The interaction of antiemetic dose of droperidol with propofol on QT interval during anesthetic induction

Purpose

We investigated the effect of low-dose droperidol on heart rate-corrected QT (QTc) interval and interaction with propofol.

Methods

Seventy-two patients undergoing upper limb surgery were included in this study. Patients were randomly allocated to one of three groups: group S (n = 24), which received 1 ml saline; group D1 (n = 24), which received 1.25 mg droperidol; or group D2 (n = 24), which received 2.5 mg droperidol. One minute later, fentanyl (3 μg/kg) was administered. Two minutes after fentanyl administration, anesthesia was induced using propofol (1.5 mg/kg) and vecronium. Tracheal intubation was performed 3 min after the administration of propofol. Heart rate, mean arterial pressure, bispectral index, and QTc interval were recorded at the following time points: immediately before the droperidol injection (baseline); 3 min after the saline or droperidol injection; 3 min after the propofol injection; and 2 min after tracheal intubation.

Results

Compared to baseline, the QTc interval in group S and group D1 was significantly shorter after propofol injection, but recovered after tracheal intubation. In group D2, the QTc interval was significantly prolonged after droperidol injection, but recovered after propofol injection, and was significantly prolonged after tracheal intubation.

Conclusions

We found that saline or 1.25 mg droperidol did not prolong QTc interval, whereas 2.5 mg droperidol prolonged the QTc interval significantly, and that propofol injection counteracted the prolongation of the QTc interval induced by 2.5 mg droperidol.     

The effect of alfentanil versus ketamine on the intubation condition and hemodynamics with low-dose rocuronium in children

Purpose

We investigated the effect of alfentanil and ketamine on the intubation condition and hemodynamic parameters during propofol anesthesia with low-dose rocuronium in children.

Methods

Fifty-four children, aged 3–9 years undergoing tonsillectomy, were randomly allocated to receive either alfentanil 20 μg/kg (alfentanil group, n = 27) or ketamine 0.5 mg/kg (ketamine group, n = 27) 1 min before anesthesia induction. Anesthesia was induced with propofol 2.5 mg/kg and rocuronium 0.3 mg/kg and maintained with propofol infusion (6 mg/kg/h). The neuromuscular relaxation was monitored, and intubation conditions, hemodynamic changes, and recovery time were assessed.

Results

All patients were successfully intubated and there were no significant differences in the intubation conditions between alfentanil and ketamine groups. At the time of tracheal intubation, the median [inter-quartile range] twitch height was similar between two groups (37 [4–48] % in the alfentanil group vs. 29 [4–43.5] % in the ketamine group, p = 0.326).

Conclusions

This study showed that both ketamine 0.5 mg/kg and alfentanil 20 μg/kg provided adequate intubation condition during propofol induction with low-dose rocuronium in children. The mean arterial pressure and heart rate were higher in the ketamine group after propofol injection but they remained within the normal limit in both groups throughout the study period.     

Antiemetic effect of naloxone in combination with dexamethasone and droperidol in patients undergoing laparoscopic gynecological surgery

Purpose

We examined the effects of dexamethasone, droperidol, naloxone, and a combination of these three agents on postoperative nausea and vomiting (PONV) in female patients.

Methods

In this randomized, controlled study, 120 female patients with ASA PS I or II undergoing laparoscopic gynecological surgery were randomly allocated into four groups. Patients received dexamethasone 8 mg (Dx group) or droperidol 1 mg (Dr group) before induction of general anesthesia. Anesthesia was induced and maintained with propofol and remifentanil. Postoperative analgesia was provided by intravenous patient-controlled analgesia using a disposable infusion pump filled with fentanyl 20 μg/kg alone (Dx group), fentanyl 20 μg/kg with droperidol 2 mg (Dr group), fentanyl 20 μg/kg with naloxone 0.1 mg (Nx group), or fentanyl 20 μg/kg with droperidol 2 mg and naloxone 0.1 mg (Cm group) in a total volume of 80 ml, with a constant infusion rate of 4 ml/h and a bolus dose 2 ml with a 30-min lockout time.

Results

The number of patients who developed PONV and required a rescue antiemetic was significantly less in the Cm group than in the Nx group (p < 0.001 for all). The incidence of PONV was 43, 43, 70, and 17 % in the Dx, Dr, Nx, and Cm groups, respectively.

Conclusion

A combination of naloxone, droperidol, and dexamethasone was effective for preventing PONV in patients receiving fentanyl for postoperative analgesia after laparoscopic gynecological surgery, although further investigations are required to examine the effect of adding naloxone to other antiemetics.     

Intubation time required for tracheal intubation with low-dose rocuronium in children with and without atropine

Purpose

The purpose of this study was to determine the intubation time needed to facilitate tracheal intubation (Time_EI) with a low dose of rocuronium (0.3 mg/kg) during propofol induction, and to determine whether this time was reduced by the administration of atropine.

Methods

Forty-six children, aged 3–10 years, were randomly assigned to receive either saline (control group) or atropine 10 μg/kg (atropine group). Anesthesia was induced with alfentanil 10 μg/kg, propofol 2.5 mg/kg, and rocuronium 0.3 mg/kg. Each Time_EI at which tracheal intubation was attempted was predetermined according to the up-and-down method. The values of Time_EI that provided excellent intubation conditions in 50 and 95 % of patients were defined as Time_EI50 and Time_EI95, respectively.

Results

Time_EI50 ± SD was 160 ± 26.2 and 150 ± 13.7 s in the control and atropine groups, respectively. Using isotonic regression, Time_EI95 in the control and atropine groups was 199 s (95 % CI 198.8–200.7 s) and 171 s (95 % CI 171.3–172.1 s), respectively. Time_EI95 was significantly higher in the control group than in the atropine group (P < 0.001). HR was significantly higher in the atropine group than in the control group during the study period.

Conclusions

This study demonstrated that the Time_EI95 of a low dose of rocuronium (0.3 mg/kg) required for excellent tracheal intubation was 199 s during i.v. anesthesia induction using propofol and alfentanil in children. Also, i.v. atropine (10 μg/kg) before anesthesia induction was able to reduce Time_EI95 by 28 s.     

Effects of pretreatment with a small dose of dexmedetomidine on sufentanil-induced cough during anesthetic induction

Purpose

We aimed to investigate the effects of pretreatment with a small dose of dexmedetomidine on the cough caused by sufentanil during anesthetic induction.

Methods

Two hundred and forty patients undergoing elective gynecological surgery under general anesthesia were randomly allocated to 4 groups (n = 60, each group). Dexmedetomidine 0, 0.1, 0.25, and 0.5 μg/kg was administered in 5 min to groups I, II, III, and IV, respectively, followed by the induction of general anesthesia with intravenous propofol, at a target concentration of 5 μg/ml, and sufentanil 0.5 μg/kg. The incidences and severity of cough that occurred within 1 min after the injection of sufentanil were recorded, and the incidences of cardiovascular adverse events that occurred between the administration of the dexmedetomidine infusion and 1 min after tracheal intubation were recorded.

Results

The incidences of cough in group II, group III, and group IV were lower than that in group I (6.7, 5.0, and 6.7 vs. 26.7 %, P < 0.01), while there were no significant differences between group II, group III, and group IV. The incidences of severe sinus bradycardia in group III and group IV were higher than that in group I (18.3 and 23.3 vs. 0.0 %, P < 0.01), while there was no significant difference between group I and group II. There was no significant difference in the incidence of low blood pressure among the four groups.

Conclusion

Dexmedetomidine at 0.10, 0.25, and 0.50 μg/kg significantly reduced the incidence of sufentanil-induced cough during anesthetic induction, with the effect being most marked for 0.10 μg/kg dexmedetomidine.     

Knee strength retention and analgesia with continuous perineural fentanyl infusion after total knee replacement: randomized controlled trial

Purpose

Despite providing adequate pain relief, a femoral nerve block can induce postoperative muscle weakness after total knee arthoplasty (TKA). Fentanyl has been shown to have peripheral effects but has not been used as a perineural infusate alone after TKA.

Methods

Sixty patients scheduled for TKA were randomized to one of three blinded groups: a continuous 24 h infusion of either fentanyl 3 μg/ml, ropivacaine 0.1 %, or 0.9 % normal saline through a femoral nerve sheath catheter at 10 ml/h. The main outcome was maximum voluntary isometric contraction (MVIC) in the quadriceps femoris (knee extension), measured by a handheld dynamometer (Nm/kg). Other variables assessed were preoperative and postoperative visual analog scale (VAS) scores, hamstrings MVIC (knee flexion), active range of motion of the operative knee, distance ambulated, incidence of knee buckling, supplemental morphine usage, postoperative side effects, and serum fentanyl levels.

Results

Quadriceps MVIC values were significantly greater in the fentanyl group compared to the group that received ropivacaine (median values, 0.08 vs. 0.03 Nm/kg; p = 0.028). The incidence of postoperative knee buckling upon ambulation was higher in the ropivacaine group compared to the fentanyl group, although not statistically significant (40 % vs. 15 %, respectively; p = 0.077). VAS scores while ambulating were not significantly different between the fentanyl group and the ropivacaine group (p = 0.270). Postoperative morphine consumption, nausea and vomiting, and resting VAS scores were similar among the three groups.

Conclusions

A continuous perineural infusion of fentanyl produced greater strength retention than ropivacaine post-TKA.     

Difficult and failed intubation: Incident rates and maternal, obstetrical, and anesthetic predictors

Background

Difficult and failed tracheal intubation may be more common in the obstetrical population. The objective of this study was to determine the incidence of difficult and failed tracheal intubation in a Canadian tertiary care obstetric hospital and to identify predictors.

Methods

Maternal, perinatal, and anesthetic information on all pregnant women or recently pregnant (up to three days postpartum) women undergoing general anesthesia (GA) from 1984 to 2003 at the Izaac Walton Killam Health Centre (IWK) was abstracted from the Nova Scotia Atlee Perinatal Database, and the information was augmented by chart review. The incidence and predictors of difficult and failed tracheal intubation were determined. Analyses using logistic regression were performed for the complete GA cohort and for the subgroup that had Cesarean delivery under GA.

Results

There were 102,587 deliveries of ≥20 weeks gestation in the study population, with 3,107 GAs identified, 2,986 records reviewed, and 2,633 GAs (88%) retained in the complete cohort. Difficult tracheal intubation was encountered in 123 of 2,633 (4.7%) women in the complete cohort and 60 of 1,052 (5.7%) women in the Cesarean delivery subgroup. Only two failed tracheal intubations were identified (0.08%) in the complete cohort, and both occurred during GAs for postpartum tubal ligation. The combined rate of difficult/failed tracheal intubation remained stable over the 20 years reviewed despite decreasing GA rates. Amongst the complete cohort, maternal age ≥35 yr, weight at delivery 90 to 99 kg, and absence of labour predicted increased risks; while weight at delivery 90 to 99 kg and absence of labour amongst the Cesarean delivery subgroup predicted difficult/failed tracheal intubation.

Conclusion

Previously accepted risk factors, such as labour, pre-existing medical conditions and obstetrical disorders, did not predict an increased risk of difficult tracheal intubation, while maternal age ≥35 yr, weight 90 to 99 kg, and absence of active labour were found to predict increased risk.     

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Purpose

Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS.

Methods

Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient’s head was stabilized in a neutral position by grasping the patient’s mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient’s head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.

Results

Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/105) in the control group (P < 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI_95% 5.0–9.3, P < 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed.

Conclusion

In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy.     

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

Purpose

Dexmedetomidine, a selective α₂ adrenoreceptor agonist, has analgesic and sedative properties, minimal impact on respiratory parameters, and reportedly decreases analgesic requirements after surgery. Given its pharmacodynamic profile, dexmedetomidine might have a role for postoperative pain control in children undergoing tonsillectomy. In this study, we hypothesized that dexmedetomidine would delay and decrease opioid requirements after tonsillectomy.

Methods

In a double-blind controlled trial, participants undergoing tonsillectomy were randomized to receive one intravenous dose of fentanyl (1 μg·kg^?1 or 2 μg·kg^?1) or dexmedetomidine (2 μg·kg^?1 or 4 μg·kg^?1) immediately after endotracheal intubation. Primary outcomes included requirement for rescue morphine in the initial postoperative period.

Results

One hundred and one children were enrolled. During the postoperative period, dexmedetomidine (2 and 4 μg·kg^?1 groups combined) significantly prolonged the opioid-free interval of children who underwent tonsillectomy compared with fentanyl (1 and 2 μg·kg^?1 groups combined) (P < 0.001). Children treated with dexmedetomidine 2 μg·kg^?1 vs dexmedetomidine 4 μg·kg^?1 had similar cumulative incidence curves for time to morphine rescue, whereas there was a small difference in time to first morphine rescue administration when comparing fentanyl 1 μg·kg^?1 vs fentanyl 2 μg·kg^?1. Furthermore, length of stay in the postanesthesia care unit was significantly longer for children treated with dexmedetomidine vs children treated with fentanyl (P = 0.0016).

Conclusions

High-dose dexmedetomidine decreases opioid requirements, prolongs the opioid-free interval after tonsillectomy, and prolongs length of stay in the postanesthesia care unit. It is conceivable that these early opioid-sparing effects could benefit patients at risk for respiratory complications early in the postoperative course after tonsillectomy (e.g., patients with obstructive sleep apnea). (ClinicalTrials.gov number, NCT00654511).     

The effects of single-dose intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia

Purpose

Dexmedetomidine, a selective α2-adrenoceptor agonist, has analgesic and sedative effects. The purpose of this study was to investigate the effects of small, single-dose intravenous dexmedetomidine administration after hyperbaric bupivacaine spinal anesthesia.

Methods

Sixty adult patients classified as American Society of Anesthesiologists physical status 1 or 2 and scheduled for lower extremity surgery under spinal anesthesia were studied. Patients were randomly assigned to one of three groups and administered hyperbaric intrathecal bupivacaine 12 mg. 5 min after spinal anesthesia, patients in groups 1, 2, and 3 received normal saline 10 ml, dexmedetomidine 0.25 μg/kg, and dexmedetomidine 0.5 μg/kg, respectively, over 10-min intravenous administration. The onset time, maximum block level, two-dermatome sensory regression time, duration of motor and sensory anesthesia, and side effects were assessed.

Results

The two-dermatome sensory regression time was significantly increased in groups 2 and 3. The duration of motor and sensory anesthesia was significantly increased in group 3. Onset time, maximum block level, level of sedation, and incidence of hypotension and treatment-needed bradycardia were no different among the groups.

Conclusion

Single-dose intravenous dexmedetomidine 0.25–0.5 μg/kg, administered 5 min after intrathecal injection of hyperbaric bupivacaine, improved the duration of spinal anesthesia without significant side effects. This method may be useful for increasing the duration of spinal anesthesia, even after intrathecal injection of local anesthetics.     

Comparaison de l’Airtraq, du X-Lite et du laryngoscope standard pour la chirurgie thyroïdienne: une étude clinique randomisée

Purpose

To compare the performance of the Airtraq, X-Lite, and direct laryngoscopes for tracheal intubation for elective thyroid surgery.

Methods

In this randomized prospective study, Patients who were ASA (American Society of Anesthesiologists) I or II physical status I or II and patients undergoing thyroid surgery were included in this randomized prospective study. Patients with attributes for difficult intubation criteria were excluded. After induction of anesthesia with fentanyl, propofol, and cisatracurium, patients were randomized into three groups according to the intubating device used: Airtraq laryngoscope (Airtraq), X-Lite video laryngoscope (X-lLite), and direct laryngoscope with a Macintosh blade (Direct). The primary outcome measurement was the time needed for tracheal intubation. Secondary outcomes included intubation difficulty score (IDS), Cormack-Lehane classification, as well as hemodynamic and respiratory effects.

Results

One hundred and five patients were included. Mean (standard deviation) time for intubation was 28.2 (2.1) sec in the Airtraq group vs 36.6 (3.7) sec in the X-Lite group (P < 0.001), and 41.1 (4.4) sec in the Direct group (P < 0.001). Compared with to the direct laryngoscope, the Airtraq provided better visualization of the glottis (P = 0.003) with fewer attempts (P < 0.001) and lower IDS (P < 0.001). The intubation difficulty score was lower with the Airtraq than with the X-Lite (P = 0.003). Patients in the X-Lite and Direct groups showed more hemodynamic variations than those in the Airtraq group. There was only one failed intubation, in the direct group.

Conclusion

In thyroid surgery, the Airtraq and X-Lite laryngoscopes decrease time to intubation when compared with direct laryngoscopy.     

Recurarization after sugammadex reversal in an obese patient

Purpose

We report a case that involved immediate postoperative respiratory failure necessitating tracheal intubation, which was possibly related to recurarization after sugammadex reversal.

Clinical findings

A 54-yr-old woman weighing 115-kg was scheduled for laparoscopic repair of abdominal dehiscence under general anesthesia. Muscle relaxation was induced and maintained with rocuronium (170 mg iv total dose). At the end of the 170-min procedure, two twitches were visualized after supramaximal train-of-four (TOF) stimulation at the adductor pollicis muscle, and the patient’s central core temperature was 35.6°C. Sugammadex 200 mg iv (1.74 mg·kg^?1) was administered. With the patient fully awake, a TOF ratio 0.9 was obtained five minutes later. The tracheal tube was then removed, and the patient was transferred to the postanesthesia care unit. Ten minutes later, the patient presented respiratory failure necessitating tracheal intubation and sedation with propofol. One TOF response only was visualized at the adductor pollicis muscle. Another dose of sugammadex 200 mg iv was administered. Forty-five minutes later, the patient was fully awake and her trachea was extubated after repeated measures of the TOF ratio (≥ 0.9) at the adductor pollicis muscle. The patient fully recovered without sequelae, further complication, or prolonged hospital stay.

Conclusion

Shortly after tracheal extubation, an obese patient experienced respiratory failure necessitating tracheal intubation and an additional dose of sugammadex. This occurred despite initial reversal of neuromuscular blockade with an appropriate dose of sugammadex 2 mg·kg^?1 iv given at two responses to TOF stimulation.     

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

Purpose

Our study aimed to evaluate the effects of lidocaine sprayed onto the larynx and/or injected into the tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat.

Methods

One hundred twenty women scheduled for gynecological surgery < 120 min in duration were enrolled in this randomized double-blind prospective study. Prior to tracheal intubation, 4% lidocaine or 0.9% saline was sprayed onto the patients’ supra- and subglottic areas. After tracheal intubation, the tracheal tube cuff was filled with either an alkalinized 2% lidocaine solution or 0.9% saline. This resulted in four groups: spray-cuff, spray-saline, saline-cuff, and saline-saline. A logistic regression comprising the two factors was used for analysis. The primary outcome was the incidence of cough at extubation. The secondary outcome was the incidence and severity of sore throat reported by patients at 15 min, 60 min, and 24 hr after tracheal extubation.

Results

Cough occurred in 42%, 24%, 63%, and 69% of patients in the spray-cuff, spray-saline, saline-cuff, and saline-saline groups, respectively. The use of lidocaine spray decreased the incidence of cough at extubation (odds ratio = 0.256; 95% confidence interval 0.118 to 0.554; P < 0.001); however, the use of intracuff alkalinized lidocaine had no impact on the occurrence of cough (P = 0.471). Severity of sore throat was clinically low (visual analog scale [VAS] ≤ 3) in all groups. No significant difference was observed in hoarseness, dysphagia, nausea, or vomiting.

Conclusion

Sprayed lidocaine decreases the incidence of cough at tracheal extubation in surgeries of less than two hours. The use of alkalinized lidocaine into high-volume/low-pressure endotracheal cuffs had no impact on decreasing the incidence of cough or pain.     

Higher fraction of inspired oxygen in anesthesia induction does not affect functional residual capacity reduction after intubation: a comparative study of higher and lower oxygen concentration

Background

Low fraction of inspired oxygen (F_IO₂) reduces the atelectasis area during anesthesia induction. However, atelectasis may occur during laryngoscopy and endotracheal intubation because lungs can collapse within a fraction of a second. We assessed the effects of ventilation with 100 and 40 % oxygen on functional residual capacity (FRC) in patients undergoing general anesthesia.

Methods

Twenty patients scheduled for elective open abdominal surgery were randomized into 40 % oxygen (GI, n = 10) and 100 % oxygen (GII, n = 10) groups and FRC was measured. Preoxygenation and mask ventilation with 40 and 100 % oxygen were used in GI and GII, respectively. In both groups, 40 % oxygen was used for anesthesia maintenance after intubation. Bilateral lung ventilation was performed with volume guarantee and low tidal volume (7 ml/kg predicted body weight) using bilevel airway pressure. We measured FRC and blood gas in all patients during preoxygenation, after intubation, and during surgery.

Results

FRC decreased from during preoxygenation (GI 2380 ml, GII 2313 ml) to after intubation (GI 1569 ml, GII 1586 ml) and significantly decreased during surgery (GI 1338 ml, GII 1417 ml) (P < 0.05). PaO₂/F_IO₂ decreased from during preoxygenation (GI 419 mmHg, GII 427 mmHg) to after intubation (GI 381 mmHg, GII 351 mmHg) and significantly decreased during surgery (GI 333 mmHg, GII 291 mmHg) (P < 0.05). No significant differences were found between the groups in both parameters.

Conclusions

FRC significantly decreased from the awake state to surgery in both groups. FRC was not influenced by F_IO₂ elevation at anesthesia induction.     

Use of LMA for awake intubation for Caesarean section

Purpose

This case report describes the use of a Laryngeal Mask Airway in a morbidly obese parturient with the H.E.L.L.P. syndrome. An urgent Caesarean section was required because of vaginal bleeding and fetal distress.

Clinical features

The patient was a 32 year old G3, T1, P1, L1 who presented with epigastric pain, headache, vomiting, and diarrhoea. She was hypertensive (180/110 mmHg) and thrombocytopaenic (18 × 10^?9 · L^?1). Examination of the airway revealed a short neck, receded jaw, full dentition, large breasts and she was considered to be a potential intubation problem. The patient required an awake intubation using a technique that minimized hypertension, aspiration risk, airway trauma, and hypoxia. A laryngeal mask was used to facilitate tracheal intubation, and the patient tolerated the procedure with no adverse outcome.

Conclusion

The LMA has a place to facilitate potentially difficult awake tracheal intubation with the pregnant patient.     

The LMA CTrach™ in morbidly obese and lean patients undergoing gynecological procedures: a comparative study

Purpose

The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. The aim of this study was to compare the airway management quality in morbidly obese and lean patients with use of the LMA CTrach.

Methods

After Ethics Committee approval, 60 adult patients (30 morbidly obese patients with body mass index >40 kg/m² and 30 lean patients with body mass index <30 kg/m²) scheduled to undergo gynecological surgery were enrolled in this prospective study. The induction of anesthesia was standardized using propofol, fentanyl, and rocuronium. Ventilation and intubation success rates, time taken to achieve successful ventilation, and intubation through the CTrach and airway complications were recorded.

Results

The CTrach was successfully inserted and adequate ventilation through the CTrach was achieved in 59 patients (98%). Only 1 patient in the lean group was not able to ventilate through the CTrach. We were successful in endotracheal intubation, either under vision or blind, in 56 patients (93%). We were able to view the larynx in 51 patients (85%). Total intubation time was significantly longer in morbidly obese patients, 69 (311) s, than in lean patients, 33 (107) s [median (range)] (P < 0.001).

Conclusions

We concluded that the time to intubate the trachea in obese patients was significantly longer than in lean patients when the LMA CTrach was used.     

Intraoperative Nefopam Reduces Acute Postoperative Pain after Laparoscopic Gastrectomy: a Prospective,Randomized Study

Background

We assessed whether intraoperative nefopam would reduce opioid consumption and relieve postoperative pain in patients undergoing laparoscopic gastrectomy.

Methods

The 60 enrolled patients were randomly assigned to the control (n?=?32) or nefopam (n?=?28) group. All patients were blinded to their group assignment. We administered 100 ml of normal saline only (control group) or 20 mg of nefopam mixed in 100 ml normal saline (nefopam group) after anesthesia induction and at the end of surgery. The cumulative amount of fentanyl via intravenous patient-controlled analgesia (PCA), incidence of rescue analgesic medication, and numerical rating scale (NRS) for postoperative pain were evaluated along with the total remifentanil consumption.

Results

The mean infusion rate of remifentanil was significantly lower in the nefopam group (0.08?±?0.05 μg/kg/min) than in the control group (0.13?±?0.06 μg/kg/min) (P?<?0.001). Patients in the nefopam group required less fentanyl via intravenous PCA than those in the control group during the first 6 h after surgery (323.8?±?119.3 μg vs. 421.2?±?151.6 μg, P?=?0.009). Additionally, fewer patients in the nefopam group than in the control group received a rescue analgesic during the initial 6 h postoperatively (78.6 vs. 96.9%, P?=?0.028). The NRS measured while patients were in the post-anesthetic care unit was significantly lower in the nefopam group than in the control group (3.8?±?1.1 vs. 4.8?±?1.4, P?=?0.012). The subsequent NRS obtained after patients had been transferred to the general ward was comparable between the two groups during the following postoperative period.

Conclusions

Intraoperative nefopam decreased postoperative pain and opioid consumption in the acute postoperative period after laparoscopic gastrectomy. Hence, nefopam may be considered as a component of multimodal analgesia after laparoscopic gastrectomy.

     

Efficacy of endotracheal lidocaine administration with continuous infusion of remifentanil for attenuating tube-induced coughing during emergence from total intravenous anesthesia

Purpose

Although attenuation of tube-induced coughing is necessary in specific types of surgery, the best method for such attenuation is still unclear. We studied the combined intervention of endotracheal lidocaine and intravenous remifentanil compared to intravenous remifentanil alone with respect to coughing during emergence from anesthesia.

Methods

We examined 60 ASA 1–2 patients (age, 20–69 years) undergoing tympanoplasty under general anesthesia. Anesthesia was induced with propofol, remifentanil, and rocuronium. The trachea was intubated using a laryngotracheal instillation of topical anaesthetic (LITA) tracheal tube. Anesthesia was maintained with propofol and remifentanil (0.1–0.3 μg/kg/min). Propofol was discontinued and remifentanil (0.1 μg/kg/min) was continued at the end of the operation. Patients were randomly allocated to the lidocaine (n = 30) and control groups (n = 30). We administered 3 ml 4 % lidocaine via the LITA tube to patients in lidocaine group at the end of the operation. The trachea was extubated when the patient regained consciousness and followed orders. Coughing was evaluated using a 4-point scale by an observer who examined the video records at extubation.

Results

Fewer patients in lidocaine group (8 of 30) than in control group (18 of 30, p < 0.01) coughed. Fewer patients in lidocaine group (2 of 30) than in control group (12 of 30, p < 0.01) had moderate or severe cough (scale 2 or 3).

Conclusions

This study is consistent with the finding that endotracheal lidocaine administration and continuous infusion of remifentanil before extubation is useful to prevent coughing on emergence from anesthesia.     

Different administration schedules of darbepoetin alfa affect oxidized and reduced glutathione levels to a similar extent in 5/6 nephrectomized rats

Background

The development of erythropoiesis-stimulating agents (ESAs) with extended serum half-lives has allowed marked prolongation of the administration intervals. The level of oxidative stress is increased in chronic kidney disease, and is reportedly decreased after long-term ESA treatment. However, the effect of different dosing regimens of ESAs on oxidative stress has not been elucidated.

Methods

Five-sixths nephrectomized (NX) rats received either 0.4 μg/kg darbepoetin alfa (DA) weekly or 0.8 μg/kg DA fortnightly between weeks 4 and 10. NX animals receiving saline and a sham-operated (SHAM) group served as controls. The levels of oxidized and reduced glutathione (GSSG, GSH) were followed from blood samples drawn fortnightly.

Results

During the follow-up, the ratios GSSG/GSH showed similar trends in both DA groups, levels being significantly lower than those in the SHAM group at weeks 8 and 10. GSSG levels were lower than the baseline throughout the study in all groups except for NX controls. The GSH levels were increased in all three NX groups (weeks 6–10) compared with both the baseline and the SHAM group

Conclusion

Our results suggest that the extent of oxidative stress is similar in response to different dosing regimens of DA in 5/6 NX rats when comparable hemoglobin levels are maintained. These findings remain to be confirmed in chronic kidney disease patients.     

Serum aluminum levels in dialysis patients after sclerotherapy of internal hemorrhoids with aluminum potassium sulfate and tannic acid

Purpose

Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for internal hemorrhoids. However, it is contraindicated for patients with chronic renal failure on dialysis, because the aluminum in ALTA can cause aluminum encephalopathy when it is not excreted effectively. We conducted this study to measure the serum aluminum concentrations and observe for symptoms relating to aluminum encephalopathy in dialysis patients after ALTA therapy.

Methods

Ten dialysis patients underwent ALTA therapy for hemorrhoids. We measured their serum aluminum concentrations and observed them for possible symptoms of aluminum encephalopathy.

Results

The total injection volume of ALTA solution was 31 mL (24–37). The median serum aluminum concentration before ALTA therapy was 9 μg/L, which increased to 741, 377, and 103 μg/L, respectively, 1 h, 1 day, and 1 week after ALTA therapy. These levels decreased rapidly, to 33 μg/L by 1 month and 11 μg/L by 3 months after ALTA therapy. No patient suffered symptoms related to aluminum encephalopathy.

Conclusions

Although the aluminum concentrations increased temporarily after ALTA therapy, dialysis patients with levels below 150 μg/L by 1 week and thereafter are considered to be at low risk of the development of aluminum encephalopathy.