piperidines and Jaw-Cysts

To determine the median effective concentration (EC50) of remifentanil during targeted-controlled infusion for smooth tracheal extubation during emergence from total intravenous anesthesia in elderly patients.. Prospective, Dixon up-and-down method.. Postoperative emergence.. Twenty-four American Society of Anesthesiologists grade I-II female elderly patients undergoing elective jaw cyst surgery.. The EC50 of remifentanil for smooth emergence was calculated by the Dixon up-and-down method.. The EC50 and 95% confidence intervals were analyzed by probit analysis using logistic regression. Vital signs (mean arterial pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide partial pressure), postanesthesia recovery score, visual analogue pain scale, and adverse effects were monitored. Mean arterial pressure and heart rate were compared between patients with smooth extubation vs those with failed smooth extubation.. The Dixon up-and-down method showed that the EC50 of remifentanil for smooth tracheal extubation during emergency from anesthesia was 0.94 ng/mL in female elderly patients. The probit analysis showed that the EC50 of remifentanil was 0.99 ng/mL (95% confidence interval, 0.52-1.51 ng/mL). Heart rate and mean arterial pressure were significantly lower in patients with smooth extubation as compared with those with failed smooth extubation at 0 minute (at extubation) as well as 1 and 5 minutes after extubation (P< .05).. Target infusion of remifentanil at 0.94 ng/mL could effectively inhibit tracheal extubation-related cough response and cardiovascular responses in 50% of the female elderly patients without delaying recovery from anesthesia, which could ensure smooth tracheal extubation during emergence from anesthesia.

Topics: Aged; Aged, 80 and over; Airway Extubation; Anesthesia Recovery Period; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Blood Pressure; Drug Administration Schedule; Female; Heart Rate; Humans; Intubation, Intratracheal; Jaw Cysts; Piperidines; Prospective Studies; Remifentanil

This prospective randomized study, deals with neurosedation in dental treatment of 200 disabled patients and unable to cooperate, subdivided in 4 groups of 50 male only patients, with age ranging from 28 to 59 (39+/-11), ASA I-III.. The pharmaceuticals used were Midazolam (group MID) Propofol (group Prop) and Remifentanil. Midazolam and Propofol were used following a bolus-infusion sequence, both separately and in combination among themselves (MID\\PROP group), or with an opioid, Remifentanil (MID\\PROP\\REMI group). ECG, heart rate , non invasive blood pressure (NIBP), SaO(2), EtCO(2) during the procedure were monitored. Induction time, duration of the sedation, recovery time and discharge were reported.. The statistical analysis demonstrated the superiority of the PROP group for induction time in minute (3.1+/-0.5) in comparison with the MID group (10.6+/-2.1), the MID\\PROP group (4.3+/-1.3) and MID\\PROP\\REMI (3.7+/-1.2). The recovery and discharge times have confirmed the superiority of the MID\\PROP\\REMI group in comparison with the other 3 groups.. This combination proved best at leveraging the synergistic characteristics of each single pharmaceutical and minimizing the collateral effects of each individually.

Topics: Adult; Conscious Sedation; Dental Anxiety; Dental Implantation; Disabled Persons; Drug Synergism; Drug Therapy, Combination; Hemodynamics; Humans; Hypnotics and Sedatives; Infusions, Intravenous; Injections, Intravenous; Jaw Cysts; Male; Mandibular Diseases; Midazolam; Middle Aged; Oral Hygiene; Piperidines; Propofol; Prospective Studies; Psychomotor Agitation; Remifentanil; Root Canal Therapy; Tooth Extraction; Treatment Outcome