INTRODUCTION: The depth of sedation required for patients in critical care units varies over time and should be subject to control. The clinical assessment scales used at present are inadequate, and several electroencephalographic variables have been investigated in recent years with the aim of quantifying depth of sedation. One such variable is the spectral edge frequency 90 (SEF90). OBJECTIVES: To establish the correlation between SEF90 and the Ramsay score as indicators of depth of sedation. To estimate the ability of SEF90 to predict sedation and a patient's hemodynamic response during aspiration of secretions through the orotracheal tube. PATIENTS AND METHODS: Patients in a surgical intensive care unit. The ability of SEF90 to predict a certain Ramsay score was assessed by logistic regression. We also calculated the predictive probability (Pk) of SEF90 for the appearance of hemodynamic change and of movement in the event of endotracheal aspiration. RESULTS: When SEF90 was < 16 Hz, the probability of a Ramsay score >= 4 was >= 90% (Pk = 0.91). Neither SEF90 nor the Ramsay score predicted hemodynamic response to orotracheal aspiration. CONCLUSIONS: SEF90 distinguishes superficial from deep sedation but does not differentiate further degrees of depth or the likelihood of hemodynamic instability or movement in response to aspiration.

Anesthesia↗

PubMedDate not supplied

[Complications during epilepsy surgery. Experience after 102 interventions between 1997 and 2001].

OBJECTIVES: To describe perioperative complications in different approaches to surgery for epilepsy. PATIENTS AND METHODS: All patients undergoing surgery related to epilepsy between January 1997 and December 2001 were studied. We gathered information on patient characteristics, diagnosis, anticonvulsant treatment, surgical procedure, type of anesthesia and perioperative complications. RESULTS: Ninety-eighty patients underwent 90 procedures under general anesthesia and 12 procedures with local anesthesia and sedation. Surgery was for anteromedial temporal resection in 74 patients, electrode implantation through the foramen ovale in 10 patients, extratemporal excisions in 7 patients, callosotomy in 3 patients, functional hemispherectomy in 3 patients, implantation of electrode grids in 2 patients, and craniotomy with an awake patient in 3 cases. Complications related to the surgical procedure were intraoperative bradycardia (5 cases), dural tension at the start of surgery (3), bleeding (2) and seizure (1). Complications related to anesthesia were bronchospasm (2 cases), histamine-releasing reaction upon administration of the muscle relaxant (1), and difficult intubation (1). During recovery we saw 1 case of postoperative aphasia, 1 of polyuria, 1 of pulmonary condensation, and 1 of factor VII deficit requiring plasma transfusion. CONCLUSIONS: The rate of perioperative complications in surgery for drug-resistant epilepsy is low, the most common complication being self-limiting bradycardia related to surgical maneuvers.

Adult↗

PubMedDate not supplied

[Maintenance of organ donor].

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Brain Death↗

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[Thrombosis of intrathoracic veins. A complication of venous catheterization for temporary hemodialysis].

Venous thrombosis of large vessels is a common complication, generally asymptomatic, that may occur during central venous catheterization for temporal hemodialysis. We report 2 cases of intrathoracic venous thrombosis which were suspected because of the difficulties occurring during catheterization of a new venous approach during dialysis. Both cases were diagnosed by angiography.

Aged↗

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Lack of effect of rapamycin in anti-CCP antibody production in a rheumatoid arthritis kidney allograft recipient.

Autoimmune diseases may lead to end-stage renal disease and, as a consequence, kidney transplantation. Classical immunosuppressive drugs, such as cyclosporine or corticosteroids, are well-established therapies for both transplantation and autoimmune diseases. Rapamycin is a new immunosuppressant useful for allograft transplantation and with a promising future for autoimmune diseases, although it has not been extensively studied in humans. Here the case of a patient diagnosed with rheumatoid arthritis (RA) who received a renal allograft is reported. She was started on prednisolone, azathioprine and cyclosporine immunosuppression and changed to rapamycin instead of cyclosporine 4 years after transplantation, because of chronic allograft nephropathy. At present, the patient has a functioning graft. However, the arthritis symptoms reappeared after the change in immunosuppressant. Titers of RA-specific anti-cyclic citrullinated peptides antibodies increased whereas rheumatoid factor titers decreased. This case report suggests that rapamycin used for kidney transplantation might have a different influence on the spectrum of RA autoantibodies.

Aged↗

PubMedDate not supplied

[Use of a new inotropic agent, enoximone, in heart surgery].

We report our experience with the use of enoximone in 5 patients with severely depressed preoperative myocardial function who underwent cardiac surgery. In patients 1 and 2, enoximone was administered as the inotropic of choice before cardiopulmonary bypass (CPB) and a substantial improvement of cardiac index was achieved; in these patients, enoximone administration after CPB permitted to overcome low cardiac output which persisted after high dose dobutamine in patient 1, and in patient 2 right ventricular contractility improved. In patient 3 the use of enoximone permitted the discontinuation of CPB, which had not been previously possible with the association of dopamine and dobutamine. In this patient, adrenaline perfusion improved the low cardiac output syndrome but resulted in poorly tolerated side effects. However, in patient 4 the administration of enoximone during pre-CPB did not improve in a reduction in filling pressures without an increase in the cardiac index because the patient was hypovolemic. In patient 5, the administration of enoximone permitted to interrupt the infusion of dobutamine and to reduce the dose of sodium nitroprusside, which had resulted in significant tachycardia, with increased myocardial contractility and a reduction of vascular peripheral and pulmonary resistances. We conclude that enoximone, single or in association with other inotropics, should be considered a drug of choice in patients undergoing cardiac surgery who develop a low cardiac output syndrome.

Adrenergic beta-Agonists↗

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[Comparative study of propofol and sodium thiopental in short-duration anesthesia].

We have compared propofol and sodium thiopental in two groups of 20 women undergoing curettage. Patients received premedication with diazepam and were randomly allotted to propofol group (2 mg/kg, intravenously) or sodium thiopental group (5 mg/kg, intravenously). Anesthesia maintenance was carried out with spontaneous ventilation with 0(2)-N2O. When complementary doses were required, 20% of the initial dose was administered. There were no significant differences with respect to base arterial blood pressure and heart rate on induction, 2 minutes after induction and at the end of the operation. The time from the end of the operation to the patient began to respond to the order of open eyes and to the patient was aware enough to establish a coherent talk and to seat without help was similar in both groups. Adverse effects were minor in bith groups and significantly more frequent in propofol group. We conclude that propofol is a particularly interesting new anesthetic agent for short duration anesthesia.

Adolescent↗

PubMedDate not supplied

[Comparison of intramuscular and intranasal premedication with midazolam in children].

The study involved 40 children ASA I to II type who were randomly divided into two groups of 20 patients with comparable age and sex profile. Premedication consisting of 0.2 mg/kg of midazolam (Dormicum, Roche) and 0.015 mg/kg of atropine was administered 30 to 40 min before surgical intervention by intramuscular way in one group and by intranasal in the other one. In the operating room a peripheral vein was cannulated and general anesthesia was induced with thiopental sodium and succinylcholine. Arterial blood oxygen saturation, heart rate, arterial blood pressure and respiratory rate were measured at baseline, beginning of sedation (closing eyes), and arrival at the operating room. The time at the onset of sedation, the degree of sedation at the operating room, and the reaction to the venopuncture were also measured. In both groups of patients heart rate and systolic arterial blood pressure measured at the arrival to the operating room were significantly higher than those recorded at baseline and at the onset of sedation. Diastolic blood pressure in patients with intranasal premedication increased on arrival to the operating room with respect to the sedation values. Arterial oxygen saturation significantly decreased from the baseline values in both groups at the onset of sedation and on arrival at the operating room. There were no significant changes in respiratory rate. None of the alterations had clinical consequences. There were no significant differences in the onset of sedation (12.42 +/- 4.07 min in the intramuscular group and 15.26 +/- 7.99 min in the intranasal administration), degree of sedation and response to venopunction in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗

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[Comparison of anesthesia with thiopental or etomidate in short duration operations].

Forty ASA I-II women who were scheduled for uterine curettage were randomly allotted to two groups of 20 patients each. Both groups were age- and weight- matched. They were pre-treated with atropine (0.01 mg/kg) and diazepam (0.1 mg/kg). Anesthesia was induced with 2.5% thiopental (5 mg/kg) or 0.1% etomidate (0.3 mg/kg) and was maintained with N2/O2 at 50% and isoflurane at 1% adding supplementation doses of inducer (20% of initial dose) when required. Quality of induction and maintenance of anesthesia, cardiovascular effects, secondary effects and quality and rapidity of awakening were evaluated. Etomidate patients presented a higher number of secondary effects and pain on injection of the drug (p less than 0.05) and occurrence of excitatory motions (p less than 0.01) attained statistical significance. Evaluation of anesthesia quality was significantly higher with thiopental (p less than 0.05). There were no differences with respect to the remaining studied variables. We conclude that etomidate when used as unique agent in anesthesia induction has no advantages over thiopental in healthy patients undergoing short duration operations.

Adult↗

PubMedDate not supplied

[Effect of intravenous anesthetic premedication using diazepam and fentanyl on the arterial oxygen saturation. A pulse-oximetric study].

The effects of anesthetic premedication with diazepam and phentanyl on the arterial oxyhemoglobin saturation (SpO2) were monitored with a pulsioximeter (BIOX 3700, Ohmeda) in 83 patients scheduled for traumatologic and orthopedic surgery who had baseline SpO2 higher than 95%. Premedication was carried out with phentanyl (0.1 mg) and diazepam (2.5 mg increments) until a somnolence state (eye closure), reversible with verbal stimuli, was achieved. The patients were breathing room air during the study. Premedication induced a significant reduction of SpO2 (p less than 0.001) from baseline values of 96.6 +/- 1.2% to 92.7 +/- 2.9% after sedation and to minimal values of 85.9 +/- 6.1%. In 60 patients (72.3%), minimal SpO2 was lower than 90%, and it was lower than 85% in 32 (38.8%). However, 34 of them (73.3%) recovered a SpO2 higher than 90% with verbal respiratory stimuli, but 16 (26.7%) only did so with oxygen administration. Cyanosis was not detected in any case. Minimal saturation was significantly correlated with baseline SpO2, age and smoking habit. Pulsioximetric monitoring or, if not available, routine oxygen administration, are recommended in patients undergoing pharmacological sedation.

Adolescent↗

PubMedDate not supplied

[Pulmonary edema during a cesarean].

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Adult↗