piperidines and Laryngismus

To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults.. After hospital Ethics Committee approval, eighteen ASA I-II adult patients (19-65 years of age), who had been scheduled for elective ambulatory surgery were included in the study. Anaesthesia was induced with propofol 2.5mg.kg. It was found that the end-tidal concentration of desflurane was 3.17±0.18% (95% CI: 3%-3.35%) for successful extubation in 50% of adults.. Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.

Topics: Adult; Aged; Airway Extubation; Ambulatory Surgical Procedures; Anesthetics, Inhalation; Breath Tests; Cough; Cross-Over Studies; Desflurane; Female; Hemodynamics; Humans; Isoflurane; Laryngismus; Male; Middle Aged; Neuromuscular Monitoring; Piperidines; Postoperative Complications; Remifentanil; Young Adult

Topics: Analgesics, Opioid; Anaphylaxis; Anesthesiology; Anesthetics; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Child, Preschool; Drug Therapy, Combination; Humans; Hypnotics and Sedatives; Infant; Intubation, Intratracheal; Laryngismus; Lidocaine; Methyl Ethers; Neuromuscular Blocking Agents; Pediatrics; Piperidines; Propofol; Remifentanil; Sevoflurane

To compare the incidence of laryngospasm by using halothane-fentanyl anaesthesia and midazolam-remifentanil anaesthesia in paediatric patients undergoing eye surgery.. We enrolled 120 ASA physical status I children aged 7-12 years scheduled for eye surgery from March 2004 to February 2006 in this prospective clinical trial study. Children suffering from any medical condition that could affect airway reflexes such as active upper respiratory infection, symptomatic asthma, obesity, patients with predicted difficulty in tracheal intubation were not included in the study. Patients with prolonged or difficult intubation or those who received another drug before extubation were excluded from the study. Using a random numbers table, participants were allocated to two equal groups. After induction of anaesthesia, in one group Halothane 1% was administered for the maintenance of anaesthesia in addition with intravenous fentanyl 1.5 microg kg(-1), and for the patients of the other group midazolam with a dose of 0.1 mg kg(-1) and remifentanil infusion by a dose of 0.1 microg kg(-1) min(-1) was administered. The patients were extubated in a unique plan of anaesthesia, using the sign of swallowing as a clinical indicator for extubation of patients.. The incidence of laryngospasm was lower in midazolam-remifentanil group (0%) in comparison with halothane-fentanyl group (6.6%).. The results of our study suggest that remifentanil combined with midazolam in children undergoing eye surgery provided a better condition for extubation of the patients.

Topics: Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Drug Therapy, Combination; Fentanyl; Halothane; Humans; Incidence; Laryngismus; Midazolam; Ophthalmologic Surgical Procedures; Piperidines; Postoperative Complications; Postoperative Period; Remifentanil; Risk Factors

The laryngeal chemoresponse (LCR), comprising laryngeal adductor spasm, central apnea, and subsequent cardiovascular instability, is thought to be a factor in sudden infant death syndrome. A muscarinic subtype receptor, M3, appears to be involved in central respiratory drive and control. Both the duration of the LCR apnea and levels of M3 receptor messenger RNA in the brain stem change according to postnatal age. This study examined the effect of central nervous system antagonism at M3 receptors on the LCR with respect to animal age and dose of antagonist. Ten piglets in each of three age groups (group 1, 5 to 8 days; group 2, 18 to 21 days; and group 3, 40 to 43 days) received a series of four increasing doses of an M3 antagonist (p-fluoro-hexahydro-sila-diphenidol) by intracerebral ventricle injection. The LCR was evoked at baseline and after each dose of antagonist. An effect on susceptible animals (groups 1 and 2) was evident by the second antagonist dose, and persisted for the remainder of the experiment (2 hours). At completion of the experiment, mean apnea duration had decreased in group 1 (61%, p < .05), and group 2 (57%, p < .05), but was unchanged in group 3 (<10%, p not significant). Length of mean baseline apneas correlated directly with degree of apnea shortening. The reduction is not attributable to changes in arterial PO2 or PCO2 or baseline respiratory rate. These results support an age-related influence on the LCR by M3 receptors in younger animals that decreases with maturation.

Topics: Age Factors; Animals; Animals, Newborn; Apnea; Chemoreceptor Cells; Disease Models, Animal; Dose-Response Relationship, Drug; Hemodynamics; Humans; Infant, Newborn; Laryngismus; Larynx; Muscarinic Antagonists; Piperidines; Receptor, Muscarinic M3; Receptors, Muscarinic; Sudden Infant Death; Swine; Time Factors