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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Does magnesium sulfate affect the incidence of respiratory complications in children undergoing esophageal dilatation? An observational pilot study

Abstract

Background. In this pilot observational study, we aimed to investigate the effect of preoperative magnesium infusion on laryngospasm frequency and other respiratory complications in children with respiratory findings undergoing esophageal dilatation after the ingestion of caustic substances.

Methods. Sixty children between the ages of 2 and 12 scheduled for esophageal dilatation were divided into two groups: the magnesium group (Group M), which consisted of children with respiratory symptoms and who received IV 30 mg/kg magnesium sulfate preoperatively, and the control group (Group C), who received the same volume of saline. Anesthesia was induced with fentanyl, propofol, and mivacurium and maintained using a 60% N2O and 2-3% sevoflurane mixture in oxygen. Demographic and hemodynamic data, as well as the incidence of respiratory complications (laryngospasm, bronchospasm, apnea, cough, and desaturation) during the perioperative period were recorded until the time of discharge from the recovery room.

Results. Demographic data and hemodynamics were similar in the two groups. The laryngospasm, bronchospasm, apnea, and cough incidences were also similar between the groups, although the desaturation incidence was lower in Group M than in Group C (p=0.013). The number of complications in total was lower in Group M as well (p=0.008), although the number of children who experienced complications in each group was similar.

Conclusion. Prophylactic administration of 30 mg/kg of magnesium to children with respiratory symptoms may decrease the frequency of postoperative respiratory complications in children undergoing esophageal dilatation.

Key words: corrosive stricture, magnesium sulfate, general anesthesia, complication, respiratory tract

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Comparison of remifentanil versus fentanyl general anesthesia for short outpatient urologic procedures

Abstract

Study objectives. To compare the effect of remifentanil versus fentanyl isoflurane general anesthesia on Aldrete score, emergence, extubation and discharge times from the operating room (OR) and postanesthesia care unit (PACU) following short outpatient urologic procedures (panendoscopy and cystoscopy, bladder hydrodilatation, stent placement).

Patients and methods. 40 patients 18 years of age or older scheduled for short elective outpatient urological procedures with an expected duration of less than 30 minutes.

Following Institutional Review Board (IRB) approval and written informed consent, 40 American Society of Anesthesiologists (ASA) physical class 1-3 adult outpatients were enrolled and equally (n=20) randomized into remifentanil and fentanyl groups. Preoperatively, all subjects received intravenous (IV) midazolam 1-2 mg and were induced with propofol 2 mg/kg IV. Muscle relaxation was achieved with succinylcholine or rocuronium, followed by intubation. The remifentanil group received remifentanil 1 g/kg IV at induction with a maintenance dose of remifentanil 0.1 to 2 g/kg/min IV in the presence of 60% nitrous oxide (N2O)/40% oxygen (O2) and end-tidal isoflurane of 0.3 to 0.4% (for amnesia). The fentanyl group received fentanyl 2 g/kg IV at induction, maintenance dose of fentanyl 2 to 3 g/kg IV intermittent bolus, and 60% N2O/40% O2 with 2% end-tidal isoflurane. Muscle relaxation was reversed at the end of anesthesia as needed. Times for OR entry, emergence, extubation, total OR time (entry to exit) and PACU discharge time, as well as Aldrete scores at time of OR exit and PACU discharge were determined. Data was evaluated by ANOVA, t-test and Mann-Whitney tests. A p

Results. There was no significant difference between groups in age, gender, weight, ASA class, PACU analgesic or antiemetic use, or times of emergence, extubation, OR exit and PACU discharge. There was a significant difference (p<0.05) in OR exit Aldrete score but not PACU discharge Aldrete score. No adverse events were noted.

Conclusions. While there was no difference between the remifentanil and fentanyl groups regarding recovery time from OR and PACU, remifentanil patients had significantly better OR exit Aldrete scores with less sedation upon arrival at phase I PACU recovery than the fentanyl group. This anesthesia technique may prove helpful for fast-track eligibility of these patients.

Key words: remifentanil, fentanyl, isoflurane, general anesthesia, urologic procedures, outpatient surgery, Aldrete score, recovery time, discharge time

 

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