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The Journal of International Medical... Jun 2014To measure the plasma concentrations of three endogenous opioid peptides and the levels of preproenkephalin (PPE) and preprodynorphin (PPD) mRNA in peripheral blood...
OBJECTIVE
To measure the plasma concentrations of three endogenous opioid peptides and the levels of preproenkephalin (PPE) and preprodynorphin (PPD) mRNA in peripheral blood lymphocytes of patients during scheduled surgery performed under intravenous general anaesthesia combined with an epidural block.
METHODS
Patients were anaesthetized and arterial blood was collected at 0 (baseline), 20, 40, 60, and 80 min during surgery. The plasma concentrations of β-endorphin, leucine-enkephalin and dynorphin A were measured using radioimmunoassay. Reverse transcription-polymerase chain reaction was used to measure the levels of PPD and PPE mRNA in peripheral blood lymphocytes collected during surgery.
RESULTS
Fifteen patients participated in this prospective study. The plasma concentrations of β-endorphin were significantly lower at all time-points compared with the baseline value. The plasma concentrations of leucine-enkephalin and dynorphin A were significantly lower at 40, 60, and 80 min compared with baseline. The PPD/β-actin ratio was significantly lower at 80 min compared with baseline, while the PPE/β-actin ratio showed no significant change.
CONCLUSION
The level of mRNA from two pre-endogenous opioid peptide genes either decreased or remained unchanged during surgery under intravenous general anaesthesia with epidural block, suggesting that patients remained pain free during surgery.
Topics: Abdomen; Adult; Anesthesia, Epidural; Anesthesia, General; Anesthetics, Intravenous; Bupivacaine; Dynorphins; Enkephalin, Leucine; Enkephalins; Female; Fentanyl; Gene Expression; Humans; Male; Midazolam; Middle Aged; Pain; Prospective Studies; Protein Precursors; RNA, Messenger; Radioimmunoassay; Reverse Transcriptase Polymerase Chain Reaction; Vecuronium Bromide; beta-Endorphin
PubMed: 24743873
DOI: 10.1177/0300060513515642 -
Turkish Journal of Anaesthesiology and... Apr 2014The aim of this study was to evaluate the effects of esmolol infusion on the prevention of haemodynamic responses to tracheal extubation in patients undergoing elective...
OBJECTIVE
The aim of this study was to evaluate the effects of esmolol infusion on the prevention of haemodynamic responses to tracheal extubation in patients undergoing elective craniotomy.
METHODS
With approval from the Medical School Ethics Committee at Marmara University and the patients' written consent, 30 patients between 20-65 years of age undergoing elective craniotomy were randomly placed in either the Group Esmolol (n=15) or the Group Control (n=15). Anaesthesia was induced with 5-7 mg kg(-1) thiopental sodium, 1 μg kg(-1) remifentanil, and 0.1 mg kg(-1) vecuronium bromide iv, and was maintained with 1 MAC sevoflurane in oxygen-air mixture (50:50) and 0.25 μg kg(-1) min(-1) remifentanil infusion. At the end of the operation, patients inhaled 100% oxygen after the discontinuation of the anaesthetic agents. For Group Esmolol, 5 min before extubation 2 mg kg(-1) esmolol in 50 mL was infused over 10 min (0.2 μg kg(-1) min(-1)), while for Group Control, 50 mL saline was infused over 10 min. The quality of extubation was evaluated with a 5 point scale, recording heat rate, systolic, diastolic, and mean arterial pressures before infusion, 1 min after infusion, during extubation, and at 1, 3, 5, and 10 min after extubation.
RESULTS
In the esmolol group, systolic, diastolic, and mean arterial pressures, as well as heart rate, decreased significantly after esmolol infusion and were significantly lower than in the control group after extubation (p<0.05). The ratio of patients with an extubation score of one was significantly higher in the esmolol group than in the control group (p<0.05).
CONCLUSION
We concluded that 2 mg kg(-1) esmolol infusion before extubation can prevent hypertension and tachycardia caused by extubation in patients undergoing elective craniotomy.
PubMed: 27366396
DOI: 10.5152/TJAR.2013.57 -
Anaesthesiology Intensive Therapy 2014Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of desflurane in off-pump coronary surgery has not been clarified yet. Our study hypothesis was that desflurane-fentanyl anaesthesia could decrease myocardial injury markers and improve haemodynamics compared to propofol-fentanyl in patients undergoing off-pump coronary surgery.
DESIGN
Prospective, randomised open-lable study. Sixty elective patients with left ventricular ejection fraction above 30% received either desflurane (group D, n = 32) or propofol (group P, n = 28), in addition to fentanyl and vecuronium bromide anaesthesia for off-pump coronary surgery. Assessment of haemodynamic function included thermodilution continuous cardiac output and right ventricular end diastolic volume.
RESULTS
No significant differences in cardiac output, stroke volume and mean arterial pressure were noted between groups. The only observed difference in haemodynamic profile was that group D demonstrated improved stability, expressed as left ventricular stroke work index (LVSWI). Decrease in LVSWI after performing distal anastomoses was smaller in D compared to P (median value: -14.3 and -19.8 [g m m⁻² beat⁻¹]), respectively (P = 0.029). Oxygen uptake index (VO₂I) and oxygen extraction ratio (OER) after skin incision were lower in D, while blood lactate concentration was slightly higher after surgery in D compared to P. The groups did not differ with respect to CK-MB and troponin I concentration.
CONCLUSIONS
This study demonstrated no difference between desflurane and propofol anaesthesia for off-pump coronary surgery in major haemodynamic parameters, as well as in myocardial injury markers and the long-term outcome. However, the study indicated that desflurane might accelerate recovery of myocardial contractility, as assessed by LVSWI. Lower oxygen uptake and elevated lactate under desflurane anaesthesia indicated a discrete shift towards anaerobic metabolism.
CLINICAL TRIAL REGISTRATION INFORMATION
NCT00528515 (http://www.clinicaltrials.gov/ ct2/show/NCT00528515?term = NCT00528515&rank = 1).
Topics: Adult; Aged; Anesthetics, Inhalation; Anesthetics, Intravenous; Biomarkers; Coronary Artery Bypass, Off-Pump; Creatine Kinase, MB Form; Desflurane; Female; Follow-Up Studies; Hemodynamics; Humans; Isoflurane; Male; Middle Aged; Myocardium; Necrosis; Oxygen Consumption; Propofol; Prospective Studies; Troponin I
PubMed: 24643920
DOI: 10.5603/AIT.2014.0002 -
Brazilian Journal of Anesthesiology... 2013We investigated the effect of Nitrous Oxide (N2O) on controlled hypotension in low-flow isoflurane-dexmedetomidine anesthesia in terms of hemodynamics, anesthetic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
We investigated the effect of Nitrous Oxide (N2O) on controlled hypotension in low-flow isoflurane-dexmedetomidine anesthesia in terms of hemodynamics, anesthetic consumption, and costs.
METHODS
We allocated forty patients randomly into two equal groups. We then maintained dexmedetomidine infusion (0.1 μg.kg-1.min-1) for 10 minutes. Next, we continued it until the last 30 minutes of the operation at a dose of 0.7 μg.kg(-1).hour(-1). We administered thiopental (4-6 mg. kg(-1)) and 0.08-0.12 mg.kg(-1) vecuronium bromide at induction for both groups. We used isoflurane (2%) for anesthesia maintenance. Group N received a 50% O2-N2O mixture and Group A received 50% O -air mixture as carrier gas. We started low-flow anesthesia (1 L.min(-1)) after a 10-minute period of initial high flow (4.4 L.min(-1)). We recorded values for blood pressure, heart rate, peripheral O2 saturation, inspiratory isoflurane, expiratory isoflurane, inspiratory O2, expiratory O2, inspiratory N2O, expiratory N2O, inspiratory CO2, CO2 concentration after expiration, Minimum Alveolar Concentration. In addition, we determined the total consumption rate of fentanyl, dexmedetomidine and isoflurane as well as bleeding.
RESULTS
In each group the heart rate decreased after dexmedetomidine loading. After intubation, values were higher for Group A at one, three, five, 10, and 15 minutes. After intubation, the patients reached desired hypotension values at minute five for Group N and at minute 20 for group A. MAC values were higher for Group N at minute one, three, five, 10, and 15 (p < 0.05). FiO2 values were high between minute five and 60 for Group A, while at minute 90 Group N values were higher (p < 0.05). Fi Iso (inspiratuvar isofluran) values were lower in Group N at minute 15 and 30 (p < 0.05).
CONCLUSION
By using dexmedetomidine instead of nitrous oxide in low flow isoflurane anesthesia, we attained desired MAP levels, sufficient anesthesia depth, hemodynamic stability and safe inspiration parameters. Dexmedetomidine infusion with medical air-oxygen as a carrier gas represents an alternative anesthetic technique.
Topics: Adolescent; Adult; Anesthetics, Inhalation; Blood Pressure; Dexmedetomidine; Female; Fentanyl; Heart Rate; Humans; Hypotension, Controlled; Isoflurane; Male; Middle Aged; Nitrous Oxide; Oxygen; Prospective Studies; Thiopental; Vecuronium Bromide; Young Adult
PubMed: 24565122
DOI: 10.1016/j.bjane.2012.02.004 -
The Canadian Veterinary Journal = La... Feb 2014Residual neuromuscular block (NMB) during recovery from general anesthesia may be minimized by antagonizing NMB with neostigmine. We examined neostigmine for restoring...
Residual neuromuscular block (NMB) during recovery from general anesthesia may be minimized by antagonizing NMB with neostigmine. We examined neostigmine for restoring neuromuscular function when administered at 2 levels of vecuronium-induced NMB in dogs. Eight healthy adult dogs received vecuronium 0.1 mg/kg body weight (BW), IV, during isoflurane anesthesia. Recovery from vecuronium occurred spontaneously (control group; C), or was enhanced with neostigmine, 0.04 mg/kg BW, IV, administered when 2 (N2) or 4 (N4) responses to train-of-four (TOF) stimulation were first observed. Duration of NMB was significantly shorter for N2 and N4 than for C. The period of complete NMB was equal for all groups; differences were observed during the recovery phase of NMB. Time of neostigmine-enhanced recovery was significantly shorter for N4 than N2, but overall duration of NMB was not reduced. Recovery from NMB was faster with neostigmine. There is no clinical advantage in delaying neostigmine administration once 2 responses to TOF are present.
Topics: Anesthetics, Inhalation; Animals; Dogs; Female; Isoflurane; Male; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Vecuronium Bromide
PubMed: 24489395
DOI: No ID Found -
European Review For Medical and... Dec 2013To investigate biochemically whether total intravenous anesthesia (TIVA) using propofol creates a risk for Propofol Infusion Syndrome (PRIS). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To investigate biochemically whether total intravenous anesthesia (TIVA) using propofol creates a risk for Propofol Infusion Syndrome (PRIS).
PATIENTS AND METHODS
Forty patients scheduled for thyroid gland surgery were randomly assigned into Group T or C and premedicated 30 min before operation. Group T received remifentanyl hydrochloride, propofol infusion following anesthesia induction with propofol, vecuronium bromide and intubation. Group C received remifentanyl hydrochloride infusion, 1-1.5 MAC desflurane inhalation following anesthesia induction with thiopental, vecuronium bromide and intubation. Patients were respired 50% O2-air mixture. Blood gas, potassium, lactic acid, CK-MB, myoglobin, troponin I, total carnitine, triglyceride, creatinine concentrations were determined before operation, at intraoperative hour-2, postoperative hour-6.
RESULTS
There were no significant differences between groups in potassium, lactic acid CK-MB, myoglobin, total carnitine or creatinine levels. Triglyceride level at intraoperative hour-2 increased in Group T, decreased at postoperative hour-6. Troponin I was higher in Group C than Group T at intraoperative hour-2 (p < 0.05). No asystole, bradycardia, arrhythmia, hypotension or change in urine color was detected.
CONCLUSIONS
The present biochemical findings suggest that TIVA using propofol is safe.
Topics: Adult; Analysis of Variance; Anesthesia, Intravenous; Anesthetics, Combined; Anesthetics, Intravenous; Biomarkers; Chi-Square Distribution; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Monitoring, Intraoperative; Pilot Projects; Propofol; Prospective Studies; Respiration, Artificial; Risk Factors; Syndrome; Thyroid Gland; Time Factors; Turkey
PubMed: 24379072
DOI: No ID Found -
Frontiers in Public Health 2013
PubMed: 24350224
DOI: 10.3389/fpubh.2013.00055 -
Anesthesiology and Pain Medicine 2013Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients.
BACKGROUND
Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients.
OBJECTIVES
We aimed to investigate the safety of train-of-four ratio and clinical tests in the assessment of patient recovery, and to determine the effects of the rocuronium, vecuronium, and cisatracurium on intubation, extubation and recovery times in elderly patients undergoing abdominal surgery.
PATIENTS AND METHODS
After obtaining institutional approval and informed consent, 60 patients over 60 years old and undergoing elective abdominal operations were included in this double-blind, randomized clinical trial. Following a standard anesthesia induction, 0.6mg kg-1 rocuronium, 0.1mg kg-1 vecuronium, and 0.1mg kg-1 cisatracurium were administered to the patients in Group R, Group V, and Group C, respectively. Train-of-four (TOF) ratios were recorded at 10-minute intervals during and after the operation. Modified Aldrete Score (MAS) and clinical tests were recorded in the recovery room at 10-minute intervals. In addition, intubation and extubation times, duration of recovery room stay, and any complications were recorded.
RESULTS
Intubation time was found to be shorter in Group R than that in Groups V and C (P ˂ 0.001). Times to positive visual disturbances and grip strength tests were shorter in Group C than that in Group V (P = 0.016 and P = 0.011, respectively). In Group R and group C, time to TOF ≥ 0.9 was significantly longer than all positive clinical test times except grip strength (P < 0.05).
CONCLUSIONS
We hold the opinion that cisatracurium is safer in elderly patients compared to other drugs. We also concluded that the usage of TOF ratio together with clinical tests is suitable for assessment of neuromuscular recovery in these patients.
PubMed: 24223350
DOI: 10.5812/aapm.8406 -
Anaesthesia Nov 2013
Comparative Study Randomized Controlled Trial
Topics: Adult; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Cholecystectomy, Laparoscopic; Disposable Equipment; Elective Surgical Procedures; Equipment Design; Humans; Laryngeal Masks; Middle Aged; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Pressure; Propofol; Vecuronium Bromide; Young Adult
PubMed: 24128032
DOI: 10.1111/anae.12428 -
Anales de Pediatria (Barcelona, Spain :... Mar 2014
Topics: Airway Extubation; Humans; Infant; Male; Nerve Block; Neuromuscular Nondepolarizing Agents; Sugammadex; Time Factors; Treatment Failure; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 24103238
DOI: 10.1016/j.anpedi.2013.08.005