piperidines and Tracheal-Neoplasms

We describe anesthetic management of a patient with airway stenosis due to a tracheal tumor involving the carina. A 68-year-old man developed dyspnea and was scheduled for YAG laser surgery under general anesthesia. Awake fiberoptic intubation was selected for anesthesia induction, and percutaneous cardiopulmonary support (PCPS) was ready to be established prior to induction of anesthesia. Anesthesia was maintained with remifentanil (0.05 microg x kg(-1) x min(-1)) and propofol (2 mg x kg(-1) x hr(-1)), and spontaneous breathing was preserved throughout the surgical procedure. The operation was completed successfully without any adverse events, and PCPS was not used. In this patient, preservation of spontaneous breathing using remifentanil was found to be useful for airway management.

Topics: Aged; Airway Management; Anesthesia, General; Dyspnea; Humans; Laser Therapy; Lasers, Solid-State; Male; Piperidines; Remifentanil; Respiration; Tracheal Neoplasms; Treatment Outcome

A 22-year-old muscular karate player was diagnosed to have a tracheal tumor with a diameter of 2.8 cm that existed 2 cm under the glottis and occupied 60% of his trachea. He was scheduled for trachea resection and construction surgery. After awake-fiber intubation, anesthesia was maintained by continuous infusion of propofol and remifentanil, together with thoracic epidural anesthesia (T4-5). After 431 minutes of surgery, 50 mm of trachea was rejected. To prevent him from extending his neck, the surgeon placed stay-sutures between the patient's chin and chest wall. Twenty minutes after the termination of propofol and remifentanil infusion, the patient became awake and was extubated. Subsequently, although the body temperature was 37.6 degrees C, excessive shivering occurred and his neck was nearly extended. We immediately injected 0.8 mEq of magnesium sulfate and 70 mg of pethidine. It took almost 10 minutes to stop shivering completely, and the patient became too sedated and required noninvasive positive pressure ventilation overnight. We speculate that intraoperative remifentanil infusion induced severe shivering in this case. Shivering after remifentanil infusion can be a fatal complication in tracheal resection and construction surgery, especially in muscular patients.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Intravenous; Humans; Intraoperative Care; Intraoperative Complications; Magnesium Sulfate; Male; Martial Arts; Meperidine; Piperidines; Plastic Surgery Procedures; Remifentanil; Shivering; Trachea; Tracheal Neoplasms; Tracheotomy; Young Adult

N'-Nitrosonornicotine (NNN) and N'-nitrosoanabasine (NAB) were synthesized and injected subcutaneously three times weekly in male and female Syrian golden hamsters for 25 weeks (total dose 375 mg). N-Nitrosopiperidine (NPD) served as positive control (total dose 150 mg). Within 83 weeks 12 out of 19 hamsters given NNN had developed tracheal tumors, 1 had a carcinoma of the nasal cavity. During the same time none of the hamsters given NAB developed tumors, whereas all 20 hamsters given NPD developed tracheal tumors and about 50% had additional neoplasms in the nasal cavity. Under the described conditions and in comparison to NPD, NNN appears to be a moderately active tumorigenic agent in the upper respiratory tract of Syrian hamsters, whereas NAB is inactive.

Topics: Anabasine; Animals; Cricetinae; Female; Male; Mesocricetus; Neoplasms, Experimental; Nicotiana; Nicotine; Nitrosamines; Nose Neoplasms; Piperidines; Plants, Toxic; Smoking; Tracheal Neoplasms

Topics: Animals; Bronchial Neoplasms; Cricetinae; Epithelial Cells; Epithelium; Female; Laryngeal Neoplasms; Lethal Dose 50; Male; Microscopy, Electron, Scanning; Morpholines; Neoplasms, Experimental; Nitroso Compounds; Nose Neoplasms; Piperidines; Polyps; Respiratory Tract Neoplasms; Trachea; Tracheal Neoplasms

Topics: Animals; Carcinogens; Chemical and Drug Induced Liver Injury; Cricetinae; Dose-Response Relationship, Drug; Female; Injections, Subcutaneous; Lung Neoplasms; Male; Morpholines; Neoplasms, Experimental; Nitrosamines; Nitroso Compounds; Nitrosourea Compounds; Nose Neoplasms; Piperidines; Sarcoma; Sarcoma, Experimental; Skin Neoplasms; Stomach Neoplasms; Tracheal Neoplasms