piperidines and Otitis-Media

Adults frequently develop eustachian tube dysfunction and middle ear pressure (MEP) abnormalities during natural and experimental influenza and human rhinovirus (HRV) infections. Oral rimantadine treatment did not reduce the otologic manifestations of experimental influenza in adults or natural influenza in children. However, intranasal zanamivir and oral oseltamivir significantly reduced MEP abnormalities during experimental influenza in adults, and oseltamivir treatment appears to reduce the likelihood of otitis media in children with acute influenza. Investigational anti-HRV agents, including intranasal tremacamra, intranasal AG7088, and oral pleconaril, warrant study in this regard. Depending on the virus, early antiviral therapy has the potential to impact the risk of otitis media following respiratory tract infections.

Topics: Acetamides; Adult; Anti-Bacterial Agents; Antiviral Agents; Child; Child, Preschool; Clinical Trials as Topic; Eustachian Tube; Guanidines; Humans; Infant; Influenza A virus; Influenza B virus; Influenza, Human; Interferon-beta; Oseltamivir; Otitis Media; Otitis Media with Effusion; Picornaviridae Infections; Piperidines; Pressure; Pyrans; Pyridazines; Respiratory Tract Infections; Rhinovirus; Rimantadine; Sialic Acids; Superinfection; Virus Replication; Zanamivir

Cardiac arrhythmia and bradycardia occasionally occur from the effect of inhaled anesthetic agent and opioid on cardiac conduction. We experienced a case of intermittent bradycardia-dependent bundle branch block (IBDBBB) during sevoflurane and remifentanil anesthesia. A 17-year-old woman suffering from recurrent left ottitis media was scheduled for tympanoplasty under general anesthesia. Her preoperative electrocardiogram (ECG) revealed normal sinus rhythm at heart rate (HR) of 48 beats x min(-1). Her tracheal was intubated following anesthesia induction with propofol and vecuronium, and anesthesia was maintained using inhalation of 40% oxygen with air and 1.5-2.0% sevoflurane, and continuous venous infusion of remifentanil at a rate of 0.15 microg x kg(-1) min(-1). Two hours 20 minutes after starting operation, the P-P interval was constant but the waveforms of low and broad QRS complexes appeared intermittently on the ECG monitor. The blood pressure remained stable at 95/55 mmHg and the HR decreased to 46 beats x min(-1). The waveform of pulse oxymetric oxygen saturation (Spo2) did not change. We diagnosed the ECG pattern as IBDBBB. After intravenous injection of atropine 0.5 mg, the waveforms of QRS complexes recovered to normal sinus rhythm at HR 90 beats x min(-1). Sevoflurane and remifentanil in adolescence could induce ventricular conduction disturbance and result in IBDBBB. Atropine could be effective for IBDBBB induced by sevoflurane and remifentanil.

Topics: Adolescent; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Atropine; Bundle-Branch Block; Electrocardiography; Female; Humans; Injections, Intravenous; Intraoperative Complications; Methyl Ethers; Monitoring, Intraoperative; Otitis Media; Piperidines; Remifentanil; Sevoflurane; Treatment Outcome; Tympanoplasty