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remifentanil in icu patient

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https://www.readbyqxmd.com/read/27871542/severe-respiratory-depression-and-bradycardia-before-induction-of-anesthesia-and-onset-of-takotsubo-cardiomyopathy-after-cardiopulmonary-resuscitation
#1
Yuko Furuichi, Ayaka Hamada, Keiko Nakazato, Katsuya Kobayashi, Atsuhiro Sakamoto
A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27867133/fiberoptic-bronchoscopy-and-remifentanil-target-controlled-infusion-in-critically-ill-patients-with-acute-hypoxaemic-respiratory-failure-a-descriptive-study
#2
Saïda Rezaiguia-Delclaux, Florent Laverdure, Talna Kortchinsky, Léa Lemasle, Audrey Imbert, François Stéphan
INTRODUCTION: Sedation optimizes patient comfort and ease of execution during fiberoptic bronchoscopy (FOB). Our objective was to describe the safety and efficacy of remifentanil-TCI during FOB in non-intubated, hypoxaemic, thoracic-surgery ICU patients. METHODS: Consecutive spontaneously breathing adults requiring FOB after thoracic surgery were included if they had hypoxaemia (PaO2/FiO2 < 300mmHg or need for non-invasive ventilation [NIV]) and prior FOB failure under topical anaesthesia...
November 17, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27793243/anesthesia-in-pregnant-women-with-hellp-syndrome-case-report
#3
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 cesarean. CASE REPORT: Female patient, 36 years old, gestational age of 24 weeks, with hypertensive crisis (BP 180/100mmHg) and severe headache, was admitted to the operating room for a cesarean section after diagnosis of HELLP syndrome...
November 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27788524/insufficient-sedation-and-severe-side-effects-after-fast-administration-of-remifentanil-during-insure-in-preterm-newborns
#4
Ellen H M de Kort, Lidwien M Hanff, Daniella Roofthooft, Irwin K M Reiss, Sinno H P Simons
BACKGROUND: Neonatal intubation is stressful and should be performed with premedication. In the case of an INSURE (intubation/surfactant/extubation) procedure a short duration of action of the premedication used is needed to facilitate fast extubation. Given its pharmacological profile, remifentanil seems a suitable candidate. OBJECTIVES: The aim here was to evaluate the effect and side effects of remifentanil as a premedication for preterm neonates undergoing INSURE...
October 28, 2016: Neonatology
https://www.readbyqxmd.com/read/27752976/pharmacogenomics-and-pharmacogenetics-for-the-intensive-care-unit-a-narrative-review
#5
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
https://www.readbyqxmd.com/read/27610299/successful-management-of-dexmedetomidine-for-postoperative-intensive-care-sedation-in-a-patient-with-anti-nmda-receptor-encephalitis-a-case-report-and-animal-experiment
#6
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
https://www.readbyqxmd.com/read/27555146/ultrashort-acting-remifentanil-is-not-superior-to-long-acting-sufentanil-in-preserving-cognitive-function-a-randomized-study
#7
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
https://www.readbyqxmd.com/read/27442676/comparison-of-the-effects-of-remifentanil-based-general-anesthesia-and-popliteal-nerve-block-on-postoperative-pain-and-hemodynamic-stability-in-diabetic-patients-undergoing-distal-foot-amputation-a-retrospective-observational-study
#8
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)
https://www.readbyqxmd.com/read/27132450/-the-influence-of-the-sedation-based-on-remifentanil-analgesia-on-the-occurrence-of-delirium-in-critically-ill-patients
#9
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
https://www.readbyqxmd.com/read/27043785/the-beneficial-effect-of-hypnosis-in-elective-cardiac-surgery-a-preliminary-study
#10
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
https://www.readbyqxmd.com/read/27041521/management-of-anesthesia-during-lung-transplantations-in-a-single-turkish-center
#11
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
https://www.readbyqxmd.com/read/27021174/remifentanil-compared-with-sufentanil-does-not-enhance-fast-track-possibilities-in-cardiac-surgery-a-randomized-study
#12
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
https://www.readbyqxmd.com/read/26874556/impact-of-different-sedation-protocols-and-perioperative-procedures-on-patients-admitted-to-the-intensive-care-unit-after-maxillofacial-tumor-surgery-of-the-lower-jaw-a-retrospective-study
#13
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
https://www.readbyqxmd.com/read/26804714/-postoperative-visual-loss-due-to-conversion-disorder-after-spine-surgery-a-case-report
#14
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
https://www.readbyqxmd.com/read/26803376/-a-first-step-towards-safer-sedation-and-analgesia-a-systematic-evaluation-of-outcomes-and-level-of-sedation-and-analgesia-in-the-mechanically-ventilated-critically-ill-patient
#15
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
https://www.readbyqxmd.com/read/26790329/-perioperative-management-of-emergency-operation-for-a-patient-with-carcinoid-syndrome
#16
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
https://www.readbyqxmd.com/read/26650950/-analgesia-sedation-and-delir-%C3%A2-treatment-of-patients-in-the-neuro-intensive-care-unit
#17
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
https://www.readbyqxmd.com/read/26442418/-acute-ventilatory-failure-during-prone-thoracoscopic-esophagectomy-with-carbon-dioxide-insufflation-in-a-patient-managed-by-a-single-lumen-tracheal-tube
#18
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
https://www.readbyqxmd.com/read/26437551/-a-biphasic-anaphylactic-attack-from-sugammadex-with-a-severe-second-attack
#19
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
https://www.readbyqxmd.com/read/26072156/impact-of-obesity-on-recovery-and-pulmonary-functions-of-obese-women-undergoing-major-abdominal-gynecological-surgeries
#20
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
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