Reversal of morphine with naloxone precipitates haloperidol-induced extrapyramidal side effects.
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Adolescent↗
Biomedical subjects
Chen-Jung Lin
Publications and source records attributed to Chen-Jung Lin.
Oxidative stress during 1-lung ventilation.
OBJECTIVES: Resuming 2-lung ventilation from 1-lung ventilation might induce a re-expansion and reoxygenation effect. The oxidative stress during 1-lung ventilation/2-lung ventilation has not been studied, although severe complications, such as re-expansion pulmonary edema, were reported. Reactive oxygen species production and total antioxidant status assay levels were measured in this study during 1-lung ventilation/2-lung ventilation. The effects on extravascular lung water, cardiac output, and intrathoracic blood volume were also studied by using the Pulsion PiCCO system. METHODS: Twenty patients undergoing 1-lung ventilation/2-lung ventilation (>60 minutes) for video-assisted thoracoscopic surgery with minimal lung injuries were included in this study. Reactive oxygen species production was measured by means of lucigenin (detecting superoxide mainly) and luminol (detecting H2O2 and HOCl mainly) chemiluminescence. Reactive oxygen species production, total antioxidant status assay (by using the Randox TAS kit), extravascular lung water, cardiac output, and intrathoracic blood volume values were measured before 1-lung ventilation (T1), before resuming 2-lung ventilation (T2), 5 minutes after 2-lung ventilation (T3), and 30 minutes after 2-lung ventilation (T4). RESULTS: One-lung ventilation time was 118 +/- 33 minutes. Lucigenin chemiluminescence (but not luminol chemiluminescence) increased significantly at T3 and T4. Total antioxidant status decreased nonsignificantly. Extravascular lung water, intrathoracic blood volume, and permeability index values changed nonsignificantly after 2-lung ventilation. Cardiac output increased significantly at T4, and there is a negative correlation between cardiac output and extravascular lung water (r = -0.431, P < .005). CONCLUSIONS: Resuming 2-lung ventilation induces a massive superoxide production. Comparable extravascular lung water and intrathoracic blood volume and a nonsignificant decrease of total antioxidant status indicate adequate antioxidant capacity to counteract it. Severe oxidative injuries after 1-lung ventilation/2-lung ventilation should be considered in patients without adequate antioxidative capacity, such as those with cancer and trauma.
Adult↗
The optimal injection time of alfentanil for blunting circulatory responses to tracheal intubation.
BACKGROUND: The aim of this study is to investigate the optimal injection time of alfentanil during induction of anesthesia to blunt the circulatory responses induced by laryngoscopy and tracheal intubation. METHODS: Seventy-five patients of ASA class I or II were randomly assigned to five groups. Group I was the placebo group in which the patients received normal saline 2 ml just before induction. Patients in groups II, III, IV and V received alfentanil 10 microg/kg at 5, 3, 1 and 0.5 min before intubation respectively. Anesthesia was maintained with 1.5% isoflurane and nitrous oxide in 50% oxygen (2:2 L/min). The patients' heart rate and blood pressure before and after intubation were documented and compared. The occurrence of adverse effects was also recorded. RESULTS: Patients' demographic data, baseline hemodynamic profile and the laryngoscopic time did not differ among the five groups. The patients in groups II, III and IV showed decreased heart rate compared with group I within 3 min after intubation. The patients in group V like those in group I did not show a reduction in heart rate 1 min after intubation. The patients in groups II, III, IV and V all showed reduced systolic blood pressure and rate-pressure product (RPP) 2 min after intubation. The occurrence of hypotension and bradycardia was not different among the five groups; hypertension and high RPP were less in groups II, III and IV as compared with group I. Ninety-three percent patients in group II and group III suffered from dizziness after alfentanil administration. One patient in group II had nausea and another one patient displayed hypoxemia after alfentanil administration. CONCLUSIONS: Considering equal effectiveness and fewer side effects, one minute before intubation is the optimal injection time of alfentanil to blunt the circulatory responses induced by laryngoscopy and tracheal intubation.
Adult↗
Differentiation of ketamine effects on renal nerve activity and renal blood flow in rats.
BACKGROUND: A biphasic pattern in the effects of increasing dose of ketamine on mean arterial blood pressure (MBP) and renal sympathetic nerve activities (RSNA) was shown in previous study. We hypothesized that if renal vascular resistance (RVR) and renal blood flow (RBF) are mainly controlled by RSNA, they will show a similar biphasic pattern under increasing doses of ketamine. METHODS: 16 female Wistar rats anesthetized with urethane were studied for ketamine at 0.5, 1, 2 mg/kg, i.v. at 30 min intervals. Multifiber RSNA recording was studied in 8 rats and RBF (by electromagnetic flowmeter) and RVR were studied in the other 8 rats with intact renal nerves. RESULTS: Our results showed that although incremental doses of ketamine brought about a biphasic pattern in MBP and RSNA, the decrease in RBF and the increase in RVR went a dose-related way. CONCLUSIONS: We concluded that there was a differentiation of ketamine effects on renal nerve activity and renal blood flow in rats. The changes of RBF and RVR can not only be attributed to the effects of sympathetic nerve activities.
Animals↗
Does the suggested lightwand bent length fit every patient? The relation between bent length and patient's thyroid prominence-to-mandibular angle distance.
BACKGROUND: To date, no study has explored the effect of bent length on lightwand intubation. For successful intubation in daily practice, the authors found that bent length should be approximated to the patient's thyroid prominence-to-mandibular angle distance (TMD), but some patients have a TMD much shorter than the suggested bent length range. The purposes of this study were to understand TMD distribution in adults and to test the influence of bent length on lightwand intubation. METHODS: The TMD, airway, and demographic data of 379 patients were collected. To test the bent length influence, patients were enrolled in group A (158 patients, TMD </= 5.5 cm) and group B (131 patients, TMD > 5.5 cm) and were intubated randomly using the lower (6.5 cm) and upper (8.5 cm) limits of the suggested range. Success rate and lightwand search time were compared. RESULTS: In group A, the success rate was 98.8% with 6.5-cm bent length and 78.2% with 8.5-cm bent length (P < 0.05). Search times were 5.7 +/- 2.90 and 8.9 +/- 5.80 s with 6.5- and 8.5-cm bent length, respectively (P < 0.01). In group B, there was no statistical difference in success rate and search time between 6.5- and 8.5-cm bent length. CONCLUSION: The suggested range was suitable for patients in group B (TMD > 5.5 cm). However, in group A (</=5.5 cm), the large discrepancy between the upper limit of the suggested range and this TMD caused difficulty in lightwand intubation. A 6.5-cm bent length is more suitable than an 8.5-cm bent length in these patients.
Adult↗
General anesthetic management for diagnostic splenectomy in a patient with paraneoplastic pemphigus.
Paraneoplastic pemphigus (PNP) is an autoantibody-mediated mucocutaneous blistering disease that often occurs with confirmed or occult malignancy. It is often accompanied by extensive eruption of respiratory mucosa and can lead to respiratory failure. The indications for anesthetic management in patients with PNP are rare due to the high risk of generating further eruption of respiratory mucosa during intubation, with potentially disastrous consequences. We report the anesthetic management in a 43-year-old woman with PNP scheduled for diagnostic splenectomy. The surgery was postponed due to persistent hoarseness, diffuse oral-pharyngeal mucositis, and laryngeal erosion. Methylprednisolone 40 mg 3 times daily was prescribed for controlling the mucosa lesions. Two weeks later, after the improvement of mucosal lesions, direct laryngoscopic intubation and the scheduled splenectomy were performed under general anesthesia. Pathology of the spleen showed low-grade B-cell lymphoma had induced PNP. Flexible fiberoptic bronchoscopic examination revealed neither bleeding nor bullae formation in the trachea either immediately after intubation or before extubation. The tracheal mucosa is highly susceptible to mechanical stimulation with direct laryngoscopic intubation. Cuff inflation and positive pressure ventilation, awareness of the disease characteristics of PNP, a sufficient course of steroid therapy beforehand, and adequate mucosal protection are essential to the uneventful anesthetic management of the patient with PNP involving the respiratory tract mucosa.
Adult↗
Intraoperative TEE monitoring on pulmonary thromboembolectomy--a case report.
We present a successful thromboembolectomy under intraoperative transesophageal echocardiography (TEE) monitoring on a woman with massive pulmonary embolism (PE). Sudden onset of dyspnea happened 7 days after lumbar spine surgery and ventilation/perfusion scan and angiography performed right away were suggestive of PE. Operation was performed 17 days later after invalid anticoagulant treatments and unavailing catheter fragmentation. Intraoperative TEE showed massive emboli in the main and right pulmonary arteries (MPA and RPA) and dilated right atrium (RA) with deviated intraatrial septum. Removal of the emboli was performed smoothly under TEE monitoring. The dilation of RA, right ventricle (RV) and PA were resolved soon after thromboembolectomy. The patient was extubated the next day with obvious improvement of clinical symptoms and discharged two weeks later without neurological sequale. We conclude that TEE can be an excellent tool not only for early diagnosing PE in high risk patients but also for intraoperative monitoring on removing emboli and managing cardiac functions.
Echocardiography, Transesophageal↗
Intravenous tenoxicam reduces uterine cramps after Cesarean delivery.
PURPOSE: Postpartum uterine contraction pain is a common phenomenon after Cesarean delivery. We investigated the effectiveness of tenoxicam in reducing uterine contraction pain. METHODS: We enrolled 120 consecutive non-breastfeeding women who were scheduled for elective Cesarean delivery. After the administration of spinal anesthesia with bupivacaine and intrathecal morphine 0.15 mg injection, the patients were randomly divided into two groups. Group I received placebo (normal saline) iv injection, and Group II received tenoxicam 40 mg iv injection after clamping the umbilical cord. Verbal analogue scale of wound pain and uterine contraction pain were recorded at two, four, eight,16, and 24 hr after Cesarean delivery. RESULTS: There was no significant difference in wound pain scores between the two groups (all scores < or =3). However, the tenoxicam group had significant lower uterine contraction pain scores and required less supplemental meperidine medication than did the placebo group (8.5% vs 41.4%, P <0.05). The incidences of nausea or vomiting, pruritus, and bleeding were not significantly different between groups. CONCLUSION: Intravenous tenoxicam 40 mg significantly reduced the intensity of uterine cramps in patients undergoing Cesarean delivery without increasing side effects.
Adult↗
The effect of IVPCA morphine on post-hysterectomy bowel function.
BACKGROUND: Although morphine has been shown to induce bowel dysfunction in a dose-dependent fashion, in most relevant studies it was investigated in single bolus injection. Recently, intravenous morphine via patient-controlled analgesia (IVPCA) has been widely used to provide analgesia by divided bolus doses on patients' demand with satisfactory effects. This approach, by reducing the peak serum surge, largely resembles the pharmacokinetic and pharmacodynamic advantage of continuous infusion. There is yet no report on the investigation of its effect on post-operative bowel dysfunction. METHODS: Fifty-one women who underwent abdominal total hysterectomy (ATH) due to uterine myoma were enrolled to investigate the association between the doses of morphine consumption by PCA and the time of first passage of flatus. In all patients morphine was administered intravenously via a PCA pump immediately after recovery from general anesthesia. RESULTS: We found that 49 out of 51 patients (96%) exhibited mild pain with IVPCA morphine. They had consumed an average dose of 16.9 mg morphine (range, 0-46 mg) upon the first passage of flatus which occurred 2036.4 min (average) post-operatively. There was no correlation between the dose of morphine and the time of first passage of flatus (r = 0.053, P > 0.05). CONCLUSIONS: The absence of suppression of bowel movement by IVPCA morphine for post-operative pain control suggests that favorable pharmacokinetic profile of IVPCA can help reduce the morphine-induced bowel dysfunction at its therapeutic level.
Adult↗
Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough.
PURPOSE: The aim of this study was to evaluate the effectiveness of lidocaine, propofol and ephedrine in suppressing fentanyl-induced cough. METHODS: One hundred and eighteen patients were randomly assigned into four groups and the following medications were given intravenously: patients in Group I (n = 31) received normal saline 2 mL, Group II (n = 29) received lidocaine 2 mg.kg(-1), Group III (n = 30) received propofol 0.6 mg.kg(-1) and Group IV (n = 28) received ephedrine 5 mg. At one minute after the study medication, fentanyl 2.5 microg.kg(-1) was given intravenously within two seconds. The occurrence of cough and vital sign profiles were recorded within two minutes after fentanyl bolus by an anesthesiologist blinded to study design. RESULTS: Sixty-five percent of patients in the placebo group had cough, whereas the frequency was significantly decreased in Groups II (14%) and IV (21%). Although a numerically lower frequency of cough was noted in Group III (37%), it was not statistically different from that of the placebo group. SpO(2) decreased significantly in patients of Group III compared to placebo; one patient experienced hypoxemia necessitating mask ventilation. Patients in Group III showed a decrease in heart rate and systolic blood pressure (2 beats.min(-1) and 8 mmHg vs baseline). Patients in Group IV showed an increase in both measurements (5 beats.min(-1) and 8 mmHg vs baseline). No truncal rigidity was observed throughout the study. CONCLUSIONS: Intravenous lidocaine 2 mg.kg(-1) or ephedrine 5 mg, but not propofol 0.6 mg.kg(-1), was effective in preventing fentanyl-induced cough. The results provide a convenient method to decrease fentanyl-induced cough.
Adult↗
Differential analgesic effect of tenoxicam on the wound pain and uterine cramping pain after cesarean section.
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to enhance opioid analgesia in the acute pain service. The question, however, of whether NSAIDs produce a similar extent of potentiation among different types of pain, has not been thoroughly investigated. MATERIALS AND METHODS: A randomized, placebo-controlled, double-blind study was performed to characterize the analgesic effect of tenoxicam, a long-acting NSAID, on resting wound pain, evoked wound pain, and uterine cramping pain after cesarean section. Saline (n = 48) or 20 mg tenoxicam (n = 45) was intravenously injected immediately after clamping the umbilical cord. All patients were instructed to obtain maximal postoperative analgesia by intravenous patient-controlled morphine. RESULTS Tenoxicam profoundly reduced the intensity of uterine cramping pain (3.6 [2.0-5.6] versus 5.5 [3.4-6.6]; p < 0.01) but had no additional effect on wound pain at rest, with movement, changing position, sitting, and walking. Intraoperative injection of 20 mg tenoxicam decreased the demand ratio for patient-controlled analgesia (PCA) and 24-hour morphine consumption by approximately 30%. CONCLUSIONS: The data show that tenoxicam potentiates opioid analgesic effect on the somatic and visceral types of pain to different extents, and they suggest that intraoperative injection of 20 mg tenoxicam is sufficient to enhance intravenous PCA morphine on uterine cramping pain for the first 24 hours after cesarean section.
Adolescent↗