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remifentanil in icu patient

Meghan MacKenzie, Richard Hall
PURPOSE: Knowledge of how alterations in pharmacogenomics and pharmacogenetics may affect drug therapy in the intensive care unit (ICU) has received little study. We review the clinically relevant application of pharmacogenetics and pharmacogenomics to drugs and conditions encountered in the ICU. SOURCE: We selected relevant literature to illustrate the important concepts contained within. PRINCIPAL FINDINGS: Two main approaches have been used to identify genetic abnormalities - the candidate gene approach and the genome-wide approach...
October 17, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Daiki Yamanaka, Takashi Kawano, Hiroki Tateiwa, Hideki Iwata, Fabricio M Locatelli, Masataka Yokoyama
BACKGROUND: Anti-N-methyl-d-aspartate receptor (NMDA-R) encephalitis is a recently identified but increasingly recognized autoimmune paraneoplastic disease. Because these patients present complex neuropsychiatric symptoms due to NMDA-R dysfunction, the optimal methods of sedation/anesthesia remain controversial. Here, we present animal experiment data, along with a related case report, implying the safe and effective use of dexmedetomidine in patients with anti-NMDA-R encephalitis. FINDINGS: (1) Animal experiment: in order to investigate whether dexmedetomidine may interfere with NMDA-R activity, an NMDA antagonist (MK-801) model in rats was used to simulate anti-NMDA-R encephalitis...
2016: SpringerPlus
Linda A Rasmussen, Pia K Ryhammer, Jacob Greisen, Rajesh R Bhavsar, Anne-Grethe Lorentzen, Carl-Johan Jakobsen
STUDY OBJECTIVE: Postoperative cognitive dysfunction (POCD) is a well-known complication after cardiac surgery and may cause permanent disabilities with severe consequences for quality of life. The objectives of this study were, first, to estimate the frequency of POCD after on-pump cardiac surgery in patients randomized to remifentanil- or sufentanil-based anesthesia and, second, to evaluate the association between POCD and quality of recovery and perioperative hemodynamics, respectively...
September 2016: Journal of Clinical Anesthesia
Na Young Kim, Ki-Young Lee, Sun Joon Bai, Jung Hwa Hong, Jinwoo Lee, Jong Min Park, Shin Hyung Kim
Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. This retrospective observational study aimed to compare the effects of remifentanil-based general anesthesia (GEA) and popliteal nerve block (PNB) on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation...
July 2016: Medicine (Baltimore)
Jie Lyu, Dan Liu, Youzhong An, Yi Feng
OBJECTIVE: To investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU). METHODS: A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled...
October 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Ahmet Akgul, Beyhan Guner, Musa Çırak, Derya Çelik, Oya Hergünsel, Sevim Bedirhan
Background Single-session hypnosis has never been evaluated as a premedication technique in patients undergoing coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the beneficial effects of clinical hypnotherapy on perioperative anxiety, pain perception, sedation, and necessity for ventilator assistance in patients undergoing CABG. Methods Double-blind, randomized, clinical trial was performed. Forty-four patients undergoing CABG surgery were randomized into two groups. The patients in group A received preprocedural hypnosis by an anesthesiologist...
April 4, 2016: Thoracic and Cardiovascular Surgeon
Tülin Akarsu Ayazoğlu, Aynur Ozensoy, Mehmet Dedemoğlu, Ayse Baysal, Yasar G Gul, Didem Onk, Alper Onk
AIM: The aim of this study is to present our institutional experience during the management of anesthesia in lung transplantation (LT) surgeries as a definitive surgical treatment option in end-stage lung diseases. METHODS: From a total of 15 patients, lung transplantation was performed as single LT (SLT) in 4 patients (n = 4) and as sequential bilateral LT (BLT) in 11 patients (n = 11). The anesthetic management included; for induction; intravenous ketamine, midazolam at doses of 2 mg/kg, 0...
April 2016: Archives of Iranian Medicine
Rajesh Bhavsar, Pia Katerina Ryhammer, Jacob Greisen, Linda A Rasmussen, Carl-Johan Jakobsen
OBJECTIVE: Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted. The authors hypothesized that remifentanil compared with sufentanil would reduce ventilation time and LOS in the ICU and that remifentanil would have beneficial effects on the overall quality of recovery...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Diana Lebherz-Eichinger, Bianca Tudor, Claus G Krenn, Georg A Roth, Rudolf Seemann
Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs...
April 2016: Journal of Cranio-maxillo-facial Surgery
Dailson Mamede Bezerra, Eglantine Mamede Bezerra, Antonio Jorge Silva Junior, Marco Aurélio Soares Amorim, Denismar Borges de Miranda
BACKGROUND AND OBJECTIVE: Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. CASE REPORT: A male patient, 39 years old, 71kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8...
January 21, 2016: Revista Brasileira de Anestesiologia
M J Frade-Mera, N Regueiro-Díaz, L Díaz-Castellano, L Torres-Valverde, L Alonso-Pérez, M M Landívar-Redondo, R Muñoz-Pasín, L J Terceros-Almanza, S Temprano-Vázquez, J Á Sánchez-Izquierdo-Riera
INTRODUCTION: Safe analgesia and sedation strategies are necessary in order to avoid under or over sedation, as well as improving the comfort and safety of critical care patients. OBJECTIVES: To compare and contrast a multidisciplinary protocol of systematic evaluation and management of analgesia and sedation in a group of critical care patients on mechanical ventilation with the usual procedures. MATERIALS AND METHODS: A cohort study with contemporary series was conducted in a tertiary care medical-surgical ICU February to November during 2013 and 2014...
January 20, 2016: Enfermería Intensiva
Yuri Oishi, Naoya Kawanoue, Eriko Minami, Tomoki Ishikawa, Yoshiaki Shin, Hideyuki Mieda, Mizue Ishii, Etsu Iwasaki, Tomihiro Fukushima, Hiroaki Tokioka
We report a case of carcinoid syndrome requiring an emergency operation for an upper gastrointestinal perforation. A 46-year-old man had undergone left lower lobectomy for a lung carcinoid tumor seven years previously, and liver metastasis was found five years previously. He developed cutaneous flushing and watery diarrhea, and was diagnosed with carcinoid syndrome one year previously. Although he was treated with octreotid, his symptoms became worse and he was admitted to our hospital. During the hospital stay, he underwent an emergency operation for an upper gastrointestinal perforation...
December 2015: Masui. the Japanese Journal of Anesthesiology
Christine Jungk
Analgesia and sedation of patients in the neuro intensive care unit, in particular in case of intracranial hypertension, remains a challenge even today. A goal for analgesia and sedation should be set for each individual patient (RASS -5 in case of intracranial hypertension) and should be re-evaluated repeatedly based on standardized scores (RASS plus EEG monitoring where appropriate, NCS). There are no sufficient evidence-based sedation algorithms in this patient cohort. Remifentanil, sufentanil and fentanyl have been proven safe and effective for continuous application; however, bolus application should be avoided...
November 2015: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Motoi Inoue, Masato Nakasuji, Aki Kawasaki, Miwako Nagai, Taeko Miyata, Norie Imanaka, Masuji Tanaka
A 67-year-old woman underwent prone thoracoscopic esophagectomy with carbon dioxide (CO2) insufflation. After insertion of an epidural catheter, general anesthesia was induced with propofol, sevoflurane, remifentanil and rocuronium. The trachea was intubated with a single lumen endotracheal tube (SLET). CO2 insufflation at 5 mmHg with the SLET deflated the right lung and provided excellent visualization without respiratory instability. The left side pleura was injured during the inferior mediastinal lymphadenectomy and the patient went into sudden profound hypoventilation with an increase in end-tidal CO2 from 43 to 64 mmHg...
August 2015: Masui. the Japanese Journal of Anesthesiology
Yasuo Hori, Chikako Oi, Kie Yoshimura, Hiroaki Sano, Yoko Bepu
A 74-year-old man was scheduled for transurethral resection of the prostate under general anesthesia. Anesthesia was induced by propofol, rocuronium, remifentanil and maintained with sevoflurane. The operation was finished in 56 minutes without trouble. After operation, sugammadex was administered, and after about 2 minutes, redness, tachycardia, hypotension and itchiness appeared. Treatment was initiated using steroids, adrenaline, and antihistamine upon diagnosis of anaphylaxis caused by sugammadex. Reaction to the treatment was good and the general condition improved to normal; however, the patient was moved to the intensive care unit for follow-up observation...
June 2015: Masui. the Japanese Journal of Anesthesiology
Ahmed A M Moustafa, Ibrahim A Abdelazim
To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded...
June 2016: Journal of Clinical Monitoring and Computing
Riku Aantaa, Peter Tonner, Giorgio Conti, Dan Longrois, Jean Mantz, Jan P Mulier
BACKGROUND: We offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU). DISCUSSION: Sedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing is required. Remifentanil is the preferred agent where continuous stable opioid levels using an infusion are required, because of its lack of context-sensitive accumulation...
2015: Multidisciplinary Respiratory Medicine
Mohamad Gharavi-Fard, Mehryar Taghavi-Gilani, Samira Kazemi, Majid Razavi
OBJECTIVE: Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy. METHODS: One-hundred fifty infants with post conceptional age (PCA) less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%...
April 2014: Iranian Journal of Pediatrics
Eduardo Barbin Zuccolotto, Eugenio Pagnussatt Neto, Glínia Cavalcante Nogueira, José Roberto Nociti
BACKGROUND AND OBJECTIVES: HELLP syndrome, characterized by hemolysis, high levels of liver enzyme, and low platelet count, is an advanced clinical stage of pre-eclampsia, progressing to high maternal (24%) and perinatal (up 40%) mortality, despite childbirth care in a timely manner. The goal is to describe the anesthetic management of a case with indication to emergency caesarean. CASE REPORT: Female patient, 36 years old, gestational age of 24 weeks, with hypertensive crisis (BP 180/100 mmHg) and severe headache, was admitted to the operating room for a cesarean section after diagnosis of HELLP syndrome...
November 27, 2014: Revista Brasileira de Anestesiologia
Takayuki Kunisawa, Kazuhiro Fujimoto, Atsushi Kurosawa, Michio Nagashima, Koji Matsui, Dai Hayashi, Kunihiko Yamamoto, Yuya Goto, Hiroaki Akutsu, Hiroshi Iwasaki
PURPOSE: The general dexmedetomidine (DEX) concentration required for sedation of intensive care unit patients is considered to be approximately 0.7 ng/mL. However, higher DEX concentrations are considered to be required for sedation and/or pain management after major surgery using remifentanil. We determined the DEX concentration required after major surgery by using a target-controlled infusion (TCI) system for DEX. METHODS: Fourteen patients undergoing surgery for abdominal aortic aneurysms (AAA) were randomly, double-blindly assigned to two groups and underwent fentanyl- or remifentanil-based anesthetic management...
2014: Therapeutics and Clinical Risk Management
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