piperidines and Hernia--Inguinal

Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients.. Randomized, prospective trial.. University hospital day-surgery center.. 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy.. Patients were randomized to either LAI (lidocaine+ropivacaine), SPIN (bupivacaine+fentanyl) or TIVA (propofol+remifentanil). Perioperative Ringer infusion was 1.5mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90.. Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered.. Surgery lasted longer in LAI group (median 40min) than in SPIN group (35min) (P=.003) and TIVA group (33min) (P<.001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P=.001). Time until readiness for discharge was shorter in LAI group (93min) than in TIVA (147min) and SPIN (190min) groups (P<.001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related.. Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.

Topics: Adult; Aged; Ambulatory Surgical Procedures; Amides; Anesthesia; Anesthesia Recovery Period; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Feasibility Studies; Fentanyl; Hernia, Inguinal; Herniorrhaphy; Humans; Lidocaine; Male; Middle Aged; Operative Time; Patient Satisfaction; Piperidines; Propofol; Prospective Studies; Remifentanil; Ropivacaine; Urinary Retention

To evaluate the effect of remifentanil on the isoflurane end-tidal concentration required to eliminate movement reaction upon surgical incision in children.. Prospective, double blinded, serial study.. Operating room of a university-affiliated hospital.. Patients of ASA status 1 or 2, aged 4 to 7 years, scheduled for either inguinal hernia repair or orchidopexy surgery with general anesthesia.. After endotracheal intubation, 108 children serially received 1 of 6 dose (nil, 0.05, 0.10, 0.15, 0.20, or 0.25 μg kg(-1) min(-1)) of remifentanil. End-tidal isoflurane concentration was adjusted according to a Dixon's up-and-down approach. Twenty-five minutes after starting the remifentanil infusion, the surgical incision was performed. The response of patients was classified as either "response" or "no response." Response was defined as a purposeful response in response to skin incision.. The MAC of isoflurane were 1.50 ± 0.16%, 1.33 ± 0.27%, 0.93 ± 0.13%, 0.73 ± 0.27%, 0.63 ± 0.19%, and 0.60 ± 0.15% for remifentanil infusion rates of nil, 0.05, 0.10, 0.15, 0.20, and 0.25 μg kg(-1) min(-1), respectively.. The MAC of isoflurane decreased with increasing infusion rate of remifentanil, showing an initial step reduction followed by a ceiling effect.

Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Child, Preschool; Double-Blind Method; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Isoflurane; Male; Piperidines; Prospective Studies; Pulmonary Alveoli; Remifentanil

General anaesthesia is a balance between hypnosis and analgesia. We investigated whether an increase in remifentanil blood concentration would reduce the amount of propofol required to maintain a comparable level of anaesthesia in 60 patients undergoing ambulatory surgery.. Patients were allocated randomly to receive remifentanil to a target blood concentration of 2 ng ml(-1) (low), 4 ng ml(-1) (medium), or 8 ng ml(-1) (high), administered by target-controlled infusion (TCI). After equilibration, propofol TCI was commenced in closed-loop control, with auditory evoked potentials (AEPex) as the input signal, aiming for an AEPex of 35. This was to ensure a comparable and unbiased level of anaesthesia in all patients.. We found a dose-dependent decrease in propofol requirements with increasing remifentanil concentrations. The mean (95% CI) propofol target blood concentration during adequate anaesthesia was 4.96 (3.85-6.01) micro g ml(-1) in the low, 3.46 (2.96-3.96) micro g ml(-1) in the medium, and 3.01 (2.20-3.38) micro g ml(-1) in the high group. There was no significant difference when recovery end points were achieved between the groups. Cardiovascular changes were moderate, but most pronounced in the high concentration group, with a decrease in heart rate of 21% compared with baseline. The mean calculated effect site propofol concentration at loss of consciousness was 2.08 (1.85-2.32) micro g ml(-1), and at recovery of consciousness was 1.85 (1.68-2.00) micro g ml(-1).. This study confirms a synergistic interaction between remifentanil and propofol during surgery, whereas the contribution of remifentanil in the absence of stimulation seems limited. In addition, our results suggest that the propofol effect site concentration provides a guide to the value at which the patient recovers consciousness.

Topics: Adolescent; Adult; Aged; Ambulatory Surgical Procedures; Anesthesia, Intravenous; Anesthetics, Combined; Anesthetics, Intravenous; Dose-Response Relationship, Drug; Drug Synergism; Evoked Potentials, Auditory; Female; Hemodynamics; Hernia, Inguinal; Humans; Infusions, Intravenous; Male; Middle Aged; Piperidines; Propofol; Prospective Studies; Remifentanil; Varicose Veins

To assess the efficacy and safety of remifentanil in comparison with fentanyl-midazolam for analgesia and sedation during subarachnoid anesthesia.. Sixty ASA I-III patients between 25 and 75 years old and scheduled for inguinal hernia repair were enrolled. Before the subarachnoid block, the patients were randomly assigned to receive an intravenous infusion of 0.1 microgram.Kg-1.min.-1 of remifentanil (group R) or 1 microgram.Kg-1 of fentanyl and 0.02 mg.Kg-1 of midazolam (group F). Ten minutes later a subarachnoid block to L3-L4 was performed with 10 mg of hyperbaric bupivacaine. We recorded intensity of pain during performance of the block on a simple verbal scale, the observer's assessment of alertness/sedation (OAA/S), hemodynamic variables, respiratory frequency and SpO2, level of comfort and side effects.. Over 70% of patients had no pain or slight pain during the subarachnoid puncture and absence of pain was significantly greater in group R than in group F (37% vs. 16%, p < 0.05). Sedation was adequate during surgery in both groups (OAA/S 2-3). There were no differences in level of comfort between the two groups. The incidences of hypoxemia, hypoventilation and excessive sedation were significantly higher in group R (40%, 20% and 16%, respectively; p < 0.05).. Remifentanil is more effective for treating pain associated with a subarachnoid block and provides cardiovascular stability with a limited level of sedation per dose, but its use is associated with a high incidence of respiratory depression.

Topics: Adult; Aged; Analgesia; Analgesics, Opioid; Anesthesia, Spinal; Conscious Sedation; Fentanyl; Hernia, Inguinal; Humans; Hypnotics and Sedatives; Male; Midazolam; Middle Aged; Piperidines; Prospective Studies; Remifentanil

Sameridine is a new compound with local anesthetic and analgesic properties when injected intrathecally. We studied the anesthetic and analgesic efficacy of three doses of isobaric sameridine (15, 20, and 23 mg) compared with 100 mg of hyperbaric lidocaine for spinal anesthesia in 140 healthy male patients undergoing inguinal hernia repair. Patients received spinal anesthesia with 4 mL of the study drug injected at the L2-3 or L3-4 interspace in the lateral decubitus position. All three doses of sameridine provided spinal anesthesia similar to lidocaine, with a slightly longer time to reach peak block height. The failure rate was highest in the 15-mg sameridine group, and accrual was discontinued in that group after 35 patients. The duration of blockade was shorter with lidocaine, but the time to voiding and ambulation was similar in all groups. Patients receiving sameridine were less likely to request morphine for postoperative analgesia and were less likely to request any analgesia in the first 4 h after injection of the drug. Use of oral analgesics (hydrocodone and acetaminophen) was similar in all groups after the first 4 h of the 24-h observation. We conclude that, in the three doses studied, sameridine provided spinal anesthesia similar to lidocaine, but with residual analgesia after drug injection that reduced the need for systemic analgesics in the first 4 h postoperatively.. In this clinical trial, we show the potential efficacy of a class of drugs that can produce both spinal anesthesia and postoperative analgesia when used for hernia repair.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesia; Anesthesia, Spinal; Anesthetics, Local; Dose-Response Relationship, Drug; Hernia, Inguinal; Humans; Lidocaine; Male; Middle Aged; Piperidines; Time Factors

Nausea and vomiting are among the most frequent complications following anesthesia and surgery. Due to anesthesia seems to be primarily responsible for post operative nausea and vomiting (PONV) in Day Surgery facilities, the aim of the study is to evaluate how different methods of anesthesia could modify the onset of postoperative nausea and vomiting in a population of patients undergoing inguinal hernia repair.. Ninehundredten patients, aged between 18 and 87 years, underwent open inguinal hernia repair. The PONV risk has been assessed according to Apfel Score. Local anesthetic infiltration, performed by the surgeon in any cases, has been supported by and analgo-sedation with Remifentanil in 740 patients; Fentanyl was used in 96 cases and the last 74 underwent deep sedation with Propofol .. Among the 910 patients who underwent inguinal hernia repair, PONV occurred in 68 patients (7.5%). Among patients presenting PONV, 29 received Remifentanil, whereas 39 received Fentanyl. In the group of patients receiving Propofol, no one presented PONV. This difference is statistically significant (p < .01). Moreover, only 50 patients of the total sample received antiemetic prophylaxis, and amongst these, PONV occurred in 3 subjects.. Compared to Remifentanil, Fentanyl has a major influence in causing PONV. Nonetheless, an appropriate antiemetic prophylaxis can significantly reduce this undesirable complication. Key words: Day Surgery, Fentanyl, Inguinal, Hernia repair, Nausea, Vomiting.. Nausea e vomito sono tra le più frequenti complicazioni a seguito di interventi chirurgici anche nella Day Surgery. Poiché l’anestesia rappresenta specificamente la causa principale di PONV, l’obiettivo dello studio è quello di valutare in quale modo i differenti tipi di anestesia possano modificare l’insorgenza di nausea e vomito postoperatori in pazienti sottoposti ad intervento di ernioplastica inguinale. 910 pazienti di età compresa tra 18 e 87 anni, sono stati sottoposti ad ernioplastica inguinale per via inguinotomica. Il rischio di PONV è stato calcolato per ogni paziente in base all’Apfel Score. L’infiltrazione di anestetico locale effettuata in ogni intervento, è stata associata ad analgosedazione con Remifentanil (740 pazienti), alla somministrazione di Fentanyl (96 pazienti) ed, infine, a sedazione profonda con Propofol (74 pazienti). Tra i 910 pazienti sottoposti ad ernioplastica inguinale, il vomito e nausea postoperatori si sono manifestati in 68 casi (7.5%). Tra questi, 29 erano stati trattati con Remifentanil, mentre 39 con Fentanyl. Nel gruppo di pazienti trattati con Propofol, nessuno ha manifestato PONV. Questa differenza risulta statisticamente significativa (p<.01). Inoltre, solo 50 pazienti globalmente hanno ricevuto profilassi antiemetica, e di questi, solo 3 hanno manifestato PONV. Rispetto al Remifentanil, il Fentanyl si è rivelato avere una più spiccata capacità emetigena. Tuttavia, una appropriata profilassi antiemetica può ridurre significativamente l’insorgenza di questa invalidante complicanza.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anesthesia, Local; Antiemetics; Deep Sedation; Dexamethasone; Female; Fentanyl; Hernia, Inguinal; Herniorrhaphy; Humans; Male; Middle Aged; Ondansetron; Piperidines; Postoperative Nausea and Vomiting; Preanesthetic Medication; Propofol; Remifentanil; Retrospective Studies; Young Adult

We gave general anesthesia for an infant with ilioinguinal hernia and Möbius syndrome. Anesthesia was performed with sevoflurane inhalation and intravenous infusion of remifentanil. Intraoperative anesthetic course was uneventful. Möbius syndrome is a syndrome of rhombencephalic maldevelopment involving predominantly motor nuclei and axons, as well as traversing long tracts. Airway management is a great challenge in these patients. Micrognathia, retrognathia, mandibular hypoplasia, and palatine cleft are some of the manifestations seen in these patients.

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Female; Hernia, Inguinal; Humans; Infant; Methyl Ethers; Mobius Syndrome; Piperidines; Remifentanil; Sevoflurane

The prevalence of moderate-to-severe pain after inguinal hernia repair (IHR) in adults is ≈ 10%. Two studies with very long follow-up periods (16.8 and 49 yr, respectively) have, however, suggested that the risk of developing chronic pain is much lower in children. The purpose of the present study was to examine the prevalence of chronic pain 6-48 months after IHR in children.. Postal questionnaires were sent to 156 children who had undergone IHR between the age of 6 months and 12 yr. The children were asked to recall the duration of postoperative pain, if necessary with help from their parents, and to describe the intensity and character of their pain, if the pain was still present. Children with chronic pain were offered quantitative sensory testing (QST), and a surgical examination, including ultrasound, in order to exclude hernia recurrence.. Ninety-eight children, mean (sd) age 7.8 (2.6) yr, answered the questionnaire. Their age at the time of surgery was mean (sd) 4.6 (2.4) yr, and the follow-up period was mean (sd) 3.2 (1.3) yr. Five children (5.1%, 95% confidence interval: 0.75-9.5) had pain located in the inguinal region, and three of these children underwent further examination. There was no hernia recurrence, but QST revealed pinprick hyperalgesia and decreased pressure pain thresholds on the operated side in all three children.. The prevalence of chronic pain after IHR in children is 5.1%, which is lower than the prevalence reported after adult hernia repair.

Topics: Anesthesia, Intravenous; Anesthetics, Intravenous; Child; Child, Preschool; Chronic Pain; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Male; Nerve Block; Pain Measurement; Pain, Postoperative; Piperidines; Propofol; Remifentanil; Surveys and Questionnaires

This paper discusses the efficacy and difficulty of the management of monitored anesthesia care (MAC) for inguinal hernia repairs using tumescent local anesthesia(TLA).. Eighty patients were retrospectively divided into four groups (all n = 20) according to the drugs used; group P (propofol), group PF (propofol and fentanyl), group PFM (propofol, fentanyl and midazolam), group PR (propofol and remifentanyl). The four groups were analyzed in terms of the applied dose, airway use, wake-up test to determine whether hernia was repaired, postoperative pain and nausea.. More propofol was administered in group P than in group PFM and PR. Although, airway was used for nine patients, there was no difference between the four groups. Postoperative pain and nausea also do not differ between the groups. One patient in group P showed unsuccessful repair with wake-up test.. MAC shows a beneficial effect on inguinal hernia repairs under TLA. The rate of airway use was as high as eleven percent, and maintenance of the patients' airway requires attention. In terms of wake-up test, propofol combined with opioid administration may be more effective than propofol administration alone. There was no significant difference between the groups in pain and nausea, regardless at the use of fentanyl or remifentanil.

Topics: Aged; Aged, 80 and over; Anesthesia, Local; Female; Fentanyl; Hernia, Inguinal; Humans; Male; Midazolam; Middle Aged; Monitoring, Intraoperative; Pain, Postoperative; Piperidines; Postoperative Nausea and Vomiting; Propofol; Remifentanil; Retrospective Studies

Stickler's syndrome is an autosomal multisystem disorder accompanying characteristic midface hypoplasia, retromicrognathia, and cleft palate. Mandibular hypoplasia causes difficulties in mask ventilation and endotracheal intubation, especially in infants. A 7-month-old girl diagnosed as Stickler's syndrome was scheduled for the laparoscopic inguinal hernia repair. However, during the direct laryngoscopy for endotracheal intubation, neither the vocal cords nor the epiglottis were visualized. At fifth intubation attempts, the part of the vocal cords was barely visualized, and the tracheal intubation was finaly successful. Anesthesia was maintained with sevoflurane and remifentanil. The patient had an uneventful recovery and was discharged on the second postoperative day without any complications. Sevoflurane and remifentanil allow faster recovery from anesthesia and both have been recommended for patients with difficult tracheal intubation in a patient such as with Stickler's syndrome.

Topics: Anesthesia; Cleft Palate; Face; Female; Hernia, Inguinal; Humans; Infant; Intubation, Intratracheal; Laparoscopy; Laryngoscopy; Methyl Ethers; Mouth Abnormalities; Piperidines; Remifentanil; Sevoflurane; Syndrome

We report anesthetic management of a 6-month-old boy with Menkes disease who underwent three surgeries for vesicoureteral reflux, rupture of the bladder diverticulum, inguinal hernia, and gastroesophageal reflux. Menkes disease is a rare sex-linked disorder of copper absorption and metabolism. Anesthetic management of such patients is rather challenging because of high incidence of seizures, gastroesophageal reflux with the risk of aspiration, hypothermia, airway and vascular complications. In our patient general anesthesia was uneventfully maintained by sevoflurane combined with intravenous remifentanil and fentanyl. We experienced no major complications except some difficulties with intravenous and arterial cannulation. It was especially difficult to establish intravenous and invasive blood pressure lines because of tortuous blood vessels in this patient. We conclude that in patients with Menkes disease scheduled for surgery intravenous access should be established before the induction of general anesthesia. The necessity of invasive blood pressure monitoring should be also carefully considered beforehand.

Topics: Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Catheterization, Peripheral; Fentanyl; Hernia, Inguinal; Humans; Infant; Male; Menkes Kinky Hair Syndrome; Methyl Ethers; Piperidines; Remifentanil; Sevoflurane; Urinary Bladder Diseases; Vesico-Ureteral Reflux

Topics: Adolescent; Adult; Aged; Anesthesia, General; Appendectomy; Child; Child, Preschool; Female; Gastrectomy; Hematoma, Subdural; Hernia, Inguinal; Humans; Infant; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Phencyclidine; Piperidines