Efecto de la infusión controlada de remifentanil en combinación con desfluorano durante el mantenimiento de la anestesia general
Effect of a target-controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia.
Shin MK, Shim HS, Yang GY, Sung WS.
Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Korean J Anesthesiol. 2012 Jul;63(1):25-9. Epub 2012 Jul 24.
Abstract
BACKGROUND: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. METHODS: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. RESULTS: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 ± 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 ± 0.5 vol%; P < 0.001) compared to patients in group D (7.9 ± 0.5 vol%). CONCLUSIONS: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408510/pdf/kjae-63-25.pdf
Comparación entre dexmedetomidina y remifentanilo para atenuar las respuestas hemodinámicas a laringoscopía e intubación traqueal
Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation.
Lee JH, Kim H, Kim HT, Kim MH, Cho K, Lim SH, Lee KM, Kim YJ, Shin CM.
Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Korean J Anesthesiol. 2012 Aug;63(2):124-9. Epub 2012 Aug 14.
Abstract
BACKGROUND: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. METHODS: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. RESULTS: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). CONCLUSIONS: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427804/pdf/kjae-63-124.pdf
Apnea por remifentanilo: informe de un caso y revisión de la literatura
Remifentanil apnea: Case report and review of the literature.
Shaikh N, Hanssens Y, Louon A.
Department of Anesthesiology and Intensive Care, Hamad Medical Corporation-Hamad General Hospital, Doha, Qatar.
J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):553-5.
Abstract
Remifentanil is an opioid analgesic frequently used in intensive care patients because of its rapid onset of action, potency, and ultra-short duration. If an excessive dose is given, it leads to rapid, short lasting, potentially life-threatening side effects such as apnea, bradycadia, hypotension, and rigidity, following rapid peak serum levels. We report a 36-year-old woman developing apnea with bradycardia and hypotension, following an infusion in the central venous catheter lumen that had been used for remifentanil till tracheal extubation. The patient was immediately ventilated with bag-valve-mask and improved within 8 minutes. She became fully awake, heart rate and blood pressure returned to normal, and oxygen saturation improved to 100%. Acute care physicians, intensivists, anesthesiologists, and critical care nurses should be aware of this clinical problem in order prevent it as much as possible and to initiate immediate resuscitative measures.
http://www.joacp.org/temp/JAnaesthClinPharmacol274553-721946_200314.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Effect of a target-controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia.
Shin MK, Shim HS, Yang GY, Sung WS.
Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Korean J Anesthesiol. 2012 Jul;63(1):25-9. Epub 2012 Jul 24.
Abstract
BACKGROUND: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. METHODS: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. RESULTS: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 ± 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 ± 0.5 vol%; P < 0.001) compared to patients in group D (7.9 ± 0.5 vol%). CONCLUSIONS: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408510/pdf/kjae-63-25.pdf
Comparación entre dexmedetomidina y remifentanilo para atenuar las respuestas hemodinámicas a laringoscopía e intubación traqueal
Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation.
Lee JH, Kim H, Kim HT, Kim MH, Cho K, Lim SH, Lee KM, Kim YJ, Shin CM.
Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Korean J Anesthesiol. 2012 Aug;63(2):124-9. Epub 2012 Aug 14.
Abstract
BACKGROUND: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. METHODS: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. RESULTS: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). CONCLUSIONS: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427804/pdf/kjae-63-124.pdf
Apnea por remifentanilo: informe de un caso y revisión de la literatura
Remifentanil apnea: Case report and review of the literature.
Shaikh N, Hanssens Y, Louon A.
Department of Anesthesiology and Intensive Care, Hamad Medical Corporation-Hamad General Hospital, Doha, Qatar.
J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):553-5.
Abstract
Remifentanil is an opioid analgesic frequently used in intensive care patients because of its rapid onset of action, potency, and ultra-short duration. If an excessive dose is given, it leads to rapid, short lasting, potentially life-threatening side effects such as apnea, bradycadia, hypotension, and rigidity, following rapid peak serum levels. We report a 36-year-old woman developing apnea with bradycardia and hypotension, following an infusion in the central venous catheter lumen that had been used for remifentanil till tracheal extubation. The patient was immediately ventilated with bag-valve-mask and improved within 8 minutes. She became fully awake, heart rate and blood pressure returned to normal, and oxygen saturation improved to 100%. Acute care physicians, intensivists, anesthesiologists, and critical care nurses should be aware of this clinical problem in order prevent it as much as possible and to initiate immediate resuscitative measures.
http://www.joacp.org/temp/JAnaesthClinPharmacol274553-721946_200314.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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