piperidines and Foreign-Bodies

To compare the safety and efficacy of dexmedetomidine/propofol (DP)-total i.v. anaesthesia (TIVA) vs remifentanil/propofol (RP)-TIVA, both with spontaneous breathing, during airway foreign body (FB) removal in children.. Seventy-seven children undergoing rigid bronchoscopy for FB removal were randomly allocated to receive either RP-TIVA and spontaneous ventilation (Group RP, n=38) or DP-TIVA and spontaneous ventilation (Group DP, n=39). Heart rate, arterial pressure, pulse oxygen saturation (Sp(O2)), respiratory rate, end-tidal CO2 (E'(CO2)), and induction time were recorded. Adverse events, the intervention for these events, and postoperative care duration were also assessed.. The mean induction times were comparable between the two groups (Group RP 12.2 min vs Group DP 13.1 min, P>0.05). At the end of the procedure, the mean (E'(CO2)) was higher in Group RP (Group RP 6.8 kPa vs Group DP 5.8 kPa, P<0.001), and respiratory rate was lower in Group RP (Group RP 20.4 vs Group DP 35.8, P<0.001). Additionally, the perioperative haemodynamic profile was more stable in Group DP than that in Group RP. The incidence rate of breath-holding and intervention were comparable between the two groups. In the post-anaesthesia care unit (PACU), no hypoxaemia was observed, and emergence time increased in Group DP (Group DP 65.1 min vs Group RP 23.8 min, P<0.0001). The incidence of cough in PACU was higher in Group RP (Group RP 55.3% vs Group DP 10.3%, P<0.0001).. Compared with RP-TIVA, DP-TIVA provided more stable respiratory and haemodynamic profiles, but required a longer recovery time. Clinical trial registration China Clinical Research Information Service, ChiCTR-TRC-13003018.

Topics: Airway Obstruction; Anesthesia Recovery Period; Anesthesia, Intravenous; Blood Pressure; Bronchoscopy; Child, Preschool; Dexmedetomidine; Female; Foreign Bodies; Heart Rate; Humans; Hypnotics and Sedatives; Infant; Length of Stay; Male; Piperidines; Remifentanil; Respiration; Respiratory Rate; Tidal Volume; Time Factors; Treatment Outcome

To assess the effect of two different remifentanil infusion doses on hemodynamic stability and recovery characteristics in children undergoing tracheobronchial foreign body removal during rigid bronchoscopy.. Prospective, randomized, clinical comparison study.. Operating room of a university hospital.. 70 ASA physical status 1 and 2 children, aged 3-12 years, presenting for tracheobronchial foreign body removal during rigid bronchoscopy.. Children were divided equally into two groups to receive either a 0.1 μg/kg/min (Group R1) or 0.2 μg/kg/min (Group R2) remifentanil infusion. Ten minutes after the remifentanil infusion, 3 mg/kg of propofol and 0.02 mg/kg of atropine were given. Anesthesia was maintained with 0.1 μg/kg/min of remifentanil and 100-250 μg/kg/min of propofol in Group R1 and 0.2 μg/kg/min of remifentanil and 100-250 μg/kg/min of propofol in Group R2. After baseline measurements were recorded, 0.2 mg/kg of mivacurium was given intravenously. Ventilation was maintained with 100% O(2) via a "T" piece connected to the side arm of the bronchoscope.. Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP), and O2 saturation (SpO2) were recorded before (baseline) and after induction, and 1, 3, 5, 10, 15, 20, 25, and 30 minutes after insertion of the rigid bronchoscope into the trachea. Emergence characteristics and complications were noted. Statistical analysis was performed using independent samples t-test, repeated measures, and chi-square test as appropriate.. Groups were similar in demographics and duration of bronchoscopy and anesthesia (P > 0.05). In Group R1, HR, SBP, DBP, and MAP increased one minute after insertion of the bronchoscope in Group R1 (P < 0.01). Propofol consumption was significantly higher in Group R1 (63.6 ± 30.1 mg) than Group R2 (39.8 ± 26.6 mg; P < 0.01). Time to spontaneous eye opening was 8.6 ± 1.3 minutes in Group R1 and 6.3 ± 1.1 minutes in Group R2 (P < 0.05). The time to recovery to an Aldrete score of 9 was greater in Group R1 (19.8±3.0 min) than Group R2 (16.1±3.0 min; P < 0.01).. A remifentanil 0.2 μg/kg/min infusion with propofol provides hemodynamic stability and early recovery in children undergoing foreign body removal during rigid bronchoscopy.

Topics: Anesthesia Recovery Period; Anesthetics, Combined; Anesthetics, Intravenous; Bronchi; Bronchoscopy; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Foreign Bodies; Hemodynamics; Humans; Male; Piperidines; Propofol; Prospective Studies; Remifentanil; Trachea

Foreign body aspiration is a life-threatening condition, with children under 3 years of age most at risk. This study was designed to compare the clinical characteristics of sevoflurane volatile induction/maintenance anaesthesia (VIMA) and propofol-remifentanil total intravenous anaesthesia (TIVA) for children undergoing rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal.. Sixty-four children undergoing rigid bronchoscopy were allocated randomly to receive sevoflurane (Group VIMA; n = 32) or propofol-remifentanil (Group TIVA, n = 32) between 2007 and 2009. Respiratory rate, heart rate and mean blood pressure were compared at the time points including baseline level (T 0); laryngoscopy (T lary); insertion of rigid bronchoscope (T bron); 5, 10 and 20 min during procedure (T 5 min, T 10 min, T 20 min); the end of procedure (Tend) and discharge (T dis). Induction time, emergence time, intubating condition scores and the incidence of adverse events were compared.. Time for loss of consciousness (Group VIMA 95.6 ± 15.2 s vs. Group TIVA 146.2 ± 26.9 s, P < 0.05), time of Bispectral Index value decreased to 40 (Group VIMA 115.3 ± 16.5 s vs. Group TIVA 160.4 ± 25.8 s, P < 0.05) and emergence time (Group VIMA 10.5 ± 2.6 min vs. Group TIVA 16.9 ± 3.1 min, P < 0.05) in Group VIMA were significantly shorter than those in Group TIVA. Intubating condition scores between the two groups were comparable (8.1 ± 0.9 in Group VIMA vs. 8.1 ± 1.0 in Group TIVA). The incidence rates of breath holding (Group VIMA 6.25% vs. Group TIVA 31.25%, P < 0.05) and desaturation (Group VIMA 15.63% vs. Group TIVA 37.50%, P < 0.05) in Group VIMA were significantly lower than those in Group TIVA. Heart rate, mean blood pressure and respiratory rate were significantly higher in Group VIMA than in Group TIVA.. Compared with propofol-remifentanil TIVA, sevoflurane VIMA provides more stable haemodynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal under spontaneous breathing.

Topics: Anesthesia Recovery Period; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Bronchi; Bronchoscopy; Child, Preschool; Female; Foreign Bodies; Humans; Infant; Laryngoscopy; Male; Methyl Ethers; Oxygen; Piperidines; Propofol; Remifentanil; Sevoflurane; Time Factors; Trachea

The study compared sevoflurane or propofol as anaesthesia supplements to remifentanil infusion and topical local anaesthesia for insertion of a rigid bronchoscope for bronchial foreign body removal in children aged one to three years. Seventy children were randomly allocated to two groups to receive remifentanil infusion at 0.2 microg x kg(-1) x min(-1) with either sevoflurane or propofol supplements for insertion of the rigid bronchoscope. Heart rate and systolic blood pressure before anaesthesia, prior to and on insertion of the bronchoscope and one, three, five, seven and ten minutes after insertion were measured. Incidence of cough and apnoea were recorded. The haemodynamic changes during bronchoscopy were moderate and did not differ between groups. The sevoflurane group had a lower incidence of cough than the propofol group. No significant difference was detected in the incidence of apnoea between groups. It can be concluded that remifentanil infusion with modest use of general anaesthetic agents facilitates rigid bronchoscopy successfully in children.

Topics: Anesthetics, Inhalation; Anesthetics, Intravenous; Apnea; Blood Pressure; Bronchoscopy; Child, Preschool; Cough; Female; Foreign Bodies; Heart Rate; Humans; Infant; Male; Methyl Ethers; Piperidines; Propofol; Remifentanil; Sevoflurane

Topics: Aged, 80 and over; Anesthesia; Bronchoscopes; Bronchoscopy; Dentures; Etomidate; Foreign Bodies; Humans; Hypnotics and Sedatives; Levodopa; Male; Parkinson Disease; Piperidines; Remifentanil; Respiratory Aspiration; Trachea

Angiogenesis depends on a complex interaction between cellular networks and mediators. The endocannabinoid system and its receptors have been shown to play a role in models of inflammation. Here, we investigated whether blockade of cannabinoid receptors may interfere with inflammatory angiogenesis.. Polyester-polyurethane sponges were implanted in C57Bl/6j mice. Animals received doses (3 and 10 mg/kg/daily, s.c.) of the cannabinoid receptor antagonists SR141716A (CB1) or SR144528 (CB2). Implants were collected at days 7 and 14 for cytokines, hemoglobin, myeloperoxidase, and N-acetylglucosaminidase measurements, as indices of inflammation, angiogenesis, neutrophil and macrophage accumulation, respectively. Histological and morphometric analysis were also performed.. Cannabinoid receptors expression in implants was detected from day 4 after implantation. Treatment with CB1 or CB2 receptor antagonists reduced cellular influx into sponges at days 7 and 14 after implantation, although CB1 receptor antagonist were more effective at blocking leukocyte accumulation. There was a reduction in TNF-α, VEGF, CXCL1/KC, CCL2/JE, and CCL3/MIP-1α levels, with increase in CCL5/RANTES. Both treatments reduced neovascularization. Dual blockade of cannabinoid receptors resulted in maximum inhibition of inflammatory angiogenesis.. Blockade of cannabinoid receptors reduced leukocyte accumulation, inflammation and neovascularization, suggesting an important role of endocannabinoids in sponge-induced inflammatory angiogenesis both via CB1 and CB2 receptors.

Topics: Animals; Camphanes; Cannabinoid Receptor Antagonists; Cytokines; Foreign Bodies; Foreign-Body Reaction; Leukocytes; Male; Mice; Mice, Inbred C57BL; Neovascularization, Pathologic; Piperidines; Polyesters; Polyurethanes; Pyrazoles; Receptor, Cannabinoid, CB1; Receptor, Cannabinoid, CB2; Rimonabant; Skin

Foreign body aspiration is a common life-threatening event in young children. Tracheobronchial foreign body removal is usually performed by rigid tracheobronchoscopy under general anesthesia. Anesthetic and ventilation techniques vary greatly among anesthesiologists and institutions. In the present retrospective study, we report our anesthetic experience over 5 years. We describe complications and outcomes and analyze the clinical characteristics of anesthesia and ventilation.. We retrospectively reviewed relevant clinical findings of 586 pediatric patients treated with rigid tracheobronchoscopy under general anesthesia. All procedures were performed under inhaled sevoflurane anesthesia combined with remifentanil infusion, with spontaneous respiration assisted by high-frequency jet ventilation (HFJV) and topical airway anesthesia.. Among 586 patients, the foreign body was successfully removed by rigid tracheobronchoscopy in 558 patients, and no foreign body was found in 28 patients. Laryngospasm was observed during the procedure in five patients. Hypoxemia was observed in 15 patients (2.6%). No severe complications or deaths occurred. The mean operation time was 22 min and the average hospital stay was 2 days.. Inhaled sevoflurane anesthesia combined with remifentanil infusion, with spontaneous respiration assisted by HFJV and topical airway anesthesia, is safe and effective for tracheobronchial foreign body removal.

Topics: Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Bronchi; Bronchoscopy; Child; Female; Foreign Bodies; High-Frequency Jet Ventilation; Humans; Male; Methyl Ethers; Piperidines; Remifentanil; Retrospective Studies; Sevoflurane; Trachea

To investigate the efficacy and safety of propofol-remifentanil total intravenous anesthesia (TIVA) and spontaneous ventilation for foreign body (FB) removal in pediatric patients with preoperative respiratory impairment.. We carried out a prospective observational clinical study of FB removal using a rigid bronchoscope under propofol-remifentanil TIVA and spontaneous ventilation in 65 pediatric patients who presented with preoperative respiratory impairment. Heart rate, blood pressure, pulse oxygen saturation (SpO(2)), respiratory rate, endtidal CO(2) (ETCO(2))(ETCO2), induction time, and remifentanil rate were recorded. Adverse events, the intervention for these events, and the duration of postoperative care were also of interest.. Sixty children completed the study. The mean induction time was 12.3 min. During the procedure, the maximum remifentanil rate was 0.14 μg · kg(-1) · min(-1). Light breath holding occurred in 16 (26.7%) patients. No severe breath holding or body movements were observed. An SpO(2) below 90% occurred in 10 (16.7%) cases. No progressive desaturation was observed. The mean ETCO(2) at the end of the procedures was 7.91 KPa and returned to normal 5 min after the procedure. In the postanesthesia care unit (PACU), no hypoxemia was observed and the mean recovery time was 23.4 min. No laryngospasm, pneumothorax, or arrhythmias were observed.. Propofol-remifentanil TIVA and spontaneous ventilation are effective and safe techniques to manage anesthesia during airway FB removal in children with preoperative respiratory impairment.

Topics: Anesthesia, Intravenous; Anesthetics, Intravenous; Blood Pressure; Bronchoscopy; Carbon Dioxide; Child, Preschool; Cough; Female; Foreign Bodies; Heart Rate; Humans; Infant; Male; Monitoring, Intraoperative; Muscle Relaxants, Central; Piperidines; Postoperative Complications; Propofol; Remifentanil; Respiration Disorders

Topics: Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Bronchoscopy; Child, Preschool; Foreign Bodies; Humans; Lidocaine; Male; Methyl Ethers; Piperidines; Remifentanil; Sevoflurane; Trachea

Topics: Anesthesia; Anesthetics, Combined; Anesthetics, Intravenous; Bronchoscopy; Child, Preschool; Foreign Bodies; Humans; Hypoxia; Piperidines; Propofol; Remifentanil; Respiratory Mechanics; Risk Factors; Treatment Outcome

Topics: Adenoidectomy; Age Factors; Child; Child, Preschool; Foreign Bodies; Fracture Fixation; Humans; Nitriles; Phenothiazines; Piperidines; Preanesthetic Medication; Tonsillectomy; Tranquilizing Agents