Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialRemifentanil vs. alfentanil for direct laryngoscopy: a randomized study comparing two total intravenous anaesthesia techniques. TIVA for direct laryngoscopy.
The ideal anaesthesia for direct laryngoscopy is profound and yet brief. The present study sought to determine whether a new anaesthetic technique based on infusion of the ultra short-acting opioid remifentanil was superior to our routine alfentanil multiple-dose technique in terms of haemodynamic stability, stress responses and recovery. A total of 58 patients were randomized to receive propofol and either remifentanil or alfentanil as part of a total intravenous anaesthesia. ⋯ In the remifentanil group, hypotension or bradycardia requiring intervention arose in 5 (18%) and 3 patients (11%); neither response was seen in the alfentanil group. The period from the end of propofol infusion until extubation was 5 min longer in the remifentanil group (P < 0.0001), whereas the time from extubation until discharge was similar in the two groups. Thus, neither technique showed sufficient haemodynamic stability, and further studies are needed to determine optimal dosages of propofol and opioid.
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Acta Anaesthesiol Belg · Jan 2002
Review Comparative StudyPartial versus full agonists for opioid-mediated analgesia--focus on fentanyl and buprenorphine.
In contrast to other opioids, fentanyl and buprenorphine share a number of physicochemical properties that render both agents potentially suitable for transdermal delivery. However, there are significant differences between them in terms of their pharmacological profiles, as fentanyl is a full mu opioid receptor agonist capable of exerting a maximal response in certain tissues, while buprenorphine is a partial agonist unable to exert this maximum effect even at high doses. This review examines the hypothesis that partial opioid agonists would confer a number of benefits over full agonists, namely effective analgesia with a better tolerability and a lower propensity for addiction, with respect to fentanyl and buprenorphine. ⋯ Considerable data concerning buprenorphine suggest that the advantages initially espoused for partial opioid agonists are not borne out in clinical practice. Indeed, it may be postulated that full mu opioid agonists, particularly those with high selectivity and potency such as fentanyl, have a superior clinical profile and fulfill the above criteria more closely. Relative receptor binding, selectivity, potency and intrinsic efficacy of the opioids appear to be key determinants of their individual pharmacological profiles, contributing significantly to the heterogeneity of this class of analgesics.
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Acta Anaesthesiol Belg · Jan 2002
Randomized Controlled Trial Clinical TrialTOF-tube, a new protection for acceleromyography, compared with the TOF-Guard/TOF-Watch arm board.
Neuromuscular blockade monitoring at the adductor pollicis has become easier using acceleromyography. In order to guarantee a reliable analysis of its acceleration, the thumb movement has to be free and protected from external influences. To this end, we describe here-in two hand fixation- and protection-devices for use with acceleromyography. ⋯ Yet, a short and clinically irrelevant delay was observed for TOF-tube data during recovery. This was probably caused by a difference in thumb position and repositioning technique. In conclusion, the more convenient TOF-tube can be used as well as the TOF-Guard/TOF-Watch arm board in daily clinical practice.
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Desflurane use is associated with carbon monoxide production and sympathetic activation. These side effects can be eliminated taking into account certain recommendations such as closing fresh gas flow at the end of anaesthesia, regular replacement of carbon dioxide absorbents and the use of new absorbents for carbon monoxide production and opioid administration with slow increases of inspiration concentrations during desflurane initiation for sympathetic activation.