Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1998
Randomized Controlled Trial Comparative Study Clinical TrialEffect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofol-alfentanil anesthesia.
Laryngomicroscopy is a short-lasting procedure, which causes considerable hemodynamic and ECG changes. Therefore it sets specific demands on anesthetic care. In this double-blind randomized work, we studied hemodynamic and ECG changes in patients during laryngomicroscopy in jet ventilation under propofol-alfentanil anesthesia with and without esmolol, a short-acting beta1-adrenergic receptor blocking agent. ⋯ No cardiac arrhythmias occurred in either of the groups. On the basis of the present study, propofol-alfentanil anesthesia combined with esmolol is a satisfactory method to meet specific demands of laryngomicroscopy in young and middle-aged ASA I-II patients. However, a combination of propofol and esmolol showed a tendency to decrease both the heart rate and arterial pressure and a caution is necessary when the combination were used in elderly patients.
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Acta Anaesthesiol Belg · Jan 1998
Randomized Controlled Trial Clinical TrialHemodynamic effects of epinephrine associated to an epidural clonidine-bupivacaïne mixture during combined lumbar epidural and general anesthesia.
Clonidine or epinephrine are frequently combined to epidural local anesthetics to strengthen sensory block and prolong analgesia. Both drugs impair the hemodynamic profile of central neural blockade but the effects of their combination on arterial pressure and heart rate are not known and were examined in this double-blind prospective randomised study. Forty four patients scheduled for lumbar disc surgery were allocated to two groups. ⋯ Combined epidural and general anesthesia induced a significant decrease in arterial pressure and heart rate in both groups. SAP and MAP decreased significantly less in the patients receiving epinephrine. Low dose epidural epinephrine decreases arterial pressure instability during combined epidural and general anesthesia.
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Acta Anaesthesiol Belg · Jan 1998
Randomized Controlled Trial Clinical TrialEffect of additional general anesthesia with propofol, midazolam or sevoflurane on stress hormone levels in hysterectomy patients, receiving epidural anesthesia.
Hormonal responses after surgery are characterized by increased pituitary-adrenal axis hormones. We undertook this study to determine whether the choice of anesthesia influences stress hormone levels. ⋯ The concentrations of beta-endorphin and aldosterone in group P and group M were significantly less than that of group S at 60 min after the incision and after extubation. We conclude that combined epidural and general anesthesia with propofol or midazolam has a greater suppressive effect than sevoflurane on the stress response of the pituitary-adrenal axis during hysterectomy.
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The unique features of remifentanil are its rapid clearance and rapid ke0, resulting in a rapid onset and offset of drug effect. It is tempting to speculate that these characteristics will make remifentanil an easy drug to titrate, and that clinicians will not need to consider patient covariates such as advanced age when choosing a dosing regimen. However, the rapid onset of drug effect may be accompanied by rapid onset of adverse events such as apnea and muscle rigidity. ⋯ By adjusting the bolus and infusion doses, the anesthesiologist can hope to avoid the peaks and valleys that might expose these patients to risk. When the proper adjustment is made, the variability in remifentanil pharmacokinetics is considerably less than for any other intravenous opioid. This makes remifentanil the most predictable opioid for treatment of the elderly.