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Ferré F, Viarnes M, Martin C, Bosch L, Bouisset F, Lhermusier T, Reina N, Lairez O, Minville V. Is preoperative balloon aortic valvuloplasty of interest for severe aortic stenosis in hip fracture surgery? Injury 2021; 52:1438-1444. [PMID: 32998825 DOI: 10.1016/j.injury.2020.09.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/16/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE In elderly patients, the discovery and management of a severe aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent and controversial issue. The objective of this study was to evaluate preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip fracture surgery. METHODS We conducted an observational, monocentric, retrospective study from 2011 to 2018. Survival (30-day, 90-day and 180-day mortality) and the occurrence of perioperative complications were analyzed and compared between control (i.e. no BAV prior to surgery) and preoperative BAV groups in patients with hip fracture surgery and a formal transthoracic echocardiographic diagnosis of severe AS (aortic valve area < 1 cm²). Patients' allocation to the intervention and control groups was after a discussion between cardiologist, anesthesiologist and the surgeon. RESULTS Among the 8506 patients who underwent hip fracture surgery, 29 patients in the control group and 30 patients in the BAV group were finally included. Kaplan-Meier survival analysis demonstrated a significant decrease in mortality in the BAV group (p=0.014) despite an increase in median time to operation of about 48 hours (p<0.0001). Multivariate analysis (stepwise logistic regression) showed that postoperative delirium (OR [95%CI]: 17.5 [1.8-168]; p=0.013) and postoperative acute congestive heart failure (OR [95%CI]: 59.4 [5.0-711.1]; p=0.0013) were predictive factors of 30-day mortality with an area under ROC curve of 0.90 (95%CI: 0.80-0.97; p<0.0001). CONCLUSIONS preoperative BAV for severe AS could reduce the mortality of hip fracture patients despite an increase in time to operation. This improved survival could be linked to the decrease in cardiologic and neurologic adverse events. A larger prospective randomized study is necessary before generalizing our results.
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Affiliation(s)
- Fabrice Ferré
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Morgane Viarnes
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Charlotte Martin
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Laetitia Bosch
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Frédéric Bouisset
- Cardiologie, Pôle cardiovasculaire et métabolique, CHU Rangueil, Toulouse, France
| | - Thibault Lhermusier
- Cardiologie, Pôle cardiovasculaire et métabolique, CHU Rangueil, Toulouse, France
| | - Nicolas Reina
- Département de chirurgie Orthopédique et Traumatologique, Hôpital Pierre-Paul Riquet, CHU Purpan, Toulouse, France
| | - Olivier Lairez
- Cardiologie, Pôle cardiovasculaire et métabolique, CHU Rangueil, Toulouse, France
| | - Vincent Minville
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France.
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Dolsan A, Bruneteau L, Roche C, Ferré F, Labaste F, Sommet A, Conil JM, Minville V. Comparison of intubating conditions after induction with propofol and remifentanil or sufentanil : Randomized controlled REMIDENT trial for surgical tooth extraction. Anaesthesist 2020; 69:262-269. [PMID: 32112114 DOI: 10.1007/s00101-020-00739-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/05/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare tracheal intubation conditions after induction of anesthesia with a bolus of propofol-sufentanil or propofol-remifentanil and a rapid induction technique. MATERIAL AND METHODS A total of 70 patients (American Society of Anesthesiologists (ASA) classification I‑II) undergoing outpatient surgery under general anesthesia with intubation for tooth extraction were randomly assigned to two groups in this double-blind study. Patients received either a bolus of remifentanil (3 μg/kg) or sufentanil (0.3 μg/kg) together with 2.5 mg/kg propofol for intubation. The primary outcome was the percentage of excellent intubation conditions and the secondary outcomes were the percentage of patients with a decrease of over 20% in mean arterial pressure (MAP) or heart rate (HR), time to achieve spontaneous respiration, time between the end of surgery and extubation and time to achieve an Aldrete score of 10. VAS pain score was >3 or having laryngeal pain 15 min after arriving in the postanesthesia care unit (PACU) were also analyzed. RESULTS Intubating conditions (perfect + good conditions) were significantly better with remifentanil than with sufentanil (88.5% vs. 68.6%; p = 0.01). When using remifentanil, the hemodynamic conditions were good. Using remifentanil did not significantly increase the pain score or the laryngeal pain in the recovery room. This was confirmed by no significant differences between the groups for morphine consumption. Remifentanil significantly decreased the time to achieve an Aldrete score of 10. CONCLUSION When intubation without muscle relaxants is required, intubating conditions are much better when a remifentanil bolus is used compared to a sufentanil bolus. The remifentanil/propofol rapid induction technique is a valuable technique to quickly intubate and achieve good conditions.
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Affiliation(s)
- A Dolsan
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - L Bruneteau
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - C Roche
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - F Ferré
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - F Labaste
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - A Sommet
- Laboratory of Medical and Clinical Pharmacology, Pharmacoepidemiology, Inserm U1027, Toulouse University, Faculty of Medicine, Toulouse, France
| | - J-M Conil
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France
| | - V Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France.
- INSERM, U1048, Université Paul Sabatier, Institute of Metabolic and Cardiovascular Diseases, I2MC, 31432, Toulouse, France.
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Naziri F, Amiri HA, Rabiee M, Banihashem N, Nejad FM, Shirkhani Z, Solimanian S. Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study. Saudi J Anaesth 2015; 9:409-12. [PMID: 26543458 PMCID: PMC4610085 DOI: 10.4103/1658-354x.159465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Endotracheal intubation is essential during general anesthesia and muscle relaxant drugs provide ideal conditions for this purpose. The objective of this study was to evaluate the intubating condition of remifentanil combined with propofol without muscle relaxant. Materials and Methods: In this prospective randomized study, 60 children aged 3-12 years, American Society of Anesthesiologists physical status I and II were included. All the children were premedicated with 0.05 mg/kg midazolam and 1.5 mg/kg lidocaine 5 min before the induction of anesthesia with 3 mg/kg propofol. Then, they were allocated randomly to receive either 2 μg/kg remifentanil (group R) or 1.5 mg/kg succinylcholine (group S). Tracheal intubation was attempted 90 s after the administration of propofol. The quality of intubation was assessed by using Copenhagen score based on jaw relaxation, ease of laryngoscopy, position of vocal cord, coughing and limb movement. Heart rate and blood pressure were recorded before and after induction, and 1, 3, 5 min after intubation. Results: There was no significant difference in intubating condition between the two groups (P = 0.11). Intubation condition was excellent in 26 of 30 (86.7%) patients in the group R compared with 30 (100%) patients in the group S. We observed significant difference in heart rate and systolic blood pressure over time between two groups (P = 0.02, P = 0.03 respectively). After intubation, we had higher heart rate and systolic blood pressure with a significant difference in group S compared with group R (P = 0.006, P = 0.018). None of the children had a chest rigidity, laryngospasm, and hypoxia. Conclusions: In premedicated children, propofol-remifentanil combination provides adequate conditions for tracheal intubation that is comparable with succinylcholine. Hemodynamic response to laryngoscopy and tracheal intubation was controlled better in group R.
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Affiliation(s)
- Freshteh Naziri
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Hakimeh Alereza Amiri
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Mozaffar Rabiee
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Nadia Banihashem
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Farhad Mohammad Nejad
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Ziba Shirkhani
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
| | - Sedigheh Solimanian
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran
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Sultan SS. Patient-controlled sedation with propofol/remifentanil versus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth 2014; 8:S36-40. [PMID: 25538518 PMCID: PMC4268525 DOI: 10.4103/1658-354x.144068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
CONTEXT Many techniques are used for sedation of colonoscopies. Patient-controlled sedation (PCS) is utilizing many drugs or drug combinations. AIMS The aim of this study is to compare the safety and feasibility of propofol/remifentanil versus propofol/alfentanil given to sedate patients undergoing outpatient colonoscopies through a patient-controlled technique. SETTINGS AND DESIGN Controlled randomized and double-blind study. MATERIALS AND METHODS A total of 80 patients were randomly divided into two groups; PA group received a combination of propofol/alfentanil and PR group received propofol/remifentanil combination. Patients were monitored for heart rate (HR), blood pressure (BP), oxygen saturation, and Ramsay sedation scale (RSS). Times of the following events were recorded; initiation of sedation, insertion and removal of the colonoscope, recovery and discharge. Five intervals were calculated; time to sedation, procedure time, postprocedure time, procedure room time, and postanesthesia care unit (PACU) time. Endoscopist and patient satisfaction scores were obtained. STATISTICAL ANALYSIS USED Unpaired Student's t-test was used to compare between the two groups. Paired Student's t-test was used to compare baseline readings with readings after 30 min of sedation in the same group when needed. RESULTS Both groups showed slowing of the HR and decrease in mean arterial BP. HR and mean arterial BP were significantly lower 5 and 10 min after initiation of sedation in PR group when compared with PA group. Both HR and mean arterial BP returned to presedation readings 30 min after initiation of sedation in PR group but not in PA group. No differences between the two groups concerning oxygen saturation, RSS, endoscopist and patient satisfaction scores. Postprocedure and PACU times were significantly prolonged in PA group. CONCLUSION PCS with either remifentanil/propofol or alfentanil/propofol for patients undergoing outpatient colonoscopy is safe and feasible. Remifentanil/proofol has more beneficial advantages in this setting secondary to its more rapid clearance.
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Affiliation(s)
- Sherif S. Sultan
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Türk HŞ, Aydoğmuş M, Ünsal O, Köksal HM, Açik ME, Oba S. Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil. Rev Bras Anestesiol 2014; 63:352-7. [PMID: 23931250 DOI: 10.1016/j.bjan.2012.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/19/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients. METHODS This prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1 μg.kg-1 fentanyl, 1 mg.kg-1 propofol in the propofol-fentanyl group (Group PF) and 10 μg.kg-1 alfentanil, 1 mg.kg-1 propofol in the propofol-alfentanil group (Group PA). Patients’ scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5 mg.kg-1 bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores. RESULTS MAP at the 15th minute in Group PA was signifi cantly higher than in Group PF (p = 0.037). Group PA’s beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was signifi cantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was signifi cantly longer than that of Group PF (p = 0.032). CONCLUSION Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.
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Affiliation(s)
- Hacer Şebnem Türk
- Şişli Etfal Training and Research Hospital, Department of Anesthesiology and Intensive Care Medicine, Istanbul, Turkey.
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Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil. Braz J Anesthesiol 2013; 63:352-7. [PMID: 24565243 DOI: 10.1016/j.bjane.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/19/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients. METHODS This prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1 μg.kg(-1) fentanyl, 1mg.kg(-1) propofol in the propofol-fentanyl group (Group PF) and 10 μg.kg(-1) alfentanil, 1mg.kg(-1) propofol in the propofol-alfentanil group (Group PA). Patients' scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5mg.kg(-1) bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores. RESULTS MAP at the 15(th) minute in Group PA was significantly higher than in Group PF (p = 0.037). Group PA's beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was significantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was significantly longer than that of Group PF (p = 0.032). CONCLUSION Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.
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Brull SJ, Kopman AF, Naguib M. Management Principles to Reduce the Risk of Residual Neuromuscular Blockade. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0014-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Magnesium sulphate: an adjuvant to tracheal intubation without muscle relaxation--a randomised study. Eur J Anaesthesiol 2012; 29:391-7. [PMID: 22717726 DOI: 10.1097/eja.0b013e328355cf35] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Tracheal intubation without administration of a neuromuscular blocking drug is used frequently in anaesthesia. Several techniques and adjuvants have been tried to improve intubating conditions. Magnesium sulphate is an agent with analgesic, anaesthetic and muscle relaxant effects. OBJECTIVE To assess the effect of magnesium sulphate on intubating conditions after induction of anaesthesia without a neuromuscular blocking drug. DESIGN Double-blinded randomised study. PATIENTS Sixty patients with American Society of Anesthesiologists physical status 1/2 scheduled for elective surgery under general anaesthesia were included. SETTING Avicenna Military Hospital between June 2010 and March 2011. INTERVENTIONS Before induction of general anaesthesia, patients were assigned to receive either a 10-min infusion of magnesium sulphate 45 mg kg(-1) in 100 ml of isotonic saline (magnesium group, n = 30) or the same volume of saline (control group, n = 30). Anaesthesia was induced with fentanyl 3 μg kg(-1) followed 3 min later by propofol 2.5 mg kg(-1). MAIN OUTCOME MEASURES Intubating conditions were evaluated by a blinded anaesthesiologist using the criteria of the Copenhagen consensus conference: ease of laryngoscopy, vocal cord position and/or movement and response to intubation or cuff inflation (cough or diaphragmatic movement). Intubating conditions were considered as acceptable (excellent or good) or unacceptable (poor). Mean arterial pressure and heart rate were also recorded during the study period. RESULTS The two groups were comparable in their demographic profiles. Clinically acceptable intubating conditions were observed more frequently in the magnesium group than in the control group: 25 (83%) vs. 18 patients (60%) (P = 0.042). There was no failed intubation. There were no differences between the groups with regard to haemodynamic variables. CONCLUSION Addition of magnesium sulphate to propofol and fentanyl at induction of anaesthesia significantly improved intubating conditions without administration of a neuromuscular blocking drug.
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Affiliation(s)
- Ronald J Gordon
- Department of Anesthesiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste. 5, San Diego, CA 92134-1005, USA.
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Tracheal Intubation Without Use of Muscle Relaxants: Comparison of Remifentanil and Alfentanil. Anesth Pain Med 2012. [DOI: 10.5812/aapm.3599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Endotracheal intubation has been performed during the administration of Propofol anaesthesia without neuromuscular blockade. In the study, we have assessed tracheal intubating conditions and haemodynamic responses in children aged 4 to12 years by using combination of either Fentanyl and Propofol; or Propofol and a neuromuscular blocker, suxamethonium. Intubating conditions were assessed on a 1-4 scale based on ease of laryngoscopy, position of vocal cords, degree of coughing and jaw relaxation. Tracheal intubation was successful in 95% of patients receiving Fentanyl-Propofol and 100% of patients receiving Propofol-suxamethonium. Fentanyl-Propofol provided better haemodynamic stability than Propofol-suxamethonium. We conclude that Propofol-Fentanyl combination could be a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or need to be avoided.
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Affiliation(s)
- Safiya I Shaikh
- Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka - 580 022, India
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Hancı V, Erdoğan G, Okyay RD, Yurtlu BS, Ayoğlu H, Baydilek Y, Turan IÖ. Effects of Fentanyl-lidocaine-propofol and Dexmedetomidine-lidocaine-propofol on Tracheal Intubation Without Use of Muscle Relaxants. Kaohsiung J Med Sci 2010; 26:244-50. [DOI: 10.1016/s1607-551x(10)70035-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 12/15/2009] [Indexed: 11/24/2022] Open
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Alvarez Gómez JA, Ariño Irujo JJ, Errando Oyonarte CL, Matínez Torrente F, Roigé i Solé J, Gilsanz Rodríguez F. [Use of neuromuscular blocking agents and reversal of blockade: guidelines from Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor]. ACTA ACUST UNITED AC 2010; 56:616-27. [PMID: 20151524 DOI: 10.1016/s0034-9356(09)70478-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J A Alvarez Gómez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Santa María del Rosell, Cartagena, Murcia
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Mohammadreza S, Azim H. Tracheal intubation without muscle relaxants: a randomized study of remifentanil or alfentanil in combination with thiopental. Ann Saudi Med 2008; 28:89-95. [PMID: 18398278 PMCID: PMC6074535 DOI: 10.5144/0256-4947.2008.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The combination of alfentanil-propofol or remifentanil-propofol provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients, but hypottension can occur during induction of anesthesia with propofol. We compared clinically acceptable intubating conditions and cardiovascular responses to induction and endotracheal intubation in patients receiving either alfentanil 40 microg/kg or remifentanil 2, 3 or 4 microg/kg, followed by thiopental 5 mg/kg. PATIENTS AND METHODS In a randomized trial, 80 patients were assigned in equal numbers to one of four groups: remifentanil 2, 3, or 4 microg/kg (groups R2, R3, R4, respectively) or alfentanil 40 microg/kg (group A40). In each group, the injection was given over 90 seconds followed by thiopental 5 mg/kg. Ninety seconds after the administration of thiopental, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, satisfactory, fair, or unsatisfactory. Arterial blood pressure and heart rate changes accompanying the four induction techniques were also recorded. RESULTS Overall conditions at intubation were significantly better (P<.05), and the frequency of excellent conditions was significantly higher (P<.05) in the R4 or A40 group compared with the R2 or R3 group. Intubating conditions were not significantly different between group R4 and A40 (P>.05). The highest dose of remifentanil (4 microg/kg) resulted in an 18.7% decrease in mean arterial pressure (MAP) after induction of anesthesia compared with a 16.4% decrease in MAP with alfentanil 40 microg/kg (difference not statistically significant). CONCLUSION The administration of remifentanil 4 I(1/4)g/kg or alfentanil 40 microg/kg before thiopental 5 mg/kg provided good to excellent conditions for endotracheal intubation with acceptable hemodynamic changes.
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Affiliation(s)
- Safavi Mohammadreza
- Department of Anesthesiology and Intensive Care Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Prakash S, Arora D, Prakash S, Bhartiya V, Singh R. A combination of fentanyl-midazolam-propofol provides better intubating conditions than fentanyl-lignocaine-propofol in the absence of neuromuscular blocking agents. Acta Anaesthesiol Scand 2006; 50:999-1004. [PMID: 16923097 DOI: 10.1111/j.1399-6576.2006.01093.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of propofol and adjuvants such as opioids, benzodiazepines and local anaesthetic agents, may provide adequate conditions for tracheal intubation without the need for neuromuscular blocking agents. In this randomized, double-blind study, intubating conditions after induction of anaesthesia with propofol, midazolam and fentanyl were compared with those after propofol, lignocaine and fentanyl. METHODS In 80 ASA I/II adult patients undergoing elective gynaecological surgery, intubating conditions were compared after induction of anaesthesia with a fentanyl 2 microg/kg, midazolam 0.03 mg/kg, propofol 2.5 mg/kg combination (group FMP) vs. a fentanyl 2 microg/kg, lignocaine 1.5 mg/kg, propofol 2.5 mg/kg combination (group FLP). Intubating conditions were assessed using a qualitative scoring system. RESULTS Intubation was successful in all patients in group FMP and in 87.5% of patients in group FLP; (P= 0.021). Overall, intubating conditions were clinically acceptable in 77.5% and 55% of patients in group FMP and group FLP, respectively (P= 0.033). CONCLUSION We conclude that the fentanyl, midazolam, propofol combination more reliably provides acceptable conditions for intubation than the fentanyl, lignocaine, propofol combination. Intubation was successful in all patients receiving the fentanyl, midazolam, propofol combination.
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Affiliation(s)
- S Prakash
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India.
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El-Orbany M. Do we really need ephedrine to improve tracheal intubating conditions? Acta Anaesthesiol Scand 2006; 50:390; author reply 390-1. [PMID: 16480479 DOI: 10.1111/j.1399-6576.2006.00957.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kovacs G, Law JA, Ross J, Tallon J, MacQuarrie K, Petrie D, Campbell S, Soder C. Acute airway management in the emergency department by non-anesthesiologists. Can J Anaesth 2004; 51:174-80. [PMID: 14766697 DOI: 10.1007/bf03018780] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed. SOURCE A narrative review of the literature on the practice of airway management by non-anesthesiologists. PRINCIPAL FINDINGS A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) is recognized as a core procedure within the domain of EM. RSI is being performed routinely by emergency physicians practicing in larger centres. Anesthesiologist support for the practice of RSI by non-anesthesiologists has been weak. Formal educational support outside of postgraduate training in the form of dedicated programs for advanced airway management are now being offered. The majority of the literature on the use of RSI by non-anesthesiologists represents retrospective case series, observational studies and registry data published in EM journals. The reported success rates for RSI performed by non-anesthesiologists is high. Complication rates are significant, however reporting consistency has been poor. CONCLUSIONS The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided.
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Affiliation(s)
- George Kovacs
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Donati F. Tracheal intubation: unconsciousness, analgesia and muscle relaxation. Can J Anaesth 2003; 50:99-103. [PMID: 12560296 DOI: 10.1007/bf03017838] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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