Adverse reactions to vancomycin prophylaxis in cardiac surgery

Several adverse effects of vancomycin have been reported. The aim of this study was to assess the incidence of adverse responses to antibiotic prophylaxis with vancomycin in cardiac surgical patients. Prospectively, 116 consecutive patients (106 adults and 10 children) undergoing cardiac surgical procedures in this institution from January to June 1990 were studied. After the anesthetic induction, vancomycin, 1 g in adults and 10 mg/kg in children, was intravenously administered over 30 minutes. The infusion rate was slowed if any adverse effect was observed. As a control group, 10 similar patients were evaluated during the same period of 30 minutes after anesthetic induction but prior to vancomycin administration and surgical stimulation. Thirty-one patients (26.72%) developed an adverse effect, mainly hypotension (29 patients, 25%), which was considered severe in 15 patients (12.93%). Seven patients (6.03%) developed a maculopapular erythema that was associated with hypotension (Red-Man's syndrome) in 5 patients and with bronchospasm in 1 patient. The incidence of adverse reactions in children (20%) was similar to the overall incidence. Only 1 patient in the control group (10%) developed hypotension during the period studied. The incidence of adverse reactions was not related to age, body weight, vancomycin dose administered per kilogram body weight, type of surgical procedure, or associated disease. Mean duration of the infusion was similar in patients with and without adverse responses (34.60 +/- 12.41 minutes and 37.38 +/- 14.55 minutes, respectively). It is concluded that perioperative prophylaxis with vancomycin in cardiac surgery produces a high and unpredictable risk of significant hypotension.

[Comparative study of propofol and sodium thiopental in short-duration anesthesia]

We have compared propofol and sodium thiopental in two groups of 20 women undergoing curettage. Patients received premedication with diazepam and were randomly allotted to propofol group (2 mg/kg, intravenously) or sodium thiopental group (5 mg/kg, intravenously). Anesthesia maintenance was carried out with spontaneous ventilation with 0(2)-N2O. When complementary doses were required, 20% of the initial dose was administered. There were no significant differences with respect to base arterial blood pressure and heart rate on induction, 2 minutes after induction and at the end of the operation. The time from the end of the operation to the patient began to respond to the order of open eyes and to the patient was aware enough to establish a coherent talk and to seat without help was similar in both groups. Adverse effects were minor in bith groups and significantly more frequent in propofol group. We conclude that propofol is a particularly interesting new anesthetic agent for short duration anesthesia.

[Use of a new inotropic agent, enoximone, in heart surgery]

We report our experience with the use of enoximone in 5 patients with severely depressed preoperative myocardial function who underwent cardiac surgery. In patients 1 and 2, enoximone was administered as the inotropic of choice before cardiopulmonary bypass (CPB) and a substantial improvement of cardiac index was achieved; in these patients, enoximone administration after CPB permitted to overcome low cardiac output which persisted after high dose dobutamine in patient 1, and in patient 2 right ventricular contractility improved. In patient 3 the use of enoximone permitted the discontinuation of CPB, which had not been previously possible with the association of dopamine and dobutamine. In this patient, adrenaline perfusion improved the low cardiac output syndrome but resulted in poorly tolerated side effects. However, in patient 4 the administration of enoximone during pre-CPB did not improve in a reduction in filling pressures without an increase in the cardiac index because the patient was hypovolemic. In patient 5, the administration of enoximone permitted to interrupt the infusion of dobutamine and to reduce the dose of sodium nitroprusside, which had resulted in significant tachycardia, with increased myocardial contractility and a reduction of vascular peripheral and pulmonary resistances. We conclude that enoximone, single or in association with other inotropics, should be considered a drug of choice in patients undergoing cardiac surgery who develop a low cardiac output syndrome.

[Comparison of intramuscular and intranasal premedication with midazolam in children]

The study involved 40 children ASA I to II type who were randomly divided into two groups of 20 patients with comparable age and sex profile. Premedication consisting of 0.2 mg/kg of midazolam (Dormicum, Roche) and 0.015 mg/kg of atropine was administered 30 to 40 min before surgical intervention by intramuscular way in one group and by intranasal in the other one. In the operating room a peripheral vein was cannulated and general anesthesia was induced with thiopental sodium and succinylcholine. Arterial blood oxygen saturation, heart rate, arterial blood pressure and respiratory rate were measured at baseline, beginning of sedation (closing eyes), and arrival at the operating room. The time at the onset of sedation, the degree of sedation at the operating room, and the reaction to the venopuncture were also measured. In both groups of patients heart rate and systolic arterial blood pressure measured at the arrival to the operating room were significantly higher than those recorded at baseline and at the onset of sedation. Diastolic blood pressure in patients with intranasal premedication increased on arrival to the operating room with respect to the sedation values. Arterial oxygen saturation significantly decreased from the baseline values in both groups at the onset of sedation and on arrival at the operating room. There were no significant changes in respiratory rate. None of the alterations had clinical consequences. There were no significant differences in the onset of sedation (12.42 +/- 4.07 min in the intramuscular group and 15.26 +/- 7.99 min in the intranasal administration), degree of sedation and response to venopunction in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of anesthesia with thiopental or etomidate in short duration operations]

Forty ASA I-II women who were scheduled for uterine curettage were randomly allotted to two groups of 20 patients each. Both groups were age- and weight- matched. They were pre-treated with atropine (0.01 mg/kg) and diazepam (0.1 mg/kg). Anesthesia was induced with 2.5% thiopental (5 mg/kg) or 0.1% etomidate (0.3 mg/kg) and was maintained with N2/O2 at 50% and isoflurane at 1% adding supplementation doses of inducer (20% of initial dose) when required. Quality of induction and maintenance of anesthesia, cardiovascular effects, secondary effects and quality and rapidity of awakening were evaluated. Etomidate patients presented a higher number of secondary effects and pain on injection of the drug (p less than 0.05) and occurrence of excitatory motions (p less than 0.01) attained statistical significance. Evaluation of anesthesia quality was significantly higher with thiopental (p less than 0.05). There were no differences with respect to the remaining studied variables. We conclude that etomidate when used as unique agent in anesthesia induction has no advantages over thiopental in healthy patients undergoing short duration operations.

[Effect of intravenous anesthetic premedication using diazepam and fentanyl on the arterial oxygen saturation. A pulse-oximetric study]

The effects of anesthetic premedication with diazepam and phentanyl on the arterial oxyhemoglobin saturation (SpO2) were monitored with a pulsioximeter (BIOX 3700, Ohmeda) in 83 patients scheduled for traumatologic and orthopedic surgery who had baseline SpO2 higher than 95%. Premedication was carried out with phentanyl (0.1 mg) and diazepam (2.5 mg increments) until a somnolence state (eye closure), reversible with verbal stimuli, was achieved. The patients were breathing room air during the study. Premedication induced a significant reduction of SpO2 (p less than 0.001) from baseline values of 96.6 +/- 1.2% to 92.7 +/- 2.9% after sedation and to minimal values of 85.9 +/- 6.1%. In 60 patients (72.3%), minimal SpO2 was lower than 90%, and it was lower than 85% in 32 (38.8%). However, 34 of them (73.3%) recovered a SpO2 higher than 90% with verbal respiratory stimuli, but 16 (26.7%) only did so with oxygen administration. Cyanosis was not detected in any case. Minimal saturation was significantly correlated with baseline SpO2, age and smoking habit. Pulsioximetric monitoring or, if not available, routine oxygen administration, are recommended in patients undergoing pharmacological sedation.

[Epidemiologic aspects of accidental poisoning in children in Aragón (author's transl)]

Authors have studied epidemiologic aspects of 1,363 cases of accidental poisonings in children on a total of 25,136 cases of accidents that have been observed in Aragon hospitals. The following parameters were included in the protocol: sex (males: 57.6%), age (between 1-3 years: 57.9%), day time (12.00-16.00 hours: 30.8%), year season (spring-summer: 56.5%), week day (monday: 18.0%), poisoning (drugs and domestic products: 65.9%), house place (kitchen: 38.1%) and treatment (ambulatory: 81.7%).