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PubMed1979

[Ketamine administration technic in pediatric anesthesia].

Psychic trauma connected with surgical operations and with all their preparatory procedures in children, often cause behavioural alterations. Problems related to the type of anesthetic premedication and to the anesthesiologic technique also come within this field. The Authors describe their experience with ketamine, administered by oral route, as a sole drug to obtain a deep sedation (when radiographic examination and orthopedic procedures were required) and as an induction drug for a balanced anesthesia.

Administration, Oral↗
PubMed2003

Inhalational techniques in ambulatory anesthesia.

In the current health care environment, anesthesia practitioners are frequently required to reevaluate their practice to be more efficient and cost-effective. Although IV induction with propofol and inhalational induction with sevoflurane are both suitable techniques for outpatients, patients prefer IV induction. Maintenance of anesthesia with the newer inhaled anesthetics (ie, desflurane and sevoflurane) provide for a rapid early recovery as compared with infusion of propofol (ie, TIVA), while allowing easy titratability of anesthetic depth. Titration of hypnotic sedatives using BIS monitoring may reduce the time to awakening and thereby may facilitate fast tracking (ie, bypassing the PACU) and reduce hospital stay. Inhalational anesthesia is associated with a higher incidence of PONV, but no differences have been demonstrated with respect to late recovery (eg, PACU stay and home readiness). Although clinical differences between desflurane and sevoflurane appear to be small, desflurane may be associated with faster emergence, particularly in elderly and morbidly obese patients. Balanced anesthesia with IV propofol induction and inhalation anesthesia with N2O for maintenance, and an LMA for airway management, may be an optimal technique for ambulatory surgery. Inhalational anesthesia may have an economic advantage over a TIVA technique.

Ambulatory Surgical Procedures↗
PubMed1998

[Intraocular pressure values in intubation anesthesia in patients with and without chronic open angle glaucoma].

BACKGROUND: A number of clinical studies have investigated the influence of hypnotics and relaxants on intraocular pressure. All of them referred to the normal eye. Our goal was to show if there is a difference in intraocular pressure profile during general anesthesia between eyes with and without primary open angle glaucoma. PATIENTS AND METHODS: We prospectively examined two groups of 20 patients with and without primary open angle glaucoma. Intraocular pressure (IOP) readings were taken using a Perkins hand held applanation tonometer during routine surgery on cataract or glaucoma on the fellow eye. Balanced anesthesia was carried out using Etomidate, Vecuronium, Fentanyl, N2O and Enflurane. RESULTS: In the glaucoma group IOP fell from 20.3 +/- 4.1 mm Hg before induction of anesthesia (baseline) to 13.2 +/- 3.8 mm Hg (65% of baseline) after induction and 12.6 +/- 4.2 mm Hg (62%) 5 minutes after induction. In the non-glaucoma group IOP was 16.3 +/- 3.5, 9.7 +/- 3.0 (62%) und 9.6 +/- 3.0 (59%) respectively. Directly after placement of endotracheal tube we read 17.8 +/- 7.6 mm Hg (87%) in the glaucoma and 13.0 +/- 5.9 mm Hg (82%) in the non-glaucoma group. Shortly before removal of endotracheal tube we found IOP to be 21.3 +/- 4.5 mm Hg (107%) in the glaucoma and 17.8 +/- 6.8 mm Hg (106%) in the non-glaucoma group. Back on the ward we measured 19.8 +/- 4.1 mm Hg (94%) and 15.4 +/- 3.5 (93%) respectively. Pressure changes relative to baseline values show no statistically significant differences between the two groups. CONCLUSIONS: General anesthesia lowers IOP to the advantage of intraocular surgery. There is no statistically significant difference in pressure change relative to baseline value in eyes with and without primary open angle glaucoma.

Aged↗
PubMed1981

[FHR long term variability under various obstetrics analgesia (author's transl)].

Changes of FHR long term variability (LTV) were studied in four groups of patients under different types of analgesia. The LTV was evaluated according to our visual criteria in each episode of more than one minute of duration on baseline fetal heart rate level between contractions. In the balanced anesthesia group incidence of the episodes with LTV decreased significantly after the administration of Diazepam and Methoxyflurane (64%-30%), further decreasing after the injection of Pethilorfan, but it increased to some degree within 20 min. before delivery. In the epidural group the change of LTV was mild, but the LTV decreased after each administration of 0.25% Bupivacaine (58%-44%-36%). It is also showed mild increase within 20 min. before delivery. Loss of variability was persistently noted until the end of labor from 20-40 min. after the administration of Diazepam and Pentazocine in the modified NLA group. The change in paracervical block group was quite different from the other groups. The incidence of episodes with LTV was increased after the injection of 1% Lidocaine Hydrochloride (35%-41%). There was no significant different of blood gas and acid-base balance among four types of analgesia.

Anesthesia, Epidural↗
PubMed2004

Developing a specialty: J.S. Lundy's three major contributions to anesthesiology.

John S. Lundy was able to accomplish three major goals during the early years of his stewardship of the section on anesthesia of the Mayo Clinic. In 1925, Lundy established the first anatomy lab at the Mayo Clinic. He believed that the lab would serve as a useful tool for teaching residents as well as research into regional anesthetic techniques. Second, Lundy desired to advance the science of anesthesiology. Lundy developed the concept of balanced anesthesia, pioneered the introduction of barbiturates to the practice of anesthesia, developed anesthesia section services for the use of ventilators, ventilator vests, oxygen tents, and nasal oxygen supplementation. Lastly, in 1935, he established the nation's first blood bank. Lundy and Ralph Tovell had the opportunity to do pioneering work in transfusion medicine, which led to an improvement in the quality of service, and patient safety. These three major accomplishments provided Lundy with abundant scientific material to present to the American Medical Association (AMA) in Chicago. These trips to Chicago allowed him to gain the ear of Olin West, Morris Fishbien, and James E. Pallin. Lundy was able to successfully lobby in 1939 for the creation of a section of anesthesia within the AMA. In 1940, Lundy's dream came true with the recognition of anesthesia as a specialty by the AMA.

Anatomy↗
PubMed1994

General anesthetic techniques.

General anesthesia is the most common form of anesthetic management for ambulatory surgery. Patients, in general, prefer general anesthesia because it is less anxiety provoking. During the last decade, the availability of several short-acting agents with high clearance has made general anesthetic techniques much safer and more predictable for outpatients. Besides, general anesthesia today is associated with a quick and full recovery with minimal postoperative side effects. Proper preanesthetic psychological and, when necessary, pharmacological preparation as well as proper selection of anesthetic agents are the keys to the success of general anesthetic technique for ambulatory surgery. Although both TIVA and total inhalation anesthetic techniques have their advocates, balanced anesthesia is most popular. The introduction of several new agents (e.g., propofol, desflurane, vecuronium, atracurium, mivacurium, rocuronium, alfentanil, ondansetron, ketorolac) has made ambulatory general anesthesia less challenging and more interesting. In the future, the new anesthetic sevoflurane, and the new opioid remifentanil, may prove useful for ambulatory anesthesia. The LMA has all but revolutionized airway management during general anesthesia for ambulatory surgery.

Ambulatory Surgical Procedures↗
PubMed1985

Potentiation of the combination of pancuronium and metocurine by halothane and isoflurane in humans with and without renal failure.

Dose-response relationships for a 1:4 weight ratio-mixture of pancuronium and metocurine were studied during inhalational anesthesia with halothane and isoflurane in patients with and without renal failure. The time for recovery from 10 to 20% of control thumb twitch tension also was determined. In subjects with normal renal function, relaxant doses required for 95% twitch height suppression (ED95) were 50% of those predicted by simple addition of effects when used with a balanced anesthetic technique, 37% of predicted when used with 1.3 MAC halothane, and 25% of predicted when used with 1.3 MAC isoflurane (P less than 0.05). In subjects with renal failure, ED95 values for the combination were 40% of predicted when used with 1.2 MAC halothane and 45% of predicted when used with 1.2 MAC isoflurane (NS). For relaxants used singly in renal failure, pancuronium alone was slightly enhanced by 1.2 MAC halothane (85% of predicted), while 1.1 MAC isoflurane reduced the ED95 to 57% of predicted (P less than 0.05). Similar results were obtained for metocurine alone when used in renal failure (77 and 58% of predicted when used with halothane and isoflurane, respectively) (NS). Predicted values are published results for balanced anesthesia in normals. Recovery times were prolonged twofold in renal failure (P less than 0.05). Thus, the combination of pancuronium and metocurine is synergistic to the same degree in normals and in renal failure patients, but the total blockade produced by the combination is enhanced by halothane and isoflurane only in normals.

Adult↗
PubMedDate not supplied

[Possibilities and prospects of regional anesthesia in the current anesthesiological practice].

Presents a modern concept of conduction blocking, permitting revision of indication for it. Blocking is regarded as the basic component of present-day anesthesiologic care responsible for analgesia and regional muscle relaxation. Use of objective methods of verification of the elements of nervous formations improves the efficacy of and extends the range of indications for regional blocking solves the problem of regulation, and rational combination of this modality with selectively acting drugs provides the optimal realization of balanced anesthesia.

Anesthesia, Conduction↗
PubMed1996

Pharmacology of drugs used for anesthesia and sedation.

This article reviews and defines the concepts underlying modern pharmacologic science, such as the study of pharmacokinetics, pharmodynamics, and drug interactions. Differences in anesthetic and sedative effects observed among species may be explained in part, by varying pharmacokinetics and dynamics unique to each species. Pharmacokinetic data from ruminants and swine for many of the commonly used anesthetics and adjunctive sedatives are included. The receptor mechanism mediating the actions of anesthetics and sedatives is also reviewed. Rationale for combining CNS depressant drugs and analgesics to achieve "balanced anesthesia" and other favorable drug interactions is discussed. Several drug combinations used in ruminants and swine are provided in table form.

Anesthesia↗
PubMedDate not supplied

Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity.

BACKGROUND: Prompt recovery of protective airway reflexes, freedom from pain, ability to cooperate with respiratory physical therapy, early ambulation and discharge from the postanesthesia care unit (PACU), coupled with a stable intraoperative environment have been desired goals of anesthesia management of morbidly obese patients. We used ketorolac in lieu of narcotics toward this goal and present our subjective and objective data in this study. METHODS: A total of 50 morbidly obese patients undergoing laparoscopic gastric bypass surgery were randomly assigned to 2 groups of 25 each. Group I received intravenous ketorolac perioperatively, which was continued 24 hours postoperatively. Group II received remifentanyl intraoperatively as a part of balanced anesthesia. Intraoperative hemodynamic stability was assessed based on blood pressure, pulse rate, and bispectral index score values. Postoperative pain intensity using a visual analogue scale, as well as the presence of nausea, vomiting, hypotension, or respiratory depression, were also recorded. RESULTS: Postoperative side effects, including pain, nausea, and vomiting; requirements for analgesics and antiemetic medications in the PACU; and the time spent in the PACU varied significantly between the 2 groups. Continued administration of ketorolac during the first 24 hours postoperatively led to improved patient satisfaction and more enthusiastic participation in respiratory physical therapy. CONCLUSIONS: Perioperative use of intravenous ketorolac up to 24 hours after laparoscopic gastric bypass surgery for morbid obesity helps provide a more stable intraoperative environment, earlier discharge from the PACU, and better outcome in this subset of patients.

Adolescent↗
PubMed2006

Anesthesia for encephalo-trigeminal angiomatosis (Sturge-Weber syndrome).

A case report of rare congenital disease of encephalo-trigeminal angiomatosis (Sturge-Weber Syndrome) (SWS), is presented to alert the anesthesiologist of its potential risk. The case was anesthetized for emergency orthopedic surgery. Anesthesia management is directed towards observing the clinical manifestations of localized superficial skin lesions, extensive systemic involvement, evaluating its associated anomalies and anticipating difficult intubation due to angiomas of the mouth and upper airway and be a ware of concurrent therapy. The authors reviewed the English-language literature and reported findings regarding the SWS pathophysiologic features, interventions, and outcomes, with emphasis on issues relevant to anesthesiologists. This patient tolerated balanced anesthesia well. Anesthesia should be planned to avoid trauma to the hemangiomata, increases in intraocular and intracranial pressure, and be cognizent of current anticonvulsant therapy.

Anesthesia↗
PubMed2002

Implicit memory for words played during isoflurane- or propofol-based anesthesia: the lexical decision task.

BACKGROUND: Unconscious processing of words during general anesthesia has been suggested after surgery with several tests of implicit memory. Patients can neither recall those words nor do they have explicit memories of other intraoperative events. It is unclear to what degree information is processed during general anesthesia and which tests are best suited to detect implicit memory. In the current study, a lexical decision paradigm not previously used to demonstrate implicit memory during anesthesia was used. METHODS: Sixty patients undergoing lumbar disc surgery were assigned to receive isoflurane infusion- or propofol infusion-based anesthesia combined with alfentanil infusions and a nitrous oxide-oxygen mixture. A control group of 10 medical students listened to tapes without receiving anesthesia. Two tapes, each containing a list of 30 low-frequency German nouns repeated for 15 min, were prepared, with half of the patients listening to tape A and the other half listening to tape B during the operation. Exposure time was 15 min from the time of skin incision onward. In the test phase, approximately 7 h later, words from lists A and B plus 60 nonwords were presented in random order by a computer program. Subjects were asked to indicate, by pressing one of two response buttons, whether the spoken word was or was not a legal German word (lexical decision). RESULTS: A recognition test revealed chance recognition for words presented during anesthesia. Lexical decision responses, however, were slightly faster to primed (previously presented) words than to unprimed (not previously presented) words when the entire group of patients was tested, suggesting a small implicit memory effect, which barely failed to reach the significance level. When the two medication groups were tested separately, no significant implicit memory effect could be ascertained statistically. The effects of previous exposure were much more pronounced in the control group. CONCLUSIONS: Balanced anesthesia techniques with isoflurane or propofol lead to only a minimal, statistically borderline implicit memory effect in the lexical decision paradigm.

Acoustic Stimulation↗
PubMed2005

Effect of 2 anesthetic techniques on the postoperative proinflammatory and anti-inflammatory cytokine response and cellular immune function to minor surgery.

STUDY OBJECTIVE: The aim of this study was to investigate the influence of 2 established anesthetic techniques: total intravenous anesthesia and balanced inhalation anesthesia (BAL) on the perioperative-induced changes of peripheral blood mononuclear cells (PBMCs), changes in lymphocyte subsets, and the balance of proinflammatory and anti-inflammatory cytokines. DESIGN: This is a prospective, randomized, clinical comparison study. SETTINGS: This study was set at a university hospital. PATIENTS: This study involved 50 patients with American Society of Anesthesiologists physical status I who were scheduled for elective minimal invasive partial diskectomy. INTERVENTIONS: There was no intervention involved in this study. MEASUREMENTS: Changes in differential counts, lymphocyte subsets, and proliferation rates were determined before surgery and in the early postoperative period. Plasma concentrations of proinflammatory cytokines (IL-2, IL-6, IL-12, interferon gamma) and anti-inflammatory cytokines (IL-10, IL-1RA, transforming growth factor beta), and plasma concentrations of cortisol, epinephrine, and norepinephrine were measured before, during, and after surgery. MAIN RESULTS: Absolute number of CD3+, CD4+, and CD8+, and expression of HLA-DR and activation marker CD25+, CD26+, and CD69+ decreased more in response to surgery after BAL. Changes in distribution of T-lymphocyte cells seem to be in part related to severe postoperative pain. Plasma concentration of IL-6 significantly increased during and after surgery with BAL without relation to pain. CONCLUSION: Anesthetic management may have varying influences on the postoperative immune response. Surgery-induced inflammatory response and alteration in cell-mediated immunity seem to be more pronounced after BAL. These effects were attributed to the enhanced stress response after BAL.

Adult↗
PubMed1988

[Changes in temporomandibular joint functions in various general anesthesia procedures].

In a clinical study conducted in 1986 on 100 patients, we were able to demonstrate that intubation leads to the occurrence of temporary disturbances of the stomatognathic system. To verify these results, a double-blind study was conducted involving 140 patients of ASA groups I and II. Further acceptance criteria were: operation outside of the head and neck area, no throat pack or gastric tube, and the requirement of dental antagonists on the left and right side. Group composition: Group A: oral intubation with a laryngoscope (n = 50); Group B: nasal intubation using a fiberoptic endoscope (n = 40); Group C: face mask (n = 50) Groups A and B were divided at random. Balanced anesthesia was performed for all patients. In group B, after nasal intubation the mandible was placed and fixed in the habitual occlusion position. The patients had a dental examination preoperatively and on 1st, 2nd and 3rd postoperative day. Parallel to this study, we also interviewed 400 patients after routine intubation anesthesia with regard to postoperative temporomandibular joint (TMJ) symptoms. Groups A, B, and C were comparable in age, sex, height, weight, preoperative values of maximal mandibular movement, and pathological findings of the TMJ (Tables 1-3); the only differences were a longer mean duration of surgery in groups A and B than in group C (P greater than 0.05) and that women described more stomatognathic disorders in the preoperative medical history than men.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

[Anesthesia for a patient with superior vena cava syndrome].

An 18-year-old male with a history of surgery to correct partial drainage of the pulmonary veins had been experiencing symptoms of superior vena cava syndrome (SVCS) for 2 years. Severe obstruction of the superior vena cava where it joined the right atrium became evident upon cardiac catheterization. Because the catheter could not be inserted into the atrium, angioplasty was ruled out and surgery was scheduled. Surgery was performed with the patient in Fowler's position. Electrocardiographic signals, oxygen saturation (pulse oximetry), temperature, bispectral index, diuresis, and invasive arterial pressure were monitored. A large vein was catheterized in the left foot, and a central venous catheter was inserted through the right femoral vein. Balanced anesthesia without nitrous oxide was provided, and a right axillary artery-inferior vena cava cardiopulmonary bypass was established. Once the defect was repaired, central venous pressure became normal and edema in the upper thoracic region decreased. Anesthesia for surgical correction of SVCS carries considerable risk related to such events as difficult intubation and ventilation, bleeding, and vessel collapse. Extreme precautions must be taken and certain procedures followed in order to avoid life-threatening complications.

Adolescent↗
PubMed1982

Cardiovascular effects of nalbuphine in patients with coronary or valvular heart disease.

Although the hemodynamic changes produced by small doses of nalbuphine given to patients with cardiac disease are minimal, the cardiovascular effects of large doses which have been used as supplements for general anesthesia have not been investigated. Cardiovascular variables were measured after incremental doses of nalbuphine, up to 2 or 3 mg/kg in fourteen patients with coronary artery disease with normal left ventricular function and in seven patients with mitral valve disease. No significant changes in cardiac index, stroke work index, mean arterial pressure, pulmonary diastolic or wedge pressure, heart rate, or central venous pressure occurred in the preoperative period. However, nalbuphine alone did not produce surgical anesthesia and the addition of diazepam, nitrous oxide, or halothane was required in all patients. The addition of halothane coupled with surgical stimulation significantly decreased cardiac and stroke indices, increased mean arterial and pulmonary wedge pressures, and increased systemic vascular resistance in patients with coronary artery disease. In patients with mitral valve disease, following surgical incision, there were small but significant decreases in cardiac index and left ventricular stoke work index, and increases in systemic vascular resistance. Despite its lack of deleterious hemodynamic effects, the place of nalbuphine in the armamentarium of the anesthesiologist must be limited to use as a premedicant, as an adjunct to balanced anesthesia, or for postoperative pain relief.

Adult↗
PubMed2002

The effect of remifentanil or fentanyl on postoperative vomiting and pain in children undergoing strabismus surgery.

UNLABELLED: Postoperative vomiting (POV) after strabismus surgery in children results in discomfort and prolonged hospital stays. Opioids increase the incidence of POV. Remifentanil has a context-sensitive half-life of 3 to 4 min, and how this short half-life influences POV in those patients is unknown. We conducted a prospective, double-blinded study in 81 ASA status I or II children from 2 to 12 yr of age undergoing elective strabismus surgery under general anesthesia. Patients were randomized to receive either remifentanil (bolus 1 microg/kg; infusion 0.1-0.2 microg x kg(-1) x min(-1)) or fentanyl (2 microg/kg, and 1 microg/kg every 45 min). POV episodes were recorded for 25 h. Pain scores were obtained by using an objective pain scale for 60 min during recovery. The number of patients who experienced POV did not differ significantly between groups (49% vs 48%). However, in the Remifentanil group, POV episodes were significantly less frequent (0.95 vs 2.2 episodes). In contrast, fentanyl was associated with lower pain scores during the first 30 min of recovery. We conclude that children undergoing strabismus surgery under balanced anesthesia with remifentanil, compared with fentanyl, showed less frequent POV. However, early postoperative analgesia was better with fentanyl. IMPLICATIONS: Opioids increase the incidence of postoperative vomiting (POV). Remifentanil is characterized by the shortest half-life of all opioids used in anesthetic practice. Therefore, we studied the effect of remifentanil on POV compared with the longer-acting opioid fentanyl in children undergoing strabismus surgery.

Analgesics, Opioid↗
PubMed2002

Remifentanil provides hemodynamic stability and faster awakening time in transsphenoidal surgery.

UNLABELLED: In this prospective study, we evaluated the effects of remifentanil in ASA I-II patients undergoing transsphenoidal surgery. After the induction of anesthesia, patients were randomly allocated to the Isoflurane (n = 22, 60% nitrous oxide, isoflurane up to 2% end-tidal) or Remifentanil group (n = 21, 60% nitrous oxide, 0.5% end-tidal isoflurane, remifentanil up to 2 microg x kg(-1) x min(-1)). If mean arterial pressure (MAP) increased >80 mm Hg during maximal dosage of isoflurane or remifentanil, labetalol was administered. At the end of anesthesia, extubation and awakening times, respiratory rate, SpO(2), MAP, heart rate, and adverse effects were recorded. Hemodynamics and bleeding (minimal, mild, moderate, severe) were not different between groups. Bleeding grade increased with MAP >80 mm Hg (P < 0.001). Labetalol was administered to 20 patients in the Isoflurane group, and 10 patients in the Remifentanil group (P < 0.01). The dose of labetalol was larger in the Isoflurane group (1.0 +/- 0.6 versus 0.5 +/- 0.7 mg/kg, P < 0.05). Time to extubation did not differ, whereas time to follow commands was shorter in Remifentanil patients (16 +/- 8 versus 10 +/- 2 min, P < 0.01). No adverse effects occurred in the early postoperative period. IMPLICATIONS: In patients undergoing transsphenoidal surgery, balanced anesthesia with remifentanil (0.22 +/- 0.17 microg x kg(-1) x min(-1)) provides faster awakening time, as compared with large-dose volatile-based anesthesia, without the risk of postoperative opioid respiratory depression.

Adult↗