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At least 253 records · Page 14Linked to original sources
PubMed2006

Utility of the auditory evoked potentials index as an indicator for endotracheal intubation.

BACKGROUND: The A-line ARX Index (AAI) has been used as an indicator of depth of anesthesia. The study examined whether AAI-guided endotracheal intubation (EI), compared with experience guidance, could provide better hemodynamic stability during general anesthesia (GA). METHODS: One hundred and four patients were included in this study. In the control group, EI was performed based on the judgment of the anesthesiologist by clinical experience. In the study groups, EI was performed at an AAI value of either 15, 20, or 30. GA was induced with cisatracurium, lidocaine, fentanyl, thiamylal and succinylcholine. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, 1 min before and 1 and 3 min after intubation. The change of hemodynamics over 20% in the space between 1 min before and after intubation was defined as severe change. RESULTS: The incidences of severe changes of HR and MAP in the AAI-15 and AAI-20 groups were significantly lower than those in the control group (19% and 39% vs. 68%, P < 0.01 and 0.05; 52% and 52% vs. 91%, P < 0.01, respectively). The induction time was significantly shorter in the control group than that in the study groups (183 +/- 47 vs. 366 +/- 151, 248 +/- 53, and 255 +/- 85 sec, P < 0.01). Highest dose of thiamylal and longest induction time were needed in the AAI-15 group. CONCLUSIONS: Compared with the routine clinical practice, AAI monitoring helps to achieve better condition for EI during induction with less hemodynamic changes. The AAI value of 20 is suggested as an optimal indicator for EI.

Adult↗
PubMed1991

[Prevention of hypertension at intubation with intravenous nicardipine].

We administered a calcium channel blocker, nicardipine 0.01 mg.kg-1 i. v. bolus or 5 micrograms.kg-1.min-1 i. v. infusion before induction with thiamylal or modified NLA (thiamylal, droperidol and butorphanol) to prevent hypertension at intratracheal intubation, and measured blood pressure and heart rate before and after intubation. Blood pressure of all experimental groups was significantly reduced in comparison with the control group right after intubated. Nicardipine is effective to prevent hypertension at intubation.

Adult↗
PubMed1989

[Malignant hyperthermia; two cases of MH in the presence of general anesthesia and performing caffeine contracture test].

In the present report we described two cases of malignant hyperthermia under halothane anesthesia. Case 1; A 54-year-old, 58 kg-male was scheduled for the operation of giant arterio-venous malformation. Anesthesia was induced with thiamylal, fentanyl and pancuronium, and maintained with oxygen, nitrous oxide and halothane. The patient was subjected to halothane inhalation for 26 hours prior to the development of the malignant hyperthermia. Although body temperature rose to 41 degrees C, it returned to normal with the administration of 280 mg of dantrolene and systemic cooling. Case 2; A 31-year-old, 68 kg-female was scheduled for tonsillectomy. Anesthesia was induced with thiamylal, oxygen, nitrous oxide and halothane. After the administration of 70 mg of SCC, marked muscular rigidity occurred and endotracheal intubation was impossible. The operation was postponed. Two months after the first anesthesia, operation was successfully performed under NLA with droperidol and fentanyl. Caffeine contracture test was performed in each case by skinned fiber method and the result showed that the sensitivity to caffeine increased in the isolated skeletal muscle fiber bundles from these patients. Thresholds of caffeine contracture of these skinned fiber bundles were all lower than 5mM caffeine.

Adult↗
PubMed1988

Barbiturate anesthesia and alcohol tolerance in a rat model.

Anesthetic responses to a variety of barbiturates were examined in adult male rats rendered alcohol-tolerant by administration of an ethanol-containing balanced liquid diet for 3 weeks. Within 9 hours of withdrawing the diets, groups of 10-15 ethanol-fed rats and pair-fed controls were injected intraperitoneally with one of the following drug/dose combinations: thiamylal 20, 40, or 60 mg/kg; methohexital 10, 20, or 40 mg/kg; secobarbital 20, 30, or 40 mg/kg; pentobarbital 10, 20, or 40 mg/kg; or phenobarbital 80, 120, or 160 mg/kg. Each animal was monitored for time to loss of righting reflex (onset of anesthesia), absence of response to a painful stimulus (analgesia), and sleeping time (duration of anesthesia). None of these three anesthetic responses differed significantly in ethanol-fed and control rats with any dose of thiamylal, methohexital, or secobarbital. In contrast, all three responses were significantly less in rats given the middle dose of pentobarbital (20 mg/kg) than they were in control rats. Onset and duration of anesthesia were also shorter with the middle dose of phenobarbital (120 mg/kg), but analgesia was not. The results of this study, in combination with others, suggest that 1) cross-tolerance to anesthetic effects of barbiturates in ethanol-tolerant rats is not uniform with all barbiturates: and 2) because shorter-acting barbiturates show negligible cross-tolerance with alcohol, higher doses of these agents may not be required for satisfactory anesthesia in chronically alcoholic humans.

Animals↗
PubMed1984

Cost comparison of anesthetic regimens in the dog and cat.

Comparative costs of anesthetic regimens for the dog and cat were calculated. Various combinations of currently popular sedatives, tranquilizers, and anti-muscarinics (preanesthetic drugs), and anesthetic induction and maintenance drugs were studied. The preanesthetic drug affected overall anesthetic cost through its own cost, its effect on the amount of anesthetic drug necessary for intubation, and its effect on the amount of anesthetic necessary to maintain anesthesia. The combination of acetylpromazine-thiamylal-halothane was the least expensive regimen for both the dog and cat, whereas drug combinations that included isoflurane as the maintenance drug were the most expensive. In the cat, induction of anesthesia by use of N2O, O2, and halothane in a plexiglas chamber was more expensive than by the use of thiamylal.

Anesthesia↗
PubMed1984

Common bile duct pressure changes after fentanyl, morphine, meperidine, butorphanol, and naloxone.

Five groups of 10 patients received thiamylal, enflurane, nitrous oxide-oxygen anesthesia for elective cholecystectomy. The common bile duct was intubated via the cystic duct with a 16-g plastic catheter, and the control intraductal pressure was measured. Patients then were given equi-analgesic doses of fentanyl, morphine, meperidine, butorphanol, or placebo intravenously, and the common bile duct pressure was recorded for 20 min. Fentanyl, morphine, and meperidine significantly increased pressure in the common duct (P less than 0.001). Butorphanol produced only insignificant changes. Naloxone given 20 min later significantly (P less than 0.001) decreased pressure in patients given fentanyl, morphine, and meperidine. Naloxone given without narcotics caused an increase in pressure that, although statistically significant (P less than 0.03), was clinically insignificant. In five additional patients anesthetized with thiamylal, nitrous oxide-oxygen and intermittent doses of fentanyl, common bile duct pressures were normal.

Anesthesia↗
PubMed1982

Postanesthetic hepatic injury in rats: influence of alterations in hepatic blood flow, surgery, and anesthesia time.

Hepatic injury was measured in enzyme-induced rats following ligation of the hepatic artery performed under anesthesia with thiamylal, halothane, enflurane, or isoflurane. The influence of surgical site was determined by performing upper abdominal (sham ligation), lower abdominal, and peripheral surgery on rats anesthetized with halothane. The effect of anesthesia time was evaluated by continuing halothane anesthesia for 1, 2, or 4 hours after upper abdominal (sham ligation) surgery. Centrilobular necrosis did not occur in enzyme-induced rats anesthetized with thiamylal, isoflurane, or enflurane, or in halothane-anesthetized animals that had not undergone enzyme induction. When halothane was the anesthetic, hepatic injury was significant after both the sham operation and ligation of the hepatic artery, and hepatic injury was directly related to anesthesia time. Lower abdominal surgery and the sham operation were associated with comparable hepatic damage, which was more than that occurring after peripheral surgery.

Abdomen↗
PubMed1993

[Neuromuscular effects of vecuronium in patients receiving long-term administration of dantrolene].

We report two patients who received anesthesia using vecuronium (VCB) subsequent to long-term treatment with orally administered dantrolene. The present data suggest that these doses used of dantrolene do not prolong the duration of neuromuscular blockade induced by VCB. An 8 year old boy was given general anesthesia after medication with 20 mg.day-1 of dantrolene orally for two years. Anesthesia was induced with thiamylal and maintained with nitrous oxide in oxygen and halothane. The neuromuscular blocking effect of vecuronium was evaluated using mechanomyogram (Myograph 2000, Biometer). The potency of VCB was in the normal range and the duration and recovery time were not prolonged. A 49 year old male had been treated with 50 mg.day-1 of orally administered dantrolene for several years prior to the operation. Anesthesia was induced with thiamylal and maintained with nitrous oxide in oxygen and isoflurane. The neuromuscular blocking effect of VCB was monitored by the same method as described above. Again, there was no apparent prolongation of neuromuscular blocking action of VCB. Evidently, VCB may be used in the clinic under standard conditions of neuromuscular monitoring in patients under previous long-term treatment with dantrolene.

Administration, Oral↗
PubMed1993

[Interaction of midazolam and vecuronium in anesthetized patients].

The interaction between midazolam and vecuronium was investigated in 60 patients during isoflurane-nitrous oxide-oxygen anesthesia. Neuromuscular function was evaluated by recording the single twitch of the abductor pollicis muscle. Anesthesia was induced with thiamylal 4 mg.kg-1 or midazolam 0.2 mg.kg-1 followed by injection of vecuronium 0.1 mg.kg-1. Observed values after midazolam were compared with those observed in patients with thiamylal. the onset time and the duration of action until 25% recovery were similar with both groups. Midazolam caused no significant potentiation of neuromuscular blocking agents in comparison with the control. Therefore, there was no evidence of any interaction between midazolam and vecuronium during isoflurane-nitrous oxide-oxygen anesthesia.

Adult↗
PubMed1993

[Effect of ketamine on hepatic circulation and oxygen metabolism during hypoxia in dog].

The present study was designed to determine whether ketamine could maintain hepatic circulation and oxygen metabolism even in the presence of serious hepatic hypoxia. Hepatic oxygen delivery as well as consumption and the hepatic energy charge were assessed in twenty mongrel dogs receiving 30 mg.kg-1.h-1 of ketamine or thiamylal intravenously while inhaling graded hypoxic gas mixtures (FIO2 0.21 to 0.08). Hepatic blood flow was measured using electromagnetic flowmetry: hepatic oxygen delivery and consumption were calculated from hepatic blood flow and oxygen content in hepatic arterial, portal venous and hepatic venous blood. The hepatic energy charge was assessed by measuring arterial ketone body ratio (AKBR). In the ketamine group, hepatic arterial blood flow was well maintained but portal venous blood flow decreased significantly at FIO2 0.21 and 0.12 compared with thiamylal group. At FIO2 0.08, hepatic oxygen delivery, consumption and AKBR decreased significantly in the ketamine group mainly due to the decrease in oxygen delivery from portal vein, with concomitant increase in catecholamine level. These results suggest that ketamine could not suppress the exaggerated reaction to hypoxemia, and it could not maintain hepatic circulation, hepatic oxygen metabolism or hepatic mitochondrial redox state in better condition during serious hypoxemia compared with thiobarbiturate.

Animals↗
PubMed1997

[Ban of the use of metomidate (Hypnodil) in swine. Background, consequences and alternatives].

Since the beginning of 1997 the use of the hypnotic drug metomidate (Hypnodil) in swine is not longer allowed. This ban caused a substantial therapeutic deficit for anesthesia in swine. The ban is based on provisions of the European Council Directive 2377/90 for fixing maximum residue limits (MRL) of veterinary drugs in animal-derived food and due to the fact that the pharmaceutical industry has not submitted any application for determining an MRL for metomidate. According to the regulations of the German drug law only those substances can be used as alternatives which are authorized for use in swine or another food-producing animal species. Registrations for use in swine exist for the barbiturates thiamylal and narcobarbital, for ketamine and for the neuroleptics azaperone, acepromazine and propionylpromazine. In the exceptional case of therapeutic emergency levomethadone or xylazine can be used. The administration of propofol, thiopentone, opioids (except levomethadone) or benzodiazepines (except brotizolam) to swine is not allowed since these drugs are authorized only for use in humans or companion animals. At present the most appropriate alternative for anesthesia in swine is thiamylal after premedication of azaperone and ketamine inducing general anesthesia with sufficient tolerance at low risks. In current studies general anesthesia with tolerance could further be produced by combinations of levomethadone, ketamine and azaperone or xylazine. Combined use of levomethadone with benzodiazepines appeared to be not suitable in swine.

Anesthesia↗
PubMed1993

Primary open-angle glaucoma alters retinal recovery from a thiobarbiturate: spatial frequency dependence.

Electrophysiological responses of the retina to a series of grating stimuli (6-768 min of arc/phase) were recorded in seven sessions using normal Beagles and in 21 sessions using Beagles afflicted with inherited glaucoma. A 15 degrees and a 30 degrees field, centered around the animal's area centralis, were used to stimulate the central retina. Two recording series were completed on each animal, with both stimulus sizes presented in each recording session. The first recording took place 30 min, and the second 2 hr, after the injection of thiamylal sodium. The signals recorded from the toroidal 15 degrees of the retina of the glaucomatous dogs during the second recording were significantly larger than those of the first recording. This difference was found only for the larger (> 48 min of arc/phase) gratings. No significant differences were found between the first and second recordings from the central 15 degrees of glaucomatous dogs, nor at any site in the normal dogs.

Animals↗
PubMed1977

Effects of diazepines and barbiturates on hippocampal recurrent inhibition.

The effects of two diazepines (diazepam and Ro 11-7800) and 3 barbiturates (thiamylal, pentobarbitol and phenobarbital) on GABA-mediated recurrent inhibition were assessed on single hippocampal pyramidal cells and on population spikes using extracellular recording techniques. Recurrent inhibition was evoked in spontaneously active CA1 pyramidal cells by stimulation of the fimbria or the alveus with single shocks. Microiontophoretic application of Ro 11-7800 or systemic application of diazepines or barbiturates resulted in an increase of the duration of the inhibition and in a concomitant depression of the spontaneous firing in most neurones tested. When the firing rates were kept constant artificially, using excitant amino acids, a prolongation of the recurrent inhibition was observed with barbiturates but not with diazepines. The duration of the inhibition, which was assessed from CA1 population spikes elicited by double shocks to the fimbria, was prolonged following systemic application of diazepines or barbiturates. It is concluded that both diazepines and barbiturates are able to potentiate GABAergic recurrent inhibition in the hippocampus. The demonstration of this effect appears to depend critically on certain experimental conditions.

Animals↗
PubMed1992

Experimental study on the indications for barbiturate therapy. Change in haemodynamics and the influence of dopamine.

The effect of barbiturates on the cerebral haemodynamics and the influence of dopamine on barbiturates were investigated using 20 cats, and clinical indication of barbiturate therapy is discussed. Cerebral blood flow, oxygen extraction fraction, and cerebro-vascular resistance as well as physiological variables were evaluated at various concentrations of barbiturates in the blood. Thiamylal caused simultaneous reduction of mean arterial blood pressure and cerebral blood flow. As the disruption of autoregulation proceeded, cerebro-vascular resistance and oxygen extraction fraction increased till the barbiturate-induced coma stage. Furthermore, cerebro-vascular resistance increased much more markedly by the combined use of dopamine. Clinically, our results indicate barbiturates would increase cerebral circulatory disturbances caused by vasospasm following subarachnoid haemorrhage because barbiturates further increase cerebro-vascular resistance. Then again, the combined use of dopamine is not preferable because of deterioration in vasospasm.

Animals↗
PubMed1995

Fentanyl pretreatment attenuates the haemodynamic response to sudden inhalation of 5% isoflurane.

High concentrations of inhaled isoflurane can increase heart rate and/or arterial pressure. The purpose of this study was to determine whether fentanyl has a prophylactic effect on the isoflurane-induced circulatory response in adult patients. Thirty patients due to undergo elective surgery were randomly allocated to one of three groups of ten patients. Prior to surgery, one group inhaled 2.5% isoflurane, another inhaled 5.0% isoflurane, and the third group inhaled 5.0% isoflurane and were given fentanyl 2 micrograms.kg-1 i.v. two minutes before induction of anaesthesia. Anaesthesia was induced with thiamylal followed by vecuronium. The lungs were ventilated with 100% oxygen and either 2.5% or 5.0% isoflurane via face mask. Ventilation was continued for five minutes. Heart rate (HR) and mean arterial pressure (MAP) were recorded at two minutes before induction of anaesthesia (baseline), immediately before the induction of anaesthesia, and at three and five minutes after induction, respectively. It was found that 5.0% isoflurane caused an increase in HR compared with baseline (P < 0.01) and with the 2.5% isoflurane (P < 0.05): 2.5% isoflurane did not elicit this response. An increase was also noted in MAP, compared with the 2.5% isoflurane (P < 0.01): 2.5% isoflurane did not elicit this increase. Fentanyl pretreatment attenuated the increases in HR and in MAP that occurred with 5.0% isoflurane (P < 0.01). These results suggest that fentanyl attenuates the enhancement of both HR and MAP from face mask inhalation of a high concentration of isoflurane.

Adult↗
PubMed1998

Anaesthetic management of a patient with Williams syndrome undergoing aortoplasty for supravalvular aortic stenosis.

PURPOSE: A case of a patient associated with Williams syndrome undergoing aortoplasty for supravalvular aortic stenosis is presented. CLINICAL FEATURES: Williams syndrome is a rare disease associated with a characteristic facies, supravalvular aortic stenosis, and mental retardation. A 15-yr-old girl with Williams syndrome underwent aortoplasty for supravalvular aortic stenosis. Anaesthesia was induced with fentanyl and thiamylal, and maintained with nitrous oxide, oxygen, sevoflurane, and continuous intravenous infusion of fentanyl. Supravalvular aortic stenosis was evaluated using a multiplane transesophageal echocardiography (TEE) probe before and after repair. CONCLUSION: Multiplane TEE was found to be very useful for anaesthetic management in a patient with Williams syndrome undergoing aortoplasty for supravalvular aortic stenosis.

Adolescent↗
PubMed1995

Secondary hyperparathyroidism shortens the action of vecuronium in patients with chronic renal failure.

The authors studied the duration of action of vecuronium in 15 patients with normal renal function and 40 patients with chronic renal failure to evaluate the effect of secondary hyperparathyroidism on the action of vecuronium. The patients were divided into four groups: 15 patients with normal renal function (Group A); nine patients with chronic renal failure who did not need haemodialysis (Group B); 15 anephric patients who did not require parathyroidectomy (Group C); and 16 anephric patients who underwent parathyroidectomy because of severe secondary hyperparathyroidism (Group D). The ratio of the height of the first twitch (T1) to the baseline value before vecuronium administration was measured by an electromyogram. Baseline T1 was obtained after anaesthesia induction with thiamylal iv. The time to 10% recovery of the first twitch (REC 10) after administration of vecuronium 0.12 mg.kg-1 iv was measured in each group. Anaesthesia was maintained with isoflurane and nitrous oxide in oxygen, and supplemented with fentanyl iv. Patients in Group D showed shorter REC 10 (51 +/- 4 min) than those in Groups B (71 +/- 6 min) and C (80 +/- 10 min) (P < 0.05), but similar REC 10 to patients in Group A (37 +/- 4 min). These results suggest that the duration of action of vecuronium in anephric patients with secondary hyperparathyroidism is shorter than in those without secondary hyperparathyroidism.

Anesthesia, Inhalation↗
PubMed2000

Effects of epidural anesthesia on the cardiovascular response to a rapid increase in isoflurane concentration.

STUDY OBJECTIVE: To compare circulatory variables to an abrupt increase in isoflurance concentration via mask in patients who received either upper thoracic or lumbar epidural anesthesia, or neither. DESIGN: Prospective study. SETTING: Operating room at a university hospital. PATIENTS: 45 ASA physical status I female patients scheduled for elective surgeries with general anesthesia. INTERVENTIONS: Patients received thoracic (TEA group) or lumbar (LEA group) epidural anesthesia, or neither (control group) (n = 15 per group). An epidural catheter was inserted through the T1-T2 intervertebral space in the TEA group or L2-L3 in the LEA group, and 10 mL of 2% lidocaine without epinephrine was injected. Two minutes after induction of anesthesia with thiamylal, the inspired isoflurane concentration was rapidly increased from 0.5% to 5% and maintained for 5 minutes. MEASUREMENTS AND MAIN RESULTS: Heart rate and mean arterial pressure (MAP) were measured every minute. Mean analgesic levels obtained by epidural block were C4-T6 and T10-S1 in the TEA and LEA groups, respectively. Heart rate increased after the increase in isoflurane concentration in all groups, but increased significantly less in the TEA group than in the control or LEA groups (p < 0.05). Isoflurane also increased MAP in the control group throughout the 5-minute period, but only at the first minute of inhalation in the TEA and LEA groups. The increases in MAP in the TEA and LEA groups were significantly less than that in the control group (p < 0.05). CONCLUSION: Epidural anesthesia can blunt circulatory responses to a sudden increase in isoflurane concentration.

Adult↗