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Biomedical subjects

K Korttila

Publications and source records attributed to K Korttila.

At least 37 records · Page 2Linked to original sources
PubMed1999

Sevoflurane requirement for laparoscopic tubal ligation: an electroencephalographic bispectral study.

It has been shown in healthy volunteers that a concentration of volatile anaesthetic lower than 1 minimum alveolar concentration provides unconsciousness. We tested the hypothesis that, using the electroencephalogram bispectral index, less than 1 minimum alveolar concentration of sevoflurane can produce unconsciousness in patients. Anaesthesia was induced and maintained with sevoflurane in N2O and O2 (33%) in 32 ASA I-II women undergoing laparoscopic tubal ligation. For the first patient, the sevoflurane concentration was adjusted to 1 minimum alveolar concentration with an end-tidal concentration of 0.7%. The electroencephalogram bispectral index values were used to determine the concentration to be used for the next patient. The ED50 (effective dose) measured using end tidal concentrations of sevoflurane for laparoscopic tubal ligation in a 40-year-old patient was 0.70% (CI 95%: 0.63-0.77) and ED95 0.83% (CI 95%: 0.75-0.90). None of the patients had any operation-associated recall. It is concluded that the sevoflurane concentration needed for laparoscopic tubal ligation is not lower than 1 minimum alveolar concentration.

Adult↗
PubMed1999

Comparison of sevoflurane-nitrous oxide and propofol-alfentanil-nitrous oxide anaesthesia for minor gynaecological surgery.

We studied 44 patients undergoing minor gynaecological surgery, anaesthetized in random order with sevoflurane-nitrous oxide or propofol-alfentanil-nitrous oxide. Operating conditions, recovery and postoperative nausea and vomiting (PONV) were assessed. For postoperative analgesia, all patients were given ketoprofen 100 mg rectally at the end of anaesthesia. Patients and gynaecologists were equally satisfied with both anaesthetic techniques. Patients given propofol woke up (3.5 vs 6.5 min), became orientated (5.0 vs 7.5 min) and were able to walk (57 vs 69 min) significantly (P < 0.05) earlier than those given sevoflurane, but there were no differences in times to achieve home readiness (166 vs 149 min) or in psychomotor recovery between the two groups. Intrauterine bleeding and PONV were more common with sevoflurane (incidence of PONV 64%) than with propofol anaesthesia (incidence of PONV 5%). We conclude that propofol-alfentanil is preferable to sevoflurane in ultra-short anaesthesia for minor gynaecological surgery.

Adult↗
PubMed1999

Epileptiform electroencephalogram during mask induction of anesthesia with sevoflurane.

BACKGROUND: Sevoflurane is suggested as a suitable anesthetic agent for mask induction in adults. The authors recently found that hyperventilation during sevoflurane-nitrous oxide-oxygen mask induction is associated with cardiovascular hyperdynamic response. We tested the hypothesis that the hyperdynamic response can be explained by electroencephalography (EEG) findings. METHODS: Thirty women were randomly allocated to receive sevoflurane-nitrous oxygen-oxygen mask induction using a single-breath method, followed by either spontaneous breathing (n = 15) or controlled hyperventilation (n = 15) for 6 min. EEG was recorded. Blood pressure and heart rate were recorded at 1-min intervals. RESULTS: Epileptiform EEG activity (spikes or polyspikes) was seen in all patients with controlled hyperventilation, and in seven patients with spontaneous breathing (P < 0.01). Jerking movements were seen in three patients with controlled hyperventilation. In the controlled hyperventilation group, heart rate increased 54% from baseline at 4 min after induction (P < 0.001). Mean arterial pressure increased 17% (P < 0.05), peaking at 3 min. In the spontaneous breathing group, heart rate showed no change, and mean arterial pressure decreased by 14% (P < 0.01) at 6 min. Heart rate and mean arterial pressure differed significantly between the groups from 2 min after beginning of the induction to the end of the trial. An increase in heart rate of more than 30% from baseline always was associated with epileptiform EEG activity. CONCLUSIONS: Sevoflurane mask induction elicits epileptiform EEG patterns. These are associated with an increase in heart rate in patients with controlled hyperventilation and also during spontaneous breathing of sevoflurane.

Adult↗
PubMed1999

Regional anaesthesia for outpatients.

Regional anaesthesia is useful in day surgery when properly applied. Most commonly used techniques are IVRA, axillary block, local/infiltration plus monitored anaesthesia care. Spinal anaesthesia is also frequently used in DS. Depending on the technique used RA may fasten or prolong discharge when compared to general anaesthesia. The use of monitored anaesthesia care as an adjunct to RA increases patient acceptability and satisfaction with different blocks. In most cases there is less pain after operation if RA was used when compared to GA but control of pain is important at the time when the block wears off. Patient information and cooperation as well as timely discharge of patients home is important for successful RA in DS.

Ambulatory Surgical Procedures↗
PubMed1998

Oral dolasetron mesylate for prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study. The Oral Dolasetron PONV Prevention Study Group.

STUDY OBJECTIVE: To examine the safety and effectiveness of a range of single oral doses of dolasetron mesylate for the prevention of postoperative nausea and vomiting. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 32 hospitals. PATIENTS: 789 female ASA physical status I, II, and III patients, ages 18 to 60 years, weighing between 45 and 100 kg, scheduled for major gynecologic surgery (including abdominal hysterectomy, gynecologic laparotomy, or vaginal hysterectomy) with general anesthesia. INTERVENTIONS: 25, 50, 100, or 200 mg oral doses of dolasetron mesylate or placebo were administered 1 to 2 hours before induction of anesthesia. Efficacy was assessed for 24 hours postrecovery by measuring complete response (no emetic episodes, no rescue medication), total response (complete response with no nausea), time to first emetic episode or rescue, and patient visual analog scale evaluations of nausea severity and satisfaction with antiemetic therapy. MEASUREMENTS AND MAIN RESULTS: Complete response rates for the 50, 100, and 200 mg dose groups were statistically greater than placebo (p < or = 0.018). Likewise, total response rates were statistically greater in the 50, 100, and 200 mg dose groups than in the placebo group (p = 0.012). Percentage of patients with no nausea and patient satisfaction scores were significantly higher for each dolasetron dose group than placebo (p < or = 0.047 and p < or = 0.004, respectively). Efficacy peaked at the 50 mg dose. The incidence of adverse events was similar in the placebo (30.1%) and dolasetron groups (29.4%). Headache was the most frequent treatment-related adverse event, with 2% to 5% incidence across groups. Incidence of adverse events did not increase with increasing dolasetron doses. Dose-related decreases in blood pressure at acute time points were not clinically significant. CONCLUSION: Single oral doses of dolasetron, administered 1 to 2 hours before induction of anesthesia, are safe and effective for preventing postoperative nausea and vomiting in this patient sample. Maximal antiemetic response was seen with the 50 mg oral dolasetron dose.

Adolescent↗
PubMed1998

Neostigmine with glycopyrrolate does not increase the incidence or severity of postoperative nausea and vomiting in outpatients undergoing gynaecological laparoscopy.

We studied 100 healthy women undergoing outpatient gynaecological laparoscopy in a randomized, double-blind and placebo-controlled study to evaluate the effect of neostigmine on postoperative nausea and vomiting (PONV). After induction of anaesthesia with propofol, anaesthesia was maintained with sevoflurane and 66% nitrous oxide in oxygen. Mivacurium was used for neuromuscular block. At the end of anaesthesia, neostigmine 2.0 mg and glycopyrrolate 0.4 mg, or saline, was given i.v. The incidence of PONV was evaluated in the postanaesthesia care unit, on the ward and at home. The severity of nausea and vomiting, worst pain, antiemetic and analgesic use, times to urinary voiding and home readiness were recorded. During the first 24 h after operation, 44% of patients in the neostigmine group and 43% in the saline group did not have PONV. We conclude that neostigmine with glycopyrrolate did not increase the occurrence of PONV in this patient group.

Adult↗
PubMed1997

Reversal of neuromuscular blockade with neostigmine has no effect on the incidence or severity of postoperative nausea and vomiting.

UNLABELLED: We performed this randomized, double-blind, placebo-controlled study to determine whether reversal of neuromuscular block with neostigmine increases the incidence and severity of postoperative nausea and vomiting (PONV). We studied 162 women undergoing abdominal hysterectomy and randomly allocated them into two groups. In Group A, neuromuscular block produced with mivacurium was antagonized with neostigmine 2.0 mg and glycopyrrolate 0.4 mg intravenously, whereas Group B received no drugs to facilitate antagonism of blockade. The incidence and severity of PONV was assessed up to 27 h after the operation. There was no difference in PONV between the groups (in Group A 35% had nausea and 33% vomited; in Group B 28% nauseated and 40% vomited) or in the amount of antiemetics given. We had a 75% chance to find a 30% difference in PONV. We conclude that the administration of neostigmine and glycopyrrolate at the end of anesthesia to reverse neuromuscular block does not increase the incidence or severity of PONV. IMPLICATIONS: Neostigmine may increase postoperative nausea and vomiting. In this study, omission of reversal of neuromuscular block with neostigmine failed to decrease the incidence or severity of postoperative nausea and vomiting.

Adult↗
PubMed1997

Recovery and outcome after propofol and isoflurane anesthesia in patients undergoing laparoscopic hysterectomy.

BACKGROUND: Laparoscopic hysterectomy (LH) is expected to provide fast and comfortable recovery, plus an early return to normal daily activities. This study was carried out to compare the outcome after LH in patients anesthetized with isoflurane or propofol. METHODS: Sixty-two patients undergoing LH were randomized to receive either isoflurane-N2O or propofol-N2O anesthesia. The times when the patients could drink, void and walk were recorded. Recovery was also evaluated by the Digit Symbol Substitution Test in the postanesthesia care unit (PACU) 60 and 120 min after the operation. The patients were also given a questionnaire on their further recovery (return to daily activities, pain and nausea) to be filled out at home. RESULTS: Early recovery was significantly (P < 0.05) faster in the isoflurane group (eye opening within 3 min, orientation in 6 min) when compared to the propofol group (eye opening within 7 min, orientation in 14 min), but there was no significant difference in the other parameters of recovery. Most of the patients were discharged from the hospital on the first postoperative day in both groups. Twenty-five percent of the patients, however, stayed two nights in hospital, mainly for social reasons. No difference was found regarding the recovery at home: the patients resumed their normal daily activities on about the sixth postoperative day (median). CONCLUSIONS: It is concluded that both isoflurane and propofol are suitable anesthetics for LH. In this study recovery was not fast enough to make the patients suitable for same-day surgery.

Adult↗
PubMed1997

Intravenous dolasetron and ondansetron in prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study.

BACKGROUND: Intravenous dolasetron mesilate has shown efficacy in the prevention of postoperative nausea and vomiting (PONV) when administered as a single dose prior to emergence from anesthesia. This trial compared intravenous dolasetron and ondansetron for the prevention of PONV when administered at induction of anesthesia. METHODS: This double-blind, placebo-controlled, multicenter trial randomized patients to one of four single IV treatments placebo, 25 or 50 mg dolasetron, or 4 mg ondansetron. Efficacy was measured by complete response (0 emetic episodes and no rescue medication), nausea severity and patient satisfaction as measured on a visual analog scale (VAS), investigator's rating, of nausea severity, and total response (complete response with no nausea [< or = 5 mm VAS]). RESULTS: 514 patients at 24 sites were evaluated for efficacy. The 50 mg dolasetron and 4 mg ondansetron doses were statistically equivalent, and superior to placebo, for all efficacy measures. Complete response rates were 49%, 51%, 71% and 64% for placebo, 25 and 50 mg dolasetron, and ondansetron, respectively. Dolasetron 50 mg was statistically superior to 25 mg dolasetron for complete response, total response, VAS maximum nausea, time to first emetic episode, and patient satisfaction. The majority of adverse events were of mild-to-moderate intensity. Headache was the most frequently reported treatment-related adverse event with a 3%-5% incidence across treatments. CONCLUSION: When given at induction of anesthesia, 50 mg intravenous dolasetron is equivalent to 4 mg ondansetron and superior to 25 mg dolasetron and placebo for the prevention of PONV. All treatments were safely administered and well tolerated.

Adult↗
PubMed1996

Recovery profile after desflurane with or without ondansetron compared with propofol in patients undergoing outpatient gynecological laparoscopy.

We studied the effect of combining prophylactic ondansetron (4 mg intravenously [IV]) to desflurane-based anesthesia in 90 ASA grade I or 11 women undergoing outpatient gynecological laparoscopy. Recovery after anesthesia, with special focus on postoperative nausea and vomiting (PONV), was assessed. Control groups received a similar desflurane anesthetic (placebo) or a propofol-infusion-based (active control) anesthetic. The study design was randomized, controlled, and double-blind (regarding ondansetron) and single-blind (regarding the anesthetic technique). Early recovery (eye opening, orientation, following commands, sitting) was similar in the three groups. However, overall home readiness (toleration of oral fluids, walking, pain tolerable by oral analgesics, no or only mild nausea) was achieved faster in the desflurane group receiving ondansetron (109 [21-937] min, P < 0.01) and in the propofol group (110 [33-642] min, P < 0.001) when compared to the desflurane only group (372 [45-723] min) (median [range]). The total incidence of PONV in the desflurane-only group was 80% (P < 0.01), compared to 40% and 20% in the desflurane group receiving ondansetron and the propofol group, respectively. The postoperative antiemetic requirements were consistently and significantly (P < 0.01) higher in the desflurane-only group compared to the other two groups. Postoperative sedation, analgesic requirements, and psychomotor recovery (assessed by the Maddox Wing and the Digit Symbol Substitution Tests) were similar in the three groups. Our results suggest that in order to achieve a propofol-like recovery profile in patients with a high likelihood of PONV, desflurane should be combined with a potent antiemetic (e.g., ondansetron).

Adolescent↗
PubMed1996

Balanced analgesia improves recovery and outcome after outpatient tubal ligation.

Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission. Ninety patients were randomised to this double-blind study, the aim being to evaluate the effect of balanced analgesia on postoperative pain and recovery after sterilization. The balanced analgesia group received 5 ml of 2% lidocaine gel on the sterilization clips and perioperatively 200 mg of ketoprofen i.v. The lidocaine group received 5 ml of 2% lidocaine gel on the clips and placebo i.v. perioperatively. The placebo group received 5 ml of placebo gel on the clips and placebo i.v. perioperatively. Infusion of propofol and 67% nitrous oxide in oxygen were used for maintenance of anesthesia. Succinylcholine and vecuronium were used for muscle relaxation and 0.1 mg of fentanyl i.v. was given to all patients at induction of anesthesia. Postoperative pain and analgesic requirements, incidence of PONV and need for antiemetic medication were all significantly lower in the balanced analgesia group. Home readiness was consistently achieved 70-90 min sooner in the balanced analgesia group compared to the other groups (P < 0.01 between the balanced analgesia and the placebo group), and the patients were able to return to normal activity sooner (cumulatively 93% of the patients in the balanced analgesia group vs. 60% in the other two groups (P < 0.01 between the balanced analgesia and the other groups) had returned to normal activity on the 2nd postoperative day). It is concluded that in patients undergoing laparoscopic TL the combination of analgesic regimens with different mechanisms of action offer a simple and efficient way of postoperative pain relief, as well as an improvement of quality (i.e. less PONV) and speed of recovery.

Adult↗
PubMed1995

Recovery from outpatient anaesthesia. Factors affecting outcome.

In 1994, 66% of all surgery in the USA was performed as ambulatory surgery. Day surgery is also expanding to other countries worldwide. To provide safe anaesthesia and good outcomes for longer and more extensive operations performed in ambulatory facilities, patients must be carefully evaluated before surgery, their home readiness must be assessed, and they must fully understand all relevant information. Good outcome requires adoption of policies for safe discharge from the hospital. If a patient does not have an escort home, the surgical procedure should be cancelled or the patient admitted to the hospital. As the number of patients and complexity of scheduled surgical procedures increases, the outcome of day surgery will increasingly depend on the anaesthetist's skills. The recently introduced short-acting drugs may further improve the outcome after day surgery by facilitating rapid recovery and an early return to normal daily activities.

Adolescent↗
PubMed1995

Recovery from sevoflurane and isoflurane anaesthesia after outpatient gynaecological laparoscopy.

As the low blood solubility (blood gas partition coefficient 0.69) of sevoflurane suggests a rapid emergence from anaesthesia, recovery from sevoflurane anaesthesia was compared to isoflurane in outpatient gynaecological laparoscopy. Fifty ASA I or II, consenting women participated in a randomised, controlled and single blind study. The patients received, after induction of anaesthesia with propofol, either sevoflurane or isoflurane, both with 67% nitrous oxide in oxygen, for maintenance of anaesthesia. The study drug was administered at 1 MAC (end tidal concentration 0.6% for sevoflurane and 0.5% for isoflurane) but adjusted in 0.5 MAC steps, if clinically indicated. Before the end of surgery the end tidal concentration of the study drug was reduced to 0.5 MAC. Recovery assessments were made from the time anaesthetic gases were discontinued. The subjects were able to open eyes in 2.3 (0.8-7.0) min and 4.1 (2.0-6.8) min, orientate in 2.8 (1.0-6.8) min and 4.7 (2.2-8.3) min and follow orders in 2.6 (0.7-6.8) min and 4.3 (1.2-7.3) min, in the sevoflurane and isoflurane groups, respectively (P < 0.05) [median (range)]. Walking was achieved in 72 (24-464) min and 66 (35-134) min, tolerance of oral fluids in 37 (15-88) min and 35 (45-161) min and voiding in 262 (96-459) min and 217 (52-591) min in the sevoflurane and isoflurane groups, respectively (NS). Overall home readiness was achieved in 281 (96-708) min after sevoflurane group and 242 (96-591) min after isoflurane (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Comparison of eltanolone and thiopental in anaesthesia for termination of pregnancy.

Eltanolone, a new steroid hypnotic, was compared to thiopental in short anaesthesia. Sixty unpremedicated, Asa 1-2 women were randomized to receive eltanolone 0.6 (group E1) or 0.8 mg.kg-1 (group E2) or thiopental 4 mg.kg-1 (group T) for induction of anaesthesia. One minute before induction glycopyrrolate 0.2 mg and alfentanil 15 micrograms.kg-1 i.v. were administered. If induction failed, additional boluses of the test drug were given. Anaesthesia was maintained with 67% nitrous oxide in oxygen, and additional bolus doses of the test drug were given in a standardized fashion, if needed. Recovery was assessed by a research nurse blinded to the agent used. Mean +/- s.d. induction doss were 0.7 +/- 0.1 mg.kg-1 (group E1), 0.8 +/- 0.1 mg.kg-1 (group E2) and 4.0 +/- 0.0 mg.kg-1 (group T). Induction time was prolonged in the group E1 compared to the other two groups (P < 0.05). Side effects were few in all groups, but involuntary muscle movements or hypertonus occurred in 23% of the patients in the eltanolone and in 3% in the thiopental groups (n.s). Early recovery (eye opening, orientation and sitting) was slower in both eltanolone groups compared to the thiopental group (P < 0.01). No differences between the groups were found in toleration of oral fluids, walking, voiding, postoperative analgesic requirements or postoperative nausea and vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1994

Comparison of eltanolone and propofol in anesthesia for termination of pregnancy.

A randomized study was designed to compare eltanolone (pregnanolone) and propofol anesthesia in 60 unpremedicated women undergoing outpatient termination of pregnancy. The initial doses for induction of anesthesia were 0.8 mg/kg for eltanolone and 2 mg/kg for propofol followed by an additional 25% increment if necessary. The doses required for successful induction were 0.82 +/- 0.06 and 2.1 +/- 0.3 (mean +/- SD) mg/kg for eltanolone and propofol, respectively. Discomfort or pain on injection occurred in none of the patients given eltanolone and in 20% of those receiving propofol (P < 0.05). To maintain satisfactory anesthesia, 29% of the patients given eltanolone and 70% of the patients given propofol needed extra bolus doses of the study drug (P < 0.01). Excitation (twitching of extremities or slight hypertonus) occurred in 29% of the patients in the eltanolone group compared to none in the propofol group (P < 0.05). Both clinical (opening eyes, orientation, walking, tolerating oral fluids, voiding) and psychomotor recovery (Maddox Wing test and Digit Symbol Substitution test) returned to baseline more slowly after eltanolone than after propofol. Overall home readiness was achieved later in the eltanolone group [median 57 min (range 41-190 min)] compared to the propofol [37 (32-100 min)] group. We conclude that recovery from anesthesia is more rapid from propofol as compared to eltanolone anesthesia.

Abortion, Induced↗