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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The rapid administration of vancomycin is associated with flushing and hypotension, a consequence of histamine release. The manufacturer discourages administering vancomycin to anesthetized patients, stating that vancomycin aggravates the hypotensive effects of anesthetics. To test this, we randomly assigned 36 adults (ASA classes I through III) to one of two groups: preinduction (Preind, n = 19) and postinduction (Postind, n = 17). Both groups received two different infusions: vancomycin (1 g/250 mL normal saline) and saline (250 mL normal saline) over 30-60 min. The Preind group received vancomycin before anesthesia was induced and saline was administered immediately after anesthesia was induced; for the Postind group, this order was reversed. This was done in a double-blind fashion. The anesthetic induction was standardized by the intravenous administration of thiopental and vecuronium and anesthetic maintenance by inhalation of nitrous oxide and enflurane. End-tidal enflurane, heart rate (HR), and blood pressure (BP) were measured every 3 min. Independent (unpaired) t-test was used in data analysis. The groups did not differ significantly. We conclude that vancomycin infusion may be given under anesthesia without significant adverse hemodynamic consequences if administered over a 30-60 min period of time.
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PMID:Vancomycin does not enhance hypotension under anesthesia. 846 22

During closed system anaesthesia with isoflurane, patients with a preoperative increase in blood concentration of acetone (> 10 mg litre-1) had a significantly greater concentration of acetone than patients with an initial normal blood concentration of acetone (P < 0.01). Flushing the closed system with a high flow of fresh gas had no effect on the blood concentration of acetone. Using a large fresh gas flow, there was no increase in blood acetone concentration. Acetone concentrations of about 50 mg litre-1 cause problems such as nausea and vomiting in the postoperative period. These symptoms occurred more frequently after closed system anaesthesia.
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PMID:Accumulation of acetone in blood during long-term anaesthesia with closed systems. 847 83

A group of 13 experts appointed by the French Society of Anaesthesia and Intensive Care has produced the following guidelines for arterial catheterisation and invasive measurement of systemic arterial blood pressure in adults. Teflon or polyurethane catheters are recommended with a maximal size of 18 gauge for femoral and axillary arteries and 20 gauge for the others. For small arteries (radial and pedious arteries) a maximal length of 3-5 cm should be preferred. The benefit of heparin-coating is not documented. Incorporation of salts for radiopacity is useless and increases thrombogenicity. Use of a flush device with a constant flow of 2 mL.h-1 and a fast flush valve connected to normal saline under pressure is recommended. Manual intermittent flushing with a syringe is contra-indicated. Addition of heparin (2500 IU.500 mL-1 of flush solution) increases the duration of catheter patency and is recommended for catheterisations of more than 24 h duration. Ready for use devices are to be preferred. Distortion of pressure wave may be minimized by employing low volume, low compliance, low resistance devices. The number of connections should be as low as possible and all of Luer-lock type. The stopcocks should be clearly identified to minimize the risk of accidental intra-arterial injection. The device should be transparent for disclosure of bubbles, which lead to waveform distortion. For catheter placement the operator should follow the usual preparation as for any aseptic surgical procedure with cap, mask, gloves and sterile towel. The insertion site is prepped either with chlorhexidine or povidone-iodine. In the conscious patient, local anaesthesia by injection and/or topical application (EMLA) is recommended. Direct arterial puncture should be preferred rather than transfixion. Catheterisation of deep vessels is facilitated by Seldinger technique, which is recommended whatever the site of placement when long term monitoring and/or difficulties of insertion are foreseen. The radial artery is the site of choice for elective cases. The non-dominant hand should be preferred. Puncture must be preceded by assessment of adequacy of the collateral flow by the Alien test. The femoral artery is a valuable site for emergency situations. Before catheterisation, the artery should be auscultated for a murmur. Puncture of a vascular prosthesis is contra-indicated. The dressing should be changed every four days only. Sites of blood withdrawal should be manipulated with compresses soaked with chlorhexidine or povidone-iodine. The arterial catheter is only changed in case of evidence of local infection or ischaemia. The catheter removal should be considered as an aseptic surgical procedure. The catheter completeness has to be checked. A systematic culture of the catheter is not required.
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PMID:[French Society of Anesthesia and Intensive Care. Arterial catheterization and invasive measurement of blood pressure in anesthesia and intensive care in adults]. 857 16

We present two cases of automatic hyperreflexia (AH) during labour in women with spinal cord damage, in whom AH developed before and after delivery. The AH was successfully controlled using epidural anaesthesia in Case #1, but failed in Case #2. The blood pressure was controlled with nicardipine. However, overdose of nicardipine produces vasodilation and its side effects include headache, flushing and palpitation similar to AH. Considering these effects, we recommend epidural anaesthesia to control AH, because epidural anaesthesia does not only reduce BP, but also blocks the noxious stimuli and relieves the symptoms of AH. Our experience suggests that the epidural catheter can be placed two to three weeks before the date of predicted childbirth, because the onset of labour in a patient with spinal cord damage is difficult to predict and can proceed very rapidly. Also, the epidural catheter is available after the delivery. We recommended the epidural catheter is maintained for 24-48 hr postpartum.
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PMID:Autonomic hyperreflexia during labour. 859 90

After administration of doses ranging from 0.025 to 0.25 mg/kg, the neuromuscular blocking effect of cisatracurium was assessed in 119 adult surgical patients receiving N2O-opioid-midazolam-thiopental anesthesia. The calculated 95% effective dose (ED95) for inhibition of adductor pollicis twitch evoked at 0.1 Hz was 0.053 mg/kg. With 0.10 mg/kg injected over 5-10 and 20-30 s, median onset times (range) were 5.8 (3.0-7.7) and 4.8 (1.2-10.2) min, respectively, and median times to 5% and 95% recovery (range) were 27 (19-46) and 48 (25-68) min, respectively. For doses of 0.10, 0.20, and 0.25 mg/kg, median 5%-95% and 25%-75% recovery indexes ranged from 48 to 90 min and 8 to 9 min, respectively. After administration of neostigmine (0.06 mg/kg) at 10%-15% or 16%-30% recovery, the median times to 95% recovery (range) were 6 (2-22) and 4 (2-5) min, respectively. There were no changes in heart rate, blood pressure, or plasma histamine concentrations during the first 5 min after administration of cisatracurium at doses up to 5 x ED95 injected over 5-10 s. No cutaneous flushing or bronchospasm was noted. In summary, cisatracurium is a potent neuromuscular blocking drug with an intermediate duration of action, characterized by excellent cardiovascular stability, with no apparent histamine release.
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PMID:Pharmacodynamic dose-response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2-opioid anesthesia. 883 29

We report a case of four-year-old girl who suffered a cardiac arrest under anaesthesia, due to complete heart block without ventricular escape, during the flushing of an errantly placed longterm central venous catheter. It was subsequently found that the central line was placed in a persistent left superior vena cava (LSVC) draining directly into the coronary sinus. Diagnosis was suspected by a chest x-ray and confirmed by two-dimensional echocardiography. The patient made a complete recovery from the event and was discharged from hospital three days later.
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PMID:Paediatric cardiac arrest during Hickman line insertion. 904 81

This study investigates the effects of mivacurium (3 times ED95) on neuromuscular block, intubation conditions and general safety in comparison with equipotent doses of atracurium and vecuronium. Following Ethical Care Committee approval and informed consent, 90 ASA I+II patients aged 18 to 65 were studied undergoing elective ENT surgery. Anaesthesia was induced with 1.5 mg/kg propofol and 0.2 mg/kg alfentanil and maintained through continuous infusion of propofol (8 to 10 mg . kg-1 . h-1) and nitrous oxide in oxygen. After achieving stable anaesthesia, the patients received bolus injections of mivacurium (0.20 mg/kg, n = 30), atracurium (0.69 mg/kg, n = 30) or vecuronium (0.14 mg/kg, n = 30) for endotracheal intubation. Intubation was attempted 120 s after drug application and the intubation conditions were assessed. Relaxation was recorded using peripheral nerve stimulation (Train of four). During the observation period, signs of histamine release, respiratory difficulty, cardiovascular events or other adverse signs were monitored. Onset of relaxation was longer for mivacurium (2.3 +/- 1.3 min) compared with atracurium (1.4 +/- 0.7 min) or vecuronium (1.3 +/- 0.3 min). Intubation conditions 120 s after drug application were good or very good in only 67% of cases given mivacurium compared with 90% given atracurium and 100% given vecuronium. The recovery time (DUR 25) was shorter in the mivacurium group (19.5 +/- 7.9 min) compared with atracurium (54.7 +/- 6.6 min) and vecuronium (44.3 +/- 8.6 min). Heart rate and blood pressure were similar in all groups. Facial flushing and mild bronchospasms as signs of histamine release resulted more often in the mivacurium (20%) and atracurium groups (23%) than in the vecuronium group (3%). In contrast to atracurium and vecuronium, recovery from mivacurium-induced neuromuscular blockade is rapid. However, the onset time after 3 times ED95 was significantly longer for mivacurium than for atracurium or vecuronium.
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PMID:[Mivacurium--a new muscle relaxant compared with atracurium and vecuronium]. 937 44

Systemic candidiasis with renal involvement is a rare but well-recognized complication during neonatal intensive care treatment. In addition to intravenous administration of amphotericin B, decompression of the renal pelvis and irrigation of the involved kidney with the same drug through a nephrostomy tube will provide a high concentration of antifungal agent with a flushing effect. This procedure is not always possible due to the small size of the neonatal kidneys. We have conceived a new percutaneous trocar nephrostomy which allows its application directly in an incubator without using X-rays during a single procedure. In 3 cases a bilateral percutaneous nephrostomy was performed directly in the incubator using a one-step ultrasonically guided maneuver under local anesthesia. The funguria was successfully eradicated in all cases. The availability of a nephrostomy trocar of small dimensions leads us to an improved renal approach in newborns.
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PMID:Use of new nephrostomy catheter for treatment of renal neonatal candidiasis. 941 11

In clinical practice, anaesthetists encounter many patients who are on concurrent medication which may have the potential to interact with drugs used during anaesthesia. Many patients are receiving as many as a dozen drugs of various kinds, thus, increasing the risk of a drug interaction occurring. Unfortunately anaesthetists tend not to report drug interactions which occur during anaesthesia--especially those of a minor nature such as flushing--and hence, the true number of drug interactions is unknown. We have developed a chart indicating the nature of important interactions that the anaesthetist may encounter.
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PMID:Drug interactions and the clinical anaesthetist. 958 24

Mastocytosis is a rare disorder with serious anaesthetic implications. Anaesthetic management is hazardous since trauma, stress, extremes of temperature and drugs may precipitate intra-operative mast cell degranulation. Release of histamine and other mast cell mediators can lead to profound cardiovascular collapse and even death. We present a case report of a patient with mastocytosis who suffered cardiac arrest during anaesthesia. Anaphylactoid/anaphylactic shock may be delayed and lack supporting signs of histamine release such as cutaneous flushing and bronchospasm.
Anaesthesia 1998 Aug
PMID:Systemic mastocytosis presenting as profound cardiovascular collapse during anaesthesia. 979 25


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