Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol.
The effectiveness of a single preinduction intravenous (IV) bolus of esmolol in blunting hemodynamic responses to rapid sequence induction and tracheal intubation was evaluated. In a randomized double-blind study, 32 ASA I and II healthy patients scheduled for surgery were monitored with electrocardiography (EKG) lead V5, arterial cannulation, and impedance cardiography. After preoxygenation and a priming dose of vecuronium (0.01 mg/kg), patients received either saline (n = 12), esmolol 100 mg (n = 10), or esmolol 200 mg (n = 10) as an IV bolus (20 ml volume). ⋯ Plasma norepinephrine levels at 1.5 minutes after intubation increased in the esmolol groups about 130% above that measured in the placebo group. This finding was associated with a more gradual return of peripheral resistance to baseline following tracheal intubation. However, both doses of esmolol effectively attenuated heart rate (HR), SP, and rate pressure product (RPP) increases (p less than 0.05 vs placebo) produced by laryngoscopy and tracheal intubation.
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Randomized Controlled Trial Clinical Trial
A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit.
The efficacy of a single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension was studied in a double-blind manner. Thirty patients from the Ambulatory Surgery Unit at Rush-Presbyterian-St. Luke's Medical Center were prospectively randomized to receive a placebo, 100 mg of esmolol, or 200 mg of esmolol immediately prior to induction (2.5 to 3.0 minutes before intubation). ⋯ The average maximum BP increase was 47% in the placebo group versus 22% and 19% in the esmolol 100 mg and esmolol 200 mg groups, respectively. There were no significant differences between the two esmolol groups. This study demonstrates the efficacy of a single bolus dose of esmolol in blunting the tachycardic and hypertensive responses to laryngoscopy and intubation in an ambulatory surgery setting.
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Administration of vecuronium by infusion is an increasingly common technique, both in the operating room and in the intensive care unit (ICU), for patients requiring prolonged neuromuscular blockade and mechanical ventilation. The major advantage of vecuronium over older neuromuscular blocking agents is its rapid excretion and intermediate duration of action. ⋯ A case of an 81-year-old patient with renal failure and subclinical chronic cirrhosis of the liver, who remained paralyzed for 13 days following a vecuronium infusion, is described. Intensive monitoring of neuromuscular function is recommended whenever muscle relaxants are administered by continuous infusion.
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Expanded outpatient surgery for pediatric patients makes it difficult to provide an unhurried and thorough preoperative visit. A useful component could be a videotape to be seen by parents at the time of their initial hospital visit. For this study, a videotape was made that included an actual induction of anesthesia procedure, information about pediatric anesthesia, and a discussion of the risks of injury or death during anesthesia. ⋯ Most parents (65%) appeared to accept discussion of the risk of perioperative death, although some had strongly negative reactions. The results suggest that a supportive preoperative tape can acquaint parents with the basis for anesthesiologists' concerns and facilitate the preoperative visit. Seeing an actual anesthetic may help to reassure parents about the anesthetic care their children will receive.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Potential toxicity from prolonged anesthesia: a case report of a thirty-hour anesthetic.
Selection of anesthetics for prolonged administration must include consideration of potential toxicity resulting from extended exposure. This report deals with a patient undergoing a 30-hour anesthetic that included nitrous oxide (N2O) and isoflurane (9.7 MAC-hours). ⋯ In addition to outlining basic care guidelines for patients undergoing a prolonged anesthetic, this report discusses potential toxicity from prolonged exposure to both N2O and isoflurane. It concludes that isoflurane can be tolerated in doses up to 10 MAC-hours without fluoride toxicity but cautions against the use of N2O for periods longer than 24 hours.