Airway fire resulting from ignition of the endotracheal tube (ETT) caused by electrocautery during tracheostomy is a severe and possibly fatal event, and should be avoided. An 88-year-old male because of respiratory failure received elective tracheostomy for ventilatory support on which prolonged dependence was anticipated. Unfortunately, flame was noted to jet out from the trachea incision just after a single burst of electrocautery to coagulate a bleeder in the trachea tissue nearby the incision. After primary management, including extinguishing the flame and evaluation of the tracheal injury by bronchoscope, a tracheostomy tube was inserted smoothly without causing hypoxemia or hemodynamic instability. The patient stood this ordeal of fire well without related sequelae and was returned from the intensive care unit (ICU) to the general ward two weeks later. From this accident, we recommend that, besides emphasis on lowering of the inspired oxygen concentration (FiO2) and careful use of electrocautery during the tracheostomy procedure, special attention should be paid to the integrality of ETT cuff. It serves as a barrier to prevent oxygen leaking out from the trachea to be exposed to the sparks of electrocautery while the surgical procedure is under way, and thus it plays a significant role in the avoidance of airway fire induced by electrocautery.
{"title":"Endotracheal tube fire induced by electrocautery during tracheostomy--a case report.","authors":"Chih-Cheng Wu, Ching-hui Shen, Wai-Meng Ho","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Airway fire resulting from ignition of the endotracheal tube (ETT) caused by electrocautery during tracheostomy is a severe and possibly fatal event, and should be avoided. An 88-year-old male because of respiratory failure received elective tracheostomy for ventilatory support on which prolonged dependence was anticipated. Unfortunately, flame was noted to jet out from the trachea incision just after a single burst of electrocautery to coagulate a bleeder in the trachea tissue nearby the incision. After primary management, including extinguishing the flame and evaluation of the tracheal injury by bronchoscope, a tracheostomy tube was inserted smoothly without causing hypoxemia or hemodynamic instability. The patient stood this ordeal of fire well without related sequelae and was returned from the intensive care unit (ICU) to the general ward two weeks later. From this accident, we recommend that, besides emphasis on lowering of the inspired oxygen concentration (FiO2) and careful use of electrocautery during the tracheostomy procedure, special attention should be paid to the integrality of ETT cuff. It serves as a barrier to prevent oxygen leaking out from the trachea to be exposed to the sparks of electrocautery while the surgical procedure is under way, and thus it plays a significant role in the avoidance of airway fire induced by electrocautery.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"209-13"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Tsou, H. Luk, S. Chiang, S. Hsin, Jia-Horng Wang
BACKGROUND The tussive effect of fentanyl, in sharp contrast to the antitussive effect that common opioids have, is not rarely seen in clinical anesthesia. Pretreatment with beta 2 agonist inhalation could dramatically suppress fentanyl-induced coughing. We hypothesized that airway hyperresponsiveness might exist in large proportion of the subjects who had experienced fentanyl-induced coughing during previous anesthesia. METHODS We designed a case-controlled matching study to investigate the correlation between fentanyl-induced coughing and airway hyperresponsiveness. Twenty-six consecutive subjects (ASA I-III), who experienced fentanyl-induced coughing during anesthesia in our hospital from 1999 to 2000, were enrolled in this study as the fentanyl-cough group. In all the subjects baseline spirometry was first obtained. Airway responsiveness was evaluated with either PC20 of methacholine challenge test or bronchodilator test. After matching age and sex, another 26 subjects without history of fentanyl-induced coughing during previous anesthesia were also enrolled in the study as the control group. RESULTS The proportion of airway hyperresponsiveness in fentanyl-cough group and control group was 30.77% and 19.23% respectively. After pairing of these two groups, McNemar test revealed no significant difference in the proportion of airway hyperresponsiveness between these two groups (P = 0.257). CONCLUSIONS From the analysis of the present study, we cannot prove that there is a direct correlation between fentanyl-induced coughing and airway hyperresponsiveness.
{"title":"Fentanyl-induced coughing and airway hyperresponsiveness.","authors":"C. Tsou, H. Luk, S. Chiang, S. Hsin, Jia-Horng Wang","doi":"10.6955/AAS.200212.0165","DOIUrl":"https://doi.org/10.6955/AAS.200212.0165","url":null,"abstract":"BACKGROUND\u0000The tussive effect of fentanyl, in sharp contrast to the antitussive effect that common opioids have, is not rarely seen in clinical anesthesia. Pretreatment with beta 2 agonist inhalation could dramatically suppress fentanyl-induced coughing. We hypothesized that airway hyperresponsiveness might exist in large proportion of the subjects who had experienced fentanyl-induced coughing during previous anesthesia.\u0000\u0000\u0000METHODS\u0000We designed a case-controlled matching study to investigate the correlation between fentanyl-induced coughing and airway hyperresponsiveness. Twenty-six consecutive subjects (ASA I-III), who experienced fentanyl-induced coughing during anesthesia in our hospital from 1999 to 2000, were enrolled in this study as the fentanyl-cough group. In all the subjects baseline spirometry was first obtained. Airway responsiveness was evaluated with either PC20 of methacholine challenge test or bronchodilator test. After matching age and sex, another 26 subjects without history of fentanyl-induced coughing during previous anesthesia were also enrolled in the study as the control group.\u0000\u0000\u0000RESULTS\u0000The proportion of airway hyperresponsiveness in fentanyl-cough group and control group was 30.77% and 19.23% respectively. After pairing of these two groups, McNemar test revealed no significant difference in the proportion of airway hyperresponsiveness between these two groups (P = 0.257).\u0000\u0000\u0000CONCLUSIONS\u0000From the analysis of the present study, we cannot prove that there is a direct correlation between fentanyl-induced coughing and airway hyperresponsiveness.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4 1","pages":"165-72"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Rapid Opiate Detoxification (ROD) is among the best treatments for substance abuse. Unfortunately this method is associated with severe withdrawal reaction. The effect of body acupuncture has not been clearly identified during ROD. This study was designed to evaluate the effect of acupuncture on the severity of withdrawal reaction during ROD. METHODS Forty adult male subjects addicted to opioids and scheduled for ROD by naloxone were randomly divided into acupuncture and control groups. In the acupuncture group during three consecutive days immediately before induction of ROD, body acupuncture was performed while in the control group it was exempted. Severity of withdrawal reaction was assessed having recourse to Clinical Institute Narcotic Assessment (CINA) Score and compared between two groups. RESULTS After induction of ROD, CINA score raised significantly during the consecutive days in both groups compared with baseline values but the rise was significantly lower in acupuncture group. CONCLUSIONS The result of this study shows that body acupuncture reduces the severity of withdrawal symptoms associated with rapid opiate detoxification and it is recommended that this nonpharmacologic method of treatment should be included in ROD program.
{"title":"The effect of acupuncture on the acute withdrawal symptoms from rapid opiate detoxification.","authors":"K. Montazeri, Mehdi Farahnakian, Mahmood Saghaei","doi":"10.6955/AAS.200212.0173","DOIUrl":"https://doi.org/10.6955/AAS.200212.0173","url":null,"abstract":"BACKGROUND\u0000Rapid Opiate Detoxification (ROD) is among the best treatments for substance abuse. Unfortunately this method is associated with severe withdrawal reaction. The effect of body acupuncture has not been clearly identified during ROD. This study was designed to evaluate the effect of acupuncture on the severity of withdrawal reaction during ROD.\u0000\u0000\u0000METHODS\u0000Forty adult male subjects addicted to opioids and scheduled for ROD by naloxone were randomly divided into acupuncture and control groups. In the acupuncture group during three consecutive days immediately before induction of ROD, body acupuncture was performed while in the control group it was exempted. Severity of withdrawal reaction was assessed having recourse to Clinical Institute Narcotic Assessment (CINA) Score and compared between two groups.\u0000\u0000\u0000RESULTS\u0000After induction of ROD, CINA score raised significantly during the consecutive days in both groups compared with baseline values but the rise was significantly lower in acupuncture group.\u0000\u0000\u0000CONCLUSIONS\u0000The result of this study shows that body acupuncture reduces the severity of withdrawal symptoms associated with rapid opiate detoxification and it is recommended that this nonpharmacologic method of treatment should be included in ROD program.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4 1","pages":"173-7"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pearls and pitfalls in the airway management.","authors":"Ta-Liang Chen","doi":"10.6955/AAS.200212.0157","DOIUrl":"https://doi.org/10.6955/AAS.200212.0157","url":null,"abstract":"","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"54 1","pages":"157-8"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kuan-Ting Chen, Oliver Yoa-Pu Hu, Shung-Tai Ho, Yu-Wen Chen, Jhi-Joung Wang
Background: Nalbuphine is an opioid-analgesic with agonist-antagonist properties. Recently, we have synthesized a nalbuphine prodrug, nalbuphine pivalate. The aim of the present study was to evaluate the analgesic effect and the analgesic duration of this prodrug.
Methods: Forty-eight male Sprague-Dawley rats (4 groups, n = 12 in each group) were used. Rats in group 1 received nalbuphine HCl 25 mumol/kg (in saline) intramuscular injection; rats in group 2 received nalbuphine pivalate 25 mumol/kg (in sesame oil) intramuscular injection, whereas those in groups 3 and 4 received saline and sesame oil respectively. The analgesic effects of testing agents were evaluated using the cold ethanol tail-flick test (-30 degrees C).
Results: Both nalbuphine HCl and nalbuphine pivalate demonstrated significant analgesic effects. The analgesic duration of nalbuphine HCl was 2 h while that of nalbuphine pivalate was 30 h.
Conclusions: Nalbuphine pivalate has a very long duration of analgesic action. This fascinating finding is worth further evaluation.
{"title":"The analgesic effect of nalbuphine and its long-acting prodrug, nalbuphine pivalate, in rats.","authors":"Kuan-Ting Chen, Oliver Yoa-Pu Hu, Shung-Tai Ho, Yu-Wen Chen, Jhi-Joung Wang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Nalbuphine is an opioid-analgesic with agonist-antagonist properties. Recently, we have synthesized a nalbuphine prodrug, nalbuphine pivalate. The aim of the present study was to evaluate the analgesic effect and the analgesic duration of this prodrug.</p><p><strong>Methods: </strong>Forty-eight male Sprague-Dawley rats (4 groups, n = 12 in each group) were used. Rats in group 1 received nalbuphine HCl 25 mumol/kg (in saline) intramuscular injection; rats in group 2 received nalbuphine pivalate 25 mumol/kg (in sesame oil) intramuscular injection, whereas those in groups 3 and 4 received saline and sesame oil respectively. The analgesic effects of testing agents were evaluated using the cold ethanol tail-flick test (-30 degrees C).</p><p><strong>Results: </strong>Both nalbuphine HCl and nalbuphine pivalate demonstrated significant analgesic effects. The analgesic duration of nalbuphine HCl was 2 h while that of nalbuphine pivalate was 30 h.</p><p><strong>Conclusions: </strong>Nalbuphine pivalate has a very long duration of analgesic action. This fascinating finding is worth further evaluation.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"191-5"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Peng, Chih-Cheng Wu, Chung-Pei Chang, S. Peng, W. Ho
Metastatic hepatocellular carcinoma (HCC) to the right atrium occurs rarely and may lead to lethal perioperative complications. A 61-year-old female who was about to undergo operation for resection of a right intraatrial tumor thought possibly to be metastatic hepatocellular carcinoma met with sudden protrusion of the tumor from the right atrial wall that sank into the right ventricle during induction of anesthesia. Right ventricular outflow tract obstruction developed and was quickly diagnosed by transesophageal echocardiography. Emergent cardiopulmonary bypass was rushed on the spot and the surgery was completed smoothly. Here we discuss the possible causes of the event and we recommend that special attention should be paid to the anesthetic techniques and proper precaution should be taken in the face of such a risky surgery.
{"title":"Metastatic hepatocellular carcinoma of the right atrium causing right ventricular outflow tract obstruction during induction of anesthesia--a case report.","authors":"S. Peng, Chih-Cheng Wu, Chung-Pei Chang, S. Peng, W. Ho","doi":"10.6955/AAS.200212.0205","DOIUrl":"https://doi.org/10.6955/AAS.200212.0205","url":null,"abstract":"Metastatic hepatocellular carcinoma (HCC) to the right atrium occurs rarely and may lead to lethal perioperative complications. A 61-year-old female who was about to undergo operation for resection of a right intraatrial tumor thought possibly to be metastatic hepatocellular carcinoma met with sudden protrusion of the tumor from the right atrial wall that sank into the right ventricle during induction of anesthesia. Right ventricular outflow tract obstruction developed and was quickly diagnosed by transesophageal echocardiography. Emergent cardiopulmonary bypass was rushed on the spot and the surgery was completed smoothly. Here we discuss the possible causes of the event and we recommend that special attention should be paid to the anesthetic techniques and proper precaution should be taken in the face of such a risky surgery.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4 1","pages":"205-8"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Waste anesthetic gases may have adverse effects on the health of operating room personnel. To reduce the risk of exposure, the United States National Institute of Occupational Safety and Health (US-NIOSH) recommends a time-weighted average (TWA) of 25 ppm (part-per-million) for nitrous oxide (N2O) and a ceiling of 2 ppm for sevoflurane (SEV). This study investigated the concentrations of these two gases in the atmosphere of operating room to which the working personnel (anesthetists) were exposed during anesthetic practice.
Methods: An extractive Fourier transform infrared (FTIR) spectrometer, with an optical path length of 10 meters, was used to monitor the concentrations of waste general anesthetics in the operating rooms. The FTIR in application could simultaneously determine the concentrations of several gases in a near real-time manner, which helped to accurately obtain the varying concentrations of gases in different anesthetic condition. The sampling Teflon tube of the FTIR was conveniently installed in the breathing zone of the anesthetic personnel to obtain the personal exposure concentrations of N2O and SEV.
Results: Nitrous oxide (N2O) and sevoflurane (SEV) concentrations for five surgeries in four different operating rooms were determined. In normal condition during maintenance, the SEV concentrations as measured were less than 2 ppm but the average N2O concentration was greater than 25 ppm. In addition, in three abnormal or specific conditions, the N2O and SEV concentrations increased dramatically. Firstly, at the end of maintenance (right before emergence), peak concentrations of 751 ppm for N2O and 26 ppm for SEV were measured. These unusually high concentrations resulted from flushing the tubing of the anesthetic machine to speed up the emergence of wakefulness of the patient from anesthesia. Secondly, when the cuff of the endotracheal tube was not well inflated or unserviceable, peak concentrations of 631 ppm for N2O and 32 ppm for SEV were measured. Thirdly, malfunction of or loose connection (or disconnection) between the anesthetic machine and the exhaust venting system of operating theater almost doubled the N2O and SEV concentrations.
Conclusions: To decrease the exposure of the operating personnel to waste anesthetics, minimization of the use of N2O is recommended. Besides, the three extraordinary conditions as disclosed in this study were tubing flushing, illy managed endotracheal tube cuff and disconnection of scarvenging system, the first of which sometimes is unavoidable but the last two of which should be avoided.
{"title":"Personnel exposure to waste sevoflurane and nitrous oxide during general anesthesia with cuffed endotracheal tube.","authors":"Shou-Huang Li, Shou-Nan Li, Hui-Ya Shih, Hann-De Yi, Chin-Yuan Chiang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Waste anesthetic gases may have adverse effects on the health of operating room personnel. To reduce the risk of exposure, the United States National Institute of Occupational Safety and Health (US-NIOSH) recommends a time-weighted average (TWA) of 25 ppm (part-per-million) for nitrous oxide (N2O) and a ceiling of 2 ppm for sevoflurane (SEV). This study investigated the concentrations of these two gases in the atmosphere of operating room to which the working personnel (anesthetists) were exposed during anesthetic practice.</p><p><strong>Methods: </strong>An extractive Fourier transform infrared (FTIR) spectrometer, with an optical path length of 10 meters, was used to monitor the concentrations of waste general anesthetics in the operating rooms. The FTIR in application could simultaneously determine the concentrations of several gases in a near real-time manner, which helped to accurately obtain the varying concentrations of gases in different anesthetic condition. The sampling Teflon tube of the FTIR was conveniently installed in the breathing zone of the anesthetic personnel to obtain the personal exposure concentrations of N2O and SEV.</p><p><strong>Results: </strong>Nitrous oxide (N2O) and sevoflurane (SEV) concentrations for five surgeries in four different operating rooms were determined. In normal condition during maintenance, the SEV concentrations as measured were less than 2 ppm but the average N2O concentration was greater than 25 ppm. In addition, in three abnormal or specific conditions, the N2O and SEV concentrations increased dramatically. Firstly, at the end of maintenance (right before emergence), peak concentrations of 751 ppm for N2O and 26 ppm for SEV were measured. These unusually high concentrations resulted from flushing the tubing of the anesthetic machine to speed up the emergence of wakefulness of the patient from anesthesia. Secondly, when the cuff of the endotracheal tube was not well inflated or unserviceable, peak concentrations of 631 ppm for N2O and 32 ppm for SEV were measured. Thirdly, malfunction of or loose connection (or disconnection) between the anesthetic machine and the exhaust venting system of operating theater almost doubled the N2O and SEV concentrations.</p><p><strong>Conclusions: </strong>To decrease the exposure of the operating personnel to waste anesthetics, minimization of the use of N2O is recommended. Besides, the three extraordinary conditions as disclosed in this study were tubing flushing, illy managed endotracheal tube cuff and disconnection of scarvenging system, the first of which sometimes is unavoidable but the last two of which should be avoided.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"185-90"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Young-Chen Yin, L. Chow, C. Tsao, C. Chu, M. Tsou, Kwok‐Hon Chan, S. Tsai
BACKGROUND To access the clinical effect of clonidine on reduction of myocardial ischemia events in patients with history of coronary artery disease undergoing noncardiac surgeries. METHODS Sixty ASA class III patients with coronary artery disease were allotted at random to two groups in a prospective, double-blind study to receive either clonidine (3 micrograms/kg) or placebo (control group) 90 minutes before arrival at the operating room. Continuous EKG monitoring (Holter monitor) was performed to analyze the ST segment in lead II, V2 and V5 during the preoperative (since late hours the night before operation), intraoperative and early postoperative periods (total monitoring time = 24 hours). The episode of myocardial ischemia defined as the magnitude of ST segment depression of at least 1 mm, occurring 60 ms after the J point and persisting for three minutes or more was recorded. Perioperative hemodynamic data were analyzed with two-way ANOVA with repeated measures. Student's t-test for unpaired data was used for analysis of demographics. Chi-square test was used for ST segment changes. Results are expressed as mean +/- SD and P < 0.05 was considered to be statistically significant. RESULTS In the control group, 9 patients (30%) were noted to have episodes of ischemia preoperatively, 7 patients (23.3%) intraoperatively, and 12 patients (40%) postoperatively. The occurrence of myocardial ischemia peaked in the early postoperative period (P < 0.05). On the contrary, in the clonidine group, 10 patients (33.3%) saw ischemic episodes preoperatively, 3 patients (10%) intraoperatively and 5 patients (16.7%) postoperatively. The incidence of myocardial ischemia in clonidine group was significantly lower than that in placebo group in intraoperative and postoperative periods. The mean arterial pressure was significantly lower in some clonidine-treated patients during perioperative periods (P < 0.05). A number of patients in clonidine group suffered from drowsiness (66.7%) after operation (P < 0.05), but they could be easily aroused. In regard to dryness of mouth, nausea and vomiting clonidine and control groups did not differ much (P > 0.05). Demerol consumption was significantly lower in clonidine group (43.7 +/- 4.6 mg) than in control group (76.3 +/- 3.7 mg, P < 0.05). CONCLUSIONS We conclude that premedication with oral clonidine can significantly reduce the incidence of perioperative myocardial ischemia in patients with CAD undergoing noncardiac surgeries. The incidence of myocardial ischemia in these patients is rather high during perioperative period, which deserves our exceptional caution.
{"title":"Oral clonidine reduces myocardial ischemia in patients with coronary artery disease undergoing noncardiac surgery.","authors":"Young-Chen Yin, L. Chow, C. Tsao, C. Chu, M. Tsou, Kwok‐Hon Chan, S. Tsai","doi":"10.6955/AAS.200212.0197","DOIUrl":"https://doi.org/10.6955/AAS.200212.0197","url":null,"abstract":"BACKGROUND\u0000To access the clinical effect of clonidine on reduction of myocardial ischemia events in patients with history of coronary artery disease undergoing noncardiac surgeries.\u0000\u0000\u0000METHODS\u0000Sixty ASA class III patients with coronary artery disease were allotted at random to two groups in a prospective, double-blind study to receive either clonidine (3 micrograms/kg) or placebo (control group) 90 minutes before arrival at the operating room. Continuous EKG monitoring (Holter monitor) was performed to analyze the ST segment in lead II, V2 and V5 during the preoperative (since late hours the night before operation), intraoperative and early postoperative periods (total monitoring time = 24 hours). The episode of myocardial ischemia defined as the magnitude of ST segment depression of at least 1 mm, occurring 60 ms after the J point and persisting for three minutes or more was recorded. Perioperative hemodynamic data were analyzed with two-way ANOVA with repeated measures. Student's t-test for unpaired data was used for analysis of demographics. Chi-square test was used for ST segment changes. Results are expressed as mean +/- SD and P < 0.05 was considered to be statistically significant.\u0000\u0000\u0000RESULTS\u0000In the control group, 9 patients (30%) were noted to have episodes of ischemia preoperatively, 7 patients (23.3%) intraoperatively, and 12 patients (40%) postoperatively. The occurrence of myocardial ischemia peaked in the early postoperative period (P < 0.05). On the contrary, in the clonidine group, 10 patients (33.3%) saw ischemic episodes preoperatively, 3 patients (10%) intraoperatively and 5 patients (16.7%) postoperatively. The incidence of myocardial ischemia in clonidine group was significantly lower than that in placebo group in intraoperative and postoperative periods. The mean arterial pressure was significantly lower in some clonidine-treated patients during perioperative periods (P < 0.05). A number of patients in clonidine group suffered from drowsiness (66.7%) after operation (P < 0.05), but they could be easily aroused. In regard to dryness of mouth, nausea and vomiting clonidine and control groups did not differ much (P > 0.05). Demerol consumption was significantly lower in clonidine group (43.7 +/- 4.6 mg) than in control group (76.3 +/- 3.7 mg, P < 0.05).\u0000\u0000\u0000CONCLUSIONS\u0000We conclude that premedication with oral clonidine can significantly reduce the incidence of perioperative myocardial ischemia in patients with CAD undergoing noncardiac surgeries. The incidence of myocardial ischemia in these patients is rather high during perioperative period, which deserves our exceptional caution.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4 1","pages":"197-203"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND The tracheal detecting-bulb (TDB) is a diagnostic tool for confirmation of tracheal intubation. Capnography is also accepted as a standard way for such confirmation. The purpose of this investigation was to determine whether the results by TDB agreed with those by capnography. METHODS Four hundred patients were allocated to three separate studies. In 200 consecutive patients of study 1, tracheal intubation was first confirmed with the TDB followed by capnography. In study 2, 100 patients had the esophagus intentionally intubated, and confirmation was performed likewise as in study 1. The tube was then removed, the trachea was intubated, and confirmation tests followed. Study 3 involved 100 patients and was carried out in a double-blind, randomized manner. The tube was intentionally inserted into either the esophagus (n = 42) or trachea (n = 58), and confirmation tests immediately followed. RESULTS In study 1, the rhythmic expansion-contraction of TDB was evident in 173 patients, and always agreed with capnographic reading; In 27 instances, the latex bulb of TDB remained collapsed or was scantily filled without the turning-up of capnographic reading as counterchecked, indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between TDB and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100% too. In the 400 patients studied, the results from the TDB were in complete accord with those of capnogram. The sensitivity, specificity, and predictive value of the TDB in all of these studies were 100%. CONCLUSIONS The TDB is a valuable diagnostic technique for confirming tracheal intubation as it could correctly detect esophageal or tracheal intubation of the tracheal tube in all our 400 patients. The results of using TDB agree with the results of using capnography.
{"title":"The tracheal detecting-bulb: a new device to distinguish tracheal from esophageal intubation.","authors":"Y. Tong, Ming Sun, Wen Tang, Jiang-Yan Xia","doi":"10.6955/AAS.200212.0159","DOIUrl":"https://doi.org/10.6955/AAS.200212.0159","url":null,"abstract":"BACKGROUND\u0000The tracheal detecting-bulb (TDB) is a diagnostic tool for confirmation of tracheal intubation. Capnography is also accepted as a standard way for such confirmation. The purpose of this investigation was to determine whether the results by TDB agreed with those by capnography.\u0000\u0000\u0000METHODS\u0000Four hundred patients were allocated to three separate studies. In 200 consecutive patients of study 1, tracheal intubation was first confirmed with the TDB followed by capnography. In study 2, 100 patients had the esophagus intentionally intubated, and confirmation was performed likewise as in study 1. The tube was then removed, the trachea was intubated, and confirmation tests followed. Study 3 involved 100 patients and was carried out in a double-blind, randomized manner. The tube was intentionally inserted into either the esophagus (n = 42) or trachea (n = 58), and confirmation tests immediately followed.\u0000\u0000\u0000RESULTS\u0000In study 1, the rhythmic expansion-contraction of TDB was evident in 173 patients, and always agreed with capnographic reading; In 27 instances, the latex bulb of TDB remained collapsed or was scantily filled without the turning-up of capnographic reading as counterchecked, indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between TDB and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100% too. In the 400 patients studied, the results from the TDB were in complete accord with those of capnogram. The sensitivity, specificity, and predictive value of the TDB in all of these studies were 100%.\u0000\u0000\u0000CONCLUSIONS\u0000The TDB is a valuable diagnostic technique for confirming tracheal intubation as it could correctly detect esophageal or tracheal intubation of the tracheal tube in all our 400 patients. The results of using TDB agree with the results of using capnography.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4 1","pages":"159-63"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Man, Jen-Kun Cheng, Kar-lok Wong, C. Chen, R. Rau, Kuo-Hwa Wu, Ching-Rong Cheng
BACKGROUND Rocuronium, a monoquaternary steroid analogue of vecuronium, is designed to provide a rapid onset of action. Experimentally, it has been shown that two non-depolarizing neuromuscular relaxants administered together can produce either a neuromuscular block of a size expected to be the sum of the individual doses (additive effect) or a larger neuromuscular block (synergistic effect). Experimental observations have suggested that during onset rocuronium acts synergistically with other nondepolarizing agents, but that at a steady state the combined action is additive. METHODS To investigate whether rocuronium can speed up the onset of atracurium for intubation, 120 patients who consented to receive elective surgery requiring tracheal intubation were randomly assigned to 3 equally divided groups to receive one of the following three different combinations of muscle relaxants: twice ED95 of rocuronium (0.6 mg/kg group 1), an equipotent mixture of ED95 of rocuronium and atracurium (0.3 mg/kg and 0.25 mg/kg respectively, group 2), and rocuronium 0.1 mg/kg to prime atracurium 0.42 mg/kg at 1 min interval. Intubation conditions were assessed 1 minute after intravenous muscle relaxant injection, and scored as good, acceptable and poor based on four clinical evaluators: the ease of laryngoscopy (score of 1-3), the relaxation of vocal cord (1-3), the degree of coughing (1-3), and movement of extremity (1-3). Adding up together, intubation condition that scored 4-5 was considered to be good, 6-7 acceptable, and 8-12 poor. RESULTS The conditions produced in the rocuronium and the mixture groups were similar and both were moderately better than those of the priming group. Good intubation conditions were achieved in 58% patients of the rocuronium group, 63% of the mixture group and 43% of the priming group. By Pearson Chi-square test, the comparisons did not show statistical significance between groups. CONCLUSIONS Statistically, rocuronium alone, mixture of equipotent atracurium and rocuronium, and using rocuronium to prime atracurium all provided similar onset for satisfactory intubation.
{"title":"Tracheal intubation condition--a comparison between one minute after rocuronium alone, one minute after rocuronium combined with atracurium and one minute after atracurium with rocuronium at one minute priming interval.","authors":"T. Man, Jen-Kun Cheng, Kar-lok Wong, C. Chen, R. Rau, Kuo-Hwa Wu, Ching-Rong Cheng","doi":"10.6955/AAS.200212.0179","DOIUrl":"https://doi.org/10.6955/AAS.200212.0179","url":null,"abstract":"BACKGROUND\u0000Rocuronium, a monoquaternary steroid analogue of vecuronium, is designed to provide a rapid onset of action. Experimentally, it has been shown that two non-depolarizing neuromuscular relaxants administered together can produce either a neuromuscular block of a size expected to be the sum of the individual doses (additive effect) or a larger neuromuscular block (synergistic effect). Experimental observations have suggested that during onset rocuronium acts synergistically with other nondepolarizing agents, but that at a steady state the combined action is additive.\u0000\u0000\u0000METHODS\u0000To investigate whether rocuronium can speed up the onset of atracurium for intubation, 120 patients who consented to receive elective surgery requiring tracheal intubation were randomly assigned to 3 equally divided groups to receive one of the following three different combinations of muscle relaxants: twice ED95 of rocuronium (0.6 mg/kg group 1), an equipotent mixture of ED95 of rocuronium and atracurium (0.3 mg/kg and 0.25 mg/kg respectively, group 2), and rocuronium 0.1 mg/kg to prime atracurium 0.42 mg/kg at 1 min interval. Intubation conditions were assessed 1 minute after intravenous muscle relaxant injection, and scored as good, acceptable and poor based on four clinical evaluators: the ease of laryngoscopy (score of 1-3), the relaxation of vocal cord (1-3), the degree of coughing (1-3), and movement of extremity (1-3). Adding up together, intubation condition that scored 4-5 was considered to be good, 6-7 acceptable, and 8-12 poor.\u0000\u0000\u0000RESULTS\u0000The conditions produced in the rocuronium and the mixture groups were similar and both were moderately better than those of the priming group. Good intubation conditions were achieved in 58% patients of the rocuronium group, 63% of the mixture group and 43% of the priming group. By Pearson Chi-square test, the comparisons did not show statistical significance between groups.\u0000\u0000\u0000CONCLUSIONS\u0000Statistically, rocuronium alone, mixture of equipotent atracurium and rocuronium, and using rocuronium to prime atracurium all provided similar onset for satisfactory intubation.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4 1","pages":"179-83"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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