd), QT corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subjects with malnutrition diagnosed in the pre-anaesthetic assessment, compared to those without malnutrition. A total of 76 adult patients were included. Main diagnoses, anthropometric measurement, body mass index, electrocardiogram and serum sodium, potassium, chloride, magnesium and calcium levels were recorded for all patients. Pwd, QT and QTd intervals were measured on all electrocardiogram records and QTc and QTcd intervals determined with the Bazett formula. Protein-energy malnutrition was diagnosed with the nutritional risk index. No statistically significant difference was found between the age, gender and malignant cancer diagnosis rates between patients with malnutrition (group M) and those not suffering from malnutrition (group N) (P > 0.05). Serum albumin, total protein, potassium, calcium, magnesium and chloride values of group M were found to be significantly lower than group N (P < 0.05). In group M, Pwd, QT, QTc, QTd and QTcd intervals were significantly longer than in group N (P < 0.001). Patients diagnosed with malnutrition during pre-anaesthetic assessment had significantly longer Pwd, QTc and QTcd interval durations than the control group. We attribute such extended Pwd, QTc and QTcd durations in these patients to malnutrition and malnutrition-related electrolyte imbalance.
Assuntos
Eletrocardiografia/estatística & dados numéricos , Desnutrição/fisiopatologia , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Antropometria , Contagem de Células Sanguíneas , Análise Química do Sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , TurquiaRESUMO
The aim of this study was to evaluate the effects of intravenous fentanyl and local lidocaine infiltration on the hemodynamic response to Mayfield skull pin head holder (MH) placement. Forty-five patients scheduled for elective craniotomy were studied. They were randomly divided into three groups. Group F received fentanyl 2 microg/kg IV 5 min before placement of the MH, group L was administered plain lidocaine 3 ml 1% by infiltration at each pin site 1 minute before placement, and both methods were applied together in group FL. Mean blood pressure (MAP) and heart rate (HR) were recorded at 5 preset times. In group F during and after MH placement, MAP and HR were significantly higher than in the L and FL groups. In the L group, there was significantly higher MAP and HR during the placement of MH than in the FL group. In the FL group, there was no significant increase in MAP or HR at any time of the recordings. We conclude that intravenous fentanyl with local infiltration of lidocaine into the periosteum is effective in reducing the hemodynamic response to MH placement in patients undergoing craniotomy.
Assuntos
Anestesia Local , Pinos Ortopédicos , Neoplasias Encefálicas/cirurgia , Fentanila , Hemodinâmica/efeitos dos fármacos , Aneurisma Intracraniano/cirurgia , Lidocaína , Técnicas Estereotáxicas/instrumentação , Adulto , Idoso , Anestesia Intravenosa , Pressão Sanguínea/efeitos dos fármacos , Craniotomia , Quimioterapia Combinada , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The aim of this study is to evaluate the effects of intravenous fentanyl and local lidocaine infiltration on the haemodynamic response to Mayfield skull pin head holder (MH) placement. Forty-five patients scheduled for elective craniotomy were studied. They were randomly divided into three groups. Group F received 2 microg/kg(-1) fentanyl i.v. 5 min before placement of the MH, group L was administered 3 ml 1% plain lidocaine by infiltration at each pin site 1 minute later and before placement of the MH, and both methods were applied together in group FL. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at 5 preset times. Both were significantly increased during and after MH placement in group F compared to groups L and FL. In group L, there was a significant increase in MAP and HR during the placement of MH compared to group FL. In group FL, there was no significant increase in MAP or HR at any time of the recordings. We conclude that intravenous fentanyl with local infiltration of lidocaine into the periosteum is effective in reducing the haemodynamic response to MH placement in patients undergoing craniotomy.