rocuronium and Hypertension

The objective was to determine whether the use of fentanyl with ketamine for emergency department (ED) rapid sequence intubation (RSI) results in fewer patients with systolic blood pressure (SBP) measurements outside the pre-specified target range of 100-150 mm Hg following the induction of anesthesia. Methods This study was conducted in the ED of five Australian hospitals. A total of 290 participants were randomized to receive either fentanyl or 0.9% saline (placebo) in combination with ketamine and rocuronium, according to a weight-based dosing schedule. The primary outcome was the proportion of patients in each group with at least one SBP measurement outside the prespecified range of 100-150 mm Hg (with adjustment for baseline abnormality). Secondary outcomes included first-pass intubation success, hypotension, hypertension and hypoxia, mortality, and ventilator-free days 30 days following enrollment.. A total of 142 in the fentanyl group and 148 in the placebo group commenced the protocol. A total of 66% of patients receiving fentanyl and 65% of patients receiving placebo met the primary outcome (difference = 1%, 95% CI = -10 to 12). Hypotension (SBP ≤ 99 mm Hg) was more common with fentanyl (29% vs. 16%; difference = 13%, 95% CI = 3% to 23%), while hypertension (≥150 mm Hg) occurred more with placebo (69% vs. 55%; difference = 14%, 95% CI = 3 to 24). First-pass success rate, 30 day mortality, and ventilator-free days were similar.. There was no difference in the primary outcome between groups, although lower blood pressures were more common with fentanyl. Clinicians should consider baseline hemodynamics and postinduction targets when deciding whether to use fentanyl as a coinduction agent with ketamine.

Topics: Australia; Emergency Service, Hospital; Fentanyl; Humans; Hypertension; Hypotension; Intubation, Intratracheal; Ketamine; Rapid Sequence Induction and Intubation; Rocuronium

To compare 4 different anesthesia induction protocols, in a simulated model of rapid-sequence induction, in controlled hypertensive patients.. Prospective, randomized, double-blind, clinical investigation.. Large metropolitan university hospital.. 120 ASA II-III adult hypertensive patients.. Patients were allocated to 4 groups at random. After preoxygenation for 3 minutes, induction and tracheal intubation was performed in a 30 degrees head-up position. Thiopental (5-7 mg/kg) was the induction agent. Study groups were as follows: group LS (n = 30), lidocaine (1.5 mg/kg) and succinylcholine (1 mg/kg); group LR (n = 30), lidocaine (1.5 mg/kg) and rocuronium (1 mg/kg); group RS (n = 30), remifentanil (1 microg/kg) and succinylcholine (1 mg/kg); group RR (n = 30), remifentanil (1 microg/kg) and rocuronium (1 mg/kg). Patients were intubated 60 seconds after administration of muscle relaxant.. Hemodynamic data were obtained before induction (baseline), after induction, at intubation, and at 1, 3, 5, and 10 minutes after intubation. More than 20% change in blood pressure and heart rate was considered significant.. Systolic and mean arterial blood pressures at intubation and 1 and 3 minutes after intubation were higher in group LS compared with groups RS and RR (P < 0.01). Mean arterial blood pressure decreased after induction in groups LS, LR, and RR, but increased at intubation and 1 minute after intubation in groups LS and LR (P < 0.01). Mean arterial blood pressure was similar at all measurement intervals in group RS. The median area under the systolic, mean, and diastolic blood pressure time curves was higher in groups LS and LR compared with groups RS and RR (P < 0.05 and P < 0.01).. Remifentanil is a better adjunct for attenuation of the response to laryngoscopy and intubation compared with lidocaine, whereas remifentanil-succinylcholine combination appears to be more beneficial in terms of hemodynamic stability in hypertensive patients.

Topics: Analgesics, Opioid; Androstanols; Anesthesia; Anesthetics, Local; Blood Pressure; Double-Blind Method; Female; Heart Rate; Humans; Hypertension; Hypnotics and Sedatives; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Piperidines; Remifentanil; Rocuronium; Succinylcholine; Thiopental

To evaluate the blood pressure (BP) and heart rate (HR) response to tracheal intubation after vital capacity rapid inhalation induction (VCRII) with four concentrations of sevoflurane followed by nitrous oxide (N2O) 50% and sevoflurane in concentrations administered by clinical judgment.. Prospective, randomized study.. University teaching hospital.. 60 unpremedicated, ASA physical status I and II adult patients undergoing surgery with general anesthesia.. After fentanyl 3 micrograms/kg, VCRII was accomplished with four concentrations of sevoflurane in O2: Group 1 (n = 15): sevoflurane 3%; Group 2 (n = 15): sevoflurane 4%; Group 3 (n = 15): sevoflurane 5%; and Group 4 (n = 15): sevoflurane 6%. At loss of consciousness, rocuronium 0.6 mg/kg was given, and intubation was performed 90 seconds later. Thereafter, anesthesia continued with N2O 50% and sevoflurane.. BP and HR measurements were made at the ward (baseline), at loss of consciousness, and just prior to, and each minute after, tracheal intubation during a 5-minute period. The hemodynamic profile among groups was similar, with a slight hypertensive and tachycardic response to intubation.. VCRII with sevoflurane 3% to 6% following fentanyl 3 micrograms/kg can be considered for blunting the hemodynamic response to tracheal intubation in healthy patients.

Topics: Adult; Androstanols; Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Pressure; Consciousness; Female; Fentanyl; Heart Rate; Humans; Hypertension; Intubation, Intratracheal; Male; Methyl Ethers; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Prospective Studies; Rocuronium; Sevoflurane; Tachycardia; Time Factors; Vital Capacity

Following the return of spontaneous circulation after out-of-hospital cardiac arrest, neurological dysfunction, airway or ventilatory compromise can impede transport to early percutaneous coronary intervention, necessitating pre-hospital or emergency department anaesthesia to facilitate this procedure. There are no published reports of the ideal induction agents in these patients. We sought to describe haemodynamic changes associated with induction of anaesthesia using a midazolam (0.1 mg.kg

Topics: Adult; Aged; Anesthesia; Anesthetics, Intravenous; Dose-Response Relationship, Drug; Emergency Medical Services; Female; Fentanyl; Guideline Adherence; Hemodynamics; Humans; Hypertension; Hypnotics and Sedatives; Hypotension; Male; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Out-of-Hospital Cardiac Arrest; Retrospective Studies; Rocuronium

Topics: Androstanols; Anesthesia, General; Anesthetics; Drug Synergism; Female; gamma-Cyclodextrins; Humans; Hypertension; Magnesium Sulfate; Middle Aged; Myocardial Ischemia; Neuromuscular Nondepolarizing Agents; Obesity, Morbid; Rocuronium; Sugammadex

Acute angle-closure glaucoma (AACG) is a rare complication of general anesthesia. The coexistence of individual risk factors for postoperative AACG and factors associated with intraocular hypertension are considered to be required for postoperative AACG to develop. We present a case of AACG after general anesthesia for oral bone grafting in a patient with no preoperative eye symptoms. In this case, several factors such as postoperative care in a darkened room, psychological stress, and postoperative hypertension may have precipitated the event in this patient, who may have had preexisting undiagnosed elevated intraocular pressure. The interval between the earliest appearance of symptoms at 9 hours and the ultimate diagnosis was 36 hours. In the postoperative period following general anesthesia, any patient is at risk for AACG. It is important that a postoperative diagnosis of AACG should be considered and a timely consultation with an ophthalmologist be considered if a postoperative patient complains of red eyes, visual disorder, eye pain, headache, and nausea.

Topics: Alveolar Ridge Augmentation; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Darkness; Female; Fentanyl; Glaucoma, Angle-Closure; Humans; Hypertension; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Ocular Hypertension; Postoperative Complications; Postoperative Nausea and Vomiting; Propofol; Risk Factors; Rocuronium; Stress, Psychological

Sugammadex can reverse rocuronium-induced muscular relaxation by encapsulation of steroidal muscle relaxants without muscarinergic side effects. Clinical studies show effective dose-dependent reversal of neuromuscular blockades after rocuronium and vecuronium. We report on a patient with deep neuromuscular block at the end of surgery following rapid sequence induction of anesthesia with high-dose rocuronium, who could rapidly be reversed without side effects after adequate i.v. sugammadex application.

Topics: Androstanols; Anesthesia; Cholecystectomy, Laparoscopic; Contraindications; gamma-Cyclodextrins; Gastroesophageal Reflux; Humans; Hypertension; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Preanesthetic Medication; Rocuronium; Sleep Apnea, Obstructive; Succinylcholine; Sugammadex

Topics: Adrenal Gland Neoplasms; Aged, 80 and over; Androstanols; Anesthesia; Diagnosis, Differential; Female; Humans; Hypertension; Intraoperative Complications; Neuromuscular Nondepolarizing Agents; Pheochromocytoma; Rocuronium

We describe the case of a woman who had two penroperative hypertensive crises that may have been due to her use of phentermine, a little-known sympathomimetic anti-obesity medication. The currently available anti-obesity medications are discussed: phentermine, diethylpropion, and sibutramine; all of which are sympathomimetics possessing noradrenaline and serotonin reuptake inhibitor activity. These medications should be discontinued one week preoperatively and have potential interactions with tramadol and antidepressants. The drug orlistat inhibits gastrointestinal lipase and may lead to fat soluble vitamin (A, D, E, and K) deficiency, so consideration should be given to checking coagulation status preoperatively.

Topics: Alfentanil; Androstanols; Anesthesia; Anesthetics, Intravenous; Appetite Depressants; Blood Pressure; Diagnosis, Differential; Drug Interactions; Female; Fentanyl; Heart Rate; Humans; Hypertension; Hysterectomy; Intraoperative Complications; Leiomyoma; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Phentermine; Propofol; Reoperation; Rocuronium

Gordon's syndrome is a rare condition characterized by hypertension and hyperkalemia despite normal renal glomerular function. We report the administration of an anaesthetic to one such patient for an urgent surgical procedure. The patient's serum potassium was only marginally raised at the outset of the procedure. During surgery the serum potassium rose significantly, but responded to conventional management. Hyperkalaemia is a specific electrolyte disturbance that has numerous implications for the administration of an anaesthetic. Most importantly, there is a danger that further acute elevations may occur, caused by the surgery, the anaesthetic, or the condition itself

Topics: Accidents, Traffic; Androstanols; Anesthesia; Emergencies; Glomerular Filtration Rate; Humans; Hyperkalemia; Hypertension; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Potassium; Rocuronium; Syndrome