Background and objective: Propofol may decrease seizure duration in electroconvulsive therapy. Although not proven, prolonged seizures may be more efficacious. The goal of this study was to evaluate ...and compare effects of alfentanil and remifentanil on seizure duration, recovery parameters and degree of stimulus amplitude in patients undergoing electroconvulsive therapy.
Methods: Twenty‐four ASA I–II patients enrolled in this prospective, randomized trial, each receiving a total of seven electroconvulsive therapies. Patients were randomized to receive only Propofol, group P (0.75 mg kg−1, n = 8), Propofol with alfentanil, group A (10 µg kg−1 alfentanil + 0.5 mg kg−1 Propofol, n = 8) and Propofol with remifentanil, group R (1 µg kg−1 remifentanil +0.5 mg kg−1 propofol, n = 8) via an iv route. Supplemental doses of propofol were given as required to achieve loss of consciousness. Succinylcholine 0.5 mg kg−1 iv was given to all groups for muscular paralysis. We recorded hemodynamic parameters, cortical and motor seizure durations, and recovery parameters.
Results: Mean motor seizure duration was found to be significantly longer in patients receiving propofol‐remifentanil anesthesia (53.3 ± 13.6 s) and propofol‐alfentanil anesthesia (52.2 ± 0.4 s) compared with propofol anesthesia (37.6 ± 9.2 s) (P = 0.001). Recovery parameters and stimulus amplitudes were similar in groups A and R; significantly different from group P (P = 0.001).
Conclusions: Adding 10 µg kg−1 alfentanil or 1 µg kg−1 remifentanil to reduced doses of propofol provided unconsciousness and increased seizure durations. For patients who need higher stimulus amplitudes for longer seizure durations, combining low‐dose propofol with alfentanil or remifentanil may be good alternative regimens for ECT.
Background and objective: This prospective, randomized trial was designed to test the hypothesis that continuous infusion of low‐dose remifentanil can provide effective analgesia, sedation, amnesia, ...patient comfort and stable recovery profile without respiratory depression when compared with propofol infusion during colonoscopy.
Methods: One hundred patients were randomly assigned to receive either remifentanil (group R, 0.5 μg/kg followed by 0.05 μg/kg/min, n= 50) or propofol (group P, 0.5 mg/kg followed by 50 μg/kg/min, n= 50). Supplemental doses of remifentanil 12.5 μg in group R and propofol 10 mg in group P were given to treat complaints of moderate to severe pain and discomfort. Hemodynamic and respiratory data, pain, discomfort and sedation scores, patient and gastroenterologist satisfaction and recovery profiles were recorded.
Results: The duration of colonoscopy was longer in group P. The mean arterial pressure, heart rate and end‐tidal CO2 remained stable during the procedure and were comparable between the groups. After bolus injection of the study drugs, the respiratory rate and oxygen saturation values were lower in group R than in group P. Only one patient in group R required airway support. Pain and discomfort scores were better in group R than in group P. Sedation levels were higher in group P than in group R. Group P needed more supplemental doses than group R. The time to reach an Aldrete score of nine or more was shorter in group R, but discharge times were similar in the two groups. Amnesia was better in group P. Nausea and vomiting were more frequent in group R during the recovery phase.
Conclusion: Low‐dose remifentanil infusion with intermittent bolus injections can provide adequate sedation, amnesia and better analgesia than propofol infusion during colonoscopy. However, remifentanil‐induced nausea and vomiting may be a problem during the recovery phase.
Inguinal herniorrhaphy (IH) is a common surgical procedure that can be successfully performed by using general, regional or local anesthesia and is usually performed in an outpatient setting. In this ...study, recovery profile, incidence of adverse effects, postoperative pain scores and patient satisfaction between paravertebral block (PVB) and spinal anesthesia (SA) for fast track ambulatory IH were compared.
Sixty patients were randomly assigned to receive either PVB or unilateral SA under standardized protocols (PVB at T9-L1 levels with 5 mL of 0.5 % levobupivacaine for each, unilateral SA at L2-L3 level with 8 mg 0.5% hyperbaric levobupivacaine). All patients were sedated with propofol, 10-70 mg.kg.min. Data on anesthesia, surgery and PACU times, hemodynamic changes, home readiness, pain, and incidence of adverse effects were recorded.
One block failed in the PVB group. Anesthesia-related time and onset time were longer in the PVB group, but phase 1 PACU time, time to home-readiness with and without voiding and actual discharge time were significantly shorter in the PVB group. Although the fast-tracking rate was higher in the PVB group, this difference was not significant. The mean propofol dose was higher in the PVB group (52.03+/-19.32 35-73 mg x kg x min-1) than in the SA group (44.0+/-18.8 33-70 mg x kg x min-1) (P=0.002). VAS scores at 4, 6 and 12 hours were significantly lower in the PVB group, both at rest and during movement. VAS scores at 30, 60, 120, 180 min and at 18, 24 and 48 hours were comparable in the two groups. Duration of sensory block, onset time of discomfort, time to first analgesic, and time to first rescue analgesic were longer in the PVB group.
In ambulatory IH, PVB provided shorter home readiness time, long lasting postoperative analgesia and improved quality of recovery, and could be a good alternative to SA.
Purpose
Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of ...adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH.
Methods
Sixty patients were randomly assigned to receive either PVB or GA under standardized protocols (group PVB: at T
9
–L
1
levels, 5 mL of 0.5% levobupivacaine for both procedures, and continuous propofol sedation; group GA: GA with 2 mg kg
−1
propofol induction and 2–4% desflurane maintenance via LMA, and routine antiemetic prophylaxis and multimodal analgesic treatment). Anesthesia-related, onset, recovery, and home discharge times, hemodynamic changes, pain, and incidence of adverse effects were compared.
Results
Anesthesia-related time and onset time were longer, but recovery and home discharge times were shorter in group PVB. Verbal rating scores (VRS) at 30, 60, 120, and 180 min and 6, and 12 h post-surgery were significantly lower in group PVB patients. VRS at 18, 24, and 48 h were comparable in both groups. No patient in group PVB and eight patients in group GA needed meperidine in the post-anesthesia care unit, and time to first analgesic and first rescue analgesic requirements were significantly longer in group PVB.
Conclusion
In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.
To the Editor,
X-linked lymphoproliferative disease (XLP) is a rare
disorder characterized by an extreme vulnerability to Epstein-
Barr virus (EBV) infection, frequently resulting in hemophagocytic
...lymphohistiocytosis (HLH) 1. XLP-1, its more common subtype,
is caused by defects in the SH2D1A gene that encodes the
signaling lymphocyte activation molecule-associated protein
(SAP), which regulates the activation of T lymphocytes 2,
whereas XLP-2 is caused by mutations in the XIAP gene, also
known as BIRC4 3.
Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the ...quality of anesthesia, tourniquet pain and postoperative pain as well.
After the ethics committee approval 51 patients of ASA physical status I–II aged 18–65 years were enrolled. The patients were divided into three groups. Group P (n=17) received 3mg/kg 0.5% prilocaine; group PT (n=17) 3mg/kg 0.5% prilocaine+2mL (100mg) tramadol and group PL (n=17) 3mg/kg 0.5% prilocaine+2mL (8mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions.
Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively.
Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.
A dor relacionada ao torniquete é um dos maiores obstáculos para a anestesia regional intravenosa (ARIV). Nosso objetivo foi comparar tramadol e lornoxicam usados em ARIV em relação aos seus efeitos sobre a qualidade da anestesia, dor relacionada ao torniquete e dor no pós-operatório.
Após a aprovação do Comitê de Ética, 51 pacientes com estado físico ASA I–II e idades entre 18–65 anos foram inscritos. Os pacientes foram divididos em três grupos. Grupo P (n=17) recebeu 3mg/kg de prilocaína a 0,5%; Grupo PT (n=17) 3mg/kg de prilocaína a 0,5%+2mL (100mg) de tramadol e Grupo PL (n=17) de 3mg/kg de prilocaína a 0,5%+2mL (8mg) de lornoxicam para ARIV. O início do bloqueio sensorial e motor e os tempos de recuperação foram registrados, bem como a dor relacionada ao torniquete e o consumo de analgésico no pós-operatório.
Os tempos de início do bloqueio sensorial foram mais curtos nos grupos PT e PL, enquanto que os tempos de recuperação correspondentes foram mais longos que os do Grupo P. Os tempos de início do bloqueio motor nos grupos PT e PL foram menores que no Grupo P, enquanto que o tempo de recuperação do grupo PL foi maior que os dos grupos P e PT. O tempo para início da dor relacionada ao torniquete foi menor no Grupo P e maior no Grupo PL. Não houve diferença em relação à dor relacionada ao torniquete entre os grupos. O Grupo PL apresentou o menor consumo de analgésicos no pós-operatório.
A adição de tramadol e lornoxicam à prilocaína para ARIV produz efeitos favoráveis sobre o bloqueio sensorial e motor. O consumo de analgésicos no pós-operatório pode ser reduzido com a adição de tramadol e lornoxicam à prilocaína em ARIV.
JUSTIFICATIVA E OBJETIVOS: Avaliar a eficácia, a duração do bloqueio, a permanência na sala de recuperação pós-anestesia e os efeitos adversos do uso por via intratecal de doses baixas de bupivacaína ...em combinação com fentanil e compará-los com a dose convencional de prilocaína e fentanil em cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial. MATERIAIS E MÉTODOS: Foram randomicamente designados 60 pacientes para dois grupos: o Grupo B recebeu 4 mg de bupivacaína a 0,5% + 25 µg de fentanil e o Grupo P recebeu 50 mg de prilocaína a 2% + 25 µg de fentanil intratecal. Qualidade e duração dos bloqueios, tempo de permanência na sala de recuperação pós-anestésica e efeitos adversos foram comparados. RESULTADOS: A duração do bloqueio e o tempo de permanência na sala de recuperação pós-anestésica foram menores no Grupo B do que no Grupo P (p < 0,001 para ambos). Hipotensão e bradicardia não foram observadas no Grupo B, que foi significativamente diferente do Grupo P (p = 0,024, p = 0,011, respectivamente). CONCLUSÃO: A administração intratecal de 4 mg de bupivacaína + 25 µg de fentanil forneceu raquianestesia adequada com menos tempo de duração do bloqueio e de permanência na sala de recuperação pós-anestésica com perfil hemodinâmico estável comparado à administração intratecal de 50 mg de prilocaína + 25 µg de fentanil para cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial.
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