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PubMed1981

Adrenergic response to morphine-diazepam anesthesia for myocardial revascularization.

To evaluate sympathetic nervous system activity during narcotic-hypnotic "balanced anesthesia," plasma catecholamine concentrations and hemodynamic variables were assessed simultaneously in 10 men with coronary artery disease who received, sequentially, morphine sulfate, 3 mg/kg IV, and diazepam, 0.25 to 0.35 mg/kg IV, for myocardial revascularization surgery. Infusion or morphine sulfate rates of 5 to 10 mg/min significantly decreased both mean systemic arterial pressure (from 98 plus or minus 6 to 84 plus or minus 5 torr, p less than 0.01) and systemic vascular resistance index (from 38 plus or minus 3 to 30 plus or minus 5 units, p less than 0.05). These changes were associated with 2-fold increases in plasma norepinephrine levels (from 246 plus or minus 31 to 488 plus or minus 85 pg/ml, p less than 0.01) and 4-fold increases in plasma epinephrine levels (from 129 plus or minus 20 to 570 plus or minus 182 pg/ml, p less than 0.01). Addition of diazepam further decreased systemic arterial pressure (from 84 plus or minus 5 to 73 plus or minus 3 torr, p less than 0.01) and was associated with significant decreases in cardiac and stroke volume indices when compared with values obtained after morphine sulfate alone. Plasma concentrations of both norepinephrine and epinephrine also declined in association with these hemodynamic changes. Following skin incision, systemic arterial pressure and systemic vascular resistance index increased, the latter to the highest measured value (50 units). Norepinephrine concentrations increased significantly more than it had after morphine-diazepam anesthesia (321 plus or minus 63 pg/ml). It was concluded that the administration oif high dose morphine anesthesia acutely activates the sympathoadrenal system while producing peripheral vasodilation. Diazepam, when used following morphine to assure loss of consciousness, exacerbates the hypotensive effects produced by morphine and is associated with decreased levels of plasma catecholamines. Surgical incision produces significant peripheral sympathetic activation and increases vascular resistance during morphine-diazepam anesthesia.

Anesthesia↗
PubMed2002

Neuronal activity determined by quantitative EEG and cortical microdialysis is increased following controlled cortical impact injury in rats.

Following brain injury increased glutamate release is linked to sustained neuronal activation resulting in excitotoxic tissue damage. Isoflurane anesthesia has been shown to decrease electroencephalographic (EEG) activity and extracellular (e.c.) glutamate, possibly attenuating excitotoxic tissue damage. However, based on clinical experience EEG activity can fluctuate despite stable isoflurane concentrations. Therefore, the aims of this study were to investigate the impact of neuronal activity assessed by quantitative EEG on e.c. glutamate during isoflurane anesthesia following controlled cortical impact injury (CCII). In 10 rats balanced anesthesia using isoflurane was induced at 4 hours after CCII. Under steady-state conditions maintaining isoflurane at 1.8 vol%, EEG was recorded for 3 hours. During this period, e.c. glutamate was sampled in the pericontusional cortex by microdialysis. Despite maintaining isoflurane at 1.8 vol%, neuronal activity expressed as low frequency EEG power showed marked fluctuations. Spontaneous increases in neuronal activity coincided with elevated e.c. glutamate levels and vice versa. Overall, EEG power correlated significantly with pathologically elevated e.c. glutamate levels (n = 58; R2 = 0.54; p < 0.05). Despite unchanged isoflurance concentrations fluctuations in neuronal activity were reflected by altered EEG power and e.c. glutamate concentrations. Therefore, neuronal activity needs to be considered for the interpretation of e.c. glutamate levels.

Animals↗
PubMed2005

No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery.

Balanced anesthesia with sevoflurane-fentanyl has been widely accepted as anesthetic management for neurosurgery. Propofol-remifentanil regimen has been successfully used in various surgical settings, but a comprehensive comparison of sevoflurane-fentanyl and propofol-remifentanil anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery has not yet been done. The aim of this prospective, randomized, open-label clinical trial was to compare clinical properties of sevoflurane-fentanyl with propofol-remifentanil anesthesia in patients undergoing supratentorial intracranial surgery. The primary endpoint was to compare early postoperative recovery and cognitive functions within the two groups; we also evaluated hemodynamic events, vomiting, shivering, and pain. One hundred twenty patients (64 males; age 15-75 years) were randomized to either total intravenous anesthesia (group T) or sevoflurane anesthesia (group S). Emergence and extubation times and cognitive function (Short Orientation Memory Concentration Test [SOMCT]) were compared in the two groups. Brain swelling, incidence of hypotensive and hypertensive episodes, postoperative vomiting, shivering, and pain were also analyzed. The mean emergence time (12.2 +/- 4.9 minutes for group S versus 12.3 +/- 6.1 minutes for group T; P = 0.92) and extubation time (18.2 +/- 2.3 minutes for group S versus 18.3 +/- 2.1 minutes for group T; P = 0.80) were similar in the two groups. Average SOMCT scores, both 15 minutes after extubation (25.6 +/- 4.9 in group S versus 23.9 +/- 7.5 in group T; P = 0.14) and 45 minutes after extubation (27.3 +/- 2.2 in group S versus 26.0 +/- 5.1 in group T; P = 0.07) were also comparable. Brain swelling was present in seven and five patients in groups S and T, respectively (P = 0.76). Hypotension was present in 12% (group S) and 28% (group T) of patients (P = 0.02). Hypertension was present in 17% of patients in group S and 40% of patients in group T (P = 0.0046). Shivering was present in 18% and 25% of patients in groups T and S (P = 0.37). Our study demonstrates that there is no patient benefit of using total intravenous anesthesia with an ultra-short-acting opioid over the conventional balanced volatile technique in terms of recovery and cognitive functions.

Adolescent↗
PubMed2002

[Neuromuscular blockade with cisatracurium in infants andchildren. Its course under sevoflurane anesthesia].

OBJECTIVE: To compare the onset, duration and maximum effect of 0.1 mg/kg cisatracurium during balanced anesthesia with sevoflurane and remifentanil between infants and children. METHODS: We measured the time course of the neuromuscular blockade in 15 infants and 15 children by electromyography. Anesthesia was induced with propofol/remifentanil and maintained with sevoflurane (constant 2% endtidal) and remifentanil according to the patients individual requirements. After injection of 0.1 mg/kg cisatracurium we measured the following parameters: onset time: time between the beginning of injection of cisatracurium and maximum T1 depression, clinical duration: time between injection of the drug and recovery of T1 to 25%, recovery index: time between recovery of T1 from 25% to 75%. TOFR 0.9: time between injection of cisatracurium and recovery of the train-of-four ratio to 90%. In addition, we determined the maximum neuromuscular blockade Tmax after 0.1 mg/kg cistracurium. RESULTS: Both groups differed significantly with regard to onset time and clinical duration. In the infants, the onset time was shorter (74 s vs. 198 s) and the clinical duration longer (55 min vs. 41 min) compared to the older children. The TOFR 0.9 was 73 min (range 56-86 min) in the group of the infants and 59 min (range 43-72 min) in the group of the older children (p < 0.001). Tmax was 100% (range 97-100%) in the infants and 98% (range 92-100%) in the children (p < 0.01). However, the recovery index was comparable in both groups (21 vs. 16 min). CONCLUSIONS: Infants are substantially more sensitive to cisatracurium than children, which can be demonstrated in a significantly shorter onset time, a prolonged clinical duration and a delayed neuromuscular recovery. As there exist large interindividual differences, we recommend the use of neuromuscular monitoring in the routine practice of pediatric anesthesia.

Aging↗
PubMed1991

[A life-threatening situation due to the central anticholinergic syndrome in a case of severe coronary disease].

This report presents a case of central anticholinergic syndrome after general anesthesia in a patient with severe coronary heart disease. Eight years ago he had had two myocardial infarctions; after undergoing a bypass operation he suffered a third one. His angina pectoris had increased over the previous 6 months. General anesthesia was required for an ear operation; it was carried out as "balanced anesthesia" without any difficulties. After extubation, however, the patient became extremely agitated. Increasing myocardial work and oxygen consumption caused a life-threatening situation. The diagnosis was made immediately and the situation could be controlled by administration of physostigmine.

Anesthesia, General↗
PubMedDate not supplied

[Problems of anesthesia, surgical care and resuscitation during manned space flights].

When exploring the problems of medical aid to be rendered in manned space flights, it is necessary to take into consideration the specific features of the environment as well as the changes in the human body induced by space flight effects. In space flight anesthesia can be applied using such advanced methods as multi-component balanced anesthesia and peridural anesthesia. Surgery and resuscitation can be performed, employing the procedures and methods that allow operations in an abacterial environment, correction of vital dysfunctions with the aid of artificial pulmonary ventilation, cardiac electrotherapy, and sorptive purification of body fluids. Various aspects of infusion treatment and first medical aid are discussed.

Anesthesia↗
PubMed1997

A randomized, blind comparison of remifentanil and alfentanil during anesthesia for outpatient surgery.

UNLABELLED: We compared remifentanil, an esterase-metabolized opioid, with alfentanil as part of balanced anesthesia with at least 0.8% isoflurane during outpatient surgery in a randomized, double-blind trial. One hundred two patients received remifentanil, and 99 patients received alfentanil. Patients who received remifentanil experienced significantly fewer stress responses to surgical stimuli (52.9% and 65.7%, P < 0.05); significantly fewer remifentanil patients responded to skin closure (11% and 22%, P < 0.05) than patients who received alfentanil. Significantly more patients in the alfentanil group required extra analgesia compared with the remifentanil group (P < 0.05). Time to respond to verbal command was shorter for alfentanil than remifentanil (median 7 min vs 9 min), and times to spontaneous respiration (median 5 min vs 8 min), adequate respiratory rate (median 6 min vs 9 min), and tracheal extubation (median 6 min vs 9 min) were significantly shorter for alfentanil in comparison with remifentanil (P < 0.05). Remifentanil patients, however, showed significantly better recovery of psychomotor and psychometric function between 30 and 90 min after surgery (P < 0.05). The incidences of hypotension intraoperatively and shivering postoperatively were significantly higher with remifentanil. No unexpected or serious adverse events were recorded with remifentanil; however, one patient who received alfentanil experienced severe recurrent respiratory depression after surgery. The metabolic profile of remifentanil allowed better intraoperative analgesia without compromising recovery. IMPLICATIONS: The pharmacological profile of remifentanil, a new opioid for use in anesthesia, suggests that rapid recovery will occur after its use. This study of 200 outpatients shows that the differences suggested from kinetic studies are not always borne out in clinical practice, although later recovery variables did, in fact, favor remifentanil.

Adolescent↗
PubMedDate not supplied

[The anesthesiological support for children in extracorporeal lithotripsy on the Urat-P apparatus].

The Urat-P lithotriptor made in this country was employed for remote lithotripsy (RLT) in 94 children with urolithiasis. Altogether 132 sessions were conducted. In 120 cases the concrement disintegration progressed in a sparing regimen (impulse duration 0.3-0.4 ms, shock wave energy 5-8 J). In the rest 12 cases there were additional hard impulses (0.5-0.6 ms, the energy 10-12 J). Anesthesiological and transfusiological problems are considered. It is shown that choice of anesthesiological defense is based on the clinical form of the disease, the concrement size, the child's age. Intubation anesthesia with artificial pulmonary ventilation is indicated for young children (under 5). Intravenous balanced anesthesia under normal respiration accompanies RLT in large coral calculi treated in senior children (6-14 years of age). Single stones (up to 1.5 sm) in them are managed under local infiltration anesthesia. It is stated that a valid choice of anesthesia and transfusion therapy warrants favourable conditions for RLT sessions, adverse effects of the impulses on the renal parenchyma and adjacent tissues lessen facilitating the fragments elimination and reducing the number of complications in the postoperative period.

Adolescent↗
PubMed1988

[Evoked potentials and intravenous anesthetics].

In contrast to the electroencephalogram, which is a collection of the spontaneous brain electrical potentials generated by the cerebral cortex, evoked potentials are the electrical signals generated by the nervous system in response to brief extrinsic sensory stimuli. They can be used to establish objective evidence of an abnormality when clinical signs and symptoms are equivocal. Moreover they prove useful to define the anatomical level of lesions in the afferent pathway tested. They have been successfully applied during anesthesia and operations when pathways amenable to evoked potential recording were at risk. The most practical techniques in common intraoperative evoked response monitoring involve stimulation of visual, auditory and somatosensory pathways. As could be clearly demonstrated alterations of evoked responses can not only be found with diminished regional blood flow but in a graded manner depend on the used anesthetics as well. The potential application of evoked responses to monitor depth of anesthesia has been demonstrated by several groups. In contrast to visual, auditory and somatosensory cortical evoked potentials which show a large inter- and intraindividual variance acoustical evoked brainstem and somatosensory evoked subcortical potentials are very robust under general anesthesia. Drug-induced effects on shape, amplitude and latencies of evoked responses during balanced anesthesia must be well documented in order to establish evoked responses as sensitive indicators of systemic problems that may threaten the viability of the central nervous system. There is evidence that the effects on evoked responses during deep anesthetic states can be mimicked by several life-threatening conditions (e.g.: hypoxia, ischemia). This review describes the effects of intravenously used anesthetic drugs on visual, auditory and somatosensory evoked potentials and the alterations in evoked responses by abnormal systemic conditions as seen under hypotension, hypoxia, ischemia.

Anesthesia, Intravenous↗
PubMed1993

Assessing the potential for awareness and learning under anesthesia.

The problems of intraoperative learning and awareness during surgery have consequences for both the patient and the medical team. With or without recall, the patient can suffer severe emotional trauma that may result in psychological damage. Successful litigation against the anesthesia professional has been increasing in numbers as failure to provide adequate anesthesia can be considered a breach of the unwritten contract between patient and anesthetist. Balanced anesthesia and its use of muscle relaxants can mask indicators of anesthesia depth such as movement or lacrimation. To date, means of monitoring real-time levels of intravenous agents have not yet been fully tested and proven. Therefore, monitoring minimum alveolar concentrations of inhaled anesthetics may be the best currently available method of ensuring anesthetic depth. Investigations comparing the correlation between nitrous oxide and isoflurane minimum alveolar concentrations and anesthetic depth have indicated specific levels at which intraoperative learning ceases to occur.

Anesthesia, Inhalation↗
PubMed1998

Isoflurane plus nitrous oxide versus propofol for recording of motor evoked potentials after high frequency repetitive electrical stimulation.

The goal of this study was to test the influence of two widespread techniques of general anesthesia on motor evoked potentials (MEP) in response to transcranial and direct cortical high frequency repetitive electrical stimulation. Total intravenous anesthesia (TIVA) based on propofol and alfentanil was examined in 17 patients (group A), and balanced anesthesia (BA), based on nitrous oxide, isoflurane and fentanyl, was studied in 13 patients (group B). Distinct motor responses were available in 15 of 17 patients (88%) of group A, and in one of 13 patients (8%) of group B. Amplitudes increased significantly with increasing stimulus intensity and number of pulses under conditions of TIVA. At the same time, latencies decreased significantly with increasing stimulus intensity and decreasing interstimulus interval, but not with increasing number of pulses. It is hypothesized that propofol suppresses corticospinal I-waves at the cortical level, resulting in a conduction block at the level of the alpha-motoneuron, and that this effect may be overcome by high frequency repetitive stimulation. In contrast, nitrous oxide and isoflurane seem to have an additional suppressive effect on corticospinal D-waves, which may be overcome by higher stimulation intensity. In conclusion, transcranial high frequency repetitive stimulation and TIVA provide a feasible setting for intraoperative MEP monitoring, while higher doses of nitrous oxide and isoflurane are not compatible with recording of muscular activity elicited by the stimulation technique as described.

Adolescent↗
PubMed2000

No implicit memory for stories played during isoflurane/alfentanil/nitrous oxide anesthesia: a reading speed measurement.

UNLABELLED: Implicit memory of intraoperatively presented stories was recently detected by using the reading speed paradigm during propofol-alfentanil-nitrous oxide anesthesia. Our main goal was to evaluate the reading speed test procedure under another anesthetic regimen, i.e., isoflurane combined with nitrous oxide and alfentanil-infusion. In both experiments, patients were premedicated with oral midazolam. In a previous experiment, patients postoperatively read "old" stories that had been presented during anesthesia quicker compared with "new," unpresented stories. The same study design and test material as in the previous experiment were used. One of two audio tapes with two short stories was played randomly to patients during lumbar disk surgery and to awake controls. Approximately 7 h later, a structured interview and the reading speed test were used to determine whether the participants had any explicit or implicit memories of the presented stories. The results of 30 patients and 30 controls were calculated. Whereas the control participants showed an intact explicit and implicit memory of the previously presented material, no such effect was found in the anesthetized patients. The present experiment shows that changing the main anesthetic in otherwise equal study conditions, i. e., propofol to isoflurane (end-expiratory 0.7%), implicit memory is abolished in anesthetized patients. IMPLICATIONS: We showed that implicit memory during general anesthesia can be abolished by changing the hypnotic anesthetic. Increased postoperative reading speed for stories presented during propofol-alfentanil-nitrous oxide anesthesia was shown in a previous experiment, but not in our study using isoflurane for balanced anesthesia.

Adult↗
PubMed1989

Cesarean section in a patient with brain tumor: a clinical report.

Barbiturate anesthesia for cesarean section was well described by Kosaka almost 20 years ago. However, light balanced anesthesia has become the unofficial standard general anesthesia for cesarean section in this country. This light anesthetic technique could be catastrophic in the patient with raised intracranial pressure. The dilemma posed by cesarean section of a young woman with posterior fossa brain tumor led us to revive use of Kosaka's higher doses of thiobarbiturate. Together with regional and topical anesthesia of the larynx and trachea, this method resulted in stable maternal hemodynamics without resulting in neonatal depression.

Adolescent↗
PubMed1999

[Anesthesia experience of three patients with partial intramural coronary artery].

We experienced three patients with partial intramural coronary artery diagnosed preoperatively. We gave balanced anesthesia using narcotics and non-narcotic analgesics for non-cardiac surgery, administering phenylephrine against hypotension. The anesthetic course was relatively stable. According to the special pathophysiology of this disease, tachycardia and hypotension associated with anesthesia should be avoided, and special caution is needed when nitroglycerine is used due to its adverse effect on systolic narrowing of the coronary artery.

Aged↗
PubMed2006

[Induced hypothermia during low-flow anesthesia in elderly patients].

The purpose of the study was to investigate the possibility of reducing of level of induced hypothermia during general balanced anesthesia, by using of low - flow techniques of anesthesia in elderly and senile patients. The temperature homeostasis was studied intraoperatively in 76 patients, aged 65-84 years, ASA III - IV, underwent different surgical operations under high (n=34) and low - flow (n=42) anesthesia. It was demonstrated that the low - flow anesthesia allows not only reduce loss of moisture and heat from the patients airway during surgery, but also optimize the intraoperative patient - body temperature, decrease level of induced hypothermia and minimize frequency of complication due to temperature misbalance in the immediate postoperative period. Such anesthesia is a sufficiently effective and safe method of inhalation anesthesia, which can be used with good results in routine geriatric surgery.

Aged↗
PubMed2005

[Clinical study of vecuronium maintenance speed in trigeminal microvascular decompression surgery].

BACKGROUND: Patients receiving chronic carbamazepine therapy may be resistant to vecuronium. The purpose of this study was to determine maintenance speed of vecuronium in trigeminal microvascular decompression surgery. METHODS: The vecuronium maintenance speed of the patient for microvascular decompression diagnosed as trigeminal neuralgia (group T: n=18) or hemi-facial spasm (group C: n=18) was examined retrospectively. Anesthesia was induced with propofol, ketamine, midazolam and buprenorphine. Vecuronium was given to facilitate tracheal intubation. The patients received balanced anesthesia with infusion of propofol, ketamine, buprenorphine and vecuronium (60-80 microg x kg(-1) x h(-1)), with nitrous oxide. In both groups the scheduled vecuronium maintenance speed was increased if needed, using the TOF-Watch, at the time of body movement or with more than four TOF count. RESULTS: All patients of group T were medicated with carbamazepine before operation. None of C received carbamazepine. With C, vecuronium maintenance speed was as scheduled. With T, however, scheduled vecuronium speed increased in most of the cases. Actual vecuronium speed was significantly faster with T, compared with C. Although actual speed divided by scheduled speed was 1 in group C, it was 1.4 in T. CONCLUSIONS: Vecuronium maintenance speed is 1.4 times of scheduled speed in patients medicated with carbamazepine.

Aged↗
PubMed2005

Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery.

Combined spinal-epidural anesthesia balancing low-dose intrathecal bupivacaine/fentanyl and low-dose epidural bupivacaine may be more useful than single-shot spinal anesthesia for cesarean delivery in reducing incidences of adverse effects such as hypotension and nausea and in shortening motor recovery. Combined spinal-epidural anesthesia (n=50) or spinal anesthesia (n=50) was randomly performed in 100 parturients. Intrathecal bupivacaine 6 mg added by fentanyl 20 mug followed after 5 min by 10 mL of 0.25% epidural bupivacaine were used for combined spinal-epidural and intrathecal bupivacaine 9 mg with fentanyl 20 mug for spinal anesthesia. The initial sensory block level was higher in the spinal group (P<0.001), although the maximum levels were the same (T3). Complete surgical anesthesia was achieved and no patient complained of intraoperative pain in either group. Patients in the spinal group had denser motor block in the extremities and a higher incidence of hypotension (P<0.05) and nausea and vomiting (P<0.05). Motor recovery was faster in the combined spinal-epidural group (P<0.001). We concluded that combined spinal-epidural anesthesia using low-dose local anesthetic-opioid spinal anesthesia and routine epidural supplementation before surgery had some potential advantages over single-shot spinal anesthesia in the lower incidences of adverse effects and quicker recovery.

Adult↗
PubMedDate not supplied

[Subarachnoid anesthesia in patients with high surgical risk].

The hemodynamics was intraoperatively studied in 43 patients with multicentric atherosclerosis, ASA III-IV, operated on the peripheral vessels of legs with balanced anesthesia based on subarachnoid block. It was established in regional sympathetic block and in the course of the whole surgery that the parameter of AP were decreased by 20-25%, those of heart rate--by 15% and of TPVR--50%, whereas, the parameters of cardiac performance were stable. The authors discuss the specificity of hemodynamic restructuring under subarachnoid block in patients with at surgical risk due to vascular pathology.

Aged↗