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PubMed2000

Fast-tracking after immersion lithotripsy: general anesthesia versus monitored anesthesia care.

UNLABELLED: Both monitored anesthesia care (MAC) and general anesthesia (GA) offer advantages over epidural anesthesia for immersion lithotripsy. We compared propofol-based MAC and desflurane-based GA techniques for outpatient lithotripsy. After receiving midazolam 2 mg IV, 100 subjects were randomly assigned to one of two anesthetic treatment groups. In the MAC group, propofol 50-100 microg. kg(-1). min(-1) IV was titrated to maintain an observer's assessment of alertness/sedation score of 2-3 (5 = awake/alert to 1 = asleep). Remifentanil 0.05 microg.kg(-1). min(-1) IV supplemented with 0.125 microg/kg IV boluses, was administered for pain control. In the GA group, anesthesia was induced with propofol 1.5 mg/kg IV and remifentanil 0.125 microg/kg IV and maintained with desflurane (2%-4% inspired) and nitrous oxide (60%). Tachypnea (respiratory rate >20 breaths/min) was treated with remifentanil 0.125 microg/kg IV boluses. In the GA group, droperidol (0.625 mg IV) was administered as a prophylactic antiemetic. Recovery times and postoperative side effects were assessed up to 24 h after the procedure. Compared with MAC, the use of GA reduced the opioid requirement and decreased movements and episodes of desaturation (<90%) during the procedure. Although the GA group took longer to return to an observer's assessment of alertness/sedation score of 5, discharge times were similar in both groups. We conclude that GA can provide better conditions for outpatient immersion lithotripsy than MAC sedation without delaying discharge. IMPLICATIONS: A desflurane-based general anesthetic technique using the cuffed oropharyngeal airway device was found to be a highly acceptable alternative to propofol-based monitored anesthesia care sedation for outpatient immersion lithotripsy.

Ambulatory Care↗
PubMed2004

Effects of epidural-and-general anesthesia combined versus general anesthesia alone on the venous hemodynamics of the lower limb. A randomized study.

Our hypothesis was that, due to its sympatholytic action, epidural anesthesia (EA) administered as part of anesthesia in abdominal surgery would generate a marked venous leg flow enhancement, thus aiding in the prevention of peroperative venous stasis. We studied, and comprehensively quantified the venous haemodynamic changes in the lower limb during and immediately after abdominal surgery performed under EA and general (GA) anesthesia combined, in comparison to GA alone. This is a prospective, randomized, controlled study, stratified for hypertension and smoking, comprising ASA 1-2 patients undergoing elective total abdominal hysterectomy. Those with peripheral vascular or chronic venous disease, prior DVT or BMI>35 were excluded. Eligible recruits received either GA (Group GA) (n = 10; age 36-65, median 50) alone or epidural anesthesia (EA) and GA combined (Group EA/GA) (n = 9; age 32-58, median 46). EA (L(1-2)) was administered using lignocaine 2%. Both groups had GA induced with fentanyl and propofol, maintained with N(2)O and isoflurane; larygoscopy was facilitated with vecuronium; analgesia was provided either with morphine (Group GA) or epidurally with 2% lignocaine boli (Group EA/GA). Hemodynamics were determined at the popliteal vein in the horizontal supine position at baseline (resting prior to anesthesia), post epidural (20 min after delivery of EA), post induction (15 min after laryngeal intubation), surgery (upon uterus removal) and recovery (30 min after extubation). There was no difference in the mean velocity[V(mean)] between the 2 groups at baseline (p = 0.35([Mann-Whitney])), and post induction (p = 0.5([Mann-Whitney])). However V(mean) was significantly higher in Group EA/GA than Group GA, both at surgery (point estimate[PE]: 1.8 cm/s; 95% CI: 0.01, 6.3 cm/s; p <0.05([Mann-Whitney])) and recovery (PE: 2.6 cm/s; 95% CI: 0.4, 5.1 cm/s; p = 0.02([Mann-Whitney])). Volume flow[V(Q)] was similar in the 2 groups at baseline and post induction (both, p >0.1([Mann-Whitney])), but was significantly higher in Group EA/GA at surgery (PE: 54 ml/min; 95% CI: 18, 159 ml/min; p = 0.045([Mann-Whitney])) and recovery (PE: 49 ml/min; 95% CI: 16, 129 ml/min; p=0.0037([Mann-Whitney])). Peak velocity, V(mean) and V(Q) increased significantly post epidural in Group EA/GA. Contrary to the venous leg flow attenuation in elective abdominal surgery under GA and upon its recovery, EA administered as part of GA is associated with a significant enhancement of both V(mean) and V(Q). This beneficial hemodynamic effect of EA at the vulnerable stage of recovery may be critically essential in light of enhanced blood viscosity, fibrinolytic shut-down, endothelial/platelet activation and immobility, acting in synergy with putative cardiorespiratory protection. The results of this study lend support to the preferential selection of combined EA/GA in subjects at high risk for venous thromboembolism, particularly when optimal DVT prophylaxis is practically unattainable due to limitations pertaining to the nature of surgery.

Adult↗
PubMed2003

Intraocular pressure changes during laparoscopy in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia.

UNLABELLED: We examined intraocular pressure (IOP) changes during gynecologic laparoscopy performed under either thiopental-isoflurane anesthesia or total IV propofol anesthesia. Forty adult women with no preexisting eye disease scheduled for gynecologic CO(2) insufflation laparoscopy were included in the study. Heart rate, mean arterial blood pressure, peak and plateau airway pressure, ETCO(2), and IOP (using a Schioetz tonometer) were measured at defined intervals during the procedure. IOP decreased significantly after the induction of anesthesia in both groups, and remained so throughout the procedure in the propofol group. In the isoflurane group, however, IOP was increased significantly above the preinduction level after pneumoperitoneum with head-down position. There was no correlation between IOP and blood pressure or airway pressure. In conclusion, propofol total IV anesthesia may be a better choice for laparoscopic surgery should control of IOP be a concern. IMPLICATIONS: In this study, we examined the effect of two anesthetic techniques on the intraocular pressure changes during laparoscopic surgery in healthy subjects. Propofol IV anesthesia protected against increases in intraocular pressure with pneumoperitoneum and head-down position.

Adult↗
PubMed2005

Anesthetic and cardiovascular effects of balanced anesthesia using constant rate infusion of midazolam-ketamine-medetomidine with inhalation of oxygen-sevoflurane (MKM-OS anesthesia) in horses.

The anesthetic sparring and cardiovascular effects produced by midazolam 0.8 mg/ml-ketamine 40 mg/ml-medetomidine 0.05 mg/ml (0.025 ml/kg/hr) drug infusion during sevoflurane in oxygen (MKM-OS) anesthesia was determined in healthy horses. The anesthetic sparring effects of MKM-OS were assessed in 6 healthy thoroughbred horses in which the right carotid artery was surgically relocated to a subcutaneous position. All horses were intubated and ventilated with oxygen using intermittent positive pressure ventilation (IPPV). The end-tidal concentration of sevoflurane (ET(SEV)) required to maintain surgical anesthesia was approximately 1.7%. Heart rate and mean arterial blood pressure averaged 23-41 beats/min and 70-112 mmHg, respectively. All horses stood between 23-44 min after the cessation of all anesthetic drugs. The cardiovascular effects of MKM-OS anesthesia were evaluated in 5 healthy thoroughbred horses ventilated using IPPV. Anesthesia was maintained for 4 hr at an ET(SEV) of 1.7%. Each horse was studied during left lateral (LR) and dorsal recumbency (DR) with a minimum interval between evaluations of 1 month. Cardiac output and cardiac index were maintained between 70-80% of baseline values during LR and 65-70% of baseline values during DR. Stroke volume was maintained between 75-85% of baseline values during LR and 60-70% of baseline values during DR. Systemic vascular resistance was not different from baseline values regardless of position. MKM-OS anesthesia may be useful for prolonged equine surgery because of its minimal cardiovascular depression in both of lateral and dorsal recumbency.

Anesthesia, Inhalation↗
PubMedDate not supplied

Regional anesthesia with monitored anesthesia care for surgical repair of selected open globe injuries.

BACKGROUND AND OBJECTIVE: To investigate clinical features and visual acuity outcomes associated with the use of regional anesthesia with monitored anesthesia care (RA/MAC) versus general anesthesia for open globe injuries in adult reparable eyes. PATIENTS AND METHODS: Retrospective, consecutive case series including all adults with open globe injuries repaired at Bascom Palmer Eye Institute between 2000 and 2003. RESULTS: The study included 238 eyes of 238 patients with a median age of 41 years. RA/MAC was employed in 141 (59%) eyes and general anesthesia in 97 (41%) eyes. Patients who had RA/MAC were significantly (P< .001) more likely to have anterior wound location (64% corneal/limbal vs 50%), shorter wound length (6.5 vs 12 mm), and formed anterior chamber (82% vs 56%), and were significantly less likely to have an afferent pupillary defect (12% vs 43%). The improvement from presenting visual acuity to each postoperative follow-up interval was similar for the two groups. CONCLUSIONS: RA/MAC is a reasonable alternative to general anesthesia for selected patients with open globe injuries.

Adolescent↗
PubMed2005

[Early postoperative complications in patients with Moyamoya disease--a comparison of inhaled anesthesia with total intravenous anesthesia (TIVA)].

BACKGROUND: Moyamoya disease is a rare neurovascular disorder that requires special anesthetic managements during revascularization procedures. We have investigated the incidence of early postoperative complications under inhaled anesthesia in comparison with total intravenous anesthesia (TIVA) retrospectively. METHODS: Seventy-two patients undergoing revascularization procedures were divided into two groups, one with inhaled anesthesia (n = 23) and the other with TIVA (n = 49). Surgical procedures were performed under normocapnia, proper body temperature, and all patients were prevented from anemia by homologous transfusion. To avoid the variance in anesthetic managements, 39 patients under 15 years of age were picked up and divided in the same way as above. Early postoperative complications including transient ischemic attack and cerebral infarction during the first 2 weeks after operation were investigated. RESULTS: In all patients, early postoperative complications occurred in 48% of inhaled anesthesia group and in 49% of TIVA group. In patients under 15, these complications occurred in 44% and in 57%, respectively. There was no significant difference in the incidence of complications between the two anesthetic groups. CONCLUSIONS: Several previous studies reported the excellence of TIVA for revascularization procedure on the basis of regional blood flow because inhaled anesthesia may provoke intracerebral steal in moyamoya disease. Our investigation in this study revealed that both anesthetic methods have no significant difference in postoperative complications during the first 2 weeks after operation. Thus further study should be needed to verify the safety of inhalation anesthetics in patients with moyamoya disease.

Adolescent↗
PubMed1991

[Comparison of changes in plasma catecholamines between general anesthesia and general anesthesia plus epidural block].

To investigate the stress-response during anesthesia-operation, 16 patients were allocated into either of two groups. Eight cases in Group A underwent an operation on the abdomen under general anesthesia, while the other eight cases in Group B were operated under general anesthesia plus epidural block. Plasma catecholamine levels were measured in all subjects during anesthesia operation procedure. A significant increase in the levels of plasma catecholamines was observed at 45 min after incision in Group A (1.82 +/- 0.48 vs. 0.94 +/- 0.19 ng/ml, P less than 0.05, paired t-test), while no change was seen in Group B during the whole procedure. The result may indicate that an operation on the abdomen rather than general anesthesia itself is responsible for the observed increase in plasma catecholamines level.

Adult↗
PubMed1983

[Renal function after anesthesia and abnormal surgery. A comparative study between halothane and epidural anesthesia].

Beta 2-microglobulin (BMG) and osmolarity (OSM) in the plasma and in the urine were measured in 23 adult female patients before and after abdominal surgery. Creatinine clearance (Ccr) and free water clearance (C-H2O) were determined simultaneously. These patients were divided into two groups, the first group receiving halothane anesthesia (n = 14) and the second group undergoing epidural anesthesia (n = 9). Results were summarised as follows. Ccr temporarily increased in both groups on the day of operation (0-POD) and on the 1st postoperative day (1-POD), suggesting a physiological compensation to the increased metabolic and circulatory needs in the post-operative state. Urinary BMG (U-BMG) concentration remarkably increased in both groups after the operation but the plasma BMG levels were unchanged. U-BMG returned to the pre-operative levels on the 4-POD in the 1st group and on the 2-POD in the 2nd group. Tubular dysfunction after anesthesia and surgery is believed to be responsible for this marked rise in U-BMG. The earlier recovery of U-BMG to the preoperative levels in the 2nd group indicates that the tubular dysfunction in epidural anesthesia is probably less in halothane anesthesia. The results of C-H2O and urine OSM studies also indicate the postoperative tubular dysfunction but these parameters may not be so sensitive as U-BMG.

Abdomen↗
PubMed1994

Anesthesia and the Meyer-Overton rule. II. A solution theory view of anesthesia and perturbations.

Solution theory arguments play a significant role in the analysis of general anesthesia. However, the results are of limited value, due to the complexity of the systems to which these arguments are applied. This article suggests that we can advance our understanding of anesthesia by the analysis of a solution of hard spheres as an "ideal anesthetic medium." We obtain a precise definition of perturbation, which links together its structural and thermodynamical aspects in an accurate theory. It follows that this link applies to virtually all material systems, including the complex biological systems where anesthesia occurs. The derived relations: (i) explain the unique role of helium in hyperbaria; (ii) suggest how to establish a hierarchy of importance among possible causes of anesthesia; (iii) indicate the role of the Meyer-Overton rule in analyzing structural models of anesthesia; and (iv) depict the physical meaning of correlations, commonly used in anesthetic work, and show why they are more accurate than the Meyer-Overton rule.

Anesthesia, General↗
PubMed1999

Histamine release during the induction of anesthesia with propofol in allergic patients: a comparison with the induction of anesthesia using midazolam-ketamine.

OBJECTIVE: A prospective randomized controlled study was performed for patients with a history of allergy to evaluate the effect of the induction of anesthesia with propofol against histamine release, skin reactions, hemodynamic changes and other clinical symptoms, while also comparing these parameters during the induction of anesthesia with midazolam-ketamine for patients with a history of allergy. SUBJECTS: We examined 40 patients undergoing oral surgery, who had a history of allergy and/or the percentage of eosinophils in the leukocytes was more than 3%. METHODS: Forty patients were randomly allocated into two groups and thus received either midazolam-ketamine (M-K group, n = 20) or fentanyl-propofol (propofol group, n = 20) for the induction of anesthesia. Venous blood samples (4 ml each) were obtained before induction as a control and at 0.5, 1, 3, 5 minutes after the administration of each induction agent, and then furthermore at 0.5, 1, 3, 5 minutes after tracheal intubation in order to measure the plasma histamine level by using the HPLC post-label system. In addition, the blood pressure and heart rate were also simultaneously recorded. Skin reactions were also evaluated by two anesthesiologists. RESULTS: The incidence of 50% histamine release during the induction of anesthesia with propofol occurred in 15% of the patients with a history of allergy. Sixteen patients out of 20 (80%) showed a decrease in the systolic blood pressure after the administration of propofol without any evidence of histamine release. The incidence of 50% histamine release, skin reactions and an increase in the heart rate between the two groups were not statistically significant after the administration of each anesthetic agent. Moreover, some patients also demonstrated histamine release after tracheal intubation. Hemodynamic changes after tracheal intubation showed a similar tendency in both groups. No significant difference was observed regarding the incidence of histamine release, skin reactions and hemodynamic changes between both groups after tracheal intubation. CONCLUSIONS: Propofol was found to show a similar incidence of histamine release during the induction of anesthesia using midazolam-ketamine, and thus was also found to be a useful induction agent against histamine release for patients with a history of allergy when hydroxizine was used as a premedication.

Adult↗
PubMedDate not supplied

Mivacurium infusion during nitrous oxide-isoflurane anesthesia: a comparison with nitrous oxide-opioid anesthesia.

STUDY OBJECTIVE: To determine the potentiation of the neuromuscular blockade induced by a titrated infusion of mivacurium in the presence of isoflurane versus a nitrous oxide (N2O)-opioid anesthesia. DESIGN: An open-label, controlled study. SETTING: The inpatient anesthesia service of two university medical centers. PATIENTS: Thirty adults divided into two groups. INTERVENTION: An intravenous infusion of mivacurium during anesthesia with N2O-opioid or N2O-isoflurane. MEASUREMENTS AND MAIN RESULTS: A neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. The mivacurium infusion rate was significantly less in the presence of isoflurane [4.0 +/- 0.8 micrograms/kg/min (mean +/- SEM)] than during N2O-opioid anesthesia (6.4 +/- 0.6 micrograms/kg/min). The recovery rates did not differ between anesthetic groups. After the termination of the infusion, spontaneous recovery to T4/T1 of at least 0.75 occurred in an average of 17.9 +/- 1.5 minutes, with a mean recovery index (T25-75) of 6.0 +/- 0.7 minutes. CONCLUSION: Isoflurane anesthesia reduces the infusion rate of mivacurium required to produce about 95% depression of neuromuscular function.

Adult↗
PubMed2000

Maintaining sevoflurane anesthesia during low-flow anesthesia using a single vaporizer setting change after overpressure induction.

STUDY OBJECTIVE: A sevoflurane vaporizer dial setting of 1.9% was previously found to maintain the end-expired sevoflurane concentration (Et(sevo)) at 1.3% during maintenance of anesthesia for procedures up to one hour with an O(2) FGF of 1 L/min. We examined whether applying these parameters could simplify low-flow sevoflurane anesthesia after overpressure induction using two slightly different techniques. DESIGN: Prospective clinical study. SETTING: Large teaching hospital. PATIENTS: Sixteen patients receiving general anesthesia for a variety of peripheral procedures. INTERVENTIONS: Anesthesia was induced with overpressure with sevoflurane (8%) in an 8 L. min(-1) O(2)/N(2)O mixture (30%/70%). After a laryngeal mask airway (LMA) was placed, fresh gas flow (FGF) was lowered to 1 L. min(-1) using O(2) and N(2)O (FiO(2) 30%) with patients breathing spontaneously. In group I patients (n = 8), the vaporizer dial was set at 1.9% at the same time the FGF was lowered. In group II patients (n = 8), the vaporizer was turned off until Et(sevo) had decreased to 1.3%, after which the dial was set at 1.9%. The course of Et(sevo) in the two groups was examined. MEASUREMENTS AND MAIN RESULTS: In group I, Et(sevo) after 3 min was 4.88 +/- 1. 12%. Et(sevo) decreased slowly after reduction of FGF to 1.83 +/- 0. 19%, 1.59 +/- 0.18%, and 1.52 +/- 0.19% at 10, 20, and 30 min, respectively. In group II, Et(sevo) after 3 min was 4.34 +/- 0.84%, and decreased more rapidly after reduction of FGF to 1 L. min(-1) than in group I. Et(sevo) was 1.40 +/- 0.09%, 1.40 +/- 0.11%, and 1. 38 +/- 0.13% at 10, 20, and 30 min, respectively. CONCLUSIONS: After high-flow overpressure induction with sevoflurane, a single change in vaporizer setting (to 1.9%) and FGF (to 1 L. min(-1)) suffices for the Et(sevo) to approach the predicted Et(sevo) (1.3%) within 10-15 min; thereafter the Et(sevo) remains nearly constant. As expected, the predicted Et(sevo) is attained slightly faster when the vaporizer is temporarily turned off. Clinically applying previously derived pharmacokinetic parameters simplifies low-flow sevoflurane anesthesia after overpressure induction.

Adult↗
PubMedDate not supplied

A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs.

BACKGROUND AND OBJECTIVES: The American Board of Anesthesiologists and the Residency Review Committee for Anesthesiology do not keep records regarding the individual resident's cumulative exposure to specific peripheral nerve block techniques. Further, little is known about individual trainee confidence in performing regional anesthetic blocks. To improve training and anesthesia practice, such information is necessary. In this nationwide survey, we assessed residents' perceived cumulative regional anesthesia experience and their confidence level. METHODS: A survey was distributed to 42 U.S. residency programs in 22 states. Information collected included the resident's clinical anesthesia (CA) training level, estimated number of regional anesthetics performed, and the resident's confidence level in performing these techniques. Confidence was graded on a 3-point scale, as being very confident (1.0), somewhat confident (2.0), or not confident (3.0). We analyzed the estimated cumulative number and type of blocks performed in relation to training level and confidence level; differences were considered significant when P< .001. RESULTS: The response rate was 67.2% (736/1,096); 32% (n = 232) of responders were CA-3 residents. At all training levels, the number of blocks performed varied widely according to type of block, with spinal and epidural blocks being performed most often at all training levels and sciatic, retrobulbar, and femoral blocks being performed least (median = 0 each for CA-1, CA-2, and CA-3 residents). Confidence was high with frequently performed blocks (spinal and lumbar epidural) and low for those performed less than 10 times per resident. The CA-3 residents reported a cumulative experience with a median (interquartile range) of 100 (50-100) spinal anesthetics and 150 (100-200) lumbar epidural blocks with all residents being very confident. The CA-3 residents completed a median of 20 (10-30) axillary blocks but a median of less than 10 for each of these techniques: intravenous regional anesthesia, ankle, interscalene, femoral, sciatic, and retrobulbar. For interscalene block, 51% of CA-3 residents were not confident; for femoral, 62%; for sciatic, 75%; and for retrobulbar block, 91%, were not confident. CONCLUSIONS: Most CA-3 residents are confident in performing lumbar epidural and spinal anesthesia. However, many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes so that residents can graduate with enough confidence to continue selecting less familiar blocks in postgraduate practice.

Anesthesia, Conduction↗
PubMed1995

Intraosseous regional anesthesia as an alternative to intravenous regional anesthesia.

A series of 109 orthopedic operations was performed under intraosseous regional anesthesia on the upper and lower limbs. Anesthesia was satisfactory in 106 of the cases; in the other three, inadequate anesthesia was caused by faulty technique. The spread of lidocaine into the bone and venous network was demonstrated by radiography, and the blood levels after tourniquet release were below the toxic level. Intraosseous regional anesthesia proved to be a valuable technique to be used whenever intravenous anesthesia fails or is not feasible. Injection into cancellous bone (osteoclysis) is easily and quickly performed under aseptic conditions, and there were no systemic complications.

Adult↗
PubMed2001

General anesthesia in an office-based plastic surgical facility: a report on more than 23,000 consecutive office-based procedures under general anesthesia with no significant anesthetic complications.

The popularity of elective office-based plastic surgery has increased significantly over the past two decades. The continuing demand for improved aesthetic results has stimulated the development of ever more complex plastic surgical techniques. These techniques may require extended periods of operative time spent under anesthesia. Patients have come to expect an almost perfect anesthetic and surgical experience, with safety and comfort being their foremost concerns. Because of increasingly complex and lengthy operations, the authors believe that intravenous sedation, used for many years in their plastic surgery practice, is now suboptimal for most longer and complex surgical procedures. In their experience, under most circumstances, general anesthesia provides the optimal anesthetic experience for the patient, anesthesiologist, and surgeon. The authors present a consecutive 18-year study of general anesthesia in more than 23,000 procedures in an accredited, office-based plastic surgical facility that offers a very safe and uniformly pleasant anesthesia experience for patients. There were no intraoperative or postoperative deaths and no significant complications. The authors' experience differs from the common perception that general anesthesia is too risky for aesthetic surgery procedures.

Ambulatory Surgical Procedures↗
PubMed2004

Frequency of anesthesia-related complications in children with Down syndrome under general anesthesia for noncardiac procedures.

BACKGROUND: Craniofacial and cardiac anomalies of Down syndrome (DS; trisomy 21) would seem to place these patients at higher risk of anesthesia-related complications (ARCs), but to date no comprehensive large-scale study has quantified this risk. METHODS: A retrospective chart review was conducted on all patients with DS undergoing anesthesia between April 1, 1988, and May 31, 1995, at Children's Hospital of Pittsburgh. In addition, the Anesthesiology Department Quality Assurance (QA) System database of concurrently collected anesthesia information on all patients undergoing anesthesia at the hospital since 1985 was analyzed. RESULTS: Of the total 74,021 anesthetic encounters during the study period, 930 anesthetic encounters in 488 patients with DS undergoing noncardiac procedures were analyzed. The most frequent ARCs were bradycardia (severe) (3.66%), natural airway obstruction (1.83%), difficult intubation (0.54%), postintubation croup (1.83%), and bronchospasm (0.43%). CONCLUSIONS: Comprehensive reporting is needed to capture all significant adverse events. The incidences of bradycardia on induction, natural airway obstruction, and postintubation (or instrumentation) croup were significantly higher in the DS noncardiac group compared with the remaining population. Current anesthesia techniques and agents must be compared using quantitative QA data to ensure use of the safest options for each patient.

Academic Medical Centers↗
PubMedDate not supplied

Isoflurane anesthesia for equine colic surgery. Comparison with halothane anesthesia.

Isoflurane was compared with halothane as an anesthetic agent for emergency colic surgery in a series of 38 juvenile and adult horses. After presurgical stabilization with fluids and supportive medications, anesthesia was induced by intravenous xylazine and/or diazepam followed by ketamine. Anesthesia was maintained with isoflurane or halothane in oxygen with controlled ventilation. Heart rates (HR), arterial blood gases, mean arterial pressures (MAP), rate pressure products (RPP), requirements for cardiovascular support medications, and recovery times to standing were compared using nonparametric methods. Cardiopulmonary responses to isoflurane and halothane anesthesia were generally comparable although some temporal differences were observed. Higher HR (p less than 0.02) and lower PaCO2 levels (p less than 0.01) were identified during the course of isoflurane anesthesia. Recovery times to standing were significantly shorter (0.02 less than p less than 0.05) after isoflurane than halothane anesthesia.

Anesthesia↗
PubMed2005

Neuraxial anesthesia and low-molecular-weight heparin prophylaxis in major orthopedic surgery in the wake of the latest American Society of Regional Anesthesia guidelines.

In May 2003, the Second American Society of Regional Anesthesia Consensus Conference statement was issued partly in response to continued safety concerns over the use of regional anesthesia--in particular, neuraxial techniques--with low-molecular-weight heparin (LMWH) prophylaxis in major orthopedic surgery. As the 2003 Consensus statement makes clear, regional anesthesia may be used safely with LMWH prophylaxis. The key to optimizing patient safety, however, depends on a careful calibration of the total daily dose and the timing of the first and subsequent doses of the LMWH drug with the timing and management of the regional anesthetic procedure. Because the challenge of successfully providing regional anesthesia in the presence of LMWH thromboprophylaxis is a clinical one, anesthesiologists should do what they can to ensure that every member of the surgical team has an understanding of current literature and practice guidelines such as those recently published by the American Society of Regional Anesthesia.

Anesthesia, Conduction↗