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At least 217 records · Page 12Linked to original sources
PubMed2000

[Immediate anesthesia recovery and psychomotor function of patient after prolonged anesthesia with desflurane, sevoflurane or isoflurane].

OBJECTIVE: To compare the anesthetic maintenance and early postoperative recovery and psychomotor function in patients who have been anesthestized with desflurane, sevoflurane or isoflurane during prolonged open urological surgery. PATIENTS AND METHODS: Seventy-five patients were randomly assigned to receive desflurane, sevoflurane or isoflurane with N2O 60% for anesthetic maintenance. The concentration of each drug was adjusted to maintain arterial pressure and heart rate +/- 20% of baseline. After the operation the anesthetics were discontinued and times until eye opening, spontaneous breathing, extubation and orientation were recorded. In the post-anesthesia recovery ward we applied the Newman-Trieger and Aldrete tests and recorded instances of nausea and vomiting and need for analgesia during the first 24 hours after surgery. RESULTS: The groups were similar with regard to demographic features, anesthetic maintenance, duration of anesthesia and relative doses of the anesthetics used. Recovery times in the operating room were significantly shorter (p < 0.05) after anesthesia with desflurane and sevoflurane than with isoflurane, with no significant differences between the desflurane and sevoflurane groups (duration of anesthesia 198 +/- 90, 171 +/- 67 and 191 +/- 79; eye opening 7.6 +/- 3.7, 7.8 +/- 3.0 and 11.9 +/- 4.5; time until extubation 7.8 +/- 3.0, 8.3 +/- 3.0 and 11.0 +/- 3.5 for desflurane, sevoflurane and isoflurane, respectively; all data in minutes). Recovery in the post-anesthetic recovery ward was similar for all three groups. CONCLUSIONS: Anesthetic maintenance was comparable with all three drugs. Desflurane and sevoflurane demonstrated advantages over isoflurane during recovery from anesthesia in the operating theater. No significant differences were found in psychomotor recovery, nausea and/or vomiting or requirements for postoperative analgesia.

Adult↗
PubMed2001

Optimization of intraperitoneal injection anesthesia in mice: drugs, dosages, adverse effects, and anesthesia depth.

PURPOSE: The goals of the study were to find a safe intraperitoneal injection anesthesia protocol for medium-duration surgery in mice (e.g., embryo transfer/vasectomy) coupled with a simple method to assess anesthesia depth under routine laboratory conditions. METHODS: Eight anesthetic protocols consisting of combinations of dissociative anesthetics (ketamine, tiletamine), alpha2-agonists (xylazine, medetomidine), and/or sedatives (acepromazine, azaperone, zolazepam) were compared for their safety and efficacy (death rate, surgical tolerance), using observations and reflex tests. The four best protocols were further evaluated during vasectomy: physiologic measurements (respiratory rate, electrocardiogram, arterial blood pressure, body temperature, blood gas tensions, and acid-base balance) were used to characterize the quality of anesthesia. The reactions of physiologic parameters to surgical stimuli were used to determine anesthesia depth, and were correlated with reflex test results. RESULTS: The protocol with the highest safety margin and the longest time of surgical tolerance (54 min) was ketamine/ xylazine/acepromazine. Three further anesthetic combinations were associated with surgical tolerance: ketamine/ xylazine, ketamine/xylazinelazaperone, and tiletamine/xylazine/zolazepam (Telazol/xylazine). The protocols consisting of ketamine/medetomidine and ketamine/azaperone were not associated with clearly detectable surgical tolerance. The most reliable parameter of surgical tolerance under routine laboratory conditions was the pedal withdrawal reflex. CONCLUSIONS: The best intraperitoneal injection anesthesia regimen consisted of ketamine/xylazine/acepromazine. The dose must be adapted to the particulars of each experimental design (mouse strain, sex, age, mutation). This is best done by measuring surgical tolerance, using the pedal withdrawal reflex.

Acepromazine↗
PubMed1992

[Comparison of 2 techniques of anesthesia induction in modern closed-circuit anesthesia].

The application of low flow anesthesia goes back already for more than 65 years when Ralph Waters introduced and applied cyclopropane with a very simple canister technique. The guide-lines for the clinical use of the closed circuit anesthesia were published in Chicago and Los Angeles by Professor Lin and Professor Lowe 15 years ago. We examined and followed these procedures on a modern anesthesia machine and easily achieved a good clinical performance. Our results were consistent with the modern anesthesia standard in closed circuit t.i.: economical benefits, environment savage of waste gases, heat production and humidification and last but not least in both techniques a quick anesthesia plane on 10-12 minutes that was consistent with theoretical considerations.

Anesthesia, Closed-Circuit↗
PubMed2005

Comparison of 25 and 27 gauge needle in spinal anesthesia learning curve for anesthesia residency training.

BACKGROUND AND RATIONALE: Size of spinal needle may be a factor which influences the success rate of spinal anesthesia. OBJECTIVES: To compare learning curves of using 25G and 27G quincke spinal needle for spinal anesthesia. SETTING: Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital. DESIGN: Prospective randomized control trial. MATERIAL AND METHOD: Ten new first year anesthesia residents were randomized to 2 groups: Group I (n = 5) used 25G Quincke spinal needle, Group II (n = 5) used 27G Quincke spinal needle to perform 200 consecutive cases of spinal anesthesia. Number of success and failure was recorded by each individual resident anonymously. The learning curves of plotted by cumulative sum of success rate revealed an initial rapid improvement of success during the first 20 cases in both groups. The overall success rate of group I was 84% (95CI, 66.5-100) and group II was 87% (95%CI, 61.5-100); p = 0.89. The widest difference between the 2 learning curves at 20 attempts intervals was at the twentieth attempts with a success rate of 76.0% VS 65.0% in group I and group II respectively; p = 0.54. CONCLUSION: The learning curves of spinal anesthesia using 25G and 27G Quincke spinal needle showed rapid improvement of success rate at the first 20 spinal block and high overall success rate with no significant difference between the groups.

Adult↗
PubMed1989

[Hemostatic requirements for the performance of regional anesthesia. Workshop on hemostatic problems in regional anesthesia].

There is uncertainty as to which preoperative examinations are necessary before performing regional anesthesia. Therefore an interdisciplinary consensus conference was established to obtain recommendations on some of the open questions related to this topic. Preoperative laboratory examinations are not necessary prior to peripheral nerve blocks near large vessels if these are easy to compress. In patients on anticoagulant therapy direct puncture of the vessel should be avoided. Prior to spinal or epidural anesthesia, no preoperative laboratory examinations are necessary if no anamnestic or clinical evidence of coagulation disorders exists. Otherwise the following examinations are useful: clotting time, prothrombin time, partial thromboplastin time (PTT), and thrombocyte count. Low-dose heparin prophylaxis is no contraindication to spinal or epidural anesthesia. However, in patients at increased risk of bleeding or with low body weight, PTT and thrombocyte count are necessary. Since at present no definite data exist as to the bleeding risk in patients treated with low-molecular-weight heparin prophylaxis, spinal/epidural anesthesia should be performed in controlled studies only under these conditions. This particular precaution seems to be necessary because low-molecular-weight heparin increases levels of plasminogen activators (t-PA) and therefore has fibrinolytic activity. If plasma expanders are administered perioperatively, the highest bleeding risk exists after dextran infusions. There is also an increased bleeding risk if nonsteroidal anti-inflammatory drugs, especially acetylsalicylic acid, are administered repeatedly within 5 days prior to spinal/epidural anesthesia. In these patients preoperative determination of the clotting time appears necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Conduction↗
PubMed1989

[The sedative effects of a low dose of butorphanol combined with diazepam during spinal-epidural anesthesia (H-type anesthesia)].

The sedative effects of the low dose of butorphanol combined with diazepam during spinal-epidural (H-type) anesthesia were studied in 20 urological or gynecological patients of ASA class I or II. Patients were premedicated with 0.5mg of atropine sulfate and 50mg of hydroxyzine hydrochloride 1 hour before the operation. Spinal anesthesia was performed with 2.4 ml of 0.3% dibucaine or 2.5 ml of 3% lidocaine and if necessary 1-2% mepivacaine was administered via the catheter for maintenance of the epidural anesthesia. Butorphanol 0.5 mg and diazepam 5 mg were administered intravenously after the establishment of spinal anesthesia. We observed the condition of sedative effects, the changes in blood pressure, heart rate and respiratory rate, before the administration of butorphanol, 2 and 5 minutes after the administration of the drug and then every 5 minutes until the recovery was noticed. We found that the sedative effects of butorphanol combined with diazepam were clinically sufficient. Patients were sleeping for 40 minutes and then drowsy for 30 minutes with sufficient sedation. There was no complication except slight respiratory suppression. Our results suggest that the butorphanol combined with diazepam is a useful method for the sedation during spinal-epidural anesthesia.

Adult↗
PubMed1995

[Convulsive seizure after craniotomy--comparison of isoflurane anesthesia and sevoflurane anesthesia].

The incidence of postoperative convulsive seizure was compared retrospectively during either isoflurane or sevoflurane anesthesia in patients after craniotomy. Overall, 5 of a total of 125 patients suffered convulsive seizures after craniotomy: 2 (4%) of 45 patients with isoflurane anesthesia and 3 (4%) of 80 patients with sevoflurane anesthesia. No significant differences were observed between these two groups. The duration of anesthesia and duration of the MAC.h were similar between these two groups. The occurrence of postoperative convulsive seizure was not related with the inhalational anesthetic agents, the underlying disorders and patient characteristics. It is suggested that either isoflurane or sevoflurane anesthesia in neurosurgical patients may have no specific relationship with the postoperative convulsive seizures.

Adult↗
PubMed1995

[Measurements of ventilatory parameters during closed circuit anesthesia--comparisons with semiclosed circuit, high-flow anesthesia].

Since induction of anesthesia using a closed-circuit technique is difficult with most modern anesthesia machines, it is a common clinical practice to convert semiclosed, high-flow anesthesia (SCA) to closed circuit anesthesia (CCA) during the maintenance phase by decreasing the fresh gas flow. The purpose of the current studies was to determine if such changes in the fresh gas flow influence parameters of ventilatory dynamics. The tidal volume, airway pressure, and a ratio of expiratory volume in one second to a tidal volume (EV1.0/VT) were measured in six patients and in a lung simulator during CCA with a fresh gas flow of 200 ml.min-1 and SCA with a flow of 6 l.min-1. The ventilator settings were constant throughout the experiments. Dynamic compliance was calculated as (measured VT)/(peak airway pressure-positive end-expiratory pressure). Both in patients and in a lung simulator, dynamic compliance and EV1.0/VT were higher during CCA as compared to SCA while the tidal volume and airway pressure were lower. It was also suggested that these differences were secondary to differences in the fresh gas flow and not to the circuit situation (closed vs. semiclosed) per se. The results emphasize that the fresh gas flow should be taken into consideration in interpreting the data of ventilatory dynamics during anesthesia. This is especially so during CCA because CCA employs a minimum fresh gas flow.

Adult↗
PubMed1994

[Evaluation of low-flow sevoflurane anesthesia using modified Engström Elsa Anesthesia System].

Engström Elsa Anesthesia System (Engström Elsa) was modified to make sevoflurane administration possible, and low-flow sevoflurane anesthesia using this modified anesthesia machine was administered to 10 surgical patients. Among the breakdown products of sevoflurane, CF2 = C (CF3) OCH2F (compound A) was 14.0 +/- 7.8 ppm after the first hour of anesthesia, and remained at this level until 7 hours. CH3OCF2CH(CF3)OCH2F (compound B) was detected in 3 of 10 patients, and these concentrations were below 0.5 ppm. No patient had clinical or laboratory evidence of organ toxicity. Low-flow sevoflurane anesthesia using modified Engström Elsa can be performed safely and easily. Although low levels of two breakdown products were detected, clinical laboratory tests showed no abnormality in hepatic or renal function.

Adult↗
PubMed1993

[Evaluation of low flow closed anesthesia technique for oxygen, nitrous oxide and isoflurane using Engström Elsa Anesthesia System].

We studied low flow closed anesthesia technique for oxygen, nitrous oxide and isoflurane using Engström Elsa Anesthesia System in 47 patients undergoing elective surgery. In the low flow group, anesthesia was maintained with oxygen 300 ml.min-1, nitrous oxide 300 ml.min-1 and optimal concentration of isoflurane after endotracheal intubation. The inspired oxygen concentration was kept higher than 35% through the operation. In the minimal flow group, anesthesia was maintained with nitrous oxide 4 l.min-1, oxygen 2 l.min-1 and optimal concentration of isoflurane after intubation until the inspired oxygen concentration reached approximately 35%. Then the fresh gas flow was reduced to oxygen 250 ml.min-1 and nitrous oxide 250 ml.min-1. In order to maintain the inspired oxygen concentration at 35%, the flow of nitrous oxide should have been reduced as low as to 150 ml.min-1 after 240 min. The volumes of consumption of nitrous oxide and isoflurane in the low flow and minimal flow groups were reduced to one fifth and one third respectively, compared with those of the high flow group. In conclusion, we can perform low flow closed anesthesia safely and easily with this equipment.

Adult↗
PubMedDate not supplied

Influence of selected antiarrhythmic drugs on the hemodynamic parameters in rabbits during anesthesia. Part III. Ketamine anesthesia.

The influence of procainamide, N-acetylprocainamide, verapamil or propranolol on hemodynamic parameters in rabbits was studied during ketamine anesthesia. Using radioisotopic methods the following parameters were estimated: cardiac output, stroke volume, total peripheral resistance, renal and hepatic blood flows, arterial pressure and heart rate. During ketamine anesthesia the inhibitory effect of verapamil on peripheral resistance was intensified; after administration of the rest of antiarrhythmic drugs the decrease of peripheral resistance was not observed in the animals without general anesthesia. During ketamine anesthesia the negative chronotropic effect of N-acetylprocainamide was decreased, but the negative chronotropic effect of procainamide was intensified. Procainamide administration during ketamine anesthesia markedly decreased renal blood flow. Propranolol given without anesthetic, as well as given together with ketamine markedly decreased hepatic blood flow.

Anesthesia↗
PubMed1998

[Propofol-air-oxygen anesthesia reduces the incidence of sore throat after laryngeal mask anesthesia].

We investigated the effects of the presence or absence of N2O in propofol anesthesia using a laryngeal mask on the incidence of postoperative sore throat. In the N2O-combined anesthesia group (n = 25), score 0 (no sore throat) was observed in 11 patients; score 1 (slight pain and discomfort that improved on the next day of operation) in 9; and score 2 (persistent pain on the next day) in 5. In the non-N2O-combined anesthesia group (n = 25), score 0 was observed in 21 patients, score 1 in 3; and score 2 in 1, showing a significantly lower incidence of sore throat and milder sore throat than in the N2O-combined anesthesia group. These results suggest that propofol anesthesia using a laryngeal mask not combined with N2O reduces the incidence of postoperative sore throat.

Adult↗
PubMed1998

[Peridural anesthesia versus subarachnoid anesthesia in cesarean section. Prospective clinical study].

OBJECTIVE: To compare technical and clinical differences between epidural and spinal anesthesia for cesarean section. STUDY DESIGN: Randomized prospective trial. PATIENTS AND METHODS: 64 pregnant women at term scheduled for elective cesarean section. Two groups were randomized: A) PD Group (n = 32): continuous epidural anesthesia by administration of bupivacaine 0.5% plus epinephrine 1/400,000 via an epidural catheter. Epidural morphine 3 mg was administered at the end of surgery. B) SP Group (n = 32): "single shot" spinal anesthesia by intrathecal administration of hyperbaric 1% bupivacaine 1-1.4 ml plus morphine 0.2 mg. The pin prick block level reached T2-T6 at incision time. DATA COLLECTION: 1) Time from the beginning of anesthesia to surgical incision. 2) Hypotension episodes. 3) Ephedrine consumption. 4) Intraoperative discomfort at delivery, traction and uterine manipulation, peritoneal toilette. 5) Nausea and vomiting. 6) Apgar score. 7) Postoperative headache. RESULTS: Women in the SP group had more hypotensive episodes (81% vs 53%: p < 0.05) and more ephedrine consumption with a large individual variability (29.12 mg +/- 20.4 vs 12.83 +/- 13.8: p < 0.01) when compared to PD group, without any difference in the Apgar score. The SP group required less time consumption (10.5 min. +/- 6.7 vs 35.9 min. +/- 17.3: p < 0.01) and had less intraoperative discomfort with less analgesic and/or sedative drugs consumption (9.7% vs 29%: p < 0.05) and less vomiting (3% vs 22.5%: p < 0.05). No postoperative headache was noticed in both groups. CONCLUSIONS: With the described pharmacological and technical approach, spinal anesthesia is more suitable than continuous epidural technique for cesarean section, unless contraindicated.

Adult↗
PubMed1998

[Transdermal nitroglycerin before induction of anesthesia prevents redistribution hypothermia in patients under general anesthesia].

Initial anesthesic-induced hypothermia results largely from core-to-peripheral redistribution of heat. Administration of transdermal nitroglycerin induces vasodilation. Such vasodilation, induced well before induction of anesthesia, might redistribute heat to peripheral tissues. Minimal redistribution hypothermia might accompany subsequent induction of anesthesia. We studied 32 patients undergoing gastrointestinal surgery. Thirty minutes before induction of anesthesia, they were randomly assigned to: 1. transdermal nitroglycerin 10 mg; 2. transdermal nitroglycerin 5 mg; and, 3. control. Core temperature during the first hour of anesthesia decreased significantly more in the control patients than in those given either dose of nitroglycerin. Vasodilation induced by transdermal nitroglycerin before induction of anesthesia significantly decreased subsequent redistribution hypothermia. Drug-induced modulation of vascular tone thus produces clinically important alterations in intraoperative core temperature.

Administration, Cutaneous↗
PubMedDate not supplied

Combined general and epidural anesthesia versus general anesthesia for major abdominal surgery: postanesthesia recovery characteristics.

BACKGROUND AND OBJECTIVES: Outcome studies comparing general anesthesia combined with epidural anesthesia (GEN-EPI) to general anesthesia (GEN) for major abdominal surgery have been equivocal. However, many believe that patients anesthetized with GEN-EPI fair better than GEN. This study tests the hypothesis that there are favorable recovery characteristics associated with GEN-EPI as compared with GEN following abdominal surgery. METHODS: A prospective randomized double-blind trial, consisting of 30 patients ages 18-74 undergoing abdominal surgery was undertaken. Patients received either GEN-EPI or GEN by standardized protocol. At the end of surgery the epidural catheter was removed and psychological testing was performed over 24 hours to determine recovery characteristics. These included the modified Slater test, the Self-Assessment Manikin, the Kendrick Digital Copying Test, the Hospital Anxiety and Depression Scale, as well as visual analog scales for pain and appearance. RESULTS: Patients receiving GEN-EPI emerged from anesthesia faster (P < .03) with less pain on awakening (P < .04 at rest; P < .01 on coughing), had better psychomotor function at 2 hours (P < .04), and were less drowsy at 4 hours (P < .04), than patients with GEN. There was no difference in pain intensity after the initial assessment, morphine usage, mood, anxiety, and depression at any other measurement period. CONCLUSION: Transient quantifiable differences in recovery characteristics exist between patients receiving GEN-EPI and GEN.

Abdomen↗
PubMed2005

Total spinal anesthesia during combined general-epidural anesthesia in a 7-year-old child.

Total spinal anesthesia (TSA) is a rare complication of lumbar epidural anesthesia through inadvertent spinal injection of local anesthetics following an undiagnosed dural breach or spinal placement of the catheter. TSA has rarely been reported in children. TSA occurred during epidural anesthesia in a 7-year-old child undergoing abdominal surgery. Recent previous lumbar punctures and intrathecal chemotherapy for Burkitt's lymphoma at the same level may have facilitated dural breach. Epidural anesthesia should not be attempted at the same intervertebral level as prior recent lumbar punctures.

Abdomen↗
PubMed1993

Neuromuscular effects of pipecuronium during sevoflurane anesthesia compared with isoflurane and enflurane anesthesia.

We evaluated the neuromuscular effects of pipecuronium during anesthesia with equipotent concentrations of either sevoflurane, isoflurane or enflurane. Twenty-seven patients scheduled for minor elective otolaryngeal or plastic surgery were studied and randomly assigned to 3 groups, one group per anesthetic agent. Anesthesia was induced with thiamylal 5 mg.kg(-1) and the trachea was intubated with succinylcholine 1 mg.kg(-1), then anesthesia was maintained with 60% nitrous oxide in oxygen and sevolfurane, isoflurane or enflurane, depending on the group. Neuromuscular blocking effects were monitored by recording the electromyographic activity of the adductor pollicis muscle from supramaximal stimulation of the ulnar nerve at 10-s intervals. Pipecuronium 40 microg.kg(-1) was administered when electromyographic activity had reached a stable state, 30 min after succinylcholine administration. The maximum effect (% block of control) and clinical duration (time to 25% recovery) of pipecuronium were 99.1 +/- 1.4% and 63.7 +/- 14.7 min (mean +/- S.D.) for sevoflurane, 99.0 +/- 2.0% and 60.9 +/- 20.5 min for isoflurane, and 98.0 +/- 2.5% and 62.8 +/- 28.7 min for enflurane, respectively. There were no significant differences in these values between the anesthetics. Cardiovascular stimulant effects were not observed in any of the groups. We conclude that the effect of pipecuronium under seveflurane anesthesia is similar to that under isoflurane and enflurane anesthesia.

Clinical Trial↗
PubMedDate not supplied

Computerized patient anesthesia records: less time and better quality than manually produced anesthesia records.

STUDY OBJECTIVE: To compare manual and computerized anesthesia information management systems (AIMS's) with respect to time demands on the anesthetist and record quality. DESIGN: Videotaped clinical anesthesia cases were independently reviewed along with the records produced. SETTING: Private practice anesthesia at a 150-bed community hospital. PATIENTS: Ten consecutive ASA physical status I patients having video arthroscopy of the knee by the same surgeon and having general anesthesia. INTERVENTIONS: One anesthetist recorded six cases: three with the computer and three manually. Two more anesthetists each recorded two cases: one with the computer and one manually. MEASUREMENTS AND MAIN RESULTS: The proportion of the anesthetist's time spent on the documentation for the computer records was significantly less than that spent on manual records (14.9% vs. 36.6%; p < 0.001). Nevertheless, significantly more vital sign data points were recorded on the computer than on the manual records (245.2 vs. 45.0 vital sign points per case; p < 0.001), as well as significantly more notes and drug information (61.0 vs. 40.0 notes per case; p < 0.02). The computer record was always legible, but this was not the case with the manual records. There was no significant difference in the number of artifacts detected on the records. CONCLUSION: The concern that the introduction of computerized AIMS's may complicate the anesthesia working environment by requiring more time than manual AIMS's and thus detracting from direct patient care is not supported by this study. In fact, this computer approach not only required less time but also produced a more complete and higher-quality record than did the manual AIMS.

Anesthesiology↗