piperidines and Cleft-Lip

To compare the clinical efficacies and safety of sevoflurane and propofol versus remifentanil and propofol anesthesia for children with cleft lip and palate repair surgery.. Upon the approval of hospital ethical committee,a total of 60 pediatric patients undergoing cleft lip and palate repair surgery were recruited from two hospitals between April 2011 and December 2012. All patients were randomly divided into 2 groups (n = 30 each). Group S:sevoflurane and propofol anesthesia; and group R: propofol and remifentanil anesthesia.Heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were recorded at the time before the induction (T0), after 2 min of induction (T1), the beginning of surgery (T2) and the end of surgery (T3).Intubating satisfaction, time to extubation,incidence of emergence agitation, postoperative nausea and vomiting, and the complications of the airway were recorded.. Satisfactory intubation rate was 90% in group S, versus 83% in group R. And there was no significantly difference between the two group. There were no significantly difference between the two group with MAP and HR.Compared with T0, There were significantly difference with MAP and HR at T1, T2 in group R (P < 0.05). The incidence of emergence agitation was significantly higher in group S (7 cases) than that in group R (2 cases).there were no records of nausea, vomiting and laryngospasm.. Under an adequate depth anesthesia, these two anesthesia techniques are safe for cleft lip and palate repair surgery, emergence agitation was high in sevoflurane anesthesia, propofol and remifentanil anesthesia provides lower heart rate.

Topics: Anesthesia; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Methyl Ethers; Piperidines; Propofol; Remifentanil; Sevoflurane

Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance.. In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded.. In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery.. A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.

Topics: Anesthesia Recovery Period; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Pressure; Cleft Lip; Cleft Palate; Dose-Response Relationship, Drug; Female; Heart Rate; Humans; Infant; Intubation, Intratracheal; Male; Methyl Ethers; Mouth Abnormalities; Piperidines; Propofol; Prospective Studies; Remifentanil; Sevoflurane; Time Factors

Postoperative behavioral disorders are common in children, but the occurrence in infants is not yet clear. In the present study we focus on postoperative sleep disturbances, which we hypothesized would be more common after sevoflurane anesthesia than propofol-remifentanil anesthesia.. In total, 39 infants 4-6-mo-old were prospectively enrolled and randomized to receive either a combination of propofol and remifentanil (n = 17) or sevoflurane and fentanyl anesthesia (n = 22) for surgical repair of cleft lip-gum-palate. Postoperative observations were blinded. The parents kept a sleep diary for 2 wk before admission and 2 wk after returning home. The diary included information about how many times the infant awoke during the night and was difficult to comfort and the longest duration of continuous sleep during the night.. Longest continuous sleep was significantly longer in the sevoflurane group (median 7.2 h) compared with the propofol-remifentanil group (median 5.1 h, P < 0.05). No other significant difference was found between groups. Sleep pattern was impaired after surgery in both groups compared with that before surgery (P < 0.01), but it was considered by the parents to be back to normal after a median of 10 days, with no significant difference between groups.. Postoperative sleep disturbances occur in infants after both propofol-remifentanil and sevoflurane anesthesia. Sevoflurane seems to be associated with less impairment of postoperative sleep than propofol-remifentanil in the first weeks after repair of cleft lip and palate in infants.

Topics: Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Infant; Methyl Ethers; Piperidines; Postoperative Period; Propofol; Prospective Studies; Remifentanil; Reproducibility of Results; Severity of Illness Index; Sevoflurane; Single-Blind Method; Sleep; Sleep Wake Disorders; Surveys and Questionnaires; Time Factors

Topics: Acetaminophen; Analgesia; Analgesics, Non-Narcotic; Analgesics, Opioid; Child; Cleft Lip; Cleft Palate; Data Collection; Humans; Ireland; Pain, Postoperative; Piperidines; Remifentanil; United Kingdom

To compare the clinical effects and safety of propofol and remifentanil anaesthesia with sevoflurane and remifentanil anaesthesia for cleft lip and palate repair surgery in children.. Forty children undergoing elective cleft lip and palate repair surgery were randomly divided into two groups, 20 in each group. Group PR: Propofol and remifentanil anaesthesia; and group S: Sevoflurane and remifentanil anaesthesia. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO2), and end tidal carbon dioxide (ETCO2) were observed, and recorded at the time before the induction (T0), after 15 min of induction (T1), after 30 min of induction (T2), and after 1 min of extubation (T3). The time to extubation, incidence of restlessness, postoperative nausea and vomiting, and the complication of the airway were recorded.. There were no significantly differences between the two groups with respect to sex, age, weight, category of operation, and the time of operation. In group PR, after the period of induction, two children used atropine for bradycardia. One was 3-years-old, and the other was 8-years-old. The HR of former was lower than 100 beats per minute, and the latter was lower than 70 beats per minute. The average of HR in group PR was increased after 1 min of extubation compared with that before induction (P<0.05). In group S, the average of HR was increased in 30 min after induction and 1 min after extubation (P<0.05), and HR kept in faster range compared with that in group PR (P<0.05) at the 15 min and 30 min after induction. During the operation, SPO2 and ETCO2 of both groups consistently maintained in normal range. The time to extubation was comparable in two groups. The incidence of agitation after surgery was significantly higher in group S (8 cases) than that in group PR (2 cases). There were no records of nausea, vomiting, asphyxia, and laryngospasm.. Propofol and remifentanil anaesthesia was more significantly inhibited the HR of children. The emergence agitation has higher incidence in sevoflurane anaesthesia. Both methods can attain extubation requirement quickly.

Topics: Anesthesia; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Methyl Ethers; Piperidines; Propofol; Remifentanil; Sevoflurane

Golden hamster fetuses were extremely sensitive to the teratogenic action of jervine and cyclopamine, the steroidal alkaloid tetratogens from Veratrum californicum. Cebocephaly, harelip/cleft palate, exencephaly, and a cranial bled were the common deformities produced by dosing on the seventh day of gestation. Sprague-Dawley derived albino rats were susceptible to cyclopamine but not to jervine, and at an incidence very much lower than that of hamsters. Cebocephaly and microphthalmia were the common deformities. The terata were observed as a consequence of sixth to ninth-day dosings. Single-day dosings produced no terata. Swiss Webster mice were apparently resistant to the teratogens.

Topics: Animals; Brain; Cleft Lip; Cricetinae; Female; Furans; Gestational Age; Mice; Microphthalmos; Piperidines; Pregnancy; Rats; Teratogens; Veratrum Alkaloids