Ascending Tonic-Clonic Seizure Syndrome Secondary To Iohexol During CT Cisternography: Case Report

WOS: 000323600800028Ascending tonic-clonic seizure (ATCS) syndrome secondary to Iohexole is a rare, potentially fetal status epilepticus condition which is misdiagnosed and mixed up with malign hyperthermia. Additionally to the hardness of rapid and correct taking on diagnosis due to different clinical findings and variable presentation from patient to another, unappropriate treatments usually effects prognosis with poor outcome

Diş hekimlinde lokal anesteziklere bağlı allerji

<p><strong>Objectives: </strong>Dental treatment of many patients is delayed owing to a positive history of allergic reactions.<strong> </strong>The aim of this study is to retrospectively investigate the results of local anaesthetic allergy tests of the patients, who were sent for allergy consultation due to their history of allergic reactions, and the following dental treatments carried out under local anaesthesia in the Department of Oral Surgery, School of Dentistry, Ege University<strong> </strong></p> <p><strong>Materials and Methods: </strong>In this study,<strong> </strong>case notes of 30 patients who were sent for allergy consultation due to their history of allergic reactions were retrospectively investigated. History of allergic reactions, tooth removal, test results, and allergic reactions following the administration of the suggested local anaesthetic were noted.</p> <p><strong>Results: </strong>The consultant doctor regarded testing unnecessary for 6 (20%) of the patients. Twelve (50%) of the 24 patients, had history of allergic reactions associated with tooth removal. Of the 24 patients tested, only 1 (4.1%) patient had a positive result.</p> <p><strong>Conclusions: </strong>A detailed medical history should be taken before commencing any dental treatment. If allergic reactions are expected, the appropriate consultation should be done, and patients at risk should be treated after taking the appropriate measures.</p> <p><strong>Keywords: </strong>Local anaesthetics, allergy, dentistry.</p><p> </p><p><strong>ÖZET</strong></p> <p><strong>Amaç: </strong>Alerji öyküsü nedeniyle çok sayıda hastanın diş tedavisi gecikebilmektedir. Bu çalışmanın amacı, Ege Üniversitesi Diş hekimliği Fakültesi Ağız Diş ve Çene Cerrahisi Anabilim Dalı’na başvurup alerji öyküsü nedeniyle alerji konsultasyonu istenen hastaların alerji test sonuçlarını ve bu sonuca göre lokal anestezi altında yapılan tedavilerini retrospektif olarak araştırmaktır.</p> <p><strong>Gereç ve Yöntem: </strong>Bu çalışmada diş hekimliğinde alerji öyküsü bulunması nedeni ile alerji konsultasyonu istenen 30 hastanın arşiv notları retrospektif olarak incelendi. Kendilerinde ve/veya ailelerinde alerji öyküsü varlığı, daha önce diş çekimi yapılıp yapılmadığı, test sonuçları ve önerilen lokal anestezik ile yapılan diş çekimi sonrası alerji gelişip gelişmediği kaydedildi.</p> <p><strong>Bulgular: </strong>Alerji konsültasyonu istenen 30 olgunun 6’sında (%20), değerlendiren konsultan hekimin önerisiyle test yapılmamıştı. 24 olgunun 12’sinde (%50) önceki diş çekimi sonrası gelişen alerji öyküsü tesbit edildi. Test yapılan 24 hastadan sadece 1’inde (%4,1) pozitif sonuç saptandı.</p> <p><strong>Sonuç: </strong>Diş tedavilerinden önce tıbbi anamnez ayrıntılı olarak alınmalı, alerji şüphesi varlığında gerekli konsultasyon yapılmalı ve riskli hastalarda uygun tedbirler alınarak tedaviye başlanmalıdır.</p&gt

Comparação dos efeitos de remifentanil e remifentanil + lidocaína em intubação de pacientes intelectualmente deficientes

ResumoJustificativa e objetivoseste é um estudo prospectivo, randômico e duplo‐cego. Nosso objetivo foi comparar as condições de intubação endotraqueal e as respostas hemodinâmicas com o uso de remifentanil ou combinação de remifentanil e lidocaína em indução anestésica com sevoflurano sem agentes bloqueadores neuromusculares.Métodoscinquenta pacientes intelectualmente deficientes, estado físico ASA I‐II, submetidos à extração dentária sob anestesia geral em ambulatório foram incluídos neste estudo. Os pacientes foram randomizados para receber 2μgkg−1 de remifentanil (Grupo 1, n=25) ou uma combinação de 2μgkg−1 de remifentanil e 1mgkg−1 de lidocaína (Grupo 2, n=25). Para avaliar as condições de intubação, o sistema de pontuação de Helbo‐Hansen foi usado. Em pacientes com 2 ou menos pontos em todas as pontuações, as condições de intubação foram consideradas aceitáveis, porém, se qualquer uma das pontuações fosse superior a 2, as condições de intubação seriam consideradas inaceitáveis. Pressão arterial média, frequência cardíaca e saturação periférica de oxigênio (SpO2) foram registradas no início do estudo, após a administração de opiáceos, antes da intubação e nos minutos 1, 3 e 5 após a intubação.Resultadosparâmetros aceitáveis de intubação foram obtidos em 24 pacientes do Grupo 1 (96%) e em 23 pacientes do Grupo 2 (92%). Nas comparações intragrupo, os valores da frequência cardíaca e pressão arterial média em todos os momentod em ambos os grupos mostraram uma redução significativa em relação aos valores basais (p=0.000).Conclusãocom a adição de remifentanil (2μg/kg) durante a indução com sevoflurano, pode‐se obter intubação endotraqueal bem‐sucedida sem o uso de relaxantes musculares em pacientes intelectualmente deficientes que se submetem à extração dentária em ambulatório. Também é digno de nota que a adição de lidocaína (1mg/kg) a remifentanil (2μg/kg) não apresenta qualquer melhora adicional dos parâmetros de intubação.AbstractBackground and objectivesThis is a prospective, randomized, single‐blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents.MethodsFifty intellectually disabled, American Society of Anesthesiologists I–II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2μg/kg remifentanil (Group 1, n=25) or a combination of 2μg/kg remifentanil and 1mg/kg lidocaine (Group 2, n=25). To evaluate intubation conditions, Helbo‐Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation.ResultsAcceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra‐group comparisons, the heart rate and mean arterial pressure values at all‐time points in both groups showed a significant decrease compared to baseline values (p=0.000)ConclusionBy the addition of 2μg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1mg/kg lidocaine to 2μg/kg remifentanil does not provide any additional improvement in the intubation parameters

Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 μg kg-1 remifentanil (Group 1, n = 25) or a combination of 2 μg kg-1 remifentanil and 1 mg kg-1 lidocaine (Group 2, n = 25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p = 0.000) CONCLUSION: By the addition of 2 μg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1 mg/kg lidocaine to 2 μg/kg remifentanil does not provide any additional improvement in the intubation parameters

Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

WOS: 000325273700026PubMed ID: 24008568Objective To compare two remifentanil doses (1 mu g/kg and 2 mu g/kg) in order to determine the preferred dose in intellectually disabled patients undergoing day care dental surgery under sevoflurane-induced general anaesthesia. Methods Patients were randomly assigned to receive either 1 mu g/kg (group 1) or 2 mu g/kg (group 2) remifentanil; both groups received 8% sevoflurane anaesthesia induction. All other conditions were identical in both groups. Heart rate (HR), mean arterial pressure (MAP) and intubation conditions were assessed. Results A total of 27/30 (90.0%) patients in group 1 and 29/30 patients (96.7%) in group 2 had acceptable intubation conditions. Remifentanil administration resulted in significant reductions in HR compared with baseline levels, in both groups. There were no significant between-group differences in HR at any timepoint. MAP decreased significantly compared with baseline in group 2 only. Conclusion Successful tracheal intubation in intellectually disabled patients can be accomplished with a combination of 1 mu g/kg or 2 mu g/kg remifentanil and 8% sevoflurane anaesthesia induction, without the requirement for neuromuscular blocking drugs