Presentation
We present an 11-year-old boy who presented with vomiting, papilledema, and a history concerning for an undiagnosed neuromuscular disorder. Deep sedation or anesthesia was required during an emergent lumbar puncture to evaluate his symptoms. [ncbi.nlm.nih.gov]
Results The present study included a total of 120 ECT sessions administered to 12 patients with depression (aged 18–65 years; weight range, 49–113 kg). [doi.org]
Entire Body System
- Swelling
[…] in the legs and ankles swelling of the face, fingers, or lower legs tender, swollen glands in the neck tightness in the chest troubled breathing with exertion unexplained weight loss unusual bleeding or bruising voice changes vomiting weakness and heaviness [mayoclinic.org]
When opening the dura, the surgeon was asked to assess brain volume using a four-point brain relaxation score (1 = excellent, no swelling; 2 = minimal swelling, but acceptable; 3 = serious swelling, no change in treatment required; 4 = severe swelling [anesthesiology.pubs.asahq.org]
Tell your doctor about the allergy and what signs you had, like rash; hives ; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. [drugs.com]
- Severe Pain
Oxycodone Oxycodone is indicated for the treatment of moderate to severe pain.[Label] There is also an extended release formulation indicated for chronic moderate to severe pain requiring continuous opioid analgesics for... [drugbank.ca]
[…] opium and its derivatives, as well as a number of synthetic compounds, and are used for moderate to severe pain. [medical-dictionary.thefreedictionary.com]
On the 0–10 pain rating scale, 0 means no pain and 10 means the worst pain possible. The middle of the scale represents moderate pain; 1–3, mild pain; and 7 or greater, severe pain [ 18, 19 ]. [ajronline.org]
Opioid analgesics may be used in conditions that include: Severe acute pain Moderate to severe pain Severe chronic pain Breakthrough pain in conditions such as cancer, sickle-cell disease Diabetic peripheral neuropathy HIV-associated neuropathy Postherpetic [rxlist.com]
Grade 1 = Mild pain (complains of pain on request) Grade 2 = Moderate pain (complains of pain spontaneously) Grade 3 = Severe pain (voice change, hoarseness, aphonia) post operative pneumonia [ Time Frame: At day 7 ] proportion of patients who developed [clinicaltrials.gov]
- Intravenous Administration
administration & dosage* Polymorphism, Single Nucleotide/genetics* Prospective Studies Receptors, Opioid, mu/genetics* Remifentanil Sequence Analysis, DNA Substances Anesthetics, Intravenous Piperidines Receptors, Opioid, mu Remifentanil [ncbi.nlm.nih.gov]
All patients responded immediately to intravenous administration of ephedrine and to temporary discontinuation of the remifentanil infusion. We report here the sequence of events for one these six cases. [anesthesiology.pubs.asahq.org]
Intravenous administration of an opioid antagonist such as naloxone may be employed as a specific antidote to manage severe respiratory depression or muscle rigidity. [wikidoc.org]
Onset after intravenous administration is fast (1 to 2 minutes) because the balance between plasma and action site in the central nervous system (biophase) is fast and similar to alfentanil. Remifentanil does not release histamine 2. [scielo.br]
- Chills
[…] or shallow breathing lightheadedness, dizziness, or fainting muscle stiffness or tightness pale or blue lips, fingernails, or skin shortness of breath slow or irregular heartbeat sweating unusual tiredness or weakness Less common Bluish lips or skin chills [mayoclinic.org]
[…] reactions such as: Angioedema (swelling in the tissue under the skin or mucous membranes) Oropharyngeal edema (swelling in the mouth, tongue, and pharynx) Back pain Arthralgia (joint pain) Arthritis (inflammation of joints) Myalgia (muscle pain) Influenza Chills [rxlist.com]
Seven patients (4%) experienced shivering with a chilling sensation immediately after the procedure. Shivering was well controlled in most of these patients with conservative treatment that included administration of meperidine (Pethidine, BCWP). [ajronline.org]
1.0 tremor / Early / 0-1.0 flushing / Rapid / 1.0-1.0 injection site reaction / Rapid / Incidence not known amenorrhea / Delayed / Incidence not known gonadal suppression / Delayed / Incidence not known libido decrease / Delayed / Incidence not known chills [pdr.net]
- Collapse
Respiratory depression 157.90 104.31 37 1118 3797 3380907 Generalised erythema 127.60 104.31 28 1127 2133 3382571 Post procedural complication 123.33 104.31 32 1123 4985 3379719 Blood pressure decreased 123.02 104.31 40 1115 13796 3370908 Circulatory collapse [drugcentral.org]
Muscle spasms Hypertonia (excessive muscle tone) Skeletal muscle rigidity Abnormal coordination and gait Accidental injury Seizures Sedation Coma Intracranial pressure Upper respiratory tract infection Cough Pneumonia Atelectasis (partial or complete collapse [rxlist.com]
[…] agonists, the opiate plasma concentration may be sufficient to overcome naltrexone competitive blockade, but the patient may experience deeper and more prolonged respiratory depression and thus, may be in danger of respiratory arrest and circulatory collapse [pdr.net]
Respiratoric
- Dyspnea
Bronchoscopists' median VAS scores were as follows: overall patient cooperation 9.1 (IQR 8.5-9.6), dyspnea 0.3 (IQR 0.0-0.9), pain 0.2 (IQR 0.0-1.3), cough 1.2 (IQR 0.7-2.0), and discomfort 0.6 (IQR 0.3-1.5). [ncbi.nlm.nih.gov]
On extubation day 7, he suffered from sudden onset dyspnea with stridor. Arterial blood gas analysis (ABGA) revealed pH 7.096, PaCO 2 98.6 mmHg, PaO 2 47.3, mmHg, SaO 2 64.1% (facial mask O 2 10 L/min), and facial and neck edema rapidly developed. [omicsonline.org]
In records, the patient was only complaining from exertional dyspnea, had no obvious cardiopulmonary problems, and did not mention using any specific drugs. In the conducted examination, pulmonary auscultation had no problems. [hindawi.com]
Abnormal coordination and gait Accidental injury Seizures Sedation Coma Intracranial pressure Upper respiratory tract infection Cough Pneumonia Atelectasis (partial or complete collapse of a lung or section of a lung) Hemoptysis (coughing up blood) Dyspnea [rxlist.com]
Respiratory : cough, dyspnea, bronchospasm, laryngospasm, rhonchi, stridor, nasal congestion, pharyngitis, pleural effusion, hiccup (s), pulmonary edema, rales, bronchitis, rhinorrhea. [wikidoc.org]
- Bradypnea
The propofol and remifentanil doses were reduced by 0.5 mcg/mL and 0.5 ng/mL, respectively, depending on the occurrence of bradypnea (FR < 8), apnea, desaturation (SO 2 < 90%), hypotension and bradycardia as appropriate. [scielo.org.co]
Gastrointestinal
- Nausea
In the early intervention group, nausea decreased from median 5.0 [IQR 1.5;6.0] in session A to 2.0 [1.0;3.0] in session B (p = 0.094); in the late intervention group nausea decreased from 3.5 [2.0;5.0] in session A to 0.5 [0.0;2.0] in session C (p = [ncbi.nlm.nih.gov]
The mean nausea scores (1=no nausea, 10=worst nausea) were 1 and 2, for the fentanyl and the remifentanil groups, respectively. [signavitae.com]
GI: Nausea, vomiting. Respiratory: Respiratory depression, apnea. Skin: Pruritus. Drug: Alcohol and other cns depressants potentiate effects; mao inhibitors may precipitate hypertensive crisis. Duration: 12 min. Distribution: 70% protein bound. [robholland.com]
- Vomiting
The study investigates in healthy female volunteers if immobility after remifentanil administration protects from nausea and vomiting. [ncbi.nlm.nih.gov]
GI: Nausea, vomiting. Respiratory: Respiratory depression, apnea. Skin: Pruritus. Drug: Alcohol and other cns depressants potentiate effects; mao inhibitors may precipitate hypertensive crisis. Duration: 12 min. Distribution: 70% protein bound. [robholland.com]
- Muscle Rigidity
The probability of occurrence for muscle rigidity declined when propofol was combined with remifentanil. © 2016 John Wiley & Sons Australia, Ltd. [ncbi.nlm.nih.gov]
Body as a Whole: Muscle rigidity, shivering. CNS: Dizziness, headache. CV: Hypotension, hypertension, bradycardia. GI: Nausea, vomiting. Respiratory: Respiratory depression, apnea. Skin: Pruritus. [robholland.com]
Caution must be taken when using remifentanil in non-intubated patients as it is a potent respiratory depressant and can cause muscle rigidity with inability to mask ventilate. Source http://en.wikipedia.org/wiki/Remifentanil [openanesthesia.org]
Muscle Rigidity Skeletal muscle rigidity can be caused by remifentanil and is related to the dose and speed of administration. remifentanil may cause chest wall rigidity (inability to ventilate) after single doses of >1 mcg/kg administered over 30 to [wikidoc.org]
- Constipation
including GI obstruction or ileus, ulcerative colitis, or pre-existing constipation. [pdr.net]
Other adverse effects include drowsiness, confusion, sedation, euphoria, delirium, agitation, anxiety, anorexia, constipation, cramps, dry mouth, urinary retention, dysuria, rash, urticaria, bruising, flushing, diaphoresis, pruritus, tinnitus, blurred [medical-dictionary.thefreedictionary.com]
Synthetic opioids can cause the following side effects: Confusion Constipation Dry mouth Nausea Sleepiness Sweating Vomiting Abdominal pain Weight loss Anxiety Depression Indigestion Shortness of breath Fatigue Hallucinations Headache Nervousness Restlessness [rxlist.com]
[…] injection site restlessness trouble with sleeping tunnel vision Rare Burning while urinating heartburn hives or welts loss of bladder control loss of memory nightmares problems with memory seeing, hearing, or feeling things that are not there severe constipation [mayoclinic.org]
Cardiovascular
- Hypertension
hypertensive subgroup (Group C vs. [ncbi.nlm.nih.gov]
CV: Hypotension, hypertension, bradycardia. GI: Nausea, vomiting. Respiratory: Respiratory depression, apnea. Skin: Pruritus. Drug: Alcohol and other cns depressants potentiate effects; mao inhibitors may precipitate hypertensive crisis. [robholland.com]
Autonomic hyperreflexia with severe hypertension and bradycardia was seen immediately after the operation. We increased the dose of remifentanil in order to control the hypertension, and the systemic blood pressure was normalized gradually. [jstage.jst.go.jp]
- Tachycardia
Epicardial ablation of ventricular tachycardia (VT) presents multiple challenges for anesthetic management. [ncbi.nlm.nih.gov]
Hypertensive response to surgical stimuli during the procedure was lower in the R group as well as a lower frequency of tachycardia episodes in this group (34% vs. 56%; P = 0.033 and 28% vs. 44%; P = 0.041, respectively). [joacp.org]
1 4 Completed Treatment Tooth Extractions 1 4 Completed Treatment Tracheal Extubation 1 4 Completed Treatment Urinary Tract Problem 1 4 Completed Treatment Ventricular Tachycardia (VT) 1 4 Completed Treatment Adjunct to general anesthesia therapy 1 4 [drugbank.ca]
- Heart Failure
Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, et al. (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography [omicsonline.org]
(e.g., angina, heart failure), hypotension, cardiac arrhythmias or hypovolemia. [pdr.net]
- Heart Block
block (Figure 1 ). [hindawi.com]
Cardiovascular : various atrial and ventricular arrhythmias, heart block, ECG change consistent with myocardial ischemia, elevated CPK-MB level, syncope. Musculoskeletal : muscle stiffness, musculoskeletal chest pain. [wikidoc.org]
Psychiatrical
- Anxiety Disorder
The authors report a case of a woman with a clear diagnosis of TTS and anxiety disorder, who underwent to cataract extractions at both eyes at two different times. [ncbi.nlm.nih.gov]
His medical history was significant for two myocardial infarctions in 1990 and 1994, stable angina, hypertension, and anxiety disorder. Medications included metoprolol 50 mg twice daily, isosorbide dinitrate, sublingual nitroglycerin, and temazepam. [anesthesiology.pubs.asahq.org]
Urogenital
- Amenorrhea
[…] develop. 400 Possible risk (although causality not established) of hypogonadism or androgen deficiency with long-term opiate agonist or partial agonist use. 400 Importance of informing clinician if decreased libido, impotence, erectile dysfunction, amenorrhea [drugs.com]
Early / 0-1.0 leukocytosis / Delayed / 0-1.0 urticaria / Rapid / 0-1.0 rash / Early / 0-1.0 nightmares / Early / 0-1.0 paresthesias / Delayed / 0-1.0 tremor / Early / 0-1.0 flushing / Rapid / 1.0-1.0 injection site reaction / Rapid / Incidence not known amenorrhea [pdr.net]
Neurologic
- Seizure
2 Different anaesthetic agents have different effects on seizure duration. [doi.org]
There were no group differences in seizure duration or recovery time. [ncbi.nlm.nih.gov]
- Irritability
Between seizures the EEG often shows interictal depolarizing phenomena such as spikes reflecting an irritable focus of the brain. [ncbi.nlm.nih.gov]
[…] pupil dilation) Visual disturbances Cataracts Conjunctivitis (eye inflammation) Tinnitus (ringing in the ears) Ear pain Dysgeusia (taste distortion) Glossitis (tongue inflammation) Stomatitis (sore mouth) Xerostomia (dry mouth) Nasal congestion Nasal irritation [rxlist.com]
Coughing during emergence from anesthesia can result from irritant or stretch stimuli caused by the endotracheal tube [ 8 ]. [medsci.org]
All adverse medical events occurring during the study were recorded, including nausea and vomiting, venous irritation, and muscular rigidity. [anesthesiology.pubs.asahq.org]
- Tremor
[…] well-being Floating feeling Mood swing Restlessness Euphoria Dysphoria (unease) Anxiety Depression Depersonalization Insomnia Abnormal dreams Abnormal thinking Hallucination Delirium Paranoid reaction Suicidal tendency Psychosis Amnesia (memory loss) Tremor [rxlist.com]
Nervous : anxiety, involuntary movement, prolonged emergence from anesthesia, confusion, awareness under anesthesia without pain, rapid awakening from anesthesia, tremors, disorientation, dysphoria, nightmare (s), hallucinations, paresthesia, nystagmus [wikidoc.org]
Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, or drowsiness may be early warning signs of CNS toxicity. [pdr.net]
Treatment
Nasopharyngeal temperature after surgery fell significantly more from baseline in the tramadol treatment groups compared with the non-treatment groups. [ncbi.nlm.nih.gov]
1 4 Completed Treatment Opioid Induced Swallowing Disorders 1 4 Completed Treatment Osteoarthritis (OA) / Pain, Chronic 1 4 Completed Treatment Pain NOS 4 4 Completed Treatment Pain Relief in Labour 1 4 Completed Treatment Functional disorders of the [drugbank.ca]
Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. [pdr.net]
Introduction Electroconvulsive therapy (ECT) is an efficient and fast therapy for treatment-resistant depression. [doi.org]
Prognosis
Anesthesiological management of patients with Takotsubo syndrome (TTS) is a challenge of questions related to physiopathology, prognosis, and trigger causes. [ncbi.nlm.nih.gov]
The inhibition of circulation and respiration was more obvious at t1 and t2 in group A when compared to group B (P Introduction Gastric cancer, which greatly endangers human health, is a disease with high mortality and poor prognosis ( 1, 2 ). [spandidos-publications.com]
Etiology
7 ] proportion of patients who developed post-operative respiratory distress within 7 days of hospitalization defined by acute respiratory failure with hypoxemia, PaO2/FiO2 ratio < 300 mmHg, new bilateral infiltrations on chest X-ray without cardiac etiology [clinicaltrials.gov]
Epidemiology
There is no consensus in the literature regarding the true value of biological and skin tests, and there is a need to create a specialized unit for allergy and anaesthesia in our country in order to collect epidemiological and perioperative anaphylaxis [scielo.org.co]
References 1 Lan L, Zhao F, Cai Y, Wu RX and Meng Q: Epidemiological analysis on mortality of cancer in China, 2015. Zhonghua Liu Xing Bing Xue Za Zhi. 39:32–34. 2018.(In Chinese). [spandidos-publications.com]
A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol 1995 ; 142 : 1255 -64. ↵ Liu ZQ, Chen XB, Li HB, Qiu MT, Duan T. [bmj.com]
Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med 42, 889–896 (2016). 3. Ha, M. A. & Sieg, A. C. [nature.com]
Pathophysiology
The information is presented in a logical manner--opening chapters cover the underlying pathophysiology of obesity and move on to discuss general risk factors, legal and ethical aspects of anaesthesia, changes in pharmacokinetics and pharmacodynamics, [books.google.ro]
Prevention
Abstract Smooth emergence or cough prevention is a clinically important concern in patients undergoing laryngomicroscopic surgery (LMS). [ncbi.nlm.nih.gov]
Prevention Hyperalgesia 2 4 Completed Prevention Intubation, Endotracheal 1 4 Completed Prevention Myocardial Ischemic Reperfusion Injury 1 4 Completed Prevention Open Craniotomy 1 4 Completed Prevention Postoperative Confusion 1 4 Completed Prevention [drugbank.ca]