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PubMed1989

[Clinical evaluation of the efficacy of Ro 15-1788, Anexate after balanced intravenous anesthesia with flunitrazepam and fentanyl].

Benzodiazepines are widely used as neuroleptics in anaesthesia, but they give rise to drowsiness at the end of surgery. Anexate is an imidazobenzodiazepine with specific antagonistic activity for benzodiazepines. We have administered 0.2 mg i.v. of the drug to 20 adult patients after anaesthesia with tiopentale (250 mg), pancuronium bromide (0.07 mg.kg-1), flunitrazepam (2 mg) and fentanyl (0.10 mg); after the first dose fentanyl was administered (0.10 mg) about every 30 minute. Analgesia was supplemented with nitrous oxide 66%. Blood pressure and heart rate did not changes significantly after Anexate; respiratory volume increased significantly in all cases (ANOVA P less than 0.001). Consciousness was rapidly resumed in all cases and patients demonstrated to be oriented in time and space soon after Anexate. In 14 out of 20 patients drowsiness reappeared after about 30 minute and further doses of 0.1 mg of the drug (to a maximum of 0.4 mg in some cases) were necessary. Side effects were rare and slight, their occurrence depending on the speed of administration. In our opinion a total dose of 0.3 to 0.4 mg Anexate is need to fully antagonize the sedative effect of 2 mg flunitrazepam.

Adult↗
PubMed1985

Atracurium infusion requirements in children during halothane, isoflurane, and narcotic anesthesia.

We were interested in determining the dose-response relationship of atracurium in children (2-10 yr) during nitrous oxide-isoflurane anesthesia (1%) and the atracurium infusion rate required to maintain about 95% neuromuscular blockade during nitrous oxide-halothane (0.8%), nitrous oxide-isoflurane (1%), or nitrous oxide-narcotic anesthesia. 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 sec at 10-sec intervals. To estimate dose-response relationships, three groups of five children received 80, 100, 150 micrograms/kg atracurium, respectively. During isoflurane anesthesia, the neuromuscular block produced by 80 micrograms/kg was 23.6% +/- 6.5 (mean +/- SEM), by 100 micrograms/kg was 45% +/- 7.2, and by 150 micrograms/kg was 64% +/- 8.7. The ED50 and ED95 (estimated from linear regression plots of log dose vs probit of effect) were 120 micrograms/kg and 280 micrograms/kg, respectively. At equipotent concentrations, halothane and isoflurane augment atracurium neuromuscular block to the same extent, compared to narcotic anesthesia. Atracurium steady-state infusion requirements averaged 6.3 +/- 0.6 micrograms . kg-1 . min-1 during halothane or isoflurane anesthesia; the requirements during balanced anesthesia were 9.3 +/- 0.8 micrograms . kg-1 . min-1 (P less than 0.05). There was no evidence of cumulation during prolonged atracurium infusion.

Anesthesia, General↗
PubMed1987

[The behavior of free thyroxine and triiodothyronine concentrations after short-term balanced inhalation anesthesia].

Acute changes involving the hormones thyroxine (T4) and triiodothyronine (T3) followed by hyper -or hypothyroid crises will lead to both cardiovascular and metabolic disorders. Due to highly sensitive mechanisms controlling central hormonal production and peripheral enzymatic conversion (c.g. T4 to T3), numerous pharmacologically effective substances will influence the kinetics of these hormones. Thus, agents routinely used in anesthetic practice and their metabolites may disturb hormonal regulation in particular due to their central effectiveness [1, 2,5-7]. Based on this premise, it was our goal to search for anesthetic-induced hormonal changes in euthyroid patients living in a goiter-endemic area scheduled for short, elective orthopedic operations. Investigations were done in 21 outpatients (mean age: 24 years, mean body wt.: 64 kg) undergoing minor surgical procedures of the extremities. No clinical signs of thyroid disturbances could be observed preoperatively in the patients. Immediately after intravenous premedication (meperidine HCl 0.75 mg/kg and atropine 0.25 mg), anesthesia was induced (thiopentone 5 mg/kg) and continued by inhalation via face; mask using volatile agents: halothane, isoflurane, or enflurane (O2: N2O; FiO2 = 0.33). According to the anesthetic agent administered (halothane, isoflurane, enflurane), patients were divided into three groups of 7 patients each as listed in Table 1. Blood samples to determine free serum T4 (fT4) and T3 (fT3) as an expression of biologically available T4/T3, unconjugated to transport globulins, were drawn twice: immediately before premedication; and postoperatively after the patient had regained consciousness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Mivacurium-induced neuromuscular blockade following single bolus doses and with continuous infusion during either balanced or enflurane anesthesia.

Mivacurium chloride (BW B1090U) was administered to 72 patients during their elective surgery. The eight groups (nine subjects per cell) in the 2 x 2 x 2 study design differed in three factors: the size of the mivacurium bolus dose administered, whether or not this dose was followed by an infusion of mivacurium, and in the technique used for the maintenance of anesthesia. Four groups received a single bolus dose of mivacurium, 0.15 mg/kg, and the remaining four groups received mivacurium, 0.25 mg/kg, administered iv in 15 s. Precisely 2 min later, tracheal intubation was attempted. Conditions were judged to be good or excellent on most occasions, but intubation was not possible for two of the patients in the low-dose and one in the high-dose groups. Four groups, two at each bolus dose, received no additional mivacurium: there was a dose-dependent decrease in the rate of spontaneous recovery following the bolus dose. The other subdivision of groups was the use of either barbiturate-nitrous oxide-narcotic (balanced) anesthesia, or enflurane-nitrous oxide anesthesia; the anesthetic technique did not affect the pattern of spontaneous recovery from either bolus dose. Four groups, again two at each bolus dose, subsequently received an infusion of mivacurium, adjusted to depress the twitch response by approximately 95%. Infusion rates averaged 6.0 micrograms.kg-1.min-1 in the groups receiving balanced anesthesia and 4.2 micrograms.kg-1.min-1 for those receiving enflurane anesthesia. Recovery following administration by infusion was slower than that observed following a bolus dose of mivacurium, 0.15 mg/kg but did not differ between the anesthetic groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Ultrasound-guided epidural catheter insertion in children.

UNLABELLED: Epidural catheters (EC) are often used in pediatric patients for intraoperative and postoperative pain relief. The small anatomical structures and catheter insertion under general anesthesia make it more difficult to perform EC and to prevent damage. In this study we investigated the use of ultrasound (US) in detecting neuraxial structures during insertion and placement of EC in children. ASA I-II children scheduled for elective surgery under combined general and epidural anesthesia were studied. Patients received balanced anesthesia using sevoflurane, opioids and rocuronium. Before EC insertion US examination in a lateral position was done to visualize and identify neuraxial structures. Quality of visualization and site and depth of structures were recorded. Using a sterile kit to hold the US probe in position and enable the visualization of the neuraxial structures, an epidural cannula was inserted, using the loss of resistance technique, as the EC passed under US control to the desired level. Of 25 children, 23 were evaluated. Epidural space, ligamentum flavum, and dural structures were clearly identified and the depth to skin level estimated in all patients. Loss of resistance was visualized in all patients with a lumbar epidural approach. Correlation of US measured depth and depth of loss of resistance was 0.88. In eight of 23 patients EC could be visualized during insertion and in 11 others it could be visualized with additional US planes. US is an excellent tool to identify neuraxial structures in both infants and children. The size and the incomplete ossification of the vertebra allow exact visualization and localization of the depth of the epidural space, the loss of resistance, and all relevant neuraxial structures. IMPLICATIONS: Epidural catheters in children are mostly inserted under sedation or general anesthesia. This study showed that the use of ultrasound could help visualize all relevant neuraxial structures and their site and depth from the skin.

Analgesia, Epidural↗
PubMed1993

[Anesthesiologic aspects of minimally invasive surgery].

Minimal invasive, or more specifically laparoscopic surgery is now the standard procedure in an increasing number of surgical specialties. Inflating the abdomen with CO2 for long periods confronts the anesthesiologist with a number of problems that influence the choice of anesthetic and the monitoring deemed necessary. The increased intraabdominal pressure (IAP) and for some operations the extreme Trendelenburg position can disturb alveolar ventilation and compromise oxygenation. Pulse oximetry is therefore required to recognize and counteract these effects. The insufflated CO2 is absorbed into the blood to an unpredictable extent, and must be eliminated via the lungs by increasing the minute ventilation. Only capnometry or serial blood gas analyses can provide the information needed to correctly adjust the respiration. The endocrine stress reactions to laparoscopic surgery do not appear to be less pronounced than after conventional operations; only the interleukin-6 response to laparoscopic cholecystectomy is reduced compared to the subcostal incision. But minimal invasive surgery offers an advantage at least for cholecystectomy in that there is less impairment of postoperative respiratory function. General anesthesia will be the method of choice for laparoscopic surgery in all but a few procedures in which regional anesthesia is an acceptable alternative. Balanced anesthesia or total intravenous anesthesia is to be preferred, and the drugs employed should have rapid elimination kinetics with a short recovery time, since wound closure time is drastically reduced. Inhalational anesthesia alone may inhibit hypoxic pulmonary vasoconstriction thereby unduly increasing oxygen desaturation. The necessary degree of muscle relaxation still remains to be defined.

Anesthesia, Conduction↗
PubMed1983

[Place of peridural anesthesia in aorto-iliac surgery. Preliminary comparative study apropos of 32 patients].

UNLABELLED: Two groups of patients were studied: Twelve retroperitoneal iliac, and 20 abdominal aortic surgery with aortic clamping and bypass graft. Anesthesia was: Pure thoracic epidural T10-T11 for all iliac and 3 aortic surgery. Epidural thoracic plus light general anesthesia for 12 aortic surgery. Classic balanced anesthesia for 5 patients only. Rate of injection of anesthetic mixture and pressure measurement in epidural space are described. RESULTS: Hemodynamic changes during surgery are less in the epidural group. Post operative respiratory assistance was necessary only in the general anesthesia group, and respiratory care easier in the epidural group. Post operative peristalsis was obvious the first post operative day after epidural anesthesia, the fourth day after general anesthesia.

Aged↗
PubMed1996

Potency of doxacurium in infants, children, and adolescents during N2O-O2-alfentanil anesthesia.

STUDY OBJECTIVE: To evaluate neuromuscular potency of doxacurium during balanced anesthesia in pediatric patients. DESIGN: Prospective, consecutive sample trial. SETTING: Operating room at a university hospital. PATIENTS: 15 infants (1 to 11 months), 20 children (3 to 10 years), and 20 adolescents (13 to 19 years). INTERVENTIONS: Anesthesia was induced and maintained with thiopental, alfentanil, and nitrous oxide in oxygen. No volatile drugs were used at any time during the study. The neuromuscular function was recorded as adductor pollicis electromyography evoked by a train-of-four stimulation at 20-second intervals. A cumulative log-dose probit-response curve of doxacurium was established for every patient. MEASUREMENTS AND MAIN RESULTS: ED50 and ED95 doses of doxacurium (14 micrograms/kg and 25 micrograms/kg in infants, 26 micrograms/kg and 53 micrograms/kg in children, and 20 micrograms/kg and 41 micrograms/kg in adolescents, respectively) were smallest in infants and greatest in children (p < 0.05 between each pair of groups by analysis of variance and Scheffe's F-test). CONCLUSIONS: Potency of doxacurium was greatest in infants and least in children. We suggest that doxacurium can be administered safely in infants, and with dosages close to those reported in adults. Children's dose requirement was almost 50% greater than that of infants.

Adolescent↗
PubMed1992

The Post-anaesthetic Recovery in Obesity Surgery: comparison between two anaesthetic techniques.

Forty morbidly obese patients, scheduled for restrictive gastric surgery, were anaesthetized with two different techniques. In group A (20 patients) anesthesia was induced and maintained with Propofol (total intravenous anesthesia, TIVA); in group B (20 patients) anesthesia was induced with Thiopental and maintained with Isoflurane (balanced anesthesia). At the end of surgery, recovery time (RT) and recovery score (RS) were assessed according to a modified Aldrete score. There was no difference of RS between group A and group B. RT was shorter (though not statistically significant) in group A than in group B. Our experience suggests that both techniques can be safely used in these patients, but with TIVA, patients appeared more awake and cooperative earlier. Such an advantage may be useful to prevent serious complications (thromboembolism and pulmonary failure) in the postoperative period.

Journal Article↗
PubMed1995

[Adeno-tonsillectomy after cardiac transplantation in a child].

A case report of a boy who had a heart transplant at age one, and an adeno-tonsillectomy at age 2 years and 2 months, is presented. The patient showed severe episodic hypoxemia and poor weight gain (below 3 SD) due to upper airway obstruction caused by enlarged adenoids and tonsils. He was very active and no signs of congestive heart failure were noted. General anesthesia was induced with thiopental and maintained with a balanced anesthesia of nitrous oxide, oxygen, fentanyl, and vecuronium bromide. The heart rate did not increase with endotracheal intubation nor adenoidectomy but heart rate and blood pressure did increase slowly by the time the tonsillectomy was performed. Arrhythmia did not appear throughout the procedure and anesthesia was uneventful. A nasal endotracheal tube was kept in place for 4 days until surgical edema subsided. Respiratory inductive plethysmography performed before surgery and 2 days after extubation showed improvement of upper airway obstruction. The patient's blood concentration of cyclosporine fell briefly below the optimal level perioperatively due to unavailability of intravenous preparation in Japan. Various aspects of non-cardiac anesthesia for children who have experienced cardiac transplants are discussed.

Anesthesia, General↗