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Comparison between the Effects of Alfentanil, Lidocaine and Their Composition in Controlling the Hemodynamic Responses at the Time of Awake Extubation of Patients  [PDF]
Ali Alizadeh, Mahmoud Aghaziarati, Nasim Zarin
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.86041
Abstract: Background and aim: Instability in the hemodynamic symptoms has been common at the time of extubation in patients and the cause to create the side effects. The aim of this research was to study the effect of injection of Alfentanil, Lidocaine and their composition in reduction of side effects arising from extubation. Materials and methods: 172 patients (20 - 40 years old) that referred to Shahid Rajaee Hospital in 2014 and had been under the orthopedic surgery, were divided randomly and by using colored cards into four equal groups (43 patients in each group). Alfentanil (5 microgram/kilogram) was injected to the first group. The second group received Lidocaine (1 milligram/ kilogram). The composition of these two drugs was injected to the third group and the normal equal volume of Saline was injected to the fourth group which was the control group. The means of systolic and diastolic blood pressure, average arterial pressure and the number of heartbeat at the time of extubation were measured and registered 1, 5, 10, 15 and 20 minutes after extubation. Also, the amount of situation of bucking after extubation was registered in the groups. Results: The demographic results were similar in all groups. The mean of systolic blood pressure and number of heartbeats in the group of Alfentanil and composition of Alfentanil-Lidocaine had significant reduction (p < 0.05) in comparison with the control and Lidocaine group. The mean of diastolic blood pressure and average arterial pressure hadn’t significant difference between the control group and other groups (p > 0.05). The situation of bucking in three treatment groups had significant reduction in comparison with control group. Conclusion: Alfentanil and composition of it with Lidocaine both had caused reducing the systolic blood pressure and heartbeats.
A Comparative Study between Dexmedetomidine Alone versus Combined Low Dose of Dexmedetomidine and Lidocaine for the Hemodynamic Response to Endotracheal Extubation in Patient Undergoing Abdominal Surgery—A Prospective Randomized Controlled Study  [PDF]
El-Sayed Mohamed Abdelzaam, Ayman Mohamady Eldemrdash
Open Journal of Anesthesiology (OJAnes) , 2019, DOI: 10.4236/ojanes.2019.96011
Abstract: Background: Tracheal extubation is related to many side effects of hemodynamic, especially for patients with comorbid states. The study compared the validity of dexmedetomidine 1 μg/kg and low combination dose of dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg in softening hemodynamic stress response and estimated quality of extubation in study groups. Materials and Methods: The patients in our study, one hundred and fifty of both gender, ASA class I &II patients, aged 20 - 50 years old subject to elective abdominal operations under general anesthesia were allocated into three equal groups. Anesthetic technique was standardized. Before extubation by 10 minutes, the patients in Group N, D, and DL have given 0.9% normal Saline intravenous bolus infusion, dexmedetomidine 1 μg/kg and Dexmedetomidine 0.5 μg/kg, respectively within a 10-minute period. Before complete extubation by 90 seconds, in the three groups by syringe ten cc volumes and at time of extubation, Group N and D patients received 0.9% normal Saline intravenous bolus infusion, but in Group DL received Lidocaine 1 mg/kg then extubation completed. Heart rate (HR), Diastolic BP (DBP), Systolic BP (SBP), and Mean Arterial Pressure (MAP) were noted at baseline, at the reverse, extubation, 2, 4, 6, 8, 10 min and at the regular times after that for two hours. Extubation quality was assessed by extubation quality scale. Aldrete’s recovery score and Ramsay sedation score were also recorded and also any complications were noted and recorded. Results: All the hemodynamic parameters significantly elevated extubation and numerous periods of observation in the normal saline group than dexmedetomidine and dexmedetomidine plus Lidocaine group (p-value = 0.001). Response of tachycardia was seen in 41 (82%) in patients of N group, compared to 18 (36%) and 20 (40%) in D & DL group respectively (p = 0.001). Hypertensive response statistically significant noticed in 40 (80%) patients of N group, 9 (18%) of D group and 12 (24%) of DL group (p = 0.001). Tachycardia duration and the response of hypertension were significantly prolonged in the control group. As regards extubation quality, the three groups differed in D Groups (1.93 ± 0.57) and DL (1.51 ± 0.57) had decreased scores compared to group N (2.67 ± 0.48) modulating smoother extubation (p < 0.001). As regard to Ramsay sedation score for 25 min following incoming at PACU was Groups D (2.17 ± 0.43), DL (2.07 ± 0.35) and had raised sedation scores when compared to group N (1.93 ± 0.28) (p < 0.003). Conclusion: Low
a€ LIDOCAINE IN DENTAL SCIENCEa€  [cached]
Gaurav Solanki
International Journal of Biomedical Research , 2013, DOI: 10.7439/ijbr.v2i8.126
Abstract: General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents. Lidocaine is a local anesthetic drug used in minor dental surgery. It is also used topically to relieve itching, burning and pain from skin inflammations. Lidocaine can also be used as Topical anesthesia, Infiltration, Plexus block, Epidural block and Spinal anesthesia. A review of some patents on lidocaine is also provided that summarizes the recent technical advancements taken place in this area.
“LIDOCAINE IN DENTAL SCIENCE”
Gaurav Solanki
International Journal of Biomedical Research , 2011, DOI: 10.7439/ijbr.v2i8.126
Abstract: General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents. Lidocaine is a local anesthetic drug used in minor dental surgery. It is also used topically to relieve itching, burning and pain from skin inflammations. Lidocaine can also be used as Topical anesthesia, Infiltration, Plexus block, Epidural block and Spinal anesthesia. A review of some patents on lidocaine is also provided that summarizes the recent technical advancements taken place in this area.
Virtual Reflexes  [PDF]
Catholijn Jonker,Joost Broekens,Aske Plaat
Computer Science , 2014,
Abstract: Virtual Reality is used successfully to treat people for regular phobias. A new challenge is to develop Virtual Reality Exposure Training for social skills. Virtual actors in such systems have to show appropriate social behavior including emotions, gaze, and keeping distance. The behavior must be realistic and real-time. Current approaches consist of four steps: 1) trainee social signal detection, 2) cognitive-affective interpretation, 3) determination of the appropriate bodily responses, and 4) actuation. The "cognitive" detour of such approaches does not match the directness of human bodily reflexes and causes unrealistic responses and delay. Instead, we propose virtual reflexes as concurrent sensory-motor processes to control virtual actors. Here we present a virtual reflexes architecture, explain how emotion and cognitive modulation are embedded, detail its workings, and give an example description of an aggression training application.
PROPOFOL ALFENTANIL INTUBATION
ABDULHAMID CHOHEDRI
The Professional Medical Journal , 2004,
Abstract: Objectives: To assess the efficacy of propofol & alfentanilwithout muscle relaxant in young adults. Design: Prospective double-blind study. Setting: Shiraz University ofMedical Sciences, ( Khalili teaching hospital Shiraz Iran), Period: Aug 2002 to Apr 2003 Material andMethods: 75 non-athlete adult males scheduled for elective surgery were randomly divided to receive eithersuccinylcholine 1.5mg/kg (group S), alfentanil 40:g/kg (A-40) or alfentanil 30:g/kg (A-30) in combinationwith propofol 2.5mg/kg to induce anesthesia. Results: Hemodynamic responses and intubating conditions werecompared between the three groups. In group S marked increase in MAP and HR occurred after intubation butA-40 and A-30 patients had subtle changes (p<0.001). Intubating condition was acceptable in all patients ofgroup S and A-40, but 7 of A-30 group had significant limb movement after intubation. Conclusions:Alfentanil 40 :g/kg & propofol 2.5mg/kg could provide favourable intubating condition in young adult males.
Emergence from Anaesthesia in Supine versus Prone Position in Patients Undergoing Lumbar Laminectomy: A Study of 60 Cases  [PDF]
Priyanka Goyal,Manda Nagrale,Sandeep Joshi
ISRN Anesthesiology , 2012, DOI: 10.5402/2012/108095
Abstract: Background. Emergence in supine position in patients undergoing surgery in prone position leads to tachycardia and hypertension, coughing, and the loss of monitoring when patients are rolled to supine position at the end of surgery, aim of this prospective randomized trial was to study whether prone emergence causes less hemodynamic stimulation, coughing, and monitor disconnection compared to supine emergence in patients undergoing lumbar laminectomy. Patients and Methods. This study was conducted on 60 patients who underwent Lumbar laminectomy in prone position. Patients were anaesthetized using injected fentanyl 2?μg?kg?1, midazolam 0.1?mg?kg?1, and thiopentone 5–6?mg?kg?1 and vecuronium bromide. At the end of surgery patients were randomized into prone or supine group of 30 each. Supine group patients were rolled back and prone were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates and MAP were noted at various points of time. Coughing, vomiting, monitor disconnection if any. Results. Mean arterial pressure and heart rate were significantly higher in supine patients as compared to prone patients before and after extubation (P value < 0.05). Incidence of coughing, vomiting and monitor disconnection was highly significant in prone group than in supine group. Conclusion. Emergence and extubation in prone position can be safely performed in selected group of patients undergoing surgery in prone position. 1. Introduction Emergence from anaesthesia in supine position in patients undergoing surgery in prone position leads to hemodynamic changes in the form of tachycardia and hypertension, coughing, and loss of monitoring when patients are rolled to supine position at the end of surgery [1]. Lifting and turning of head during position change from prone to supine causes tracheal irritation because of presence of endotracheal tube, thereby precipitating cough and bronchospasm, and leads to haemodynamic changes [2, 3]. These changes may lead to increased surgical bleeding, myocardial ischemia, and increased abdominal and intracranial pressure. Various drugs like injected esmolol, [4] intracuff [5] intravenous lidocaine [3], and alpha agonist dexmedetomidine have been tried to attenuate circulatory and airway reflexes during extubation in supine position. Emergence in prone position has been found to be associated with less hemodynamic alterations, less coughing and vomiting and monitor disconnections in patients undergoing lumbar surgery [6, 7]. We have taken up this study as there are very few [8] studies that
INTUBATIONS CONDITIONS AND HOMODYNAMIC RESPONSES UNDER ANESTHESIA INDUCTION WITH THREE COMBINATION DRUGS: ALFENTANIL- MIDAZOLAM, ALFENTANIL- THIOPENTAL AND ALFENTANIL- KETAMINE  [cached]
H SOLTANI NEZHAD,M VAFABAKHSH
Journal of Research in Medical Sciences , 2000,
Abstract: Background. Administration of alfentanil followed by propofol intravenously (IV) without neuromuscular blockage for induction of anesthesia provides adaquate conditions for tracheal intubation. Other hypnotic drugs have not been thoroughly investigated in this regard. The aim of the present study was comparison of intubation conditions and hemodynamic responses of anesthesia induction with alfentanil/midazolam, alfentanil/Na thiopental and alfentanil/ ketamine. Methods. In a clinical trial study one hundred and twenty children were randomly allocated to four groups. Medication in these groups were alfentanil 40 μg/kg+ midazolam 200 μg/kg,alfentanil 40 μg/kg+Na thiopental 6 μg/kg, alfentanil 40 μg/kg+ketamin 2 mg/kg & Na thipental 6 mg/kg+suxamethonium 2 mg/kg (as control group). In all patients the ease of ventilation via face mask, jaw mobility, degree of exposure and position of vocal cords, patient's response to tracheal intubation, duration of time was needed for intubation and hemodynamic changes after intubation were assessed and recorded. Findings. There are significant differences between first three groups (interventional groups) for jaw mebility, ventilation, vocal cord visuality, vocal cord position, patient movement during laryngoscopy and mean laryngoscopy time, (P < 0.05). There is significant difference between all groups of nesdonal+alfentanil except for patient movement. There is significant difference between mean SBP and PR before and after intubation in first and third group. Conclusion. Results represent that the group of Alfentanil plus Nesdonal had a better quality of ventilation rather than two other groups. It is recommended that administration of alfentanil plus thiopental combination is preferred in cases that using muscle relaxant is contraindicated.
Proprioceptive reflexes in exodeviations  [cached]
Garg Rajiv,Menon Vimala,Prakash Prem
Indian Journal of Ophthalmology , 1988,
Abstract: The importance of non-optical ocular reflexes is being increasingly realised. The existence of proprioceptive afferents from the extra ocular muscles has been known for a long time but their contribution towards the control of eye movement is not yet clear. Ishikawa (1978) demonstrated the reverse phase reflex; movement of the eye′. The Magician′s forceps phenomenon was demonstrated by Mitsui et. al (1979) in exodeviation [2]sub . In the present study these two proprioceptive reflexes were studied in exodeviations.
Extubation failure: an outcome to be avoided
Scott K Epstein
Critical Care , 2004, DOI: 10.1186/cc2927
Abstract: The art and science of discontinuing patients from invasive mechanical ventilation continues to attract attention. The discontinuation process consists of two components: weaning (assessing the need for ventilatory support) and extubation (assessing the need for an airway). Investigators have increasingly focused on the latter component, where 5–20% of extubations may fail and require reintubation.Both unnecessarily delayed extubation and 'premature' extubation are associated with adverse outcomes. Delayed extubation is associated with increased length of stay, increased risk for ventilator-associated pneumonia, and increased mortality in brain-injured patients [1]. Conversely, reintubation (extubation failure) after planned extubation is associated with adverse outcomes, including increased hospital mortality, prolonged hospital stay, higher costs, and greater need for tracheotomy and transfer to postacute care [2-4]. Although the adverse effects of reintubation could reflect the severity of underlying illness or could result from complications during reintubation, this has not been demonstrated with multivariate analysis [2-4]. Rather, delayed timely reinstitution of ventilatory support may allow for deterioration and new organ failure, ultimately contributing to increased mortality and increased costs [5].In response to this observation, investigators have examined whether postextubation application of noninvasive ventilation (NIV) can improve outcome. Unfortunately, NIV did not improve outcome for established postextubation respiratory failure [6] and was actually associated with increased intensive care unit (ICU) mortality when used in a large cohort with early signs of extubation failure (only 10% of whom had chronic obstructive pulmonary disease) [7].Studies of extubation failure have been almost exclusively performed in academic medical centers. Hence the relevance of the study by Seymour and colleagues, who extend previous work by finding that extubation f
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