Adverse reactions to non-ionic contrast media with special regard to high-risk patients

Non-ionic contrast media (CM) are proven to be significantly safer than the high osmolar ionic contrast media (HOCM). Nevertheless deaths are reported after administration of non-ionic agents. The aim of the study was to investigate the rate of adverse reactions to non-ionic CM with special regard to high-risk patients and the effects of premedication with H1-and H2-receptor antagonists.In a prospective study conducted over about 2 years 12 995 examinations with intravenous or intra-arterial non-ionic CM were evaluated. Premedication with H1-and H2-antagonists was used in 1276 high-risk patients with known adverse reaction to CM, history of allergy or severe cardiac or pulmonary disease. 229 patients received no premedication inspite of known risk factors. In total, there were 143 (1.10%) adverse reactions (mild in 0.58%, moderate in 0.41% and severe in 0.05%). In high-risk patients there were adverse reactions in 4.37% without and in 1.57% with premedication. There were no severe adverse reactions in the high-risk patients after premedication. The age of the patient, CM dosage and CM concentration were not shown to be risk factors in the present study. In conclusion, the additional premedication with H1- and H2-antagonists could be an effective agent to reduce the risk of mild and moderate adverse reactions and to avoid severe adverse reactions in high-risk patients. Correspondence to: U. Fink     

A comparison of midazolam with trimeprazine as an oral premedicant for children

The effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg⁻¹ given 30 min pre-operatively was compared with trimeprazine 2 mg.kg⁻¹ given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p =0.0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.     

Efecto sobre el comportamiento de dexmedetomidina como premedicación anestésica en la población pediátrica: Estudio prospectivo observacional

Premedication in the pediatric population is of vital importance to reduce anxiety and facilitate anesthetic induction. Midazolam and ketamine have been used for this purpose, drugs that have shown long-term changes in neurodevelopment. Dexmedetomidine promotes a sedative, analgesic effect and lacks neurotoxic effects, its intranasal application is easy and minimally invasive. We studied the sedative and behavioral effect of intranasal dexmedetomidine 2 mcg/kg in ASA 1 and 2 children for elective surgery. They were evaluated at 10, 20 and 30 minutes of administered, in the separation of the parents and placement of the mask for inhalation induction with behavioral and sedation scores (classified from 1 to 4), we considered acceptable for admission to operating room categories 3 and 4.ResultsThirty patients between 1 and 10 years old were included in the period from September 2017 to April 2018. The sedation score obtained at 30 minutes was acceptable in 46.6% of the patients and the behavior score was in 96% of the cases. In 63% of cases the acceptance of the facial mask placement for inhalation induction was achieved. The procedure was well tolerated in all cases and parents were satisfied in 100% of the cases.     

盐酸戊乙奎醚作为全麻术前用药的安全性研究

目的对比研究盐酸戊乙奎醚与阿托品作为全麻术前用药的安全性。方法40例拟在全麻下行择期手术的患者,美国麻醉医师(ASA)分级Ⅰ～Ⅱ级,随机均分为4组,Ⅰ、Ⅱ、Ⅲ组分别肌内注射盐酸戊乙奎醚0．005、0．010和0．014 mg／kg,Ⅳ组肌内注射阿托品0．01 mg／kg。分别记录患者进入手术室后的基础口干程度视觉模拟评分和基础唾液分泌量,以及在注射药物30 min后的相应变化。记录各组患者注射药物后30、45、60和120 min的心率、平均动脉压、脉搏血氧饱和度和心电图的变化。结果肌内注射0.005和0．010 mg／kg盐酸戊乙奎醚后30 min唾液的分泌量无明显变化(P值均>0．05),而肌内注射0．014 mg／kg盐酸戊乙奎醚能明显抑制唾液分泌(P<0．01),平均抑制程度为56％。Ⅳ组注射阿托品后30 min的心率明显增快(P<0．05),Ⅰ、Ⅱ、Ⅲ组的心率无明显变化(P值均>0．05)。结论盐酸戊乙奎醚可以替代阿托品作为全麻术前用药,且特别适用于需要避免心动过速的患者。     

长托宁在老年ERCP麻醉前用药的临床观察

目的：探讨长托宁作为老年患者ERCP麻醉前用药的可行性,临床效果及安全性。方法：选取2009年5月-2013年2月本院90例在静脉麻醉下行ERCP手术老年患者,随机数字表法分为三组,长托宁组30例,阿托品组30例,生理盐水组30例,三组分别以长托宁,阿托品,生理盐水作为麻醉前用药。比较三组患者在麻醉给药后不同时间点SBP、DBP、HR以及唾液分泌量的变化,并比较三组患者在术中术后出现的不良反应情况。结果：三组患者血压变化均平稳,长托宁组患者心率变化较阿托品组平稳,和生理盐水组比较变化无统计学差异,长托宁组患者唾液分泌量明显少于阿托品及生理盐水组。阿托品组患者在给药前后心率变化差异有统计学意义（P〈0.05）。结论：长托宁在应用于老年ERCP术前麻醉时,对老年患者的循环血流动力学影响小,在抗胆碱作用时比阿托品效果更持续,并能够有效的控制围术期间呼吸道分泌物,是一种更为理想的老年患者麻醉前用药。     

Released washed platelet concentrates are effective and safe in patients with a history of transfusion reactions

Background

Plasma removal by washing is an effective approach to prevent transfusion reactions by platelet concentrates (PCs). Recently, washed PCs were released by the Japanese Red Cross Society (JRCS).

术前用药对心脏病人动脉血气的影响

选择心脏手术病人１２例，术前用药为吗啡０．２ｍｇ／ｋｇ和东莨菪碱０．００６ｍｇ／ｋｇ。比较用药前后脉搏氧饱和度及动脉血气。结果显示用药２０ｍｉｎ后开始出现动脉血氧分压、动脉血氧饱和度、动脉血氧含量降低。３例病人血氧饱和度降至９２％以下，其中１例降至８８％。说明常规剂量的吗啡和东莨菪碱可导致心脏病人术前出现低氧血症。     

Mirtazapine premedication: Effect on preoperative anxiety and propofol dose requirements at different stages of hypnosis

BackgroundMirtazapine is an antidepressant drug that blocks central 5-HT2 receptors with anxiolytic and sleep-promoting effects and theoretically can be used as a premedication.MethodsSixty ASA I-II patients aged 25–50 yr were randomly allocated according to the premedication received 2 h before induction of anesthesia into two equal groups: group M patients received mirtazapine 30 mg tablet mixed with 20 ml of water and group P patients received 20 ml of plain water. Anxiety level was measured by visual analogue scale (VAS) and bispectral index (BIS) electrodes were connected before induction of anesthesia. Intravenous (i.v) infusion of propofol 1% at a rate of 300 ml h^?1 was started to induce hypnosis till a target BIS value of 45 (BIS45) is reached, and then endotracheal intubation is performed after fentanyl and cis-atracuruim being administered. Propofol dose requirements to achieve loss of response to verbal contact (RVC), loss of eyelash reflex (ELR), and a target BIS45 were recorded. Anesthesia was maintained with sevoflurane titrated to BIS value of 40–50 and oxygen/air mixture. Recovery time was recorded. In postanaesthesia care unit (PACU), VAS for pain and Ramsay sedation score were recorded. Patients were discharged from PACU when two consecutive Aldrete scores of 9 or 10 are obtained, and time of PACU stay was recorded.ResultsPreoperative anxiety by VAS and propofol doses required achieving loss of RVC and ELR, and target BIS45 were significantly lower in mirtazapine group. The two groups were comparable with regard to recovery and PACU stay times as well as postoperative pain and anxiety.ConclusionMirtazapine 30 mg oral tablets can be used as a premedication as it reduces preoperative anxiety and hypnotic dose requirements of propofol, and does not prolong recovery time.