Opioid anaesthesia--fact or fallacy.
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Anesthesia, General↗
Biomedical subjects
P S Sebel
Publications and source records attributed to P S Sebel.
Cardiovascular effects of alfentanil anaesthesia.
In 30 patients undergoing cardiac surgery, anaesthesia was induced with alfentanil 125 micrograms kg-1 and maintained with an infusion of alfentanil 0.5 mg kg-1 h-1 until the start of cardiopulmonary bypass, and alfentanil 0.25 mg kg-1 h-1 thereafter until the end of surgery. Pancuronium was given and the lungs ventilated with air in oxygen. In the majority of patients, there were no significant changes in cardiovascular measurements throughout the study, although two received sodium nitroprusside for the control of hypertension, and in one patient hypertension was so severe that the method of anaesthesia was abandoned. Transient hypotension occurred on induction in one patient. Twenty-six patients required alfentanil supplementation before bypass. These results indicate that anaesthesia with an alfentanil infusion provides satisfactory cardiovascular stability for cardiac surgery.
Alfentanil↗
The pharmacokinetics of alfentanil (R39209): a new opioid analgesic.
The pharmacokinetics of alfentanil (R39209), a new short-acting opioid analgesic, have been studied in eleven patients. Six patients were given 50 micrograms/kg alfentanil and five patients 125 micrograms/kg as an intravenous bolus injection. Plasma concentrations were measured at intervals up to 6 h (50 micrograms/kg) or 8-10 h (125 micrograms/kg), using a specific radioimmunoassay technique. Plasma concentrations declined triexponentially in both groups. The initial elimination of alfentanil from the plasma was very rapid with 90% of the administered dose leaving the plasma within 30 min. The average half-lives for the three phases were similar for both groups. The combined mean (+/- SEM) half-lives for the 11 patients for the rapid and slow distribution phases were short (t 1/2 pi = 1.2 +/- 0.26 min, t 1/2 alpha = 11.6 +/- 1.63 min). The elimination half-life, t 1/2 beta was 94 +/- 5.87 min which is considerably shorter than that of other opioids. The mean (+/- SEM) total body clearance was 6.4 +/- 1.39 ml . kg-1 . min-1 and the volume of distribution (Vd) was 0.86 +/- 0.194 l/kg. The latter is considerably less than reported values for the chemically related drug, fentanyl, and suggests that alfentanil may have a lower tissue binding affinity than fentanyl. The rapid elimination and short duration of clinical action suggests the feasibility of repeated administration of alfentanil and its use by continuous intravenous infusion.
Adult↗
Cardiovascular effects of high-dose fentanyl anaesthesia.
An anaesthetic technique using high-dose fentanyl for coronary artery surgery is described. Fentanyl 60 or 70 micrograms kg-1 was used as the sole anaesthetic agent, and patients were ventilated with air/O2 (fentanyl 70 micrograms kg-1) or N2O/O2 (fentanyl 60 micrograms kg-1). Cardiovascular data from 30 patients are presented. Fentanyl caused no significant cardiovascular depression. The only statistically significant changes in cardiovascular parameters were seen in the patients who received fentanyl 60 micrograms kg-1. Five minutes after skin incision there was an increase in peripheral resistance. Diastolic pressure was increased following sternotomy. Problems associated with this technique of anaesthesia are a 50% incidence of hypertension following sternotomy (requiring treatment with sodium nitroprusside) and prolonged respiratory depression. The lack of cardiovascular depression produced by fentanyl and the ability of fentanyl to reduce hormonal and metabolic responses to surgery make it a satisfactory technique for cardiac anaesthesia.
Anesthesia, General↗
Cardiovascular effects of sufentanil anesthesia.
Sufentanil is a new synthetic opiate analgesic that is 4520 times more potent than morphine in animal experiments. This study evaluated the cardiovascular effects of sufentanil, 15 micrograms/kg, and air/O2 used as a complete anesthetic with 50% inspired oxygen (air/O2 mixture) in 40 adult patients undergoing elective or emergency cardiac surgery. Statistically significant changes included a decrease in systolic pressure 5 minutes after induction, decreases in systolic and mean blood pressures and peripheral resistance before incision, and a decrease in systolic pressure below control levels 2 minutes after incision. The diastolic pressure increased significantly 5 minutes after sternotomy. Two patients became hypotensive on induction of anesthesia and 16 patients developed hypertension related to sternotomy. These results indicate that sufentanil anesthesia provides good cardiovascular stability for cardiac surgery and is a technique worthy of further evaluation.
Analgesics, Opioid↗
Hormonal responses to high-dose fentanyl anaesthesia. A study in patients undergoing cardiac surgery.
The hormonal responses to anaesthesia and cardiac surgery were studied in 20 patients. Ten patients were anaesthetized with fentanyl 60 microgram kg-1 and nitrous oxide in oxygen and 10 with etomidate 0.3 mgkg-1 and nitrous oxide in oxygen plus halothane. There were no significant changes in cortisol, growth hormone or insulin concentrations in response to surgery in either group, although cortisol concentrations decreased during cardiopulmonary bypass. Both groups showed increases in prolactin concentrations. Patients anaesthetized with etomidate and halothane showed a significant increase in adrenaline and glucose concentrations not seen in the fentanyl group. Cardiopulmonary bypass was associated with marked increases in catecholamines in both groups.
Aged↗
Effects of high-dose fentanyl anesthesia on the electroencephalogram.
The purpose of this study was to define the EEG changes produced in humans by fentanyl 30-70 microgram/kg during cardiac surgery. The authors have also assessed awareness in the patients. Thirty-nine patients were studied; oral lorazepam or intramuscular morphine was used as premedication. Anesthesia was induced with intravenous injection of fentanyl over 2 min and the patients were ventilated with either air/O2 (24 patients) or N2O/O2 (15 patients). The EEGs recorded until the start of cardiopulmonary bypass were visually analyzed, classified into EEG stage, and plotted graphically as narcograms. Computerized 3-dimensional power spectral analysis and wide band spectral analysis were carried out on representative EEGs. The EEG effects of fentanyl are consistent and are characterized by high-voltage slow delta waves. Nitrous oxide had no effect on the EEG responses to fentanyl. Computer analysis confirmed the visual interpretation. There was no incidence of awareness. The authors conclude from this study that fentanyl after premedication is a suitable drug for providing unconsciousness, analgesia, and amnesia during cardiac surgery.
Amnesia↗
Effects of doxapram on postoperative pulmonary complications following thoracotomy.
An i.v. solution of 5% dextrose with doxapram 2 mg ml-1 or 5% dextrose alone was administered to 53 patients following lateral thoracotomy. Estimations of arterial PO2, PCO2 and pH were made before operation, during infusion and 7 days after after operation. Respiratory function tests were carried out before and 7 days after operation. There were no significant differences in arterial PO2, PCO2 and pH or in respiratory function tests between those who received doxapram and those who did not. In this study doxapram did not affect the frequency of postoperative pulmonary complications.
Carbon Dioxide↗
Early extubation after Fontan operation. A clinical report.
A report of early extubation after Fontan operation in nine patients is presented. All patients had a satisfactory course after operation with adequate PaO2 values. The possible benefits of early extubation are discussed.
Adolescent↗
Pharmacokinetics of high-dose fentanyl. A study in patients undergoing cardiac surgery.
The pharmacokinetics following a bolus injection of fentanyl 60 micrograms kg-1 as the sole anaesthetic in five patients undergoing cardiac surgery are described. Before cardiopulmonary bypass the kinetics can be described by a biexponential decay curve with an initial half-life of 1.7 +/- 0.85 min and a half-life during the tissue uptake phase of 69 +/- 8.2 min. Two patients had secondary peaks in plasma fentanyl concentration during the first 5 min after injection. After 5 min cardiopulmonary bypass with haemodilution, the fentanyl concentration decreased by an average of 53%. The half-life in the post-bypass elimination phase was 423 +/- 36.9 min. No second peaks during the elimination phase were found.
Aged↗
Fontan's operation: an expanded horizon.
The Fontan principle of redirecting systemic venous blood into the pulmonary arteries via a conduit has now gained a much wider application than initially intended. We have applied this type of operation in a series of 15 patients, five of whom had "classical" tricuspid atresia with concordant arterial connections. The other 10 patients showed a variety of congenital malformations, such as double-inlet univentricular heart with discordant arterial connections, double-outlet right ventricle with common atrioventricular canal. Ebstein's anomaly with almost imperforate tricuspid valve, hypoplasia of right ventricular inflow, and a crisscross heart with straddling right atrioventricular valve. Important associated anomalies, such as common atrium and anomalous pulmonary and/or systemic drainage, required particular adaptation of the technique. Thirteen of the 15 patients survived operation and are presently alive. One death occurred in a patient in whom the preoperative diagnosis had to be adjusted during operation because of unexpected total anomalous pulmonary venous connections. The other death occurred in a patient suffering from the "asplenic syndrome." The autopsy in this patient suggested that the large baffle used for atrial septation and ventricular exclusion had obstructed pulmonary venous return. Our experience thus supports the opinion that Fontan's operation has a place in the treatment of otherwise anatomically uncorrectable lesions.
Adolescent↗
Detection of venous air embolism. A clinical report using end-tidal carbon dioxide monitoring during neurosurgery.
A clinical report on the detection of venous air embolism during neurosurgery is presented. The use of end-tidal CO2 monitoring is described.
Adult↗
Indirect assessment of memory for music during anesthesia.
STUDY OBJECTIVE: To obtain evidence for intraoperative registration of auditory information in patients undergoing elective surgery. DESIGN: Within-subject design with three levels of frequency of exposure to music. SETTING: A university hospital and a university language laboratory. PATIENTS: Thirty-four patients scheduled for elective surgery and 20 healthy undergraduate psychology students. INTERVENTIONS: Selections of instrumental ethnic music were played to patients for 0, 3, or 12 exposures in one experiment and for 0, 6, or 24 exposures in another study. The undergraduates heard 0, 3, or 12 exposures of the music while awake. MEASUREMENTS AND MAIN RESULTS: Forty-eight hours after hearing the music, all subjects were tested on their preference for the selections they had heard as well as selections they had not heard. For the patients, the mean preference ratings (in millimeters, mm) on a visual analog scale following 0, 3, and 12 exposures were 73.3 mm, 74.0 mm, and 65.1 mm, respectively, a nonsignificant difference. For the patients who were exposed to the music 0, 6, and 24 times, the mean preference ratings were 64.4 mm, 66.1 mm, and 70.6 mm, respectively, a nonsignificant difference. For the waking participants, the mean preference ratings following 0, 3, and 12 exposures were 55 mm, 66.2 mm, and 62.5 mm, respectively, a significant difference (p less than 0.05). CONCLUSIONS: The anesthetized patients did not exhibit indirect memory for music played intraoperatively, at least to the extent required to demonstrate an exposure effect.
Adult↗