Akinori Yamazaki

Landiolol attenuates tachycardia in response to endotracheal intubation without affecting blood pressure

PURPOSE Beta-adrenergic receptor antagonists (beta-antagonists) have long been used to control perioperative tachyarrhythmias. The effects of a beta(1)-antagonist, landiolol, on perioperative hemodynamics are unknown. We aimed to determine the appropriate dosage of landiolol for the treatment of hemodynamic changes in response to endotracheal intubation. METHODS Sixty-four patients without heart disease or hypertension, were assigned to receive saline (group C) or landiolol (0.1 or 0.3 mg.kg(-1); groups L1 and L3). Anesthesia was induced with propofol (2 mg.kg(-1) iv) followed by saline or landiolol iv. After ventilation with facemask using 2% sevoflurane in 100% oxygen for 90 sec, endotracheal intubation was performed. After intubation, anesthesia was maintained using 1% sevoflurane in combination with 50% nitrous oxide. Values of heart rate and mean arterial blood pressure were recorded before induction to five minutes after intubation. RESULTS In group C, heart rate and mean blood pressure increased simultaneously after tracheal intubation, compared with baseline values. Heart rate values were attenuated immediately before as well as after intubation in group L3, compared with groups C and L1. Heart rate did not increase after tracheal intubation in group L1, compared with baseline. In contrast, mean arterial blood pressure values did not differ among groups. CONCLUSIONS The newly developed beta(1)-antagonist landiolol (0.1 and 0.3 mg.kg(-1)) may help prevent tachycardia without affecting blood pressure during the induction of anesthesia.PurposeBeta-adrenergic receptor antagonists (ß-antagonists) have long been used to control perioperative tachyarrhythmias. The effects of a ß1-antagonist, landiolol, on perioperative hemodynamics are unknown. We aimed to determine the appropriate dosage of landiolol for the treatment of hemodynamic changes in response to endotracheal intubation.MethodsSixty-four patients without heart disease or hypertension, were assigned to receive saline (group C) or landiolol (0.1 or 0.3 mg kg-1; groups L1 andL3). Anesthesia was induced with propofol (2 mg kg-1iv) followed by saline or landiololiv. After ventilation with facemask using 2% sevoflurane in 100% oxygen for 90 sec, endotracheal intubation was performed. After intubation, anesthesia was maintained using 1 % sevoflurane in combination with 50% nitrous oxide. Values of heart rate and mean arterial blood pressure were recorded before induction to five minutes after intubation.ResultsIn group C, heart rate and mean blood pressure increased simultaneously after tracheal intubation, compared with baseline values. Heart rate values were attenuated immediately before as well as after intubation in groupL3, compared with groups C and L1. Heart rate did not increase after tracheal intubation in group L1, compared with baseline. In contrast, mean arterial blood pressure values did not differ among groups.ConclusionsThe newly developed ß1-antagonist landiolol (0.1 and 0.3 mg·kg-1) may help prevent tachycardia without affecting blood pressure during the induction of anesthesia.RésuméObjectifLes antagonistes des récepteurs bêta-adrénergiques (ßantagonistes) ont été longtemps utilisés pour contrôler les tachyarythmies périopératoires. Les effets d’un ß 1-antagoniste, le landiolol, sur ïhémodynamique périopératoire sont inconnus. Nous voulions déterminer le dosage approprié de landiolol pour traiter les changements hémodynamiques provoqués par l’intubation endotrachéale.MéthodeSoixante-quatre patients sans cardiopathie, ni hypertension, ont reçu une solution saline (group C) ou du landiolol (0,1 ou 0,3 mg·kg-1; groupes L1 et L3). L’anesthésie a été induite avec du propofol (2 mg·kg-1 iv) suivi de la solution saline ou du landiolol iv. Après ventilation au masque, avec du sévoflurane à 2 % dans de l’oxygène à 100 pendant 90 s, l’intubation endotrachéale a été réalisée. Puis, l’anesthésie a été maintenue avec du sévoflurane à 1 % combiné à du protoxyde d’azote à 50 %. La fréquence cardiaque et la tension artérielle moyenne ont été enregistrées avant l’induction et jusqu’à cinq minutes après l’intubation.RésultatsDans le groupe C, la fréquence cardiaque et la tension artérielle moyenne ont augmenté simultanément après l’intubation endotrachéale, par rapport aux valeurs de base. La fréquence cardiaque a baissé immédiatement avant et après l’intubation dans le groupe L3 comparé aux groupes C et L1. La fréquence cardiaque n’a pas augmenté, sur les mesures de base, après l’intubation endotrachéale dans le groupe L1. Les valeurs de la tension artérielle moyenne étaient comparables entre les groupes. as]Conclusion p ]Le nouveau ß 1-antagoniste landiolol (0,1 et 0,3 mg·kg-1) peut aider à prévenir la tachycardie sans affecter la tension artérielle pendant l’induction de l’anesthésie.

Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery.

OBJECTIVE This study examined the hypothesis that ipsilateral upper extremity elevation for muscle-sparing thoracotomy procedures contributes to the postoperative shoulder pain. DESIGN Prospective observational study. SETTING Medical center. PARTICIPANTS ASA physical status 1-2 patients undergoing elective lung surgeries including pneumonectomy, lobectomy, and segmentectomy performed through either the anterolateral approach or video-assisted thoracotomy surgery. INTERVENTIONS Postoperative observation of ipsilateral shoulder pain. MEASUREMENTS AND MAIN RESULTS Postoperative examinations of sites of shoulder pain (clavicle, anterior, lateral,or posterior aspect of acromion, posterior neck, supraspinatus, infraspinatus, and these entire areas) with or without trigger points, visual analog scale score of wound pain, and requested counts of analgesics. The number of patients who suffered from postoperative shoulder pain was 37 of 70 (52.9%). Demographic data, anterolateral/VATS ratio, VAS scores, and requested counts of rescue analgesics requirement were similar in the groups of patients with and without postoperative shoulder pain. The segmentectomy caused a significantly higher incidence of postoperative shoulder pain compared with other procedures (p < 0.05). The supra- and infraspinatus were significantly higher areas of painful regions compared to the other sites. The 16 of 37 patients (43.2%) with shoulder pain showed defined trigger points in their painful areas. CONCLUSION These results supported the hypothesis that myofascial involvement contributed, to some extent, to shoulder pain after muscle-sparing thoracotomy with ipsilateral upper extremity elevation.