Anesthetic Induction In Patients Research Articles

Comparison of remimazolam-based and propofol-based total intravenous anesthesia on hemodynamics during anesthesia induction in patients undergoing transcatheter aortic valve replacement: a randomized controlled trial.

This study aimed to compare the hemodynamic effects of remimazolam- and propofol-based total intravenous anesthesia in patients who underwent transcatheter aortic valve replacement. This was a single-center, single-blind, randomized controlled trial set at Nara Medical University, Kashihara, Japan. We included 36 patients aged ≥ 20years scheduled to undergo elective transfemoral transcatheter aortic valve replacement (TAVR) under general anesthesia. The participants were randomly assigned to the remimazolam and propofol groups (n = 18 each). Remimazolam- or propofol-based total intravenous anesthesia was initiated at 12mg/kg/min or 2.5mcg/mL via target-controlled infusion, respectively, along with remifentanil. After confirming the loss of consciousness, the administration rate was adjusted using electroencephalographic monitoring. The primary outcome was the rate of arterial hypotension, defined as a mean arterial pressure < 60mmHg, from anesthesia induction until the beginning of the surgical incision. The total doses of ephedrine and phenylephrine were also assessed. During anesthesia induction, the arterial hypotension rates were 11.9% and 21.6% in the remimazolam and propofol groups, respectively (P = 0.01). The total dose of ephedrine was higher in the propofol group (14.4mg) than in the remimazolam group (1.6mg) (P < 0.001); however, the total dose of phenylephrine was not significantly different between the two groups (propofol 0.31mg vs. remimazolam: 0.17mg, P = 0.10). Remimazolam-based total intravenous anesthesia resulted in a lower hypotension rate than propofol-based total intravenous anesthesia during induction in patients undergoing TAVR. Remimazolam-based total intravenous anesthesia can be used safely during anesthetic induction in patients with severe aortic stenosis.

Efficacy of Single-Bolus Administration of Remimazolam During Induction of Anesthesia in Patients Undergoing Cardiac Surgery: A Prospective, Single-Center, Randomized Controlled Study.

Remimazolam is a recently marketed ultrashort-acting benzodiazepine. This drug is considered safe and effective during general anesthesia; however, limited information is available about its effects on patients undergoing cardiac surgery. Therefore, the present study was conducted to evaluate the efficacy and hemodynamic stability of a bolus administration of remimazolam during anesthesia induction in patients undergoing cardiac surgery. Patients undergoing elective cardiac surgery were randomly assigned to any 1 of the following 3 groups: anesthesia induction with a continuous infusion of remimazolam 6 mg/kg/h (continuous group), a single-bolus injection of remimazolam 0.1 mg/kg (bolus 0.1 group), or a single-bolus injection of remimazolam 0.2 mg/kg (bolus 0.2 group). Time to loss of responsiveness, defined as modified Observer's Assessment of Alertness/Sedation Scale <3, and changes in hemodynamic status during anesthetic induction were measured. Times to loss of responsiveness were 137 ± 20, 71 ± 35, and 48 ± 9 seconds in the continuous, bolus 0.1, and bolus 0.2 groups, respectively. The greatest mean difference was observed between the continuous and bolus 0.2 groups (89.0, 95% confidence interval [CI], 79.1-98.9), followed by the continuous and bolus 0.1 groups (65.8, 95% CI, 46.9-84.7), and lastly between the bolus 0.2 and bolus 0.1 groups (23.2, 95% CI, 6.6-39.8). No significant differences were found in terms of arterial blood pressures and heart rates of the patients. A single-bolus injection of remimazolam provided efficient anesthetic induction in patients undergoing cardiac surgery. A 0.2 mg/kg bolus injection of remimazolam resulted in the shortest time to loss of responsiveness among the 3 groups, without significantly altering the hemodynamic parameters. Therefore, this dosing can be considered a favorable anesthetic induction method for patients undergoing cardiac surgery.

Fasciculations and Hyperkalaemia Associated with Suxamethonium: Efficacy of Magnesium Sulphate

General anesthesia with controlled ventilation through endotracheal tube is an anaesthetic technique used by the anesthesiologists all over the world. Laryngoscopy and endotracheal intubation is necessary to achieve this technique. Traditionally succinylcholine is drug of choice for induction due to its rapid onset of action. Aim: This study compared the efficiency of magnesium sulphate in reducing fasciculation and increase in serum potassium which are the common complications associated with suxamethonium administration. Methods: Fifty six patients being planned for lower abdominal surgery under general anaesthesia were randomized into two groups M and S. Serum potassium was taken in the theatre, three minutes before induction of anesthesia patients in M group were given 6 mg/kg of magnesium sulphate diluted in 10 ml normal saline intravenously while in S group 10 ml of normal saline was injected intravenously. The occurrence and degree of fasciculation were recorded after administration of suxamethonium in both groups while serum potassium was also taken at the end of fasciculations. The researcher was blinded to the content of the syringes until after the study. Results: More patients in the S group had fasciculations compared to the M group while the degree of fasciculations was more in the S group, the serum potassium increase was more in the saline group.

A study to evaluate ocular changes in patients undergoing spine surgery in the prone position.

Background and Aims:AA present prospective study was conducted to evaluate ocular changes occurring in patients undergoing spine surgery in the prone position.Material and Methods:A total of 44 patients of either sex, belonging to American society of Anaesthesiology I and II (aged 18-60 years) scheduled for elective spine surgery in prone position were enrolled in the study. Baseline IOP and MAP measurement were taken prior to induction. After induction of anaesthesia patients were intubated using flexo-metallic tube of appropriate size. IOP and MAP were recorded after induction of anaesthesia, following completion of surgery and immediately after turning the patient supine and 30 min following extubation. Blood loss and duration of surgery was also noted. The OPP was derived using the formula (OPP = MAP-IOP). Ophthalmic examination was also performed using direct and indirect ophthalmoscopy on the day prior to surgery and on first post-operative day to rule out anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), and retinal ischemia.Results:Mean IOP significantly increased (18.91 ± 3.56 mm Hg) (P < 0.001) at the end of surgery as compared to baseline value 12.85 ± 3.07 mm Hg. As a result mean OPP significantly reduced (75.12 ± 16.45) (P = 0.0018) at the end of the procedure.Conclusion:In patient’s undergoing spine surgery in the prone position, careful patient positioning with no extrinsic pressure on the eyes, minimal surgical time and blood loss, and prevention of intraoperative hypotension, should be ensured to prevent the IOP rise and a reduction in OPP which can further prevent post-operative visual disturbance.

Effects of cranial electrotherapy stimulation on preoperative anxiety and blood pressure during anesthetic induction in patients with essential hypertension.

ObjectiveCranial electrotherapy stimulation (CES) is a non-invasive treatment that improves symptoms such as anxiety and pain. The purpose of this study was to analyze the effect of CES pretreatment on levels of preoperative anxiety, pain, and hemodynamic responses—especially changes in blood pressure—during anesthetic induction in patients with essential hypertension.MethodsEighty patients undergoing general anesthesia were randomly assigned to receive either no pretreatment (control group, n = 40) or CES pretreatment (CES group, n = 40). Anxiety scores, systolic and diastolic blood pressures, mean arterial pressure, and heart rate were measured in the general ward the evening before surgery, as well as in the preoperative holding area, operating room, and after intubation. Withdrawal responses to rocuronium injection were also measured.ResultsAnxiety scores in the operating room were significantly lower in the CES group. Withdrawal responses to rocuronium injection were also significantly lower in the CES group. There were no significant differences in hemodynamic values between the two groups.ConclusionsCES pretreatment reduces both preoperative anxiety levels and withdrawal responses to rocuronium injection. However, it does not have a significant effect on hemodynamic responses.

Laryngeal Mask Ventilation During Lumbar Spine Neurosurgery in Knee-Chest Position is Feasible.

This study describes our experience with laryngeal mask (LM) inserted after anesthetic induction in patients already in knee-chest position for lumbar neurosurgery. Airway management (need for LM repositioning, orotracheal intubation because of failed LM insertion), anticipated difficult airway, and airway complications were registered. Statistics were compared between groups with the t test or the χ test, as appropriate. A total of 358 cases were reviewed from 2008 to 2013. Tracheal intubation was performed in 108 patients and LM was chosen for 250 patients (69.8%). Intubated patients had a higher mean age and rate of anticipated difficult airway; duration of surgery was longer (P<0.001, all comparisons). LM insertion and anesthetic induction proved effective in 97.2% of the LM-ventilated patients; 7 patients (2.8%) were intubated because of persistent leakage. Incidences with airway management were resolved without compromising patient safety. LM airway management during lumbar neurosurgery in knee-chest position is feasible for selected patients when the anesthetist is experienced.

A comparative randomized study to evaluate the effect of gabapentin alone and in combination with labetalol in attenuating the pressor response to direct laryngoscopy and intubation

Background: Direct laryngoscopy and intubation are associated with the pressor response which leads to increase in blood pressure (BP) and heart rate (HR) which may be tolerated by young healthy individuals but can prove detrimental in elderly and comorbid patients. Hence, some premedication agents are administered to suppress these responses. Objectives: In this study, we compared gabapentin and combination of gabapentin and labetalol with a placebo group to study their effect on attenuation of these pressor responses. Materials and Methods: A total of 90 patients belonging to American Society of Anesthesiologists Class I and II were divided into three Groups A, B, and C of 30 patients each. 1 h before induction of anesthesia patients in Group A received gabapentin 800 mg and in Group B received 400 mg of gabapentin plus 50 mg of labetalol orally, while patients in Group C did not receive any drug and acted as control. Mean arterial pressure (MAP) and HR were recorded in all the three groups at baseline and at 0, 1, 3, 5, and 10 min after tracheal intubation. Results: Demographic characteristics were comparable in all the three groups. The baseline HR and MAP were also comparable in all the three groups and were statistically insignificant (P > 0.05). However, after tracheal intubation, there was significant increase in HR and MAP in the control Group (C), whereas in Group A and B the response was attenuated and was statistically significant (P = 0.05). Among the two study groups, BP was better attenuated by gabapentin, whereas the combination of gabapentin and labetalol abolishes HR response better. Conclusion: We conclude gabapentin alone and in combination with labetalol attenuates the hemodynamic response to laryngoscopy and intubation.

A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.

IntroductionAnesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery.Material and methodsIn a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min.ResultsThe decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03).ConclusionsWe found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia.

Pro: Pulmonary Artery Catheter Placement After Anesthetic Induction in Patients Undergoing Pulmonary Thromboendarterectomy

Pro: Pulmonary Artery Catheter Placement After Anesthetic Induction in Patients Undergoing Pulmonary Thromboendarterectomy

Efficacy of tramadol and butorphanol pretreatment in reducing pain on propofol injection: A placebo-controlled randomized study.

Background and Aims:Pain of propofol injection has been recalled by many patients as the most painful part of the induction of anesthesia. Tramadol and butorphanol are commonly used analgesics for perioperative analgesia in anesthesia practice. However, their potential to relieve propofol injection pain still needs to be explored.Material and Methods:A randomized, double-blind, placebo-controlled study was conducted on 90 American Society of Anesthesiologists I and II adult patients undergoing elective surgery under general anesthesia with propofol as an induction agent. Consecutive sampling technique with random assignment was used to allocate three groups of 30 patients each. Group I patients received an injection of normal saline 3 ml intravenously (placebo) while Group II and Group III patients received injection of tramadol 50 mg and butorphanol 1 mg intravenously, respectively. Before induction of anesthesia patients were asked about the intensity of pain on propofol injection by using visual analog scale (VAS) before the loss of consciousness. Descriptive statistics and analysis of variance with Chi-square test were used to analyze the data. The value of P < 0.05 was considered as a significant and P < 0.0001 as highly significant.Results:The incidence of pain in Group I was observed in 80% of the patients, while it was observed in 23.33% and 20% of patients in Group II and III, respectively. Mean VAS scores were 2.27 ± 1.51, 1.14 ± 1.74, and 1.03 ± 1.72 in Group I, II, and Group III patients, respectively. The incidence of pruritus was 10% and 6.7% and erythema in 13.2% and 6.7% in Group II and III, respectively.Conclusion:Pretreatment with both butorphanol and tramadol significantly reduced pain on propofol injection; however, they exhibited comparable efficacy among each other. Thus, either of these two drugs can be considered for pretreatment to reduce propofol injection pain.

Usefulness of Measuring QT Dispersion for Anesthesia and Surgical Procedures

Electrocardiography (ECG) is a useful monitoring method during anesthesia. Among the numerous ECG parameters, QT dispersion (QTd) is an indicator of instability during ventricle repolarization. According to previous reports, an increase of QTd may be occurred any patients with sympathetic instability. However, almost all such noncardiac patients have a physical status of 1 or 2 according to the American Society of Anesthesiology. Therefore, anesthesiologists should be aware whether the patient’s condition may increase QTd, and should be able to treat unexpected arrhythmia during the perioperative period. Increases in QTd occur during various perioperative anesthetic managements or surgical procedures. Several reports have indicated that stabilizing autonomic excitation with opioids, volatile anesthetics, β-blockers, or magnesium can prevent unexpected ventricular arrhythmia associated with increased QTd during anesthetic induction. Unexpected ventricular arrhythmia can occur intraoperatively during laparoscopic surgery under general anesthesia. Moreover, the QTd increases significantly before anesthetic induction in patients with major depression, and modified electroconvulsive therapy further increases the QTd. The disadvantage of QTd is that it cannot be monitored during the intraoperative period. However, anesthesiologists should understand the meaning of QTd increases, and measuring the QTd preoperatively may facilitate safe management during the perioperative period.

Gastric Tubes and Airway Management in Patients at Risk of Aspiration

Rapid sequence induction and intubation (RSII) and awake tracheal intubation are commonly used anesthetic techniques in patients at risk of pulmonary aspiration of gastric or esophageal contents. Some of these patients may have a gastric tube (GT) placed preoperatively. Currently, there are no guidelines regarding which patient should have a GT placed before anesthetic induction. Furthermore, clinicians are not in agreement as to whether to keep a GT in situ, or to partially or completely withdraw it before anesthetic induction. In this review we provide a historical perspective of the use of GTs during anesthetic induction in patients at risk of pulmonary aspiration. Before the introduction of cricoid pressure (CP) in 1961, various techniques were used including RSII combined with a head-up tilt. Sellick initially recommended the withdrawal of the GT before anesthetic induction. He hypothesized that a GT increases the risk of regurgitation and interferes with the compression of the upper esophagus during CP. He later modified his view and emphasized the safety of CP in the presence of a GT. Despite subsequent studies supporting the effectiveness of CP in occluding the esophagus around a GT, Sellick's early view has been perpetuated by investigators who recommend partial or complete withdrawal of the GT. On the basis of available information, we have formulated an algorithm for airway management in patients at risk of aspiration of gastric or esophageal contents. The approach in an individual patient depends on: the procedure; type and severity of the underlying pathology; state of consciousness; likelihood of difficult airway; whether or not the GT is in place; contraindications to the use of RSII or CP. The algorithm calls for the preanesthetic use of a large-bore GT to remove undigested food particles and awake intubation in patients with achalasia, and emptying the pouch by external pressure and avoidance of a GT in patients with Zenker diverticulum. It also stipulates that in patients with gastric distension without predictable airway difficulties, a clinical and imaging assessment will determine the need for a GT and in severe cases an attempt to insert a GT should be made. In the latter cases, the success of placement will indicate whether to use RSII or awake intubation. The GT should not be withdrawn and should be connected to suction during induction. Airway management and the use of GTs in the surgical correction of certain gastrointestinal anomalies in infants and children are discussed.

Blind versus fiberoptic laryngoscopic intubation through air Q laryngeal mask airway

BackgroundThe practice of airway management has become more advanced in recent years. This advancement is demonstrated by the introduction of many new airway devices, several of which have been included in the American Society of Anesthesiology (ASA).The most recently developed is air-Q which has special features and benefits that make it characteristic.The success rate of blind intubation versus fiberoptic intubation through air-Q was investigated in this study. Success rate and quality of fiberoptic guided intubations were assessed.MethodThis study was conducted on 80 patients who underwent urosurgical operations under general anesthesia. Patients were randomly allocated into two equal groups (n = 40): group I in which intubation was done blindly through air-Q, and group II in which intubation was done by FO through air-Q. All the patients were meticulously assessed by El Ganzouri score. Patients taking points from 0 to 4 were only allowed to be included in this study to avoid the use of the awake technique if the score was 5 or more. After induction of anesthesia patients were primarily ventilated with the air Q. Then the endotracheal tube was inserted either blindly or by FO through the air Q. Successful intubation was confirmed by chest wall movement, auscultation, and capnogram. After three trials of intubations the procedure was abandoned. Twenty-four hours post-intubation, patients were questioned on the occurrence of sore throat and hoarseness.ResultsThe success rate in blind intubation was 70% while in FO intubation was 97.5%.and this difference was statistically significant (p < 0.05). The total time to intubate in seconds was longer in group I than in group II and this difference was statistically significant (p < 0.05).ConclusionIn our patients the air Q appeared to be a safe supraglottic airway in general anesthesia with a low potential for trauma of the airway. It is used as a facilitator for blind intubation. It allowed successful blind intubation in 70% of the patients versus 97.5% using fiberoptic technique. Backed up by the presence of a flexible fiberscope, this device might be a useful alternative for the handling of difficult airway.

Dexmedetomidine can stabilize hemodynamics and spare anesthetics before cardiopulmonary bypass

We previously confirmed the effectiveness of dexmedetomidine (DEX) for stabilizing hemodynamics as well as sparing anesthetics during anesthetic induction in patients undergoing cardiac surgery (Kunisawa et al. in J Clin Anesth 21:194-199, 1). In this study, we investigated whether these effects of DEX continue until the start of cardiopulmonary bypass (CPB). Twenty-two patients with mild to moderate cardiovascular disease were randomized into two groups [DF2 group: DEX dose of 0.7 μg/kg/h after initial dose and effect-site concentration (ESC) of fentanyl of 2 ng/ml; PF4 group: saline and ESC of fentanyl of 4 ng/ml]. Propofol was administered for anesthetic induction and maintenance. Hemodynamics, cardiovascular drugs, ESC of propofol, and cardiovascular responses to skin incision (SI) and sternotomy (St) were measured or calculated. Blood pressure (BP) at the pre-/post-SI periods was higher in the DEX group (137 ± 17/140 ± 16 mmHg) than in the placebo group (85 ± 9/109 ± 24 mmHg). Percent increases in cardiovascular response to SI or St were lower in the DEX group than in the placebo group (for example, 1.9 ± 2.2 vs. 27.4 ± 19.9% in systolic BP due to SI). ESCs of propofol at SI and St in the DEX group were lower than those in the placebo group. DEX combined with 2 ng/ml fentanyl before CPB can suppress the decrease in blood pressure at the pre- and post-SI periods, can blunt the cardiovascular responses to SI and St, and can spare the required ESC of propofol despite fentanyl concentration, which was half of that in the placebo group.

Assessment of QT Interval and QT Dispersion During Electroconvulsive Therapy Using Computerized Measurements

Electroconvulsive therapy (ECT) used in the treatment of severe psychiatric disorders induces stimulation of the autonomic nervous system with initial parasympathetic outflow immediately followed by a sympathetic response. These responses induce an initial bradycardia, arrhythmias, and hypertension. QT dispersion (QTD), defined as maximal QT interval minus minimal QT interval on 12 leads of the surface electrocardiogram, reflects regional heterogeneity of ventricular repolarization. The effects of electrical stimulus due to ECT on QT interval and QTD are of considerable interest. : This study was designed to investigate the effects of electrical stimulation caused by ECT on RR interval, QT interval, the rate-corrected QT (QTc) interval, QTD, and the rate-corrected QTD (QTcD) under general anesthesia using computerized measurements. Thirty psychiatric patients scheduled for ECT were studied under propofol anesthesia. A 12-lead electrocardiogram was monitored to measure parameters. Muscle paralysis was achieved by administering succinylcholine 1 mg/kg intravenously, and the efficacy of ECT was determined by the tourniquet technique. The RR interval and QT interval decreased significantly immediately after electrical stimulus, and returned to the baseline level 1 minute after electrical stimulus. In 25 out of 30 patients, the baseline value of QTc interval was higher than the normal limits, and the QTc interval decreased significantly for 2 minutes after electrical stimulus. In 27 out of 30 patients, the baseline values of QTD and QTcD were higher than the normal limits, and the QTD and QTcD increased significantly from immediately after electrical stimulus to 5 minutes after electrical stimulus. The QTc interval, QTD, and QTcD, which were associated with increased risks of ventricular arrhythmias, increased significantly before anesthetic induction in patients with major depression. Electrical stimulus during ECT induced further increases of the QTD and QTcD.

Effects of anesthetic induction in patients with diastolic dysfunction

To evaluate the effects of anesthetic induction on bi-ventricular function in patients with known preoperative left ventricular (LV) diastolic dysfunction undergoing coronary artery bypass grafting surgery (CABG). Fifty patients with diastolic dysfunction undergoing CABG were studied. Preoperative transthoracic echocardiographic (TTE) examination was performed on the day before surgery and transesophageal echocardiography (TEE) assessment was undertaken after induction of anesthesia with sufentanil, midazolam, isoflurane, and pancuronium. Mean arterial pressure (MAP) and heart rate (HR) were recorded. The diameters of the left atrium (LA) and right atrium (RA) and right ventricular (RV) end-diastolic area (EDA), end-systolic area (ESA) and fractional area change (FAC) were obtained from the apical 4-chamber view. The LV EDA, LV ESA and LV FAC were measured from a transgastric midpapillary view. Pulsed wave Doppler of the transmitral flow (TMF) and transtricuspid flow (TTF), pulmonary venous flow (PVF) and hepatic venous flow (HVF) were measured. Mitral (Em, Am) and tricuspid (Et, At) annulus velocities were assessed by tissue Doppler imaging (TDI). Assessment of diastolic dysfunction was graded from normal to severe using a validated score. Following induction of anesthesia, HR decreased (66 +/- 12 vs 55 +/- 9 beats.min(-1), P < 0.0001) while MAP remained unchanged (86.1 +/- 9.0 vs 85.6 +/- 26.5 mmHg, P = 0.94). The diameters of the LA, RA and RV chambers increased, and these increases were associated with opposite changes in LV dimensions. The RV FAC decreased, but the LV FAC remained unchanged. While most Doppler velocities decreased (P < 0.05), a greater reduction in the atrial components of the TMF, TTF and TDI ratios was observed. The LV diastolic function score improved after induction of anesthesia (100% of patients with a score > or = = 3 pre-induction compared to 58% of patients with a score > or = 3 post-induction; P = 0.0004). In patients with left ventricular diastolic dysfunction, cardiac dimensions and bi-ventricular filling patterns are significantly altered after induction of general anesthesia. These changes can be explained to some extent by a reduction in venous return with general anesthesia, reduced atrial contractility, and the effect of positive pressure ventilation. Although the LV diastolic function score improved after induction of anesthesia, it is difficult to dissociate this effect from that of altered loading conditions.

Ketamine for treatment of catheter related bladder discomfort: a prospective, randomized, placebo controlled and double blind study

Intraoperative urinary catheterization might cause postoperative catheter related bladder discomfort (CRBD). We evaluated the efficacy of ketamine as a treatment modality for CRBD. Fifty-four, ASA physical status I and II, male and female adult patients, having CRBD after elective percutaneous nephrolithotomy were randomized into two equal groups of 27 each. In the postoperative period, patients who complained of CRBD received medication depending upon group allocation. Group 1 (Control) received placebo, Group II (Ketamine) received i.v. ketamine 250 microg kg(-1). After induction of anaesthesia patients were catheterized with a 16 Fr Foley's catheter and the balloon was inflated with 10 ml distilled water. Grading of CRBD was done as none, mild, moderate and severe by a blinded observer at 0, 1, 2 and 6 h after operation. Ketamine reduced the incidence of CRBD (P<0.001) at 2 and 6 h along with reduction in severity (P<0.05) at 1 h compared with control. Higher incidence of mild sedation was observed in the ketamine group (P<0.05) which was not associated with any untoward effects. Operative time and intraoperative fentanyl requirement were similar in both the groups. I.V. ketamine (250 microg kg(-1)) is an effective treatment for reducing the incidence and severity of postoperative CRBD.

Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study

Bladder discomfort related to intraoperative catheterization of urinary bladder is a distressing symptom and more so in patients awakening from anaesthesia. These symptoms are similar to symptoms of overactive bladder. Muscarinic receptor antagonists have been reported to be effective in the treatment of overactive bladder. This study was therefore undertaken to evaluate the efficacy of oxybutynin and tolterodine in preventing catheter related bladder discomfort. Two hundred and thirty-four consecutive adult patients, ASA I and II, of either sex, undergoing elective percutaneous nephrolithotomy surgery requiring urinary bladder catheterization were randomized into three equal groups of 78 each. Group C (control) received placebo, Group O (oxybutynin) received oxybutynin 5 mg and Group T (tolterodine) received tolterodine 2 mg orally 1 h before surgery. After induction of anaesthesia patients were catheterized with a 16 Fr Foley's catheter and the balloon was inflated with 10 ml distilled water. The bladder discomfort was assessed at 0, 1, 2 and 6 h after patient's arrival in the post-anaesthesia care unit. Severity of bladder discomfort was graded as mild, moderate and severe. Incidence of bladder discomfort observed in the control group was higher, i.e. 58% (45/78), compared with oxybutynin and tolterodine groups where it was 35% (28/78) and 33% (26/78), respectively (P<0.05). Significant reduction in the severity of bladder discomfort was also observed after oxybutynin and tolterodine therapy compared with control (P<0.05). Pretreatment with either oxybutynin or tolterodine reduces the incidence and severity of catheter related bladder discomfort.

Bronchial Aspiration in Patients After Weight Loss Due to Gastric Banding

Laparoscopic gastric banding is a surgical treatment of morbid obesity. There are no specific recommendations concerning anesthesia induction in patients having gastric banding. After recent experience of two bronchial aspirations during anesthetic induction in patients with gastric banding, we concluded that esophago-gastric peristalsis in these patients is altered. Such patients should consume only liquid meals the day before the operation, and we propose a rapid-sequence induction as the anesthetic technique. In patients with an expected difficult airway, an awake intubation may be considered.

The Effects of Thiopental and Generic and Nongeneric Propofol on Respiratory Resistance During Anesthetic Induction in Patients with Reactive Airways

Survey of Anesthesiology: August 2003 - Volume 47 - Issue 4 - p 204-205 doi: 10.1097/01.sa.0000087679.31092.88