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PubMed1993

Anesthesia and blood loss in preterm cesarean section: comparison between general and regional anesthesia.

Changes in maternal hemoglobin concentrations after cesarean section performed before 35 weeks gestation were analyzed according to the type of anesthesia in a case-control retrospective study. There were 30 mothers who received general anesthesia (GA group) and 30 mothers who received regional anesthesia (RA group). The groups were matched for gestational age at delivery, type of uterine incision, and the use of tocolytic therapy (isoxuprine) before delivery. The indications for delivery were preterm labor or fetal/maternal complications following premature rupture of membranes without labor. There was no significant difference between the GA and RA groups in the pre-operative hemoglobin (11.9+/-1.4 vs 11.6+/-1.1 g/dl) or postoperative hemoglobin (11.1+/-1.7 vs 11.3+/-1.2 g/dl). The GA group, however, demonstrated a significant fall in the postoperative hemoglobin (P < 0.05). The GA group also had a higher incidence of a drop in hemoglobin of > 10% compared to the RA group (46.7% vs 20.0%, P < 0.05). Our results suggest that general anesthesia may be associated with more blood loss than regional anesthesia in cesarean sections performed before 35 weeks.

Journal Article↗
PubMed2001

Screen-based anesthesia simulation with debriefing improves performance in a mannequin-based anesthesia simulator.

BACKGROUND: Previous investigations have established the need for improved training for management of anesthetic emergencies. Training with inexpensive screen-based anesthesia simulators may prove to be helpful. PURPOSES: We measured the effectiveness of screen-based simulator training with debriefing on the response to simulated anesthetic critical incidents. METHODS: Thirty-one 1st-year clinical anesthesia residents were randomized into 2 groups. The intervention group handled 10 anesthetic emergencies using the screen-based anesthesia simulator program and received written feedback on their management, whereas the traditional (control) group was asked to study a handout covering the same 10 emergencies. All residents then were evaluated on their management of 4 standardized scenarios in a mannequin-based simulator using a quantitative scoring system. RESULTS: The average point score for the simulator-with-debriefing group was 52.6 +/- 9.9 out of 95 possible points. The traditional group average point score was 43.4 +/- 5.9, p = .004. CONCLUSIONS: Residents who managed anesthetic problems using a screen-based anesthesia simulator handled the emergencies in a mannequin-based anesthesia simulator better than residents who were asked to study a handout covering the same problems. Computer simulations with feedback are effective as a supplement to traditional residency training methods for the management of medical emergencies.

Anesthesiology↗
PubMedDate not supplied

Endocrine-metabolic response to abdominal aortic surgery: a randomized trial of general anesthesia versus general plus epidural anesthesia.

The influence of epidural anesthesia on the endocrine-metabolic response following abdominal aortic reconstruction was studied in a prospective randomized trial. Cortisol and catecholamine responses and nitrogen balance were measured in two groups of five patients receiving general anesthesia only (group 1) or general anesthesia combined with epidural bupivacaine (group 2). The study lasted from preoperatively until the first postoperative day. At 2100 hours on the day of surgery serum cortisol concentrations were higher in group 1 than in group 2 (1.41 versus 0.82 mumol/L; p < 0.01). Likewise the total perioperative hypercortisolemia, expressed as the area under the curve, was significantly higher in group 1 (11.7 versus 5.7 mumol/L/hr, p < 0.01). Intraoperative urinary excretion of epinephrine and postoperative norepinephrine excretion were significantly higher in group 1 than in group 2. Urinary excretion of free cortisol and cumulative nitrogen balance were not different between the groups. Although the number of patients was limited and the sensory nerve block level was not measured perioperatively, this study suggests that epidural anesthesia attenuates the stress response to aortic surgery.

Aged↗
PubMed1990

Dopamine counteracts hypertension during general anesthesia and hypotension during combined thoracic epidural anesthesia for abdominal aortic surgery.

The influence of the degree of sympathetic nervous system activation on the cardiovascular effects of dopamine was studied during abdominal aortic surgery in 13 patients. The arterial plasma norepinephrine concentration (NE) was used as an index of sympathetic nervous system activity. During anesthesia with nitrous oxide and fentanyl, 7 patients (group 1) had a NE above 700 pg/mL and an increased mean arterial pressure (MAP) compared with the preanesthetic level (150 +/- 6 v 117 +/- 10 mm Hg; p less than 0.01, mean +/- SEM). The other 6 patients (group 2) had no significant change in MAP compared with the preanesthetic MAP (119 +/- 7 v 105 +/- 4 mm Hg). Dopamine, 4 micrograms/kg/min, decreased MAP in group 1 by 19% (150 +/- 6 to 121 +/- 8 mm Hg; P less than 0.05) because of a 32% +/- 9% decrease (P less than 0.05) in systemic vascular resistance. MAP was not altered by dopamine in group 2 (119 +/- 7 v 123 +/- 6 mm Hg; not significant). Following termination of dopamine, the anesthetic was supplemented with thoracic epidural anesthesia (TEA). This reduced MAP to 65 +/- 7 mm Hg (P less than 0.01) and 56 +/- 3 mm Hg (P less than 0.01), and NE to 441 +/- 76 (P less than 0.05) and 235 +/- 45 pg/mL (P less than 0.05) in groups 1 and 2, respectively. During TEA, dopamine increased MAP similarly in both groups, to 85 +/- 7 mm Hg (P less than 0.01) and 82 +/- 9 mm Hg (P less than 0.05), respectively. In conclusion, dopamine, at the same dosages, counteracted hypertension during general anesthesia and counteracted hypotension during general anesthesia combined with TEA.

Analysis of Variance↗
PubMed2002

Comparison of total intravenous anesthesia and sevoflurane-fentanyl anesthesia for outpatient otorhinolaryngeal surgery.

STUDY OBJECTIVE: To compare the recovery characteristics of two widely used anesthetic techniques: remifentanyl-propofol and sevoflurane-fentanyl in a standardized ambulatory population. DESIGN: Randomized, single-blinded study. SETTING: University-affiliated medical center. PATIENTS: 50 ASA physical status I and II patients undergoing elective ambulatory otorhinolaryngeal surgery. INTERVENTIONS: Patients were randomized two groups to receive total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-fentanyl (SF group). TIVA patients received induction with propofol 1.5 mg/kg intravenously (IV) and remifentanil 0.5 microg/kg IV. The anesthesia was continued with a continuous infusion of propofol 100 microg/kg/min and remifentanil 0.0625-0.25 microg/kg/min. The SF group received, at induction, fentanyl 2 microg/kg followed by propofol 1.5 mg/kg IV. Maintenance was obtained with 1 to 1.5 minimum alveolar concentration of sevoflurane and bolus of fentanyl 1 microg/kg IV as needed. MEASUREMENTS AND MAIN RESULTS: Early recovery times (eye opening, response to commands, extubation, orientation, operating room stay after surgery, and Aldrete score > or =9) and patient satisfaction were similar between the two groups. Postanesthetic discharge scoring system (PADSS) > or = 9 was significantly shorter for the TIVA group (135.9 +/- 51 vs. 103 +/- 32 min) (p < 0.01) but this difference was not associated with a shorter postanesthesia care unit (PACU) length of stay. CONCLUSION: Early recovery times are comparable between total intravenous anesthesia and sevoflurane-based anesthesia. Even though patients in the TIVA group achieved home readiness criteria in a significantly shorter time, this technique does not shorten PACU length of stay, which depends instead on multiple nonmedical and administrative issues.

Adolescent↗
PubMed1997

Reduced postoperative analgesic demand after inhaled anesthesia in comparison to combined epidural-inhaled anesthesia in patients undergoing abdominal surgery.

We studied the effect of epidural/general combination anesthesia, in comparison to inhaled anesthesia, on postoperative pain and analgesic consumption in patients undergoing upper abdominal surgery. Anesthesia was induced with propofol and maintained with enflurane in 70% N2O as necessary to maintain arterial blood pressure within 20% of baseline. Group I received bupivacaine 0.25% 0.2 mL/kg and sufentanil 1 microgram/kg 65 +/- 3 min before dermal incision and 0.1 mL/kg bupivacaine 0.25% + sufentanil 2 micrograms/mL (BS) every hour thereafter. Group II received 0.2 mL/kg of BS 316 +/- 15 min after dermal incision in the recovery room. Postoperative patient-controlled epidural analgesia (PCEA) with BS was provided. Pain intensities and consumption of PCEA BS were recorded on postoperative days (PODs) 1 to 5. Inspiratory fraction of enflurane was lower (0.5% +/- 0.01% vs 1.6% +/- 0.04%; P < 0.001) in Group I compared with Group II. Cumulative postoperative consumption of PCEA BS was higher in Group I compared with Group II from the evening of POD 2 until the end of the study (301 +/- 19 mL vs 249 +/- 17 mL; P < 0.001), while pain intensities were comparable at all times. The intraoperative effects of combined BS and enflurane/N2O (inspiratory fraction [Fi] approximately 1 minimum alveolar anesthetic concentration [MAC]) did not preempt postoperative pain in contrast to enflurane/N2O anesthesia (Fi approximately 2.8 MAC).

Abdomen↗
PubMed2002

Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: a pharmacoeconomic comparison.

UNLABELLED: We compared the cost and effectiveness of selective spinal anesthesia (SSA) with a desflurane-based general anesthetic (DES) for outpatient gynecological laparoscopy. A prospective analysis was undertaken of 10 patients randomized to receive SSA and compared with 10 patients randomized to receive DES. The groups were well matched in their demographic characteristics. The mean cost (in 2000 Canadian dollar values) of anesthesia supplies, drugs, and nursing for the SSA group of $62.31 was less than that for the DES group of $92.31 (P < 0.01). Recovery costs of both groups were similar. Time to administer anesthesia and time spent in the postanesthetic care unit were also similar. Postoperative analgesia was required by 50% of the DES group but in no patient receiving SSA (P < 0.01). SSA is a cost-effective alternative to DES in these patients. IMPLICATIONS: Small-dose spinal anesthesia is an effective alternative to a desflurane general anesthetic in terms of cost and recovery profiles in ambulatory gynecological laparoscopy.

Ambulatory Surgical Procedures↗
PubMed1993

Effect of phenylephrine bolus administration on left ventricular function during high thoracic and lumbar epidural anesthesia combined with general anesthesia.

The effect of phenylephrine (PHE) boluses on left ventricular (LV) function was examined in patients without cardiovascular disease who developed arterial hypotension during high thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) (group 1) or lumbar epidural anesthesia (LEA) combined with GA (group 2). LV function was assessed by transesophageal echocardiography (TEE) before and after central venous injection of 1 microgram/kg PHE. Fractional diameter shortening (FDS), end-systolic wall stress (ESWS), and rate-corrected velocity of circumferential fiber shortening (mVcfc) were determined. PHE effectively restored arterial blood pressure in both groups with a peak effect between 30 and 45 s after injection. FDS was reduced from 38% to 25% (mean, P < 0.01) in group 1 and remained unchanged in group 2. ESWS increased from 70 to 143 x 10(3) dyne.cm-2 (P < 0.01) and from 57 to 86 x 10(3) dyne.cm-2 (P < 0.05), in groups 1 and 2, respectively. mVcfc was significantly reduced from 1.11 to 0.80 circ/s (P < 0.05) in group 1 and was not altered in group 2. The authors conclude that PHE given as an intravenous bolus to patients under high TEA plus general anesthesia causes a transient impairment of LV function.

Abdomen↗
PubMed2006

Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia.

Magnetic resonance imaging (MRI) requires long-lasting immobilization that frequently can only be provided by general anesthesia in pediatric patients. Sevoflurane provides adequate anesthesia but many patients experience emergence agitation. Small doses of ketamine and nalbuphine provide moderate sedation but their benefits have subsided at the time of emergence. We hypothesized that delaying their administration until the end of the procedure would prevent emergence agitation without prolonging patient wake-up and discharge times from the postanesthesia care unit. We performed a double-blind study involving 90 patients (aged 6 mo to 8 yr) randomly allocated to 1 of 3 groups receiving either saline (S-group), ketamine (0.25 mg/kg) (K-group), or nalbuphine (0.1 mg/kg) (N-group) at the end of an MRI procedure under sevoflurane anesthesia. We evaluated emergence conditions, sedation/agitation status and completion of discharge criteria at 30 min. The three groups were comparable in age, sex ratio, physical status, and associated medical disorders. Emergence conditions did not differ significantly. There were significantly more agitated children, at all times, in the S-group and more obtunded patients at early times (5 and 10 min) in both K- and N-groups. All patients met discharge criteria at 30 min but significantly more children were awake and quiet in the K-group and still more in the N-group. In conclusion, small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge. Nalbuphine provided better results than ketamine.

Anesthesia Recovery Period↗
PubMed1999

Recovery after total intravenous anesthesia (TIVA) using propofol and inhalation anesthesia (IA) using halothane in day case surgery.

The aims of this study were to compare recovery by clinical tests, the Perceptual Speed Test (PST) and the Ball Bearing Test (BBT), home recovery, side effects and satisfaction of anesthesia between total intravenous anesthesia using propofol and inhalation anesthesia using halothane in day case surgery and to determine average cost per case of each technique from the provider's the perspective. Forty patients were randomly allocated into TIVA and IA groups. The anesthetic times were 42.1 +/- 26.47 minutes and 37.6 +/- 14.75 minutes respectively. Recovery was assessed by the time to orientation, sitting up, standing up and to success in obtaining baseline values of the PST & BBT. The observer was blinded to the anesthetic technique that the patient received. Recovery tests showed no difference between the two groups. The recovery times of TIVA and IA as assessed by the PST and BBT were 1.2 +/- 0.41 and 1.1 +/- 0.31 hour respectively. From a home questionnaire, both groups showed no difference in the first 2-3 hours of home recovery, incidence of side effects and satisfaction of anesthesia. When asked about the difficulty in getting home, no TIVA patients complained of sleepiness whereas 6/16 IA patient did (p = 0.018). The average cost per case of TIVA and IA was 642.15 and 363.15 bahts respectively.

Administration, Inhalation↗
PubMed2000

Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up.

The Baltimore Hip Studies, a multicenter, noninterventional, observational trial, provided an opportunity to investigate the effects of anesthetic technique on the long-term outcome of elderly patients after hip fracture repair. Detailed interviews assessing functional status and pain were conducted during the hospital stay. Out-of-hospital evaluations were repeated after the procedure at 2, 6, 12, 18, and 24 months with a portable gait and balance laboratory. Multivariate analysis was done to determine the effects of anesthetic technique on functional and other outcomes, after controlling for multiple baseline variables. Of 741 enrolled patients who completed the study, 430 and 311 patients received spinal anesthesia or general anesthesia, respectively. Subgroup analysis of three spinal anesthetics, tetracaine, lidocaine, and epinephrine, was also done. In the present large observational study, general anesthesia was at least as efficacious as spinal anesthesia, and possibly better, in affording good long-term outcome.

Activities of Daily Living↗
PubMed1992

Epidural bupivacaine versus epidural sufentanil anesthesia: hemodynamic differences during induction of anesthesia and abdominal dissection in aortic surgery.

The present study was designed to compare the hemodynamic changes of epidural bupivacaine (EB) with epidural sufentanil (ES), supplemented by general anesthesia, in patients scheduled for abdominal aorto-iliac surgery. Twenty-eight ASA Grade 2 patients randomly received bupivacaine 0.5%, 1-1.5 mg kg-1 (n = 14) or sufentanil 150 micrograms (n = 14) epidurally at T12-L1, combined with light general anesthesia. Hemodynamics were measured before (T1) and after (T2) injection of EB or ES, after induction of general anesthesia (T3), and during the aortic dissection period (T4). EB or ES injection both produced a significant decrease in systolic, mean and diastolic blood pressure, left ventricular stroke work index (LVSWI) and coronary perfusion pressure (CPP). The induction of general anesthesia caused a significant fall in heart rate (HR) and cardiac index (CI) in the ES group. Abdominal dissection restored systemic pressure and cardiac index in the ES group. It was concluded that both ES and EB provided adequate analgesia and hemodynamics during tracheal intubation and abdominal dissection for aorto-iliac surgery.

Aged↗
PubMed1992

Comparative study between the effects of total intravenous anesthesia with propofol and balanced anesthesia with halothane on the alveolar-arterial oxygen tension difference and on the pulmonary shunt.

Inhalation anesthesia with halothane, inhibiting hypoxic pulmonary vasoconstriction, causes an increase in intrapulmonary shunt development as well as an increase of alveolar-arterial oxygen tension difference. In contrast, total intravenous anesthesia with propofol, as with other intravenous anesthetics, should not alter pulmonary gas exchange. The present study was carried out using two groups of patients of similar age, sex and weight, who were subjected to neurosurgical procedures. One group was under general inhalational anesthesia with halothane and the other group under total intravenous anesthesia with propofol. In a simple clinical manner and applying established formulae, the determination of intrapulmonary shunt and alveolar-arterial oxygen tension difference showed a significant increase after 120 min in the halothane group, whereas the group that received propofol did not show any significant variation. We therefore conclude that propofol, different from halothane, does not affect the pulmonary gas exchange.

Adult↗
PubMedDate not supplied

The assessment of pain sensation during local anesthesia using a computerized local anesthesia (Wand) and a conventional syringe.

PURPOSE: The purpose of this study was to compare the behavior reaction of children who received local anesthesia with a conventional syringe injection and a computerized device (Wand). METHODS: One hundred and two children ages 3 to 10 years were selected for this study. In 1 group there were 55 children between the ages of 3 to 5 years old, and in the other group there were 47 children ages 6 to 10 years old. They all needed at least 2 clinical sessions of operative procedures, preceded by a local anesthetic injection, 1 on either side of the same jaw. The local anesthesia was delivered using either the Wand or the traditional syringe. A random crossover design was used so that each child served as his/her own control. RESULTS: There were 25 girls and 30 boys in group A (mean 4.1 +/- 0.6 years), and 26 boys and 21 girls in group B (mean 7.2 +/- 1.3 years). Most of the children had a good reaction to both techniques of local anesthesia. No significant difference in either group was found between boys and girls. The children's reactions to injection in the mandible or the maxilla with the Wand or the conventional technique, regarding crying, facial expression, hands, legs and torso movements were similar with no statistically significant difference. There was no statistical difference when the maxillary infiltration was delivered to 1 or multiple teeth. No significant difference was found when the Wand was delivered during the first or second visit. CONCLUSIONS: The results suggested there was no difference in the pain behavior of children during the administration of local anesthesia with a conventional injection or a computerized device when the operator was an experienced pediatric dentist. This was true for maxillary infiltration and mandibular block. For other techniques, such as palatal injection and periodontal ligament injection, more studies should be conducted.

Anesthesia, Dental↗
PubMed2003

[Postoperative delirium after general anesthesia vs. spinal anesthesia in geriatric patients].

BACKGROUND: Influence of the type of anesthesia on postoperative delirium was examined in geriatric patients with femoral neck fracture. METHODS: Forty patients aged 70 or more were randomly allocated to receive either general anesthesia (sevoflurane, nitrous oxide in oxygen, G group, n = 21) or spinal anesthesia (0.5% bupivacaine, S group, n = 19). G group received the oxygen therapy during the 12-hour postoperative period. Postoperative assessments included the rate of postoperative delirium during the 4-day postoperative period, oxygen saturation during the 18-hour postoperative period, the value of hemoglobin at 1 postoperative day and the number of analgesics requirements during the 4-day postoperative period. RESULTS: The rate of postoperative delirium was similar between the two groups during the 4-day postoperative period. However, that of S group tended to be higher during the 1-day postoperative period. Postoperative analgesic effect and the value of hemoglobin at 1 postoperative day were similar between the two groups. Oxygen saturation was similar between the two groups except 6 hours after the operation. CONCLUSIONS: The type of anesthesia, general or spinal, does not affect the postoperative delirium in geriatric patients with femoral neck fracture.

Aged↗
PubMedDate not supplied

The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery.

BACKGROUND: Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. METHODS: Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses of fentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. RESULTS: The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). CONCLUSION: In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

Aged↗
PubMed1990

A comparison of general anesthesia and regional anesthesia as a risk factor for deep vein thrombosis following hip surgery: a critical review.

We evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded. In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

Anesthesia, Conduction↗
PubMed1978

Nitrous-narcotic-relaxant anesthesia vs. volatile anesthesia in the adult surgical outpatient.

A review of the advantages and disadvantages of nitrous-narcotic-relaxant vs. inhaled volatile anesthesia for outpatients results in the following conclusion: For most anesthesiologists in most settings, inhaled volatile anesthesia (with or without supplemental neuromuscular blocking agents) is probably superior to nitrous-narcotic-relaxant anesthesia (Table 1). Every anesthesiologist administering anesthesia to adult surgical patients on an outpatient basis must evaluate the surgical procedure being performed and his own anesthetic skill in deciding which of these techniques is best suited to any particular patient. It is only by constant attention to all factors that we can continue to provide the finest in anesthetic care for adult outpatients.

Adult↗