piperidines and cisatracurium

Analyze clinical use of dexmedetomidine to relieve prognosis of remifentanil anesthesia recovery and analyze intervention effect.. Choose 3600 cases of cerebral functional area operation patients treated in different hospitals during June 2011 and December 2015 for general analysis, group the patients by considering relevant parting of anesthesia recovery by American Society of Anesthesiologists, and divide the patients into dexmedetomidine group and control group according to different use of drugs. The two groups of patients are anesthetized, patients' anesthesia wake-up time and wake-up success rate are recorded, and effect of two types of anesthesia wake-up way are compared.. There exists no significant statistical difference in wake-up success rate of the two groups of patients, wake-up time has small difference, but anesthesia recovery quality of dexmedetomidine group is higher, which is conducive to physical rehabilitation of patients and minimize the effects of anesthetics on patients.. In clinical surgery, after use of remifentanil anesthesia on patients, use of dexmedetomidine for anesthesia recovery can minimize adverse effects of drugs on patients and thus is worthy to be effectively promoted in clinics.

Topics: Adult; Aged; Anesthesia, General; Atracurium; Dexmedetomidine; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Hyperalgesia; Hypnotics and Sedatives; Intraoperative Care; Male; Middle Aged; Neuromuscular Blocking Agents; Piperidines; Preoperative Care; Remifentanil; Treatment Outcome

It has been demonstrated that small doses of neostigmine (10-30μg.kg(-1)) effectively antagonize atracurium blocks at a train-of-four (TOF) ratio of 0.4 under propofol anaesthesia. The results might not be valid with halogenated agents, which potentiate neuromuscular blockades. The goal of this study was to determine the dose of neostigmine required to antagonize a block corresponding to a TOF ratio of 0.4, a level at which fade is not visually detected.. Sixty patients were included and anaesthesia was induced with propofol, remifentanil and cisatracurium, and maintained with sevoflurane and remifentanil. Patients were randomized to receive neostigmine at 40, 20, 10μg.kg(-1) or placebo with atropine (20, 10, 5 or 0μg.kg(-1), respectively) as soon as the TOF ratio reached 0.4. Elapsed times to 0.9 and 1.0 TOF ratios were measured.. The median times elapsed from 0.4 to 0.9 and 1.0 TOF ratios in the placebo group were 19 (10.5-36) min and 26 (20-50) min, respectively, and significantly shorter (I=0.002) with any dose of neostigmine than without. Times for complete recovery after 40 and 20μg.kg(-1) neostigmine were similar [5.5 (4-11) min and 7.8 (3.5-11) min, respectively] but significantly shorter than after 10μg.kg(-1) neostigmine [17min (7-55); I=0.001].. Under sevoflurane anaesthesia, in absence of tactile or visual TOF fade, which corresponds to a TOF ratio≥0.4, 20μg.kg(-1) neostigmine is as effective as 40μg.kg(-1) in antagonizing shallow cisatracurium block.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Atropine; Cholinesterase Inhibitors; Double-Blind Method; Female; Humans; Male; Methyl Ethers; Middle Aged; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Piperidines; Propofol; Remifentanil; Sevoflurane

To observe the effects of 0.4 μg/(kg×h) dose of dexmedetomidine on intra-operative wake-up test in children patients undergoing scoliosis surgery.. Sixty patients for posterior scoliosis correction (ASA I-II, aged 5-16 years) from March 2013 to April 2015 were enrolled in this prospective, double-blinded, randomized, placebo-controlled study, The patients were randomly classified into two groups to receive dexmedetomidine (group RD, n=30) or saline solution (group R, n=30). In group RD, dexmedetomidine [0.4 μg/(kg×h)] was administered after tracheal intubation, while the equal volume saline solution was given instead in group R. Anesthesia was induced with midazolam, propofol, sufentanyl and cisatracurium, and anesthesia was maintained with sevoflurane inhalation and a continuous intravenous infusion of remifentanil in the both groups.BIS (bispectral index, BIS) value was maintained at 40-60,and mean arterial pressure (MAP) was maintained at ≥ 60 mmHg before the wake-up test.When the wake-up test was performed, immediately the dexmedetomidine and remifentanil infusion were stopped, and the end-tidal concentration of sevoflurane was adjusted to 0. Mean arterial pressure, and heart rate (HR) were recorded before anesthesia and at 5-minute intervals during the wake-up test. The wake-up test time, arousal quality and sedation scores were recorded also.In addition, the data were also gathered on the dosage of ephedrine and atropine were used, as well as the intraoperative awareness in the patients who were followed up on the first day after the operation.. There were no differences between group RD and group R with regard to HR and MAP at getting into the operation room (t=-1.460, P=0.150;t =-1.015, P=0.315). In group RD, no evidence was found for a difference in HR and MAP at awakening up versus at getting into the operation room (t=0.974, P=0.340; t=-1.449, P=0.161), while in group R, an increase in HR and MAP occurred at awakening versus at getting into the operation room (t=-2.106, P=0.044; t=-2.352, P=0.026). There were no significant differences in sedation scores and wake-up test time between the two groups (t=1.986, P=0.052; t=0.392, P=0.697). The wake-up test quality was significantly better in group RD than in group R (t=-2.098,P=0.041). HR in group RD was significantly lower than that in group R at any time point during the wake-up test (P<0.05). Four patients had awareness occurrence during the operation in group R, and no awareness occurrence in group RD.. Dexmedetomidine, when administered at a rate of 0.4 μg/(kg×h) as an adjuvant of sevoflurane inhalational anesthesia, could improve the wake-up test quality, and maintain hemodynamic stability during scoliosis surgery.

Topics: Adjuvants, Anesthesia; Adolescent; Anesthesia Recovery Period; Anesthesia, General; Arterial Pressure; Atracurium; Child; Child, Preschool; Dexmedetomidine; Double-Blind Method; Female; Heart Rate; Humans; Intraoperative Awareness; Intubation, Intratracheal; Male; Methyl Ethers; Midazolam; Piperidines; Propofol; Prospective Studies; Remifentanil; Scoliosis; Sevoflurane; Sufentanil

The purpose of this study was to evaluate the efficacy and safety of administration of an intercostal nerve block (INB) with general anesthesia to elderly patients undergoing a distal gastrectomy.. Elderly patients (>65 years) undergoing selective gastrectomy were randomly assigned to three groups (n = 80): general anesthesia (Group A); general + INB anesthesia (Group B); or, general + epidural anesthesia (Group C). General anesthesia was maintained with propofol, remifentanil and cisatracurium. The mean arterial blood pressure (MAP), heart rate (HR) and C-reactive protein (CRP) levels were determined before anesthesia (T0) and at 5 min after intubation (T1), skin incision (T2), exploration of the peritoneal cavity (T3), gastrointestinal anastomosis (T4), end of operation (T5) and 10 min after extubation (T6).. MAP decreased at T1 in all groups (P < 0.05) and at T2, T4 and T5 in Group C (P < 0.05) and was lower in Group C than Group B at T2 and T4 (P < 0.05). There were no differences in MAP between Groups A and B or between Groups B and C. HR increased at T2-T6 in Group A (P < 0.05) and was higher at T2-T6 in Group B and Group C (P < 0.05). CRP levels decreased at T2-T5 in Groups B and C (P < 0.05) and were lower in Groups B and C compared with Group A (P < 0.05). Propofol and remifentanil doses were lower in Groups B and C (P < 0.05 and P < 0.01, respectively) and patients recovered faster than in Group A (P < 0.05).. Administration of INB with general anesthesia enhanced analgesia, led to stable hemodynamics, and reduced anaesthetic consumption and postoperative stress response.

Topics: Aged; Aged, 80 and over; Anesthesia, General; Atracurium; Female; Gastrectomy; Humans; Intercostal Nerves; Male; Nerve Block; Piperidines; Propofol; Remifentanil

Rapid recovery after supratentorial tumors (STT) removal is important. Short-acting anesthetics, such as propofol and remifentanil might favor this objective. The aim of this study was to compare the recovery of 2 Bispectral index (BIS)-guided anesthesia protocols combining sevoflurane-sufentanil (SS) or propofol-remifentanil (PR) administered during craniotomy for STT.. After IRB approval and written consent, patients scheduled for surgical removal of STT were randomized to receive PR or SS. Anesthesia was adjusted to maintain BIS values between 45 and 55. The primary outcome was the time from discontinuation of anesthetics to extubation. Secondary endpoints were: time to respond to a simple order, and to achieve spontaneous ventilation, agitation score at emergence, postoperative Mini Mental State, postoperative Aldrete score, pain Visual Analogical Score, simplified sedation score, Glasgow Coma Scale, and surgical complications. Statistical analyses were performed using analysis of variance.. Thirty-five and 31 were included in the SS and PR groups, respectively. Times to extubation was not different between the 2 groups (11.8±6.9 vs. 13.0±8.1 min in PR and SS groups, respectively, P=0.577). Although times to achieve an Aldrete score to 10, a Glasgow Coma Scale to 15, and a MMS to 30 significantly were lower in SS group, no significant difference was found when analyzing time course of these 3 factors over the first postoperative day. All other secondary endpoints were not different between the 2 groups.. During craniotomy for STT, we could not demonstrate a reduction in the time to extubation when comparing a BIS-guided anesthesia associating PR to a BIS-guided anesthesia associating SS (Clinicatrials.gov identifier: NCT00389883).

Topics: Adult; Aged; Anesthesia Recovery Period; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Consciousness Monitors; Craniotomy; Double-Blind Method; Female; Glasgow Coma Scale; Hemodynamics; Humans; Intraoperative Period; Male; Methyl Ethers; Middle Aged; Neuromuscular Nondepolarizing Agents; Neurosurgical Procedures; Piperidines; Propofol; Remifentanil; Sevoflurane; Sufentanil; Supratentorial Neoplasms; Treatment Outcome

To compare the effects of sevoflurane and propofol-remifentanil anesthesia on neuromuscular blockade produced by continuous cisatracurium infusion.. Forty ASA I or II patients undergoing selective surgery were randomly divided into sevoflurane and propofol-remifentanil anesthesia groups (n=20). Neuromuscular blockade was monitored using train-of-four (TOF) stimulation by recording the contraction force of the adductor pollicis muscle with a muscle relaxation monitor. A bolus dose of cisatracurium of 0.15 mg/kg was administered to facilitate endotracheal intubation, followed by continuous infusion adjusted manually to maintain the first twitch (T1) < or = 5% of the control level. The following variables were recorded including the infusion rate, total amount of cisatracurium, spontaneous recovery index (RI), and the time interval from termination of infusion cisatracurium to recovery of TOF ratio (TOFR) to 0.9.. With the maintenance of a 95%-99% neuromuscular blockade, the infusion rate was significantly lower in sevoflurane group than in propofol-remifentanil group (P<0.05), and stabilized in both groups after 120 min. No significant differences were found in RI or the time to TOFR of 0.9 between the two groups (P>0.05).. During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties.

Topics: Adolescent; Adult; Aged; Anesthetics, General; Anesthetics, Intravenous; Atracurium; Drug Synergism; Elective Surgical Procedures; Female; Humans; Infusions, Intravenous; Male; Methyl Ethers; Middle Aged; Neuromuscular Blocking Agents; Piperidines; Propofol; Remifentanil; Sevoflurane; Young Adult

Intravenous lidocaine can be used intraoperatively for its analgesic and antihyperalgesic properties but local anaesthetics may also prolong the duration of action of neuromuscular blocking agents. We hypothesized that intravenous lidocaine would prolong the time to recovery of neuromuscular function after cisatracurium.. Forty-two patients were enrolled in this randomized, double-blind, placebo-controlled study. Before induction, patients were administered either a 1.5 mg/kg bolus of intravenous lidocaine followed by a 2 mg/kg/h infusion or an equal volume of saline. Anaesthesia was induced and maintained using propofol and remifentanil infusions. After loss of consciousness, a 0.15 mg/kg bolus of cisatracurium was administered. No additional cisatracurium injection was allowed. Neuromuscular function was assessed every 20 s using kinemyography. The primary endpoint was the time to spontaneous recovery of a train-of-four (TOF) ratio ≥ 0.9.. The time to spontaneous recovery of a TOF ratio ≥ 0.9 was 94 ± 15 min in the control group and 98 ± 16 min in the lidocaine group (P=0.27).. No significant prolongation of spontaneous recovery of a TOF ratio ≥ 0.9 after cisatracurium was found in patients receiving intravenous lidocaine.

Topics: Adult; Aged; Anesthesia Recovery Period; Anesthesia, General; Anesthetics, Intravenous; Anesthetics, Local; Atracurium; Double-Blind Method; Electric Stimulation; Endpoint Determination; Female; Humans; Infusions, Intravenous; Lidocaine; Male; Middle Aged; Monitoring, Intraoperative; Muscle, Skeletal; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Piperidines; Propofol; Prospective Studies; Remifentanil; Young Adult

The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol.. In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 microg x kg(-1) i.v. and propofol 2.5 mg x kg(-1) i.v., with either cisatracurium 0.15 mg x kg(-1) i.v. (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr.. Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003).. Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

Topics: Adult; Anesthetics, Intravenous; Atracurium; Double-Blind Method; Female; Hoarseness; Humans; Intubation, Intratracheal; Larynx; Neuromuscular Blocking Agents; Pharyngitis; Piperidines; Postoperative Complications; Propofol; Prospective Studies; Remifentanil; Sodium Chloride; Time Factors

To examine whether the omission of neuromuscular blocking drugs during cardiopulmonary bypass (CPB) is associated with increased anesthetic requirements, higher frequency of intraoperative movements, and lower venous oxygen saturation (SvO(2)).. Prospective, randomized study.. Large community hospital.. 30 ASA physical status III and IV patients scheduled for cardiac surgery.. Patients were randomized to one of two groups: group 1 (n = 15) received a 3xED(95) bolus dose of cisatracurium at induction and thereafter no more neuromuscular blocking drug; group 2 (n = 15) received a continuous infusion of cisatracurium during the entire procedure.. Both groups received a standardized anesthetic with bispectral index-guided propofol target-controlled infusion and a remifentanil infusion steered by hemodynamic changes. Venous oxygen saturation was continuously determined during CPB.. Propofol consumption was 5.4 +/- 1.7 and 4.4 +/- 1.0 mg/(kg/h) in groups 1 and 2, respectively (P = 0.07). Remifentanil consumption was 0.15 +/- 0.05 and 0.17 +/- 0.05 mug/(kg/min) in groups 1 and 2, respectively (P = 0.19). In groups 1 and 2, no patient recalled any intraoperative phenomena; none moved or had diaphragmatic contractions. During CPB, SvO(2) was 81.3 +/- 3.2% (76%-85%) in group 1 and 80.6 +/- 3.1% (73%-85%) in group 2 (P = 0.53).. Omitting the continuous administration of neuromuscular blocking drugs during CPB did not increase anesthetic requirements. No intraoperative movements occurred, nor was there decreased SvO(2).

Topics: Aged; Anesthesia Recovery Period; Anesthetics, Intravenous; Atracurium; Cardiopulmonary Bypass; Electroencephalography; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Length of Stay; Male; Muscle Relaxation; Neuromuscular Blocking Agents; Oxygen; Piperidines; Propofol; Prospective Studies; Remifentanil; Veins

To compare the intraoperative costs of intravenous propofol-based anesthesia for laparoscopic cholecystectomy, a total of 42 patients were randomly assigned to receive remifentanil or fentanyl as adjuvant using the bispectral index anesthesia monitoring. The average anesthesia calculated costs per hour (and per minute) were 79.45 (1.32) in the fentanyl group and 65.36 (1.09) in the remifentanil group. The calculated mean cost per patient was 76.56 in the fentanyl group and 58.86 in the remifentanil group. In conclusion, for propofol-cisatracurium-based anesthesia for laparoscopic surgery, when applying the bispectral index to guide the administration of hypnotic anesthetic drugs and ensure an adequate and stable depth of anesthesia, the cost of anesthesia is lower using remifentanil as an adjuvant rather than fentanyl. The clinical relevance is that it could be the intravenous anesthesia technique of choice in laparoscopic surgery for cholecystectomy from a cost-minimization standpoint.

Topics: Adjuvants, Anesthesia; Anesthetics, Intravenous; Atracurium; Cholecystectomy, Laparoscopic; Costs and Cost Analysis; Female; Fentanyl; Humans; Intraoperative Care; Italy; Male; Middle Aged; Piperidines; Propofol; Prospective Studies; Remifentanil

The present report investigates the rate of arousal following remifentanil-based anesthesia associated with the coadministration of pancuronium, which inhibits butyrylcholinesterase, or cisatracurium, which is partially metabolized by nonspecific esterases, versus vecuronium that is eliminated independently of ester hydrolysis.. Sixty patients, ASA I-II, scheduled for elective abdominal surgeries were enrolled in a double-blinded prospective study. In fact, patients were equally divided into three Groups with each Group receiving remifentanil and either one of the following three muscle relaxants: pancuronium, vecuronium or cisatracurium.. The rate of arousal following discontinuation of anesthesia was assessed by Modified Aldrete Score. Time to eye opening on verbal command, tracheal extubation, Modified Aldrete Score >9, and time to discharge from the recovery room were recorded.. Time to eye opening on verbal command, tracheal extubation, Modified Aldrete Score >9, and time to discharge from the recovery room were not significantly different between the three groups.. The results suggest that recovery following remifentanil-based anesthesia is not delayed by the coadministration of pancuronium, cisatracurium versus vecuronium; and by the use of neostigmine for reversal of neuromuscular blockade.

Topics: Abdomen; Adult; Anesthesia Recovery Period; Anesthetics, Intravenous; Atracurium; Double-Blind Method; Female; Humans; Male; Middle Aged; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Pancuronium; Piperidines; Remifentanil

There is conflicting evidence on the duration of action of atracurium in obese patients. Cisatracurium is one of the stereoisomers of atracurium. We investigated the neuromuscular effects of cisatracurium in morbidly obese patients. Twenty obese female patients (body mass index >40) were randomized in two groups. Group I (n = 10) received 0.2 mg/kg of cisatracurium on the basis of real body weight (RBW), whereas in Group II (n = 10) the dose was calculated on ideal body weight (IBW). In a control group of 10 normal weight female patients (body mass index 20-24), the dose of cisatracurium was based on RBW. Neuromuscular transmission was monitored using acceleromyography of the adductor pollicis, and anesthesia was induced and maintained with remifentanil and propofol. Onset time was comparable between Group I and the control group (132 s versus 135 s; P = ns). The duration 25% was longer in Group I than in the control group (74.6 min versus 59.1 min; P = 0.01) and in the control group compared with Group II (45.0 min; P = 0.016). In conclusion, the duration of action of cisatracurium was prolonged in morbidly obese patients when dosed according to RBW compared with a control group of normal weight patients. Duration was also prolonged in the control group patients compared with morbidly obese patients to whom the drug was administered on the basis of IBW.

Topics: Adult; Anesthesia, General; Anesthetics, Intravenous; Atracurium; Body Mass Index; Body Weight; Calibration; Dose-Response Relationship, Drug; Female; Humans; Neuromuscular Nondepolarizing Agents; Obesity, Morbid; Piperidines; Propofol; Remifentanil; Synaptic Transmission

Neuromuscular block times, quality of muscle relaxation for tracheal tube insertion, and the haemodynamic effects after cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia were compared in elderly patients.. The study was performed in 40 patients over 65 yr of age. Anaesthesia was induced with thiopental, and maintained with sevoflurane in N2O/O2 and remifentanil. Cisatracurium 0.15 mg kg(-1) or vecuronium 0.1 mg kg(-1) were administered after induction. Intubation was attempted when neuromuscular block was 95%. Onset time, clinical duration of action, recovery index, spontaneous recovery time and tracheal intubation conditions were assessed. Haemodynamic parameters were also monitored.. The average ages of the patients were 72.5 +/- 5.1 and 73.6 +/- 6.3 in the cisatracurium and vecuronium groups, respectively. Onset time was significantly shorter after vecuronium, 158 +/- 34 s vs. 200 +/- 50s, respectively. Recovery index was significantly shorter after cisatracurium, 19.5 +/- 7.5 s vs. 33.7 +/- 18.6 s (P < 0.05). Clinical duration and spontaneous recovery time were similar in both groups as well as haemodynamic variables.. In elderly patients, vecuronium has a faster onset time while cisatracurium has a shorter recovery index under sevoflurane-remifentanil anaesthesia.

Topics: Aged; Anesthesia Recovery Period; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Blood Pressure; Double-Blind Method; Female; Heart Rate; Hemodynamics; Humans; Intubation, Intratracheal; Male; Methyl Ethers; Muscle Relaxation; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Piperidines; Remifentanil; Sevoflurane; Time Factors; Vecuronium Bromide

To compare the onset, duration and maximum effect of 0.1 mg/kg cisatracurium during balanced anesthesia with sevoflurane and remifentanil between infants and children.. We measured the time course of the neuromuscular blockade in 15 infants and 15 children by electromyography. Anesthesia was induced with propofol/remifentanil and maintained with sevoflurane (constant 2% endtidal) and remifentanil according to the patients individual requirements. After injection of 0.1 mg/kg cisatracurium we measured the following parameters: onset time: time between the beginning of injection of cisatracurium and maximum T1 depression, clinical duration: time between injection of the drug and recovery of T1 to 25%, recovery index: time between recovery of T1 from 25% to 75%. TOFR 0.9: time between injection of cisatracurium and recovery of the train-of-four ratio to 90%. In addition, we determined the maximum neuromuscular blockade Tmax after 0.1 mg/kg cistracurium.. Both groups differed significantly with regard to onset time and clinical duration. In the infants, the onset time was shorter (74 s vs. 198 s) and the clinical duration longer (55 min vs. 41 min) compared to the older children. The TOFR 0.9 was 73 min (range 56-86 min) in the group of the infants and 59 min (range 43-72 min) in the group of the older children (p < 0.001). Tmax was 100% (range 97-100%) in the infants and 98% (range 92-100%) in the children (p < 0.01). However, the recovery index was comparable in both groups (21 vs. 16 min).. Infants are substantially more sensitive to cisatracurium than children, which can be demonstrated in a significantly shorter onset time, a prolonged clinical duration and a delayed neuromuscular recovery. As there exist large interindividual differences, we recommend the use of neuromuscular monitoring in the routine practice of pediatric anesthesia.

Topics: Aging; Anesthesia Recovery Period; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Child; Child, Preschool; Electromyography; Female; Humans; Infant; Kinetics; Male; Methyl Ethers; Monitoring, Intraoperative; Neuromuscular Nondepolarizing Agents; Piperidines; Propofol; Remifentanil; Sevoflurane

A randomized placebo-controlled double-blinded study was conducted in 40 ASA 1 and 2 patients to determine the dose response of remifentanil in attenuating the haemodynamic response to tracheal intubation. Patients were allocated to one of four groups: placebo, remifentanil 1 microgram.kg-1, remifentanil 2 micrograms.kg-1 and remifentanil 4 micrograms.kg-1. A propofol target-controlled infusion was started at 4 micrograms.ml-1 and incrementally titrated to loss of verbal contact. Muscle relaxation was provided by cisatracurium. The study drug was given three minutes later over 30 seconds, and 90 seconds later the patient's trachea was intubated under direct laryngoscopy. Baseline noninvasive blood pressure and heart rate recordings were made prior to starting target-controlled infusion, then at one-minute intervals after loss of verbal contact for the duration of the study. Demographic data and target-controlled infusion rate at intubation was similar for the groups. Following intubation, heart rate increased by 15% in the placebo group, 10% in 1 microgram.kg-1 group, with no changes in 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Systolic blood pressure following intubation increased by 30% in the placebo group, 10% in the 1 microgram.kg-1 group and remained unchanged in the 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Remifentanil 1 microgram.kg-1 attenuated the rise in heart rate and systolic blood pressure. Remifentanil 2 micrograms.kg-1 blocked the haemodynamic response completely: no further benefit was shown from increasing the dose to 4 micrograms.kg-1.

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Intravenous; Atracurium; Dose-Response Relationship, Drug; Double-Blind Method; Female; Hemodynamics; Humans; Infusions, Intravenous; Intubation, Intratracheal; Male; Middle Aged; Muscle Relaxation; Neuromuscular Blocking Agents; Piperidines; Propofol; Remifentanil

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare neurological disorder that is caused by the production of antibodies against NMDARs. As many anaesthetic drugs interact with NMDARs and may worsen the disease and because the disease poses risks, such as cardiovascular events, hyperthermia and respiratory insufficiency, while under anaesthesia, administering anaesthesia to patients with this disorder is clinically challenging.. A 55-year-old man with gastric cancer associated with anti-NMDAR encephalitis who was diagnosed 8 months prior was admitted to Peking University Cancer Hospital for tumour resection. Before surgery, the patient's symptoms had been successfully controlled via aggressive immunotherapy. Radical gastrectomy was performed under general anaesthesia induced with remifentanil, propofol, and cisatracurium and maintained with sevoflurane and remifentanil. The patient had a favourable recovery without any adverse symptoms or post-operative complications.. Adequate preparation for surgery is essential for the anaesthetic management of patients with anti-NMDAR encephalitis. These rare patients may benefit from general anaesthesia induced using remifentanil, propofol and cisatracurium and maintained using sevoflurane and remifentanil. Additionally, the use of NMDA antagonists, such as ketamine, nitrous oxide and tramadol, should be avoided.

Topics: Anesthetics, General; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Atracurium; Drug Therapy, Combination; Gastrectomy; Humans; Male; Methyl Ethers; Middle Aged; Neuromuscular Blocking Agents; Piperidines; Propofol; Remifentanil; Sevoflurane; Stomach Neoplasms

Postoperative rehabilitation after cardiac surgery is based on medical-surgical management in order to reduce the lenght of stay in hospital and the costs of this high risk surgery. Early tracheal extubation (within the first 6 hours) is the cornerstone of fast-track surgery. Our study aimed to evaluate fast-track practice and early tracheal extubation in scheduled cardiac surgery for adult patients in our Institution.. We conducted a descriptive study including all patients aged over 18 years who consecutively had undergone scheduled cardiac surgery and postoperative treatment in the post-operative intensive care unit in the Department of Thoracic and Cardiovascular Surgery at the Habib Bourguiba University Hospital, Sfax. Inclusion criteria were: patients aged 18 years and older who had undergone scheduled cardiac surgery and postoperative treatment in the post-operative intensive care unit in the Department of Thoracic and Cardiovascular Surgery. Standardized anaesthetic protocol was used in all cases: propofol, remifentanil, cisatracrium. We recorded the mean postoperative extubation time and the factors affecting extubation time.. We collected data from 200 patients who consecutively had undergone scheduled cardiac surgery. Among these patients, 115 underwent coronary artery bypass surgery, 79 valvular surgery and 6 combined surgery or another surgical procedure. Patients' demographic characteristics were comparable. 152 patients (76%) underwent postoperative extubation within the first 6 hours. 48 patients couldn't be extubated within the FIrst 6 hours. The main causes of early extubation failure were: catecholamines in high doses, bleeding, arrhythmia and neurological disorders.. Our study demonstrates that postoperative rehabilitation can be performed in our Institution and that all patients undergoing scheduled cardiac surgery should be candidates for early extubation.

Topics: Adult; Aged; Airway Extubation; Anesthesia; Atracurium; Cardiac Surgical Procedures; Coronary Artery Bypass; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Piperidines; Postoperative Period; Propofol; Remifentanil; Time Factors; Tunisia

The aim of this study was to determine whether the MACEI and MACawake of sevoflurane in infants with obstructive jaundice are different from that observed in nonjaundiced infants.. Infants scheduled for abdominal surgery were recruited into the study. General anesthesia was induced with 8% sevoflurane inhaled with 8 l·min(-1) of oxygen via mask, followed by adjustment of inspired sevoflurane to the target concentration based on the result in previous patient at which laryngoscopy and tracheal intubation were attempted and maintained for 15 min. All responses to tracheal intubation were assessed. At the end of the procedure, sevoflurane was titrated to the target concentration, which was kept constant for 15 min before a standard stimulus was applied to determine whether the infant was awake. The Dixon's 'up and down' method was used to determine progression of subsequent concentrations.. There was no significant difference between the MACEI of sevoflurane in infants with obstructive jaundice (3.40 ± 0.21%) and that observed in the control group (3.43 ± 0.18%). But the MACawake of sevoflurane in jaundiced infants (1.00 ± 0.15%) was significantly lower than that of nonjaundiced controls (1.40 ± 0.21%; P = 0.004); to complement these findings, we reported a negative correlation between serum total bilirubin and the probability of awakening (OR = 0.984, 95% CI is 0.970-0.998, P = 0.028).. The MACawake of sevoflurane was reduced in obstructive jaundiced infants compared with nonjaundiced controls, whereas there was no significant difference between the MACEI of sevoflurane in infants with obstructive jaundice and that observed in nonjaundiced infants.

Topics: Alanine Transaminase; Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Biliary Atresia; Bilirubin; Female; Humans; Infant; Jaundice, Obstructive; Male; Methyl Ethers; Neuromuscular Nondepolarizing Agents; Piperidines; Portoenterostomy, Hepatic; Pulmonary Alveoli; Reflex; Remifentanil; Sevoflurane

To explore the neuromuscular effects of cisatracurium besylate in morbidly obese patients when dosed according to real body weight under total intravenous anesthesia with propofol.. Thirty-six ASA I-II patients aged 18-65 years scheduled for elective procedures at our hospital during July 2012 to December 2012 were allocated into 2 groups according to body mass index (normal weight: body mass index: <24, overweight: body mass index >28). Anesthesia was induced with target-controlled infusion of propofol (Cp 3 µg/ml) and remifentanil (Ce 3-5 ng/ml). A bolus of cisatracurium 0.2 mg/kg was administered intravenously over 5-10 s as soon as a patient lost consciousness. Neuromuscular block was monitored with TOF-Watch SX (Oaganon, the Netherlands). Single stimulation (0.1 Hz) was applied to ulnar nerve at wrist. The maximal degree of neuromuscular block, onset time, clinical duration and recovery index were recorded. They were intubated and mechanically ventilated when neuromuscular block reached the maximal degree. The intubation condition was evaluated.. The average onset time was (164 ± 25) s in obese group versus (201 ± 48) s in normal weight group. And there was significant difference between groups (t = 2.83, P < 0.05) . The clinical duration was (68.4 ± 9.6) min in obese group versus (62.0 ± 6.5) min in normal weight group. And there was significant difference between groups (t = 2.33, P < 0.05). The recovery index was (15.6 ± 4.7) min in obese group versus (10.8 ± 4.2) min in normal weight group. And there was significant difference between groups (t = 3.03, P < 0.05) . Also 75% recovery time was (83.9 ± 11.5) min in obese group versus (73.0 ± 9.2) min in normal weight group. And there was significant difference between groups (t = 2.94, P < 0.05). But no differences existed in intubation conditions.. When dosed according to real body weight, onset time of cisatracurium is shorter while clinical duration and recovery index are prolonged in morbidly obese patients compared with normal weight counterparts.

Topics: Adolescent; Adult; Aged; Anesthesia Recovery Period; Anesthesia, General; Atracurium; Body Mass Index; Body Weight; Humans; Middle Aged; Neuromuscular Nondepolarizing Agents; Obesity, Morbid; Piperidines; Propofol; Remifentanil; Young Adult

Topics: Airway Management; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Atracurium; Biotransformation; Consciousness Monitors; Humans; Intraoperative Complications; Intubation, Intratracheal; Lesch-Nyhan Syndrome; Male; Mandibular Fractures; Nasal Cavity; Neuromuscular Blocking Agents; Neurotransmitter Agents; Piperidines; Preoperative Care; Propofol; Remifentanil; Young Adult

Topics: Anesthesia, Intravenous; Atracurium; Biopsy; Carcinoma, Squamous Cell; Epilepsies, Partial; Hernia, Hiatal; Humans; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Miller Fisher Syndrome; Monitoring, Intraoperative; Neck Dissection; Neuromuscular Blocking Agents; Piperidines; Propofol; Pulmonary Disease, Chronic Obstructive; Remifentanil; Secondary Prevention; Tracheostomy

To evaluate the utility and safety of remifentanil for hemodynamic control during cesarean section in high-risk patients ineligible for spinal anesthesia.. One minute before induction we injected a bolus of 1 microg x kg(-1) of remifentanil, followed by propofol (2.5 mg x kg(-1)), succinylcholine (1 mg x kg(-1)), cisatracurium, sevoflurane in oxygen and nitrous oxide, and fentanyl (5 microg x kg(-1)) after clamping the umbilical cord. We recorded maternal hemodynamic variables, pulse oximetry, capnography, bispectral index, and presence of muscular rigidity. In the neonate we assessed fetal wellbeing, weight, and requirement for naloxone. Hemodynamic stability was defined as no more than 15% variation in arterial pressure with respect to baseline.. Twelve patients undergoing surgery because of placenta abruptio, subarachnoid hemorrhage, HELLP syndrome, or preeclampsia were enrolled. Hemodynamic variables were consistently stable during surgery in all patients. No cases of neonatal rigidity were noted and there was no need for naloxone. The mean Apgar score was 6.42 (1.5) at 1 minute and 8.42 (0.9) at 5 minutes.. Bolus injection of 1 microg x kg(-1) of remifentanil may be useful for maintaining maternal hemodynamic stability in high-risk obstetric cases. Given the risk of neonatal depression, this resource should be used selectively and the means for neonatal resuscitation should be available.

Topics: Adult; Anesthetics, Intravenous; Atracurium; Cesarean Section; Female; Fentanyl; Fetus; Hemodynamics; Humans; Infant, Newborn; Methyl Ethers; Muscle Rigidity; Naloxone; Nitrous Oxide; Piperidines; Pregnancy; Pregnancy Complications; Pregnancy, High-Risk; Propofol; Remifentanil; Resuscitation; Retrospective Studies; Sevoflurane; Succinylcholine

We investigated the effects of prone position on respiratory dead space and gas exchange in 14 anaesthetized healthy patients undergoing elective posterior spinal surgery of more than 3 h of duration.. The patients received a total intravenous anaesthetic with propofol/remifentanil/cisatracurium. They were ventilated at a tidal volume of 8-10 mL kg(-1), zero positive end-expiratory pressure and an inspired oxygen fraction of 0.4. Physiological, airway and alveolar dead spaces were calculated by analysis of the volumetric capnography waveform. Measurements were made in supine position (20 min after the beginning of mechanical ventilation) and 30, 120 and 180 min after turning to prone position.. We found that the alveolar dead space/tidal volume ratio did not change. PaO(2)/F(i)O(2) increased, although not statistically significantly. Dynamic compliance was reduced due to a reduction in tidal volume and an increase in plateau pressure.. Patients undergoing surgery in prone position for a duration of 3 h under general anaesthesia including muscle relaxation and mechanical ventilation without positive end-expiratory pressure have stable haemodynamics and no significant changes in the alveolar dead space to tidal volume ratio. Oxygenation tended to improve.

Topics: Anesthesia, General; Anesthetics, Intravenous; Atracurium; Capnography; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Neuromuscular Blocking Agents; Piperidines; Prone Position; Propofol; Pulmonary Alveoli; Pulmonary Gas Exchange; Reference Values; Remifentanil; Respiration, Artificial; Respiratory Dead Space; Spine; Supine Position; Tidal Volume; Time; Time Factors

Topics: Aged; Anesthesia, Intravenous; Atracurium; Electromyography; Entropy; Ephedrine; Humans; Hypotension; Infusions, Intravenous; Male; Neuromuscular Blocking Agents; Piperidines; Propofol; Remifentanil

Topics: Adult; Amides; Analgesia, Epidural; Anesthesia, Epidural; Anesthesia, Inhalation; Atracurium; Brachial Plexus; Brachial Plexus Neuropathies; Desflurane; Female; Fentanyl; Humans; Isoflurane; Magnetic Resonance Imaging; Midazolam; Neurilemmoma; Neuromuscular Nondepolarizing Agents; Peripheral Nervous System Neoplasms; Piperidines; Propofol; Remifentanil; Ropivacaine

Topics: Adult; Aged; Alfentanil; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Blood Pressure; Electroencephalography; Female; Heart Rate; Humans; Lumbar Vertebrae; Male; Methyl Ethers; Middle Aged; Neuromuscular Blocking Agents; Nitrous Oxide; Oxygen; Piperidines; Propofol; Remifentanil; Sevoflurane; Spinal Fusion; Spinal Nerve Roots

Traumatic pulmonary herniation involves the protrusion of lung parenchyma beyond the normal borders of the thoracic cage through a defect in the musculoskeletal wall. Anesthetic management involves airway protection, lung isolation, and avoidance of distension of the herniated segment. We report the successful anesthetic management during surgical management of pulmonary herniation.

Topics: Accidents, Traffic; Anesthesia; Anesthetics, Intravenous; Atracurium; Hernia; Herniorrhaphy; Humans; Lung; Lung Injury; Male; Middle Aged; Neuromuscular Blocking Agents; Pelvis; Piperidines; Pneumothorax; Positive-Pressure Respiration; Propofol; Remifentanil; Respiration, Artificial; Rib Fractures; Thoracotomy; Tomography, X-Ray Computed

Topics: Aged; Anesthesia, General; Anesthetics, Intravenous; Atracurium; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Humans; Intubation, Intratracheal; Male; Monitoring, Intraoperative; Myocardial Infarction; Narcolepsy; Neuromuscular Blocking Agents; Piperidines; Propofol; Remifentanil

Topics: Adult; Anesthetics, Inhalation; Anesthetics, Intravenous; Atracurium; Cardiopulmonary Bypass; Catheterization, Central Venous; Desflurane; Dose-Response Relationship, Drug; Heart Neoplasms; Hemodynamics; Humans; Intubation, Intratracheal; Isoflurane; Male; Midazolam; Neuromuscular Blocking Agents; Norepinephrine; Pheochromocytoma; Piperidines; Propofol; Remifentanil; Vasoconstrictor Agents

Topics: Adult; Anesthesia, General; Anesthetics, Intravenous; Atracurium; Gastric Bypass; Humans; Intraoperative Complications; Male; Neuromuscular Blocking Agents; Obesity, Morbid; Pain, Postoperative; Piperidines; Remifentanil

According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed.. 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases. Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated.. The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency.. TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.

Topics: Adult; Anesthesia Recovery Period; Anesthesia, Intravenous; Anesthetics, Intravenous; Atracurium; Female; Gastroplasty; Humans; Male; Midazolam; Middle Aged; Neuromuscular Blocking Agents; Obesity, Morbid; Piperidines; Propofol; Remifentanil; Time Factors

To compare recovery parameters of total intravenous anesthesia (TIVA) with remifentanil and propofol, hemodynamic responses to perioperative events, and pharmacodynamic parameters of cisatracurium in 22 end-stage renal failure and 22 normal renal function patients.. Anesthesia was induced with 2-3 mg x kg(-1) propofol and 1 microg x kg(-1) remifentanil and maintained with 75 microg x kg(-1) x min(-1) propofol and propofol initial infusion of 0.2 microg x kg(-1) x min(-1) propofol. Arterial pressure and heart rate were maintained by remifentanil infusion rate adjustments. The first twitch (T1) was maintained at 25% by an infusion of cisatracurium.. There was no difference in the time to maintenance of adequate respiration, date of birth recollection, first analgesic administration, between the renal failure (4.8+/-2.5, 7.8+/-3.2, 12.3+/-5.3 min respectively) and the control group (5.2+/-2.8, 8.1+/-3.1, 12.7+/-5.5 min): nor were there any differences in the time to 25% T1 recovery, T1 recovery from 25% to 75%, or cisatracurium infusion rate between the renal failure group (32.1 +/-10.8 min, 18.2+/-5.5 min, 0.89+/-0.29 microg x kg(-1) min(-1) respectively) and the control group (35.9 (7.9 min, 18.4+/-3.8 min, 0.95+/-0.22 microg x kg(-1) x min(-1)).. End-stage renal failure does not prolong recovery from TIVA with remifentanil and propofol, or the recovery from cisatracurium neuromuscular block.

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Intravenous; Atracurium; Female; Hemodynamics; Humans; Kidney Failure, Chronic; Male; Middle Aged; Neuromuscular Blocking Agents; Piperidines; Propofol; Remifentanil

Aging alters both the pharmacokinetic and the pharmacodynamic aspects of anesthetic requirement. Studies of the relationship between drug concentration and effect in older adults clearly demonstrate a decline in median effective dose requirement for agents that act within the central nervous system, but there appears to be little change in the dose required for peripheral effects such as neuromuscular blockade. Most drugs also undergo somewhat slower biotransformation and demonstrate prolonged clinical effects if they require hepatic or renal degradation, although many newer agents such as remifentanil and cisatracurium have organ-independent pathways that are not affected by age. In some cases, however, the appearance of increased sensitivity to a given dose of anesthetic or opiate may actually reflect higher-than expected plasma concentrations of drug following a rapid intravenous injection. Therefore, it is impossible to completely separate the interactions between pharmacodynamic and pharmacokinetic factors associated with aging. The use of pharmacological sympathectomy with intrathecal agents and with sympatholytic adrenergic agonists may further improve outcome in a patient population at high risk because of reduced functional reserve, increased incidence of polypharmacy, and the consequences of age-related disease.

Topics: Adrenergic Agonists; Adult; Aged; Aged, 80 and over; Aging; Anesthetics, Intravenous; Atracurium; Brain; Disease; Dose-Response Relationship, Drug; Humans; Incidence; Injections, Spinal; Kidney; Liver; Middle Aged; Narcotics; Neuromuscular Blockade; Neuromuscular Blocking Agents; Peripheral Nerves; Piperidines; Polypharmacy; Remifentanil; Risk Factors; Spinal Cord; Sympathectomy, Chemical; Sympatholytics