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1.
Int Heart J ; 61(1): 60-66, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956143

RESUMO

Transcatheter aortic valve implantation (TAVI) using a transfemoral approach under local anesthesia with conscious sedation (LACS) is becoming an increasingly common TAVI strategy. However, patients who are awake during the TAVI procedure can experience stress, anxiety, and pain, even when LACS is used. Clinical hypnotherapy is an anxiolytic intervention that can be beneficial for patients undergoing invasive surgery. This study aimed to assess the perioperative outcomes of adjunctive hypnotherapy undergoing transfemoral TAVI with LACS.Consecutive patients (n = 143) with symptomatic severe aortic stenosis who underwent transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy (n = 36) between January 2015 and April 2016 were retrospectively included in the study. The clinical outcomes were compared between the two groups. The LACS with hypnotherapy group had a significantly shorter length of stay in the intensive care unit (ICU; LACS only versus LACS with hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P < 0.01). Moreover, the use of anesthetics (propofol and remifentanil) and norepinephrine was significantly lower in the LACS with hypnotherapy group (e.g., for propofol, LACS only versus LACS with hypnotherapy: 96.4 ± 104.7 mg versus 15.0 ± 31.8 mg, P < 0.001). The multiple regression analysis showed that being male, hypnotherapy, and the composite complication score were independently associated with the length of stay in the ICU.The adjunctive hypnotherapy on LACS among transfemoral TAVI patients may facilitate perioperative management. However, a prospective randomized study is necessary to confirm the efficacy of hypnotherapy among TAVI patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Sedação Consciente/métodos , Hipnose/métodos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Feminino , Humanos , Masculino , Norepinefrina/administração & dosagem , Período Perioperatório , Complicações Pós-Operatórias , Propofol/administração & dosagem , Estudos Prospectivos , Análise de Regressão , Remifentanil/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento
2.
Braz J Med Biol Res ; 53(1): e8645, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859910

RESUMO

Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.


Assuntos
Anestesia Geral/métodos , Máscaras Laríngeas , Bloqueio Nervoso/métodos , Toracoscopia/métodos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Dexmedetomidina/administração & dosagem , Estudos de Viabilidade , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Estudos Prospectivos , Remifentanil/administração & dosagem , Adulto Jovem
4.
J Surg Oncol ; 120(8): 1456-1461, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680250

RESUMO

BACKGROUND AND OBJECTIVES: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. METHODS: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. RESULTS: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. CONCLUSIONS: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.


Assuntos
Analgésicos Opioides/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/administração & dosagem , Tireoidectomia , Adulto , Procedimentos Cirúrgicos Ambulatórios , Feminino , Humanos , Infusões Intravenosas , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Medição da Dor , Alta do Paciente , Período Pós-Operatório , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 98(46): e17957, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725655

RESUMO

BACKGROUND: Although surgical field visualization is important in functional endoscopic sinus surgery (FESS), the complications associated with controlled hypotension for surgery should be considered. Intraoperative hypotension is associated with postoperative stroke, leading to subsequent hypoxia with potential neurologic injury. We investigated the effect of propofol and desflurane anesthesia on S-100ß and glial fibrillary acidic protein (GFAP) levels which are early biomarkers for cerebral ischemic change during controlled hypotension for FESS. METHODS: For controlled hypotension during FESS, anesthesia was maintained with propofol/remifentanil in propofol group (n = 30) and with desflurane/remifentanil in desflurane group (n = 30). For S-100ß and GFAP assay, blood samples were taken at base, 20 and 60 minutes after achieving the target range of mean arterial pressure, and at 60 minutes after surgery. RESULTS: The base levels of S-100ß were 98.04 ±â€Š78.57 and 112.61 ±â€Š66.38 pg/mL in the propofol and desflurane groups, respectively. The base levels of GFAP were 0.997 ±â€Š0.486 and 0.898 ±â€Š0.472 ng/mL in the propofol and desflurane groups, respectively. The S-100ß and GFAP levels were significantly increased in the study period compared to the base levels in both groups (P ≤ .001). There was no significant difference at each time point between the 2 groups. CONCLUSION: On comparing the effects of propofol and desflurane anesthesia for controlled hypotension on the levels of S-100ß and GFAP, we noted that there was no significant difference in S-100ß and GFAP levels between the 2 study groups. CLINICAL TRIAL REGISTRATION: Available at: http://cris.nih.go.kr, KCT0002698.


Assuntos
Proteína Glial Fibrilar Ácida/sangue , Hipotensão Controlada/métodos , Propofol/uso terapêutico , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Sinusite/cirurgia , Adulto , Anestésicos Intravenosos , Pressão Arterial/efeitos dos fármacos , Dióxido de Carbono/sangue , Doença Crônica , Desflurano/administração & dosagem , Desflurano/efeitos adversos , Desflurano/uso terapêutico , Endoscopia , Feminino , Proteína Glial Fibrilar Ácida/biossíntese , Humanos , Hipotensão Controlada/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Remifentanil/administração & dosagem , Subunidade beta da Proteína Ligante de Cálcio S100/biossíntese , Fatores de Tempo
6.
Bratisl Lek Listy ; 120(10): 794-801, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31663357

RESUMO

BACKGROUND: Intraoperative neuromonitoring using tc-MEPs satisfactorily detects motor tract integrity changes during spinal surgery. However, tc-MEP is affected by anesthesia and other factors, in which the stimulation threshold increases because the waveform amplitude decreases over time with the accumulation and boluses of anesthetics. METHODS: We conducted a retrospective study of 139 patients. The average age was 30 years. Tc-MEPs were recorded bilaterally from the tibialis anterior muscle and the abductor hallucis muscle. Statistical tests were used to investigate the changes to evaluate anesthetic effects. RESULTS: There were no significant differences in tc-MEP amplitude change (%) between the groups of propofol (13 %), remifentanil (22 %) and sufentanil (26 %, p < 0.01). Significant differences were found between the groups of propofol, remifentanil, and sufentanil (20 %) and bolus sufentanil (‒30 %), and bolus ketamine (730 %, p < 0.008). Major differences were observed between bolus sufentanil (‒30 %) and bolus ketamine (730 %, p < 0.001). When comparing tc-MEPs with no amplitude, no significant difference was found between the groups of propofol (26 %), remifentanil (24 %), and sufentanil (28 %, p < 0.007). Substantial difference was found between the groups of propofol, remifentanil, and sufentanil (mean 26 %) and the group where ketamine boluses were administered. We didn't observe any loss of amplitude (0 %, p < 0.0002). CONCLUSION: IONM may be useless in patients where boluses of sufentanil are administered and also with Medical Research Council grades 3 and below. Consider applying IONM in patients with severe spinal deformity along with a higher age of over 50 and neurological deficit. Increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of tc-MEP. Our concept of findings supports the neurophysiological monitoring findings in other studies (Tab. 10, Ref. 45).


Assuntos
Anestesia , Monitorização Neurofisiológica Intraoperatória , Coluna Vertebral/cirurgia , Adulto , Anestésicos Intravenosos , Potencial Evocado Motor , Humanos , Ketamina/administração & dosagem , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Estudos Retrospectivos , Sufentanil/administração & dosagem
8.
Biol Pharm Bull ; 42(10): 1637-1640, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31406051

RESUMO

Sugammadex 4 mg·kg-1 is recommended for reversal from rocuronium-induced deep neuromuscular block. However, there is limited data regarding the dose-response of sugammadex required for reversal from deep neuromuscular block in pediatric patients. The aim of this study was to determine the reversibility of rocuronium-induced deep neuromuscular block with sugammadex in infants and children. Seventy-five children (48 infants and 27 children, mean standard deviation (S.D.), age: 11.6 (6.7) months) were enrolled in this study. After induction of anesthesia and administration of 0.6 mg·kg-1 rocuronium, neuromuscular block was acceleromyographically evaluated by observing contractions of the adductor pollicis muscle to ulnar nerve train-of-four (TOF) stimulation. Subsequently, the intensity of rocuronium-induced block was determined every 6 min using post-tetanic count (PTC) stimulation during sevoflurane and remifentanil anesthesia. When the first response to the PTC stimulus was detected, either 1, 2 or 4 mg·kg-1 sugammadex was administered and the time required for facilitated recovery to a TOF ratio of 0.9 following each dose was compared. The time [mean (S.D.)] from the administration of 1 mg·kg-1 sugammadex until recovery to a TOF ratio of 0.9 was significantly longer [129.1 (83.5) s, p < 0.001] than that with 2 and 4 mg·kg-1 sugammadex [70.3 (26.7) s and 68.2 (34.5) s, respectively]. Incomplete reversal was seen in 3 patients in the 1 mg·kg-1 group. The results suggested that a 4 mg·kg-1 sugammadex dose is recommended for reversal from rocuronium-induced deep neuromuscular block even in infants and children.


Assuntos
Período de Recuperação da Anestesia , Anestesia , Contração Muscular/efeitos dos fármacos , Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes/farmacologia , Rocurônio/farmacologia , Sugammadex/administração & dosagem , Analgésicos Opioides/farmacologia , Criança , Humanos , Lactente , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiologia , Pediatria , Remifentanil/farmacologia , Sevoflurano/farmacologia , Sugammadex/farmacologia , Nervo Ulnar
10.
BMC Vet Res ; 15(1): 258, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340857

RESUMO

BACKGROUND: Heart rate variability (HRV) provides information about autonomic nervous system (ANS) activity and is therefore a possible tool with which to assess anaesthetic depth. The aim of the present study was to evaluate the effects of isoflurane, remifentanil and dexmedetomidine on HRV before and after nociceptive stimulation at different anaesthetic depths. Seven healthy domestic short-hair cats were used, and each cat was anaesthetized three times - group I with isoflurane alone, group IR with isoflurane and a constant rate infusion (CRI) of remifentanil (18 µg/kg/h), and group ID with isoflurane and a CRI of dexmedetomidine (3 µg/kg/h). Minimum alveolar concentration (MAC) values were determined via electrical supramaximal nociceptive stimulation for each treatment group. Nociceptive stimulation was repeated at 3 different MAC multiples (0.75, 1.0 and 1.5 MAC), and electrocardiographic recordings were performed for 3 min before and after stimulation. Only the 1 min epochs were used for further statistical analysis. Electrocardiographic data were exported for offline HRV analysis. RESULTS: The mean isoflurane MAC ± standard deviation (SD) was 1.83 ± 0.22 vol% in group I, 1.65 ± 0.13 vol% in group IR and 0.82 ± 0.20 vol% in group ID. Nociception was indicated by several HRV parameters, however, with high variability between treatments. The best correlation with MAC was found for the SD of heart rate (STD HR) in group I (rs = - 0.76, p = 0.0001, r2 = 0.46). STD HR was also able to distinguish 0.75 MAC from 1.5 MAC and 1.0 MAC from 1.5 MAC in group I, as well as 0.75 MAC from 1.5 MAC in group ID. CONCLUSIONS: The choice of anaesthetic protocol influences the HRV parameters in cats. Frequency domain parameters respond to nociception at lower MAC levels. The STD HR has the potential to provide additional information for the assessment of anaesthetic depth in isoflurane-anaesthetized cats. The utility of HRV analysis for the assessment of anaesthetic depth in cats is still questionable.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Dexmedetomidina/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Isoflurano/administração & dosagem , Remifentanil/administração & dosagem , Anestesia por Inalação/veterinária , Animais , Gatos , Estimulação Elétrica , Eletrocardiografia/veterinária , Feminino , Masculino , Nociceptividade/efeitos dos fármacos
11.
Anesthesiology ; 131(2): 449-450, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31313739
12.
Taiwan J Obstet Gynecol ; 58(4): 536-540, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307747

RESUMO

OBJECTIVE: Anesthesia for assisted reproductive technology is very important to provide less stressful and painful environment for patients, with minimal side effects on oocytes. In the present study, we aimed to evaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcome among patients underwent anesthesia with fentanyl, remifentanil or alfentanil. MATERIAL AND METHODS: This randomized double-blinded clinical trial was conducted in patients undergoing anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomly allocated to alfentanil (A; 15 µg/kg), fentanyl (F; 1.5 µg/kg) or remifentanil (R; 1.5 µg/kg) groups. RESULTS: Three hundred forty patients were assessed for eligibility and randomized for transvaginal oocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significant differences were noted among groups regarding basic characteristics. Although, time to respond to verbal command was significantly different among groups (A: 1.99 ± 1.64, F: 2.56 ± 1.72, R: 1.78 ± 1.34, P = 0.014). There were no significant differences among groups with respect to the first and second postoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolic blood pressure (BP). Terminal systolic (A: 101.61 ± 9.15, F: 105.29 ± 12.61, R: 102 ± 12.91, P = 0.01) and diastolic (A: 59.97 ± 9, F: 65.63 ± 9.13, R: 63.69 ± 11.01, P = 0.003) BP was significantly different among groups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%, P = 0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups. CONCLUSIONS: The results of present study demonstrated that all three opioids have the same efficiency, in regards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil compared with fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rate and less hemodynamic stability. REGISTRATION NUMBER: IRCT201410258677N4.


Assuntos
Alfentanil/administração & dosagem , Anestesia Geral/métodos , Fentanila/administração & dosagem , Recuperação de Oócitos/métodos , Remifentanil/administração & dosagem , Injeções de Esperma Intracitoplásmicas/métodos , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Método Duplo-Cego , Transferência Embrionária/métodos , Endossonografia/métodos , Feminino , Seguimentos , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Gravidez , Medição de Risco , Vagina , Adulto Jovem
18.
Drug Des Devel Ther ; 13: 1593-1607, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190739

RESUMO

Objective: Myoclonus was considered as one conundrum in etomidate induction, which led to multiple risks during clinical anesthesia. The present study was conducted to compare the efficacy of pretreatment with remifentanil to different pharmacological approaches on reducing etomidate-induced myoclonus. Methods: We searched PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure from the inception to October 2018. Randomized controlled trials comparing remifentanil versus other pharmacological approaches in reducing etomidate-induced myoclonus were eligible to be analyzed. Results: Overall, 13 trials with 1,392 patients met with the inclusion criteria. 1) Pretreatment with remifentanil could reduce the incidence of etomidate-induced myoclonus compared to placebo and fentanyl; few differences were found between the use of remifentanil and the use of midazolam: (incidence of myoclonus: 5.56% with remifentanil vs 71.65% with saline, RR=0.08, with 95% CI [0.05, 0.12], P<0.0001; 3.80% with remifentanil vs 13.33% with fentanyl, RR with 95% 0.31 [0.11, 0.86], P=0.02; 46.00% with remifentanil vs 55.45% with midazolam, RR=0.82, with 95% CI [0.64, 1.06], P=0.13). 2) Compared with placebo, pretreatment with remifentanil could reduce the incidence of mild, moderate, and severe myoclonus; compared with midazolam, patients receiving remifentanil experienced lower occurrence of severe myoclonus; compared with fentanyl, pretreatment with remifentanil associated with significant low occurrence of moderate and severe myoclonus. 3) The outcomes also indicated that pretreatment with remifentanil could prevent excessive hemodynamic changes after endotracheal intubation compared to fentanyl. Conclusions: Pretreatment with remifentanil could be considered as one operative option to reduce both incidence and severity of etomidate-induced myoclonus. Compared with fentanyl, it also provides efficacy in preventing excessive hemodynamic changes after endotracheal intubation. However, the best treatment and the proper prophylactic dosage calls for more high quality evidence with large sample size.


Assuntos
Mioclonia/prevenção & controle , Remifentanil/farmacologia , Etomidato , Humanos , Mioclonia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Remifentanil/efeitos adversos
20.
Int J Obstet Anesth ; 39: 29-34, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230993

RESUMO

BACKGROUND: Intravenous remifentanil patient-controlled analgesia (PCA) has been routinely available for labouring women in our unit since 2004, the regimen using a 40 µg bolus available two minutely on demand, continuous pulse oximetry and mandatory one-to-one care. We examined remifentanil use and compared, with the other analgesic options available in our unit, outcomes such as mode of delivery, Apgar scores, neonatal resuscitation and admission to the neonatal intensive care unit. METHODS: We retrospectively identified women who delivered in our unit between 2005 and 2014 and received remifentanil, diamorphine or epidural analgesia during labour. Data were drawn from the Northern Ireland Maternity System electronic database, which records birth details from all obstetric units in Northern Ireland. Additional data were identified from paper survey forms, completed by the midwife post delivery for all women who received remifentanil in our unit. Outcomes were compared between women who received remifentanil, diamorphine or an epidural technique for labour analgesia. RESULTS: Over the 10-year period, remifentanil was the most popular form of analgesia, being selected by 31.9% (8170/25617) women. Compared with women selecting diamorphine or epidural analgesia, those having remifentanil had similar rates of instrumental and operative delivery. Neonatal Apgar scores were also similar. Neonatal resuscitation or neonatal unit admission were not more likely in women choosing remifentanil PCA. CONCLUSION: We found remifentanil PCA to be neither less safe nor associated with poorer outcomes than other analgesic options offered in our unit, when used within our guidelines for more than a 10-year period.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Remifentanil/uso terapêutico , Índice de Apgar , Feminino , Heroína/uso terapêutico , Humanos , Recém-Nascido , Gravidez , Remifentanil/efeitos adversos , Estudos Retrospectivos
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