Pub Date : 2014-11-01DOI: 10.1016/j.bjanes.2013.10.002
Yoon Ji Choi , Kyung-Don Hahm , Koo Kwon , Eun-Ho Lee , Young Jin Ro , Hong Seuk Yang
Background and objective
The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively).
Method
In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray.
Results
L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14 ± 0.53, 2.19 ± 1.17, and −0.45 ± 0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm) = −0.037 + 0.036 × height (cm) + 0.903 × I-T-IC (cm) (adjusted r2 = 0.64).
Conclusion
The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.
{"title":"Previsión a pie de cama de la extensión de inserción de catéter en vena subclavia derecha","authors":"Yoon Ji Choi , Kyung-Don Hahm , Koo Kwon , Eun-Ho Lee , Young Jin Ro , Hong Seuk Yang","doi":"10.1016/j.bjanes.2013.10.002","DOIUrl":"10.1016/j.bjanes.2013.10.002","url":null,"abstract":"<div><h3>Background and objective</h3><p>The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively).</p></div><div><h3>Method</h3><p>In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray.</p></div><div><h3>Results</h3><p>L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14<!--> <!-->±<!--> <!-->0.53, 2.19<!--> <!-->±<!--> <!-->1.17, and −0.45<!--> <!-->±<!--> <!-->0.68<!--> <!-->cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient<!--> <!-->=<!--> <!-->0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm)<!--> <!-->=<!--> <!-->−0.037<!--> <!-->+<!--> <!-->0.036<!--> <!-->×<!--> <!-->height (cm)<!--> <!-->+<!--> <!-->0.903<!--> <!-->×<!--> <!-->I-T-IC (cm) (adjusted <em>r</em><sup>2</sup> <!-->=<!--> <!-->0.64).</p></div><div><h3>Conclusion</h3><p>The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Pages 419-424"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54226080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation.
Materials and methods
120 patients were randomly allocated to one of three groups in a double-blind fashion. 2.5 mg kg−1 propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6 mg kg−1 rocuronium, a tourniquet was applied to one arm and inflated to 50 mmHg greater than systolic pressure. The patients were divided into 3 groups; 1 mg kg−1 h−1 esmolol was given as the loading dose and in Group Es50 50 μg kg−1 min−1, in Group Es150 150 μg kg−1 min−1, and in Group Es250 250 μg kg−1 min−1 esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded.
Results
Incidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p < 0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure.
Conclusion
In clinical practise we believe that after 1 mg kg−1 loading dose, 150 μg kg−1 min−1 i.v. esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects.
{"title":"Efecto de diferentes dosis de esmolol sobre la respuesta hemodinámica, BIS y respuesta de movimiento durante la intubación orotraqueal: estudio prospectivo, aleatorizado y doble ciego","authors":"Mensure Yılmaz Çakırgöz , Aydın Taşdöğen , Çimen Olguner , Hülya Korkmaz , Ertuğrul Öğün , Burak Küçükebe , Esra Duran","doi":"10.1016/j.bjanes.2013.09.007","DOIUrl":"10.1016/j.bjanes.2013.09.007","url":null,"abstract":"<div><h3>Objective</h3><p>A prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation.</p></div><div><h3>Materials and methods</h3><p>120 patients were randomly allocated to one of three groups in a double-blind fashion. 2.5<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> rocuronium, a tourniquet was applied to one arm and inflated to 50<!--> <!-->mmHg greater than systolic pressure. The patients were divided into 3 groups; 1<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> <!-->h<sup>−1</sup> esmolol was given as the loading dose and in Group Es50 50<!--> <!-->μg<!--> <!-->kg<sup>−1</sup> <!-->min<sup>−1</sup>, in Group Es150 150<!--> <!-->μg<!--> <!-->kg<sup>−1</sup> <!-->min<sup>−1</sup>, and in Group Es250 250<!--> <!-->μg<!--> <!-->kg<sup>−1</sup> <!-->min<sup>−1</sup> esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded.</p></div><div><h3>Results</h3><p>Incidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p<!--> <!--><<!--> <!-->0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure.</p></div><div><h3>Conclusion</h3><p>In clinical practise we believe that after 1<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> loading dose, 150<!--> <!-->μg<!--> <!-->kg<sup>−1</sup> <!-->min<sup>−1</sup> i.v. esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Pages 425-432"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54225897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1016/j.bjanes.2013.08.003
Daher Rabadi , Ahmad Abu Baker , Mohannad Al-Qudah
Background and objective
Prediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro-hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation.
Method
The consecutive 500 ASA (I, II) adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, specificity, positive and negative predictive values were also reported.
Results
Cormack-Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack-Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications.
Conclusion
Friedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre-anesthetic prediction of difficult intubation where its involvement in multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway.
{"title":"Correlación entre los formatos de la orofaringe e hipofaringe y el posicionamiento en la intubación endotraqueal difícil","authors":"Daher Rabadi , Ahmad Abu Baker , Mohannad Al-Qudah","doi":"10.1016/j.bjanes.2013.08.003","DOIUrl":"10.1016/j.bjanes.2013.08.003","url":null,"abstract":"<div><h3>Background and objective</h3><p>Prediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro-hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation.</p></div><div><h3>Method</h3><p>The consecutive 500 ASA (I, II) adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, specificity, positive and negative predictive values were also reported.</p></div><div><h3>Results</h3><p>Cormack-Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack-Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications.</p></div><div><h3>Conclusion</h3><p>Friedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre-anesthetic prediction of difficult intubation where its involvement in multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Pages 433-437"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54225622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"La importancia del control de la temperatura corporal materna posterior a la inyección de meperidina durante la raquianestesia en pacientes sometidas a cesárea: una sugerencia para conducir estudios clínicos","authors":"Mohamed Amin Ghobadifar , Hassan Zabetian , Mohammad Yasin Karami , Zahra Mosallanezhad , Navid Kalani","doi":"10.1016/j.bjanes.2014.02.004","DOIUrl":"10.1016/j.bjanes.2014.02.004","url":null,"abstract":"","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Page 449"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.02.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rotura para abrir ampollas: un método más sencillo y seguro","authors":"Rudrashish Haldar, Sukhminder Jit Singh Bajwa, Jasleen Kaur","doi":"10.1016/j.bjanes.2014.02.006","DOIUrl":"10.1016/j.bjanes.2014.02.006","url":null,"abstract":"","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Pages 448-449"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.02.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1016/j.bjanes.2014.02.010
Juan A. Ramos
{"title":"Cicloplejía en el postoperatorio de cirugía oftalmológica: NO es la anestesia","authors":"Juan A. Ramos","doi":"10.1016/j.bjanes.2014.02.010","DOIUrl":"10.1016/j.bjanes.2014.02.010","url":null,"abstract":"","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Page 446"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.02.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-11-01DOI: 10.1016/j.bjanes.2014.03.001
Turhan Kara, Ozgur Ozbagriacik, Hacer Sebnem Turk, Canan Tulay Isil, Ozan Gokuc, Oya Unsal, Emrah Seyhan, Sibel Oba
Background and objectives
Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures.
Methods
80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mg kg−1 rocuronium and monitorized with train-of-four. Group RN (n = 40) received 0.03 mg kg−1 neostigmine, Group RS (n = 40) received 2 mg kg−1 sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded.
Results
There was no significant difference between the patients’ characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (P = .001, P = .002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (P = .020). Extubation train-of-four ratio was significantly lower in Group RN (P = .002).
Conclusion
Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.
{"title":"Sugammadex versus neostigmina en pacientes pediátricos: estudio prospectivo y aleatorizado","authors":"Turhan Kara, Ozgur Ozbagriacik, Hacer Sebnem Turk, Canan Tulay Isil, Ozan Gokuc, Oya Unsal, Emrah Seyhan, Sibel Oba","doi":"10.1016/j.bjanes.2014.03.001","DOIUrl":"10.1016/j.bjanes.2014.03.001","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures.</p></div><div><h3>Methods</h3><p>80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> rocuronium and monitorized with train-of-four. Group RN (<em>n</em> <!-->=<!--> <!-->40) received 0.03<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> neostigmine, Group RS (<em>n</em> <!-->=<!--> <!-->40) received 2<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four ><!--> <!-->0.9, and probable complications were recorded.</p></div><div><h3>Results</h3><p>There was no significant difference between the patients’ characteristics. Extubation time and time to reach train-of-four<!--> <!-->><!--> <!-->0.9 were significantly higher in Group RN (<em>P</em> <!-->=<!--> <!-->.001, <em>P</em> <!-->=<!--> <!-->.002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (<em>P</em> <!-->=<!--> <!-->.020). Extubation train-of-four ratio was significantly lower in Group RN (<em>P</em> <!-->=<!--> <!-->.002).</p></div><div><h3>Conclusion</h3><p>Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 6","pages":"Pages 400-405"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54234043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-09-01DOI: 10.1016/j.bjanes.2013.08.001
Harun Aydoğan , Ahmet Kucuk , Hasan Husnu Yuce , Mahmut Alp Karahan , Halil Ciftci , Mehmet Gulum , Nurten Aksoy , Saban Yalcin
Background and objectives
Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL).
Methods
60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour.
Results
Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (p = 0.002, p = 0.001 and p = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (p = 0.002, p = 0.001, p = 0.001, p = 0.001, p < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (p = 0.027).
Conclusions
Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects.
背景与目的在多模式镇痛方案中加入加巴喷丁类药物等新型辅助药物可能是合理的，可以减少经皮肾镜术后疼痛评分、阿片类药物总用量和副作用。我们的目的是评估普瑞巴林对经皮肾镜取石术(PCNL)患者术后疼痛评分、镇痛消耗和由肌酐清除率(CrCl)和血液中性粒细胞明胶酶相关脂钙蛋白(NGAL)和胱抑素C (Cys C)水平表达的肾功能的影响。方法择期PCNL患者60例。患者随机分为口服单剂量75 mg普瑞巴林组和对照组。分别于术前、术后第2、24小时测定视觉模拟量表疼痛评分(VAS)、术后24小时静脉吗啡用量、血清NGAL、Cys C水平和肌酐清除率(CrCl)。结果普瑞巴林组术后30min、1h、2h VAS评分均显著降低(p = 0.002、p = 0.001、p = 0.027)。普瑞巴林组术后各时间间隔吗啡平均用量均有统计学意义降低(p = 0.002, p = 0.001, p = 0.001, p = 0.001, p <分别为0.001)。两组患者术前、术后第2、24小时CrCl、Cys含量差异无统计学意义。普瑞巴林组术后24小时NGAL水平显著降低(p = 0.027)。结论口服单剂量普瑞巴林75mg可有效降低PCNL患者术后早期疼痛评分和总镇痛用量，且无血流动力学不稳定和不良反应。
{"title":"La adición de 75 mg de pregabalina al régimen analgésico reduce puntuaciones de dolor y consumo de opiáceos en adultos después de la nefrolitotomía percutánea","authors":"Harun Aydoğan , Ahmet Kucuk , Hasan Husnu Yuce , Mahmut Alp Karahan , Halil Ciftci , Mehmet Gulum , Nurten Aksoy , Saban Yalcin","doi":"10.1016/j.bjanes.2013.08.001","DOIUrl":"10.1016/j.bjanes.2013.08.001","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL).</p></div><div><h3>Methods</h3><p>60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour.</p></div><div><h3>Results</h3><p>Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (<em>p</em> = 0.002, <em>p</em> = 0.001 and <em>p</em> = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (<em>p</em> = 0.002, <em>p</em> = 0.001, <em>p</em> = 0.001, <em>p</em> = 0.001, <em>p</em> < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (<em>p</em> = 0.027).</p></div><div><h3>Conclusions</h3><p>Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 5","pages":"Pages 335-342"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54225519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension.
Methods
In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48 h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72 h, (2) intensive care unit stay >7days, and (3) mortality.
Results
The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n = 35, n = 16, respectively) showed significant differences in repeated measurement time points (p = 0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5 pg mL−1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r = 0.67, p = 0.0001).
Conclusions
In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5 pg mL−1 are at risk of developing low cardiac output syndrome which is an important postoperative outcome.
背景和目的在接受先天性心脏手术的儿童中，血浆脑利钠肽水平可能在低心输出量综合征的发展中起作用，低心输出量综合征被定义为肺动脉高压患儿的临床表现和增加心输出量的干预措施的结合。方法在一项前瞻性观察研究中，51名接受先天性心脏手术且术前超声心动图显示肺动脉高压的儿童入组。分别于术前、术后12、24、48 h采集血浆脑钠肽水平。纳入研究的患者根据以下因素分为两组:(1)LCOS的发展情况，LCOS的定义是临床表现或术后增加心输出量的干预措施的结合;(2)低心输出量综合征患者术前工作曲线分析确定脑钠肽截断值。次要终点为:(1)机械通气持续时间≥72 h，(2)重症监护病房住院时间≥7天，(3)死亡率。结果有无低心输出量综合征患者(n = 35, n = 16)术前、术后脑利钠肽水平差异在重复测量时间点上差异有统计学意义(p = 0.0001)。术前脑利钠肽截断值为125.5 pg mL−1，预测肺动脉高压患者低心输出量综合征的敏感性为88.9%，特异性为96.9%。术前血浆脑利钠肽水平与机械通气时间有较好的相关性(r = 0.67, p = 0.0001)。结论在接受先天性心脏手术的肺动脉高压患者中，91%术前血浆脑钠肽水平高于125.5 pg mL−1的患者存在发生低心输出量综合征的风险，这是术后重要的预后。
{"title":"El valor predictivo del plasma en niveles de péptido natriurético tipo B, y los resultados en niños con hipertensión pulmonar en proceso de cirugía de cardiopatía congénita","authors":"Ayse Baysal , Ahmet Şaşmazel , Ayse Yildirim , Buket Ozyaprak , Narin Gundogus , Tuncer Kocak","doi":"10.1016/j.bjanes.2013.10.004","DOIUrl":"10.1016/j.bjanes.2013.10.004","url":null,"abstract":"<div><h3>Background and objectives</h3><p>In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension.</p></div><div><h3>Methods</h3><p>In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48 h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72 h, (2) intensive care unit stay >7days, and (3) mortality.</p></div><div><h3>Results</h3><p>The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (<em>n</em> = 35, <em>n</em> = 16, respectively) showed significant differences in repeated measurement time points (<em>p</em> = 0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5 pg mL<sup>−1</sup> was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (<em>r</em> = 0.67, <em>p</em> = 0.0001).</p></div><div><h3>Conclusions</h3><p>In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5 pg mL<sup>−1</sup> are at risk of developing low cardiac output syndrome which is an important postoperative outcome.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 5","pages":"Pages 326-334"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54226104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-09-01DOI: 10.1016/j.bjanes.2014.02.012
Daniel Volquind
{"title":"Comentario a: Anestesia para craneotomía en paciente despierto: relato de caso","authors":"Daniel Volquind","doi":"10.1016/j.bjanes.2014.02.012","DOIUrl":"10.1016/j.bjanes.2014.02.012","url":null,"abstract":"","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"64 5","pages":"Page 374"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.02.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号