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Anaesthetic Drugs (anaesthetic + drug)
Selected AbstractsComparison between intubation and the laryngeal mask airway in moderately obese adultsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009M. ZOREMBA Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P<0.05. Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function. [source] Constrained closed-loop control of depth of anaesthesia in the operating theatre during surgeryINTERNATIONAL JOURNAL OF ADAPTIVE CONTROL AND SIGNAL PROCESSING, Issue 5 2005M. Mahfouf Abstract The constrained version of generalized predictive control (GPC) which employs the quadratic programming (QP) approach is evaluated for on-line administration of an anaesthetic drug in the operating theatre during surgery. In the first instance, a patient simulator was developed using a physiological model of the patient and the necessary control software was validated via a series of extensive simulation experiments. Such a validated system was then transferred into the operating theatre for a series of clinical evaluation trials. The clinical trials, which were performed with little involvement of the design engineer, led to a good regulation of unconsciousness using fixed-parameters as well the adaptive version of the algorithm. Furthermore, the constrained algorithm displayed good robustness properties against disturbances such as high stimulus levels and allowed for safe and economically effective administration of the anaesthetic agent isoflurane. Copyright © 2005 John Wiley & Sons, Ltd. [source] The anaesthetic management of patients with congenital insensitivity to pain with anhidrosisPEDIATRIC ANESTHESIA, Issue 4 2004V. Rozentsveig MD Summary Background :,Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. Methods :,We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. Results :,Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. Conclusions :,Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management. [source] Polymorphism and pseudopolymorphism of salicaine and salicaine hydrochloride crystal polymorphism of local anaesthetic drugs, part VJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 5 2006A.C. Schmidt Abstract The local anaesthetic drug salicaine hydrochloride (hydroxytetracaine hydrochloride, 4-butylamino-2-hydroxybenzoic acid 2-dimethylaminoethyl ester hydrochloride, SLCHC) and the free-base salicaine (SLC) were characterized by thermal analysis, vibrational and solid-state NMR-spectroscopy, X-ray powder diffraction, X-ray single crystal structure analysis, and water vapor sorption analysis. Additionally, the crystal structures of the anhydrate mod. II° (monoclinic, space group P21/n), the hydrated mod. I (triclinic, space group ), and of the free base (SLC) in the form of the hemihydrate (triclinic, space group ) are discussed. Mod. II° of the polymorphic SLCHC is the thermodynamically stable form at room temperature and is present in commercial products mostly contaminated with a hydrated form that is isomorphic with mod. I. Mod. II° crystallizes from most organic solvents and from the melt below 110°C. Mod. I crystallizes from the melt at temperatures above 110°C, and additionally appears on dehydration of the hydrated mod. I. A third polymorph monotropically related to mod. II° was found by freeze-drying. The free-base SLC was found to crystallize from ethanol/water as a triclinic hemihydrate. © 2006 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 95:1097,1113, 2006 [source] Field evaluation of the efficacy of tolfenamic acid administered in one single preoperative injection for the prevention of postoperative pain in the dogJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2007E. GRANDEMANGE In this randomized, placebo-controlled, blinded field trial, 62 dogs (of which four were excluded) taken to a veterinary practice for orthopaedic surgery with a postoperative painful component were enrolled to assess the efficacy of a preoperative intramuscular injection of tolfenamic acid (TA) at a dose of 4 mg/kg in preventing postoperative pain. The animals were clinically examined at T1 + 1H, T1 + 4H, T1 + 24H (T1 = extubation). The efficacy results showed a statistical effect of TA in preventing postoperative pain with the evolution in the pain statistically in favour of TA treatment (Visual Analogue Scale). This was confirmed by the sum of the scores calculated at T1 + 24H that was statistically higher in the placebo group, and by the evolution in the respiratory rate, which was statistically lower in the TA-treated animals after surgery. TA treatment was very well tolerated as no clinical sign (except one isolated case of vomiting and diarrhoea, i.e. 3.5%) or change in biochemical and haematological values was observed and as no interaction with the anaesthetic drugs and with marbofloxacin was reported. [source] Prevalence of positive prick test to anaesthetic drugs in the surgical populationALLERGY, Issue 8 2006E. Tamayo Prevalence of patients with positive prick tests to anaesthetics occurred in 4.7% of the surgical population. [source] Bispectral index, predicted and measured drug levels of target-controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy and emergenceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2000S. C. Høymork Background: Target-controlled infusions (TCI) have been launched as simple, accurate and reliable delivery systems of intravenous drugs. Bispectral index of EEG (BIS) seems promising in measuring hypnotic effect of anaesthetic drugs. The aims of this study were to evaluate the accuracy of TCI systems in patients undergoing laparoscopic cholecystectomy and to correlate measured drug levels to BIS values. Data were analysed for possible gender differences during emergence. Methods: After written informed consent, 20 patients were enrolled in an open study. Remifentanil was set at 7.5 ng/ml as target throughout the whole procedure, and propofol at 5 ,g/ml at induction and 3 ,g/ml after intubation. Values in blood samples of remifentanil and propofol were correlated to the estimated values and to systolic blood pressure and BIS. BIS values and measured drug levels during emergence and emergence time were compared for the two sexes. Results: Measured drug values varied considerably from the set target with a prediction error of ,22% for remifentanil and 49% for propofol. The anaesthesia level was regarded as quite deep with a mean BIS during stable surgery of 42±7, and at this level we found no correlation between measured values of either of the two drugs and BIS. The emergence time was significantly shorter for women (12.6±2.5 min) than for men (19.0±4.2 min) (P=0.001), with no significant differences in measured levels of propofol or remifentanil or BIS during the emergence period. Conclusion: Present systems for TCI of remifentanil and propofol result in large intra- and interindividual variations in measured drug levels, and measured levels differ from target. There may be possible interaction between the two anaesthetics at a pharmacokinetic level. Within the level of anaesthesia studied here, BIS was not an indicator of the actual drug levels. Women woke up significantly faster than men. [source] Clinical assessment of a new anaesthetic drug administration system: a prospective, controlled, longitudinal incident monitoring study,ANAESTHESIA, Issue 5 2010C. S. Webster Summary A safety-orientated system of delivering parenteral anaesthetic drugs was assessed in a prospective incident monitoring study at two hospitals. Anaesthetists completed an incident form for every anaesthetic, indicating if an incident occurred. Case mix data were collected and the number of drug administrations made during procedures estimated. From February 1998 at Hospital A and from June 1999 at Hospital B, until November 2003, 74 478 anaesthetics were included, for which 59 273 incident forms were returned (a 79.6% response rate). Fewer parenteral drug errors occurred with the new system than with conventional methods (58 errors in an estimated 183 852 drug administrations (0.032%, 95% CI 0.024,0.041%) vs 268 in 550 105 (0.049%, 95% CI 0.043,0.055%) respectively, p = 0.002), a relative reduction of 35% (difference 0.017%, 95% CI 0.006,0.028%). No major adverse outcomes from these errors were reported with the new system while 11 (0.002%) were reported with conventional methods (p = 0.055). We conclude that targeted system re-design can reduce medical error. [source] Anosmia after general anaesthesia: a case reportANAESTHESIA, Issue 12 2009I. Konstantinidis Summary Although anaesthetic drugs are included among the aetiological factors of anosmia, limited reports exist of anosmia induced by general anaesthesia. We present the case of a 60-year-old female patient with a 3-month history of altered smell and taste immediately after recovery from general anaesthesia for a urological operation. The anaesthetic drugs used were fentanyl, propofol and sevoflurane. Clinical examination and a computed tomography brain scan did not reveal any pathology. Psychophysical testing showed anosmia and normal taste function. Imaging studies using single photon emission computed tomography of the brain were performed twice: as a baseline examination; and after odour stimulation with phenyl ethyl alcohol. Normal brain activity without reaction to odorous stimuli suggested peripheral dysfunction or stimuli transmission problems. The patient, after four months of olfactory retraining, demonstrated significant improvement. The onset of the dysfunction in relation with the imaging findings may imply that anaesthetics could induce the olfactory dysfunction. [source] The effect of the European Clinical Trials Directive on published drug research in anaesthesiaANAESTHESIA, Issue 9 2009E. Walker Summary The clinical indications for anaesthetic drugs are developed through peer-reviewed publication of clinical trials. We performed a bibliometric analysis of all human research papers reported in nine general anaesthesia journals over 6 years (n = 6489), to determine any effects of the 2004 European Clinical Trials Directive on reported drug research in anaesthesia originating from Europe and the United Kingdom. We found 89% studies involved patients and 11% volunteers. Of 3234 (50%) drug studies, 96% were phase IV (post-marketing) trials. Worldwide, the number of research papers fell by 3.6% (p < 0.004) in the 3 years following introduction of the European Clinical Trials Directive (5% Europe, 18% United Kingdom), and drug research papers fell by 12% (p < 0.001; 15% Europe, 29% United Kingdom). The introduction of the Clinical Trials Directive has therefore coincided with a decline in European drug research, particularly that originating from the United Kingdom. We suggest a number of measures researchers could take in response, and we propose a simplification of the application process for phase IV clinical trials, emphasising patient risk assessment. [source] Guidelines and the adoption of ,lipid rescue' therapy for local anaesthetic toxicityANAESTHESIA, Issue 2 2009J. Picard Summary Gathering evidence from animal experiments, an editorial in this journal and published human case reports culminated in the Association of Anaesthetists of Great Britain and Ireland recommending in August 2007 that lipid emulsion be immediately available to all patients given potentially cardiotoxic doses of local anaesthetic drugs. This development offered an opportunity to track the adoption of an innovation by anaesthetists in the UK and to gauge the effects of guidelines. Two surveys, each of 66 NHS hospitals delivering acute care within London and its penumbra, examined the adoption of lipid emulsion therapy. After the publication of the editorial in autumn 2006, the spread of ,lipid rescue' was rapid. The timing of the adoption and the impetus for innovation varied substantially between the sampled hospitals. When the formal guidelines were published, approximately half of the hospitals surveyed did not have lipid rescue. Of those that subsequently adopted it, half attributed their decision to the guidelines. At the end of 2007, there remained a small number of hospitals that had yet to adopt lipid rescue. Lipid rescue's adoption by anaesthetists in the UK offers a rare example of swift uptake of an innovation. National guidelines accelerated the adoption of innovation by some hospitals. [source] Convulsions following axillary brachial plexus blockade with levobupivacaineANAESTHESIA, Issue 12 2002D. Pirotta Summary Neurotoxicity manifesting as convulsions is a recognised complication of the administration of local anaesthetic drugs as part of a regional anaesthetic technique. We describe a case of self-limiting convulsions following the institution of an axillary brachial plexus block with levobupivacaine. Although the occurrence of convulsions following the administration of racemic bupivacaine is a well-recognised complication, there have been no clinical case reports published describing convulsions following the use of levobupivacaine in regional anaesthesia. [source] Pump activated by a foot switch pedal for controlled administration of local anaesthetic drugsANAESTHESIA, Issue 8 2002H. B. J. Fischer No abstract is available for this article. [source] | ||||||||||