piperidines and Urinary-Incontinence--Stress

Preclinical data of TAS-303 (4-piperidinyl 2,2-diphenyl-2-[propoxy-1,1,2,2,3,3,3-d

Topics: Acetates; Administration, Oral; Adrenergic Uptake Inhibitors; Adult; Area Under Curve; Asian People; Case-Control Studies; Cytochrome P-450 CYP3A; Dose-Response Relationship, Drug; Drug Tolerance; Healthy Volunteers; Humans; Male; Piperidines; Placebos; Safety; Single-Blind Method; Urinary Incontinence, Stress

Tension-free vaginal tape insertion is a recommended treatment for stress incontinence. There is evidence that intra-operative testing of continence by asking patients to cough may improve outcomes, but an optimal sedation regimen has not been determined. We prospectively evaluated the effectiveness of propofol and remifentanil infusions in 25 patients using pre- and post-sedation peak cough pressures and pain scores. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Score (ISAS). Post-sedation cough pressures were improved compared to baseline, with a mean peak pressure increase of 24 mmHg (95% CI 15.5-32.5; p < 0.001). Pain scores (median, IQR [range]) were low for local anaesthetic infiltration (0, [0-1]) and first (0, [0-1]) and second (0, [0-3.5]) needle insertions. Of the 19 patients completing the ISAS, all felt safe and satisfied. Sedation using propofol and remifentanil provides acceptable analgesia, satisfaction and effective continence testing.

Topics: Adult; Conscious Sedation; Cough; Female; Humans; Hypnotics and Sedatives; Intraoperative Care; Middle Aged; Pain Measurement; Patient Satisfaction; Piperidines; Propofol; Prospective Studies; Prosthesis Implantation; Remifentanil; Suburethral Slings; Treatment Outcome; Urinary Incontinence, Stress

Topics: Animals; Biogenic Monoamines; Biological Transport; Blood Pressure; Female; Heart Rate; Norepinephrine; Piperidines; Pressure; Rats; Rats, Sprague-Dawley; Serotonin and Noradrenaline Reuptake Inhibitors; Tissue Distribution; Urethra; Urinary Incontinence, Stress

The tension-free vaginal tape operation (TVT) is a new surgical treatment of stress urinary incontinence in women. The tape has to be placed at the level of midurethra in the left and right paraurethral canal and has to be brought up to the abdominal wall in close contact with the back of the pubic bone with a special needle instrument. The performed anesthesia is decisive for the operative success, because a sufficient analgesia is demanded and, on the other hand, the correct placement and tension of the urethral tape has to be controlled by the patient performing a stress test by coughing and pressing. In this context the opioid remifentanil seems to be specially suitable because of its pharmacologic characteristics.. In this retrospective analysis the anesthesia related data of a total of 70 patients undergoing TVT surgery with remifentanil analgesia within one year were reviewed according to their anesthesia protocols.. All patients underwent remifentanil analgesia in combination with local anesthesia. In no case the performed procedure had to be changed. In 7 cases a temporary decrease of the pulsoximetrically measured oxygen saturation to less-than-or-equal 92 % occurred, which could be treated by reduction of the infusion rate of remifentanil or by assisted ventilation. All patients were adequately able to perform the intraoperatively required stress test. 16 patients suffered from nausea and/or vomiting postoperatively.. Continuous infusion of remifentanil is suitable for the short time profound analgesia needed for the TVT operation because of the pharmacologic characteristics of remifentanil. A antiemetic prophylaxis should be performed with this analgetic regime.

Topics: Aged; Analgesia; Analgesics, Opioid; Antiemetics; Conscious Sedation; Female; Humans; Middle Aged; Piperidines; Postoperative Nausea and Vomiting; Remifentanil; Retrospective Studies; Urethra; Urinary Incontinence, Stress

Topics: Adult; Benzene Derivatives; Carboxylic Acids; Cystoscopy; Female; Flavonoids; Humans; Male; Middle Aged; Piperidines; Quaternary Ammonium Compounds; Transducers; Urethra; Urinary Bladder; Urinary Incontinence; Urinary Incontinence, Stress; Urography