No abstract available.
Piperidines

BACKGROUND: Several methods are performed to control the pain after a laparoscopic cholecystectomy. Recently, the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods. This study was designed to evaluate the effect of the ultrasound-guided transverse abdominis plane block (US-TAP block) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. The patients in Group Control did not receive the US-TAP block. The patients in Group B(0.25) and Group B(0.5) received the US-TAP block with 0.25% and 0.5% levobupivacaine 30 ml respectively. After the general anesthesia, a bilateral US-TAP block was performed using an in-plane technique with 15 ml levobupivacaine on each side. Intraoperative use of remifentanil and postoperative demand of rescue analgesics in PACU were recorded. The postoperative verbal numerical rating scale (VNRS) was evaluated at 20, 30, and 60 min, and 6, 12, and 24 hr. Postoperative complications, including pneumoperitoneum, bleeding, infection, and sleep disturbance, were also checked. RESULTS: The intraoperative use of remifentanil, postoperative VNRS and the postoperative demand of rescue analgesics were lower in the groups receiving the US-TAP block (Group B(0.25) and Group B(0.5)) than Group Control. There were no statistically or clinically significant differences between Group B(0.25) and Group B(0.5). No complications related to the US-TAP block were observed. CONCLUSIONS: The US-TAP block with 0.25% or 0.5% levobupivacaine 30 ml (15 ml on each side) significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy.
Analgesics ; Anesthesia, General ; Bupivacaine ; Cholecystectomy, Laparoscopic ; Hemorrhage ; Humans ; Pain, Postoperative ; Piperidines ; Pneumoperitoneum ; Postoperative Complications

BACKGROUND: Ultrasound guided-interscalene brachial plexus block (US-ISBPB) becomes more popular and has higher success rate. The aim of this study was to assess the analgesic effectiveness of US-ISBPB with low dose levobupivacaine for arthroscopic shoulder surgery. METHODS: The thirty patients undergoing elective arthroscopic shoulder surgery were randomly assigned to two groups: Group B(0.5), and Group B(0.25) received ultrasound-guided ISBPB using same volume 10 ml of 0.5% levobupivacaine and 0.25% levobupivacaine, respectively. General anesthesia was standardized. All patients received continuous intra-articular infusion of a local anesthetic. Remifentanil consumption during operation, verbal numerical rating scales (VNRS) after operation were assessed. The need for rescue analgesics in post-anesthesia care unit (PACU), sleep quality, and complications were documented. RESULTS: There were no significant differences in VNRS at 20 min, 30 min, 60 min, 120 min, 8 h, 24 h after surgery, remifentanil consumption during operation, the number of patients required rescue analgesics in the PACU, sleep quality, and complication up to 24 h after surgery. CONCLUSIONS: Ultrasound-guided interscalene brachial plexus block with levobupivacaine, 10 ml of 0.5% and 0.25%, provides effective analgesia after arthroscopic shoulder surgery.
Analgesia ; Analgesics ; Anesthesia, General ; Brachial Plexus ; Bupivacaine ; Humans ; Piperidines ; Shoulder ; Weights and Measures

Effect of marcaine plus fentanyl combination for lumbar epidural anesthesia was investigated in random series of 33 patients who were undergoing lumbar discectomy. Patients received 1mg/kg marcaine with 1mcg/kg fentanyl. The volume of local anesthetic solution was calculated basing on the number of segments that needed to block: 1.5 - 1.6ml per segment. It was found that the marcaine plus fentanyl combination provided high effect (100%) on epidural anesthesia, rapid onset (7.51.8 min), long working duration (33070 min), caused milder hemodynamic changes, decreased the incidence of adverse events and produced satisfactory operating condition.
Bupivacaine ; Fentanyl ; Anesthesia, Epidural

A prospective study involved 64 patients (43 men, 21 women) aged from 20 to 62 years with lumbar disc herniation who had operated at Military Hospital 103. These patients were divided into 2 groups. Group 1 received marcaine (0.25%-0.375%) plus fentanyl, group 2 received marcaine (0.35% - 0.5%) alone for lumbar epidural anesthesia. The volume of local anesthetic solutions injected epidurally was calculated based on number of segments that had to block, with dose of 1.5 - 1.6 ml per segment. The results showed that compare with marcaine alone, the combination of marcaine and fentanyl provided better analgesic effect, faster onset and longer duration of action, caused milder hemodynamic changes, decreased the incidence of adverse effects and produced satisfactory post-operative condition
Bupivacaine ; Fentanyl ; Analgesia, Epidural

Glutethimide ; analogs & derivatives ; Humans ; Leukemia, Myeloid, Acute ; Neoadjuvant Therapy

BACKGROUND: Remifentanil is a new member of fentanyl family and a short-acting, esterase-metabolized opioid.This study compared the perioperative characteristics of a remifentanil infusion with those of fentanyl bolus administration as an adjuvant to propofol infusion for the anesthetic management of patients undergoing ureteroscopic lithotripsy. METHODS: Eighty patients were randomly assigned to receive either remifentanil target controlled infusion (R group, effect-site concentration of 4.0 ng/ml for induction followed by 2.0 ng/ml) or fentanyl bolus (F group, 2.0microgram/kg before induction).All patients received propofol infusion as the part of the induction and maintenance.We investigated recovery profiles, adverse events and the ease of insertion of laryngeal mask airway (LMA) between the two groups.Heart rate (HR) and mean blood pressure (MBP) were also compared at baseline (T0), loss of consciousness (T1), insertion of LMA (T2), beginning and end of operation (T3, T4) and removal of LMA (T5). RESULTS: The time from the end of anesthesia to spontaneous respiration, eye opening and LMA removal were significantly shorter for patients receiving remifentanil than for those receiving fentanyl.HR at T3 and T4 were lower in the R group than in the F group.Aldrete recovery score, time to discharge from recovery ward, the ease of insertion of the LMA, MAP and adverse events did not differ significantly between the two groups. CONCLUSIONS: Target controlled infusion of remifentanil combined with propofol can significantly shorten the early recovery time than fentanyl bolus administration without increasing adverse events in patients undergoing ureteroscopic lithotripsy.
Anesthesia ; Blood Pressure ; Eye ; Fentanyl ; Humans ; Laryngeal Masks ; Lithotripsy ; Piperidines ; Propofol ; Respiration ; Unconsciousness

BACKGROUND: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in combination with general anesthesia, has been investigated in several interventional studies. METHODS: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S) received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25% levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25% levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual analog scale at 1, 6, 12 and 24 hours after operation. RESULTS: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and group S (L). CONCLUSIONS: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil did not increase the pain severity and opioid requirement when performing the LC.
Analgesics ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Anesthetics, Local ; Bupivacaine ; Cholecystectomy, Laparoscopic ; Humans ; Hypogonadism ; Methyl Ethers ; Mitochondrial Diseases ; Ophthalmoplegia ; Pain, Postoperative ; Piperidines ; Surgical Instruments ; Urinary Bladder

BACKGROUND: The aim of this study was to define the optimal target concentration of remifentanil which effectively achieves conscious sedation without significant vital sign changes and side effects during spinal anesthesia. METHODS: Sixty patients underwent spinal anesthesia with 0.5% hyperbaric bupivacaine (8-16 mg), and were infused with a target controlled infusion (TCI) of remifentanil at 1.0 ng/ml (group R10, n = 15), 2.0 ng/ml (group R20, n = 15), 3.0 ng/ml (group R30, n = 15), and 3.5 ng/ml (group R35, n = 15). Observer's assessment of alertness/sedation (OAA/S) scale, the bispectral index (BIS), anxiety levels and infusion rate of remifentanil were monitored during the operation. RESULTS: OAA/S scale was significantly lower in groups R30 (3.96) and R35 (3.34) than groups R10 (4.31) and R20 (4.26). Incidence of intraoperative respiratory depression events, post operative nausea and vomiting were significantly higher in group R35 than the other groups. There were no significant differences in BIS, anxiety level and incidences of recall of the operative procedure among the groups. CONCLUSIONS: We conclude that the TCI of remifentanil at 3.0 ng/ml produces an effective sedation and anti-anxiety effects without significant side effects during spinal anesthesia.
Anesthesia, Spinal ; Anti-Anxiety Agents ; Anxiety ; Bupivacaine ; Conscious Sedation ; Humans ; Incidence ; Nausea ; Piperidines ; Respiratory Insufficiency ; Surgical Procedures, Operative ; Vital Signs ; Vomiting

The renal manifestations of systemic sclerosis include proteinuria, hypertension, azotemia, and renal crisis. Two types of scleroderma renal crisis (SRC) are recognized. Typical SRC is a syndrome consisting of acute-onset malignant hypertension accompanied by rapidly progressive renal failure, hypertensive retinopathy, and elevated plasma renin activity. The other type is normotensive renal failure, which is generally accompanied by antineutrophil cytoplasmic autoantibody (ANCA)-positive crescentic glomerulonephritis. A 51-year-old woman with scleroderma without marked dermatological change developed ANCA-related renal failure. She had neither malignant hypertension nor an elevated plasma rennin concentration. Renal biopsy showed crescentic glomerulonephritis (pauci-immune type), and the myeloperoxidase-specific ANCA (MPO-ANCA) titer was elevated at 1015 AAU. She was cured using steroid pulse therapy, combined with an angiotensin-converting-enzyme inhibitor and angiotensin-II receptor blocker
Antibodies, Antineutrophil Cytoplasmic ; Azotemia ; Biopsy ; Chymosin ; Cytoplasm ; Female ; Glomerulonephritis ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertensive Retinopathy ; Isonipecotic Acids ; Middle Aged ; Plasma ; Proteinuria ; Renal Insufficiency ; Renin ; Scleroderma, Systemic