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PubMed1999

Potency and time course of mivacurium block during sevoflurane, isoflurane and intravenous anesthesia.

PURPOSE: To determine the potency and time course of action of mivacurium neuromuscular block under routine clinical conditions during sevoflurane, isoflurane and intravenous anesthesia. METHOD: Patients were anesthetized with nitrous oxide 66% in oxygen and 1.5 MAC sevoflurane or isoflurane or a propofol infusion, neuromuscular block being monitored using mechanomyography. Potency was determined using administration of single doses of mivacurium of 40-100 micrograms.kg-1 and construction of dose-response curves (n = 72). The onset and duration of action were determined following a bolus dose of 0.2 mg.kg-1 of mivacurium (n = 30). RESULTS: The ED50 and ED95 (with 95% confidence limits) were estimated to be 42 (35-51) and 86 (74-98) micrograms.kg-1, 52 (45-60) and 89 (72-110) micrograms.kg-1, and 53 (45-62) and 95 (81-112) micrograms.kg-1 during sevoflurane, isoflurane and propofol anesthesia respectively (P < 0.05 between sevoflurane and propofol). Following administration of the 0.2 mg.kg-1 dose, neither the times (mean +/- SD) to maximum block (1.6 +/- 0.31, 1.7 +/- 0.21 and 1.6 +/- 0.45 min, respectively) nor the times to 25 and 90% recovery of T1 (20 +/- 4.5 and 33 +/- 8.8 min, 21 +/- 3.8 and 33 +/- 6.5 min, and 18 +/- 4.1 and 28 +/- 5.8 min respectively) were different among groups. The times to recovery of TOF ratio to 0.8 were 40 +/- 10.0, 36 +/- 8.5 and 29 +/- 5.5 min in the sevoflurane, isoflurane and propofol groups respectively (P = 0.017 between the sevoflurane and propofol groups). CONCLUSIONS: Under usual conditions of clinical anesthesia the potency of mivacurium was slightly enhanced during sevoflurane compared with intravenous anesthesia but the duration of action was only minimally prolonged during sevoflurane and isoflurane anesthesia.

Adolescent↗
PubMed1998

Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia.

PURPOSE: To determine the magnitude of the potentiation of rocuronium by desflurane, isoflurane and sevoflurane 1.5 MAC anaesthesia. METHODS: In a prospective, randomised, study in 80 patients, the cumulative dose-effect curves for rocuronium were determined during anaesthesia with desflurane, sevoflurane and isoflurane (with N2O 70%, 15 min steady state) or total intravenous anaesthesia (TIVA) using propofol/fentanyl. Neuromuscular block was assessed by acceleromyography (TOF-Guard) after train-of-four (TOF) stimulation of the ulnar nerve (2 Hz every 12 sec, 200 microseconds duration). Rocuronium was administered in increments of 100 micrograms.kg-1 until first twitch (T1) depression > 95%. RESULTS: Rocuronium led to more pronounced T1 depression with desflurane or sevoflurane anaesthesia than with TIVA. The ED50 and ED95 were lower during desflurane (95 +/- 25 and 190 +/- 80 micrograms.kg-1) and sevoflurane (120 +/- 30 and 210 +/- 40 micrograms.kg-1) than with TIVA (150 +/- 40 and 310 +/- 90 micrograms.kg-1) (P < .01), while the difference was not significant for isoflurane (130 +/- 40 and 250 +/- 90 micrograms.kg-1). Following equi-effective dosing (T1 > 95%) the duration to 25% T1 recovery, recovery index (25/75), and TOF0.70 was: 13.2 +/- 1.8, 12.7 +/- 3.4, and 26.9 +/- 5.7 min during anaesthesia with desflurane; 15.5 +/- 5.0, 11.4 +/- 3.8, and 31.0 +/- 6.0 min with sevoflurane; 13.9 +/- 4.7, 10.7 +/- 3.3, and 26.3 +/- 8.9 min with isoflurane; and 13.9 +/- 3.9, 11.3 +/- 5.7, and 27.5 +/- 8.2 min with TIVA anaesthesia (P: NS). CONCLUSION: Interaction of rocuronium and volatile anaesthetics resulted in augmentation of the intensity of neuromuscular block but did not result in significant effects on duration of or recovery from the block.

Adult↗
PubMed1999

Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr.

PURPOSE: To study the effect of midazolam premedication on the recovery characteristics of sevoflurane anesthesia induced with propofol in pediatric outpatients. METHODS: Sixty children, one to three years, presenting for ambulatory adenoidectomy were randomly assigned , in a double-blind fashion, to receive either 0.5 mg x kg(-1) midazolam (Group M) or placebo (Group P) p.o. 30 min before anesthesia. Anesthesia was induced with 10 microg x kg(-1) atropine, 10 microg x kg(-1) alfentanil, and 3-4 mg x kg(-1) propofol i.v.. Tracheal intubation was facilitated with 0.2 mg x kg(-1) mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane with controlled ventilation. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery end-points (emergence, full Aldrete score, discharge). A postoperative questionnaire was used to evaluate the children's well-being at home until 24 hr after discharge. RESULTS: Emergence from anesthesia (22 +/- 9 vs 16 +/- 6 min (mean +/- SD), P = 0.005) and achieving full Aldrete scores (30 +/- 11 vs 24 +/- 16 min, P = 0.006) were delayed in patients receiving midazolam. Children in the placebo group were given postoperative analgesia sooner than those in the midazolam group (18 +/- 11 vs 23 +/- 8 min, P = 0.009). More children premedicated with midazolam suffered from arousal distress (20% vs 3%, P = 0.04) and scored higher on the Pain/Discomfort scale (P = 0.004) at 20 min after arrival in the recovery room. Discharge was not affected by premedication and well-being at home was similar in the groups. CONCLUSIONS: Oral premedication with midazolam delays early recovery but not discharge after ambulatory sevoflurane anesthesia induced with propofol in children one to three years. Midazolam did not improve the quality of recovery.

Adenoidectomy↗
PubMed1997

Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium.

PURPOSE: To evaluate the tracheal intubating conditions and neuromuscular blocking characteristics of divided dose mivacurium or single dose rocuronium. METHODS: Thirty-two patients undergoing elective surgery were studied. Anaesthesia was with propofol 2 mg.kg-1, followed by an infusion of 150 micrograms.kg-1.min.1. Patients were randomized to receive either mivacurium-0.15 mg.kg-1 followed 30 sec later by 0.1 mg.kg-1, or rocuronium- 0.9 mg.kg-1, followed 30 sec later by placebo. Tracheal intubating conditions were assessed 90 sec after the initial dose of relaxant by an anaesthetists who was unaware of patient group. The electromyographic (EMG) response of the first dorsal interosseus muscle to ulnar nerve train-of-four was measured. RESULTS: Successful tracheal intubation was performed in all patients after both mivacurium and rocuronium. Intubating conditions (jaw relaxation, open visible vocal cords) were judged to be good-excellent in all but one patient before insertion of the tracheal tube. However, patients receiving mivacurium were more likely to experience coughing and bucking after tracheal tube insertion (10/16 patients) than those receiving rocuronium (3/16 patients, P < 0.05). No patient in the rocuronium group experienced moderately vigorous coughing and bucking after insertion of the tracheal tube vs six patients in the mivacurium group (P < 0.05). Time to 10 and 25% recovery of neuromuscular function was faster (P < 0.05) after divided dose mivacurium (20 +/- 1 and 23 +/- 1 min, respectively) than after rocuronium (45 +/- 5 and 57 +/- 8 min, respectively). CONCLUSION: The results suggest that, during conditions of the study, divided dose mivacurium is not recommended for a 90-sec tracheal intubation in patients where moderate coughing and bucking is deemed unacceptable.

Adult↗
PubMed1987

A controlled investigation of propofol, thiopentone and methohexitone.

This was a randomized study of 180 ASA physical status I and II patients, 60 in each group who received propofol (PROP), 2.5 mg . kg-1, thiopentone (THIO), 4 mg . kg-1, or methohexitone (METH), 1.5 mg . kg-1. Control values, followed by changes after induction and during a 3-min delay before intubation were recorded for the following parameters: heart rate (HR), systolic and diastolic blood pressures (SBP, DBP), respiratory rate (RR), end-tidal CO2 (PETCO2), and induction time (IT). In addition, the incidence of adverse reactions and time for recovery from anaesthesia were noted. The IT (mean +/- SE) was 35 +/- 1 sec for propofol, 35 +/- 1.2 sec for thiopentone and 34 +/- 1.4 sec for methohexitone. Ninety-three per cent of the PROP group fell asleep with one dose and required no additional doses. Fifty per cent of each of the THIO and METH groups required additional agents (p less than 0.05). METH was associated with the highest elevation in HR, PROP the least (p less than 0.05). PROP was associated with the most decrease in SBP and DBP and in addition respiratory depression (p less than 0.05). The incidence of injection pain or excitatory activity was equal in the three groups with the exception that 14 patients who received METH developed hiccoughs while none did in the other groups. PROP was associated with the most rapid recovery, particularly with respect to the orientation time. We conclude that PROP is an effective alternative to barbiturate induction and that the published recommended doses of THIO and METH are often ineffective.

Adult↗
PubMed1987

A comparison of propofol and thiopentone as induction agents in outpatient surgery.

We studied 90 healthy ASA physical status I or II female patients scheduled for outpatient therapeutic abortions. Sixty patients received induction doses of propofol (2.5 mg X kg-1) and 30 patients received thiopentone (4 mg X kg-1). Anaesthesia was maintained with nitrous oxide plus additional doses of the agent used for induction. Comparisons were made regarding the efficacy of induction and maintenance, rapidity of recovery, haemodynamic and respiratory variables and side effects. The number of "excellent" inductions was significantly different (p = 0.02), with 97 per cent of the patients induced with propofol and 80 per cent of the patients induced with thiopentone receiving this rating. A larger number of patients receiving propofol exhibited minor extraneous muscular movement during induction (p = 0.01). Recovery for the propofol group was significantly more rapid than with the thiopentone group (p = 0.001). The respiratory effect of the two drugs was not significantly different. Propofol caused a decrease in pulse rate and a decrease in systolic, diastolic and mean pressure which were significantly greater than with thiopentone. From the observations made we conclude that propofol has the potential to be an excellent induction and maintenance agent for outpatient surgery in combination with nitrous oxide alone.

Abortion, Therapeutic↗
PubMed1994

Propofol for pulsed dye laser treatments in paediatric outpatients.

Pulsed dye laser is a new treatment for port-wine stains, congenital lesions in the cutaneous vascular plexus. We report our anesthetic experience with paediatric outpatients treated in the dermatology clinic. From April to November 1993, 48 ASA 1 children were anaesthetised for a total of 105 consecutive laser treatments. The youngest was eight months old, the oldest was 12 yrs old and most of the sessions (43%) were done for children aged from two to four years. Each received acetaminophen (10 mg.kg-1 p.o.) before treatment. A propofol infusion was chosen for anaesthesia to achieve early discharge and to reduce the incidence of postoperative emesis. The infusion was adjusted to maintain blood pressure within 20% of baseline and to keep the child immobile. The dose was progressively reduced during the procedure from 400 micrograms.kg-1.min-1 to 100 micrograms.kg-1.min-1. Fentanyl (2 micrograms.kg-1 i.v.) was added for analgesia. Respiration was spontaneous through a nasopharyngeal airway (air in oxygen 40%). Anaesthesia proceeded uneventfully in all cases and lasted for 15-30 min (63% of treatments), 30-45 min (28%) or 45-60 min (9%) according to the size of the lesion. The mean stay in the recovery room was 25.1 min and none of the patients experienced emesis. Our experience shows that general anaesthesia with propofol supplemented with fentanyl offers a rapid onset and awakening, a painless treatment and an immobile child. It is a safe solution to alleviate pain from repeated painful procedures even in small children under two years of age.

Acetaminophen↗
PubMed1994

Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children.

Recovery after doxacurium and pancuronium neuromuscular blockade and their acceleration by neostigmine have not been compared in children. Therefore, 60 paediatric surgical patients aged 2-10 yr (ASA 1-2) were studied. They were randomized to receive doxacurium 30 micrograms.kg-1 or pancuronium 70 micrograms.kg-1 iv during propofol, fentanyl, isoflurane and nitrous oxide anaesthesia. Electromyographic (EMG) responses of the adductor pollicis to train-of-four (TOF) stimulation of the ulnar nerve were recorded every ten seconds using a Datex NMT monitor. Six patients in each relaxant group received neostigmine (0, 5, 10, 20 or 40 micrograms.kg-1) with atropine by random allocation when first twitch height (T1) had recovered to 25% of control. Spontaneous recovery after ten minutes was similar following doxacurium (mean +/- SEM values of 45.0 +/- 3.9 vs 49.5 +/- 10.0% for T1 and 25.2 +/- 3.8 vs 14.8 +/- 3.6% for TOF ratios). Dose-responses to neostigmine were calculated from the log dose vs logit of T1 or TOF ratio after ten minutes. Neostigmine-assisted recovery was not different in the two groups, with ED70 and ED90 doses for T1 of 14.3 +/- 1.8 and 25.7 +/- 2.7 micrograms.kg-1 for doxacurium and 12.5 +/- 1.7 and 25.3 +/- 2.3 micrograms.kg-1 for pancuronium. Time to recovery of TOF ratio to 70% after neostigmine 40 micrograms.kg-1 was 2.3 +/- 1.0 and 4.2 +/- 1.7 min (P = NS) following pancuronium and doxacurium, respectively. Adjusted recovery due to neostigmine alone (spontaneous recovery subtracted from the total) required two to three times higher doses of neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗
PubMed1994

Postoperative sore throat in children and the laryngeal mask airway.

Postoperative sore throat is a minor complaint after general anaesthesia of multifactorial aetiology. The purpose of this study was to compare the effect of the laryngeal mask airway (LMA) and endotracheal tube (ETT) on postoperative sore throat in children. We hypothesized that the incidence of sore throat would be less after the use of the LMA. This was a randomized, single-blind study of 112 patients of age 3 to 12 yr undergoing minor peripheral surgery. The groups were similar, except that airway maintenance was either with an LMA or ETT. After induction of anaesthesia with O2, N2O and halothane, an LMA or ETT was inserted. Anaesthesia was maintained with O2, N2O and halothane. At the end of surgery, the ETT was removed in the operating room before airway reflexes had returned. The LMA was removed after the patient's airway reflexes had returned in the recovery room. On the first postoperative day, the parents were contacted and asked whether or not their child had had a sore throat. If a sore throat had been present, the parents rated the discomfort as mild, moderate or severe. The groups were similar with respect to age, weight, sex and duration of procedure. The overall incidence of sore throat was 9%. The difference between the groups (LMA 13% vs ETT 5%) was not statistically significant. All of the reported sore throats were rated as mild. In conclusion, postoperative sore throats after minor paediatric surgery is uncommon. If it does occur, it is mild and the incidence is unaffected by the choice of an LMA or ETT.

Analgesia↗
PubMed1994

Sedation with midazolam during regional anaesthesia: is there a role for flumazenil?

The aim of this study was to reassess the efficacy of flumazenil for reversal of sedation with midazolam. Twenty-four ASA I or II patients undergoing elective surgery under epidural anaesthesia participated. Following epidural block, midazolam was administered to keep the patient sleepy but still responsive to verbal commands. At the end of surgery the patients were randomly allocated to receive, in a double-blind manner, either flumazenil (0.1 mg.ml-1) or placebo. The study drug (maximum dose: 10 ml) was titrated until the patient became fully awake. Sedation was assessed with the Modified Steward Coma Scale (MSCS), the Trieger test (TT) and Critical Flicker Frequency (CFF). The assessments were done before anaesthesia (baseline), at the end of surgery immediately before administration of study drug, and serially afterwards, at 10, 30, 60, 90, 120, 150 and 180 min. Analyses of variance for repeated measures and pooled t tests were used. The duration of surgery was (mean +/- SD) 0.72 +/- 0.25 hr in the flumazenil group and 0.74 +/- 0.28 hr in the placebo group. The total dose of midazolam was 7.2 +/- 2.2 mg for the flumazenil group and 8.9 +/- 2.7 mg for the placebo group. The volume of study drug administered was 5.5 ml +/- 1.9, equivalent to 0.55 mg, for the flumazenil group and 6.7 +/- 2.2 ml for the placebo group. Critical Flicker Frequency is the only measure which revealed a difference (P < 0.005) between the flumazenil and placebo groups and this occurred only at the ten-minute assessment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Recovery of psychomotor function after propofol sedation is prolonged in the elderly.

PURPOSE: To assess the effects of age on recovery of psychomotor function for propofol sedation during spinal anesthesia. METHODS: Propofol was continuously infused during surgery and spinal anesthesia in 15 elderly patients (65-85 yr-old) and 15 younger patients (20-50 yr-old). Infusion rates were adjusted to maintain an appropriate level of sedation using the bispectral index (range 60-70). The sedative infusion was discontinued at the end of surgery. The early recovery times from the end of propofol infusion to opening of eyes on command, sustaining a hand grip, and recall of name were noted. Psychomotor function, as measured by the Trieger's dot test, was evaluated before anesthesia and 30, 60, 90, 120 min after the end of propofol infusion. RESULTS: The duration of anesthesia was 142 +/- 55 min and 134 +/- 61 min in the elderly and younger patients, respectively. No differences were observed in early recovery times between elderly and younger patients (opened their eyes on command, 6.3 +/- 4.0 min and 5.2 +/- 2.6 min; sustained a hand grip, 7.2 +/- 3.9 min and 6.1 +/- 3.5 min and recalled their name, 8.0 +/- 4.5 min and 6.5 +/- 3.8 min, P > 0.05 ). The recovery of psychomotor function in the elderly took longer compared with the younger patients, and psychomotor function in the elderly recovered at 120 min after the end of propofol infusion. CONCLUSION: Early recovery times following propofol sedation is similar between elderly and younger patients, but recovery of psychomotor function in the elderly is delayed compared with younger patients.

Adult↗
PubMed2004

Sevoflurane for interventional neuroradiology procedures is associated with more rapid early recovery than propofol.

PURPOSE: Sevoflurane and propofol are both suitable for neuroanesthesia but have not previously been compared as maintenance agents for long duration (one to five hours) procedures. METHODS: Using a multicentre international study protocol, 103 patients were randomized to receive either sevoflurane or propofol for maintenance of anesthesia during interventional neuroradiology procedures. After a standardized induction of anesthesia with propofol, 53 patients received sevoflurane 1 to 3% with 60% nitrous oxide (N(2)O) in oxygen (O(2)), and 50 patients received propofol 4 to 10 mg x kg(-1) x hr(-1) with 60% N(2)O in O(2). Maintenance agents were titrated against systemic arterial blood pressure (baseline mean arterial pressure +/- 20%). Recovery times, changes in sedation, pain, nausea and vomiting and psychomotor function during recovery and use of rescue medication were recorded. RESULTS: The group receiving sevoflurane had a more rapid recovery to spontaneous ventilation, extubation, eye opening and orientation compared to the group receiving propofol (3 vs 4 min, P = 0.01; 5 vs 6 min, P = 0.015; 7 vs 10 min, P < 0.001; 13 vs 17 min, P = 0.028; respectively). Sedation, pain, nausea and vomiting, and psychomotor function scores were similar in the two groups. Use of opioid boluses and vasopressors were similar. CONCLUSION: The use of sevoflurane for maintenance of anesthesia for prolonged neuroradiological procedures is associated with more rapid early recovery than propofol and is associated with similar side effects. Sevoflurane and propofol can both be recommended for these procedures. The clinical benefit of the more rapid recovery with sevoflurane is unknown.

Adolescent↗
PubMedDate not supplied

The A-line ARX index may be a more sensitive detector of arousal than the bispectral index during propofol-fentanyl-nitrous oxide anesthesia: a preliminary investigation.

PURPOSE: To compare changes in the A-line ARX index (AAI) by the Alaris AEP monitor(TM) with those of the bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia. METHODS: Eighty female patients undergoing partial mastectomy were randomly allocated to AAI or BIS (40 per group). Anesthesia was induced with propofol 2 mg x kg(-1) and fentanyl 3 micro g x kg(-1) during the inhalation of oxygen. A laryngeal mask airway (LMA) #3 was inserted. Anesthesia was maintained with propofol 4 mg x kg(-1) x hr(-1), fentanyl 1 micro g x kg(-1) given at the start of surgery, and nitrous oxide 4 L x min(-1) in oxygen 2 L x min(-1). Blood pressure, heart rate, and AAI or BIS were monitored, including recovery time of the index after disturbance by electrocautery. RESULTS: The AAI but not the BIS increased significantly with LMA insertion and skin incision, while blood pressure and heart rate did not change. The BIS decreased from 87 +/- 7 to 30-60 while the AAI decreased from 75 +/- 8 to 10-25 during anesthesia. The increase of the AAI was larger than that of the BIS at recovery from anesthesia. The variation of the index was smaller in the AAI than in the BIS. Recovery time of the index after electrocautery was significantly longer in the BIS group (21 +/- 9 sec) than that in the AAI group (5 +/- 3 sec). CONCLUSIONS: During propofol-fentanyl-nitrous oxide anesthesia, the AAI responded to LMA insertion or surgical incision, but not the BIS, and the AAI had smaller variations. The AAI recovered faster from the disturbance by electrocautery than the BIS. Thus, the AAI may be a more sensitive and useful detector of arousal than the BIS.

Adult↗
PubMedDate not supplied

Intrathecal lidocaine and sufentanil shorten postoperative recovery after outpatient rectal surgery.

PURPOSE: A short recovery time for same day surgery is important to the patient and the hospital. A prospective, randomized, double-blinded study in the postanesthetic care unit was designed to compare the recovery time from spinal anesthesia with low-dose intrathecal (IT) lidocaine and sufentanil to that with IT lidocaine alone. The incidence of adverse effects was also assessed. METHODS: Forty-nine patients (ASA I-III, age 20-69 yr) underwent spinal anesthesia for rectal surgery. The patients were randomized into two groups. One group (n = 28) received low-dose IT lidocaine (15 mg) and sufentanil (10 microg) and the other group (n = 21) received IT lidocaine (50 mg). The time to ambulation, the incidence of pruritus, and other variables were recorded. Statistical difference was assumed if P < 0.05. RESULTS: Our results show a significantly shorter ambulation time (120 +/- 26 min) after IT low-dose lidocaine (15 mg) and 10 microg sufentanil vs 50 mg IT lidocaine (162 +/- 32 min, P < 0.0001). Patients who received IT lidocaine and sufentanil recovered faster. Fifty percent of the patients who received IT sufentanil suffered from pruritus. CONCLUSION: IT lidocaine (15 mg) and sufentanil resulted in a shorter time to ambulation compared to IT lidocaine (50 mg) alone and provided excellent anesthesia despite its disadvantage of pruritus.

Adult↗
PubMed2004

Desflurane increases cerebral blood flow velocity when used for rapid emergence from propofol anesthesia in children.

PURPOSE: Desflurane may be used to replace propofol at the end of anesthesia to facilitate rapid emergence. This study determined the effect of administering desflurane during emergence of anesthesia on middle cerebral artery blood flow velocity (Vmca) in children anesthetized with propofol. METHODS: Thirty healthy children aged one to six years scheduled for orchidopexy or hypospadias repair under general anesthesia were enrolled. Anesthesia was maintained with a propofol infusion targeting an estimated serum level of 3 microg x mL(-1), remifentanil 0.2 microg x kg(-1) x min(-1) and a caudal epidural block. Transcranial Doppler sonography was used to measure Vmca at five-minute intervals. In half the patients, propofol was substituted with desflurane 1 MAC, 30 min prior to the end of the surgical procedure. Once steady-state had been achieved recordings of Vmca, heart rate, and mean arterial pressure were resumed. Upon termination of the surgical procedure, the maintenance agent was discontinued and recordings continued at one-minute intervals during emergence of anesthesia. RESULTS: There were no demographic differences between the two groups. Vmca increased from 37.2 +/- 3.1 cm x sec(-1) to 57.7 +/- 4.1 cm x sec(-1) when propofol was changed to desflurane (P < 0.01). Upon emergence of anesthesia, Vmca decreased from 57.8 +/- 4.2 cm x sec(-1) to 37.8 +/- 3.2 cm x sec(-1) in the desflurane group (P < 0.01) but remained unchanged in the propofol group. CONCLUSION: Desflurane is associated with an increase in cerebral blood flow velocity when used to facilitate rapid emergence following a propofol infusion in children. This may be of clinical significance in patients with intracranial pathology.

Anesthesia Recovery Period↗
PubMed2001

Selective spinal anesthesia for outpatient laparoscopy. V: pharmacoeconomic comparison vs general anesthesia.

PURPOSE: To compare the cost and effectiveness of small-dose spinal anesthesia (SP) with general anesthesia (GA) for outpatient laparoscopy. METHODS: A retrospective record analysis of 24 patients who received SP were compared with 28 patients who received GA in our Daycare centre. The costs of anesthesia and recovery were calculated, from an institutional perspective, using 1997 Canadian Dollar values. Effectiveness was measured in terms of time for anesthesia and recovery, and postoperative antiemetic and analgesic requirements. RESULTS: Both groups were well matched for age, weight, duration and type of surgery. The mean total cost for the SP group of $53.45 +/- 10.40 was no different from that for the GA group of $48.92 +/- 10.25 (95% CI -10.3, 1.2). Time to administer anesthesia was longer in the SP group with a mean time of 18 +/- 8 min compared with 10 +/- 3 min in the GA group (CI -11.3, -4.7). Recovery time in the PACU was longer in the SP group 123 +/- 51 min compared with 94 +/- 48 min (CI -56.6,-1.4). Postoperative antiemetic requirements were similar: 8% in SP group vs 14% in GA group, whereas analgesic requirements were less in the SP group with 25% receiving analgesia compared with 75% in the GA group (P < 0.05). CONCLUSION: The total cost of anesthesia and recovery using SP is similar to that for GA when used for outpatient laparoscopy. Spinal anesthesia was less effective than GA in time to administer anesthesia and in duration of recovery. Postoperative analgesic requirements were reduced using SP.

Adult↗
PubMed2003

Tramadol 2.5 mg x kg(-1) appears to be the optimal intraoperative loading dose before patient-controlled analgesia.

PURPOSE: We previously established that a 5 mg x kg(-1) intraoperative dose can reduce the nausea/vomiting associated with tramadol patient-controlled analgesia (PCA). This study was conducted to identify the most appropriate initial dose to improve the quality of tramadol PCA. METHODS: During general anesthesia, 60 patients undergoing knee arthroplasty were randomly allocated to receive 1.25 mg x kg(-1) (Group I), 2.5 mg x kg(-1) (Group II), 3.75 mg x kg(-1) (Group III), or 5 mg x kg(-1) (Group IV) tramadol. The emergence condition was recorded. The titration of additional tramadol 20 mg + metoclopramide 1 mg doses by PCA every five minutes was performed in the postanesthesia care unit (PACU) until the visual analogue scale (VAS) score was < or = 3. An investigator blinded to study group recorded the VAS and side effects every ten minutes. RESULTS: In the PACU, significantly more tramadol (8.4 +/- 3.1 vs 4.3 +/- 2.1, 2.5 +/- 1.8, and 0.4 +/- 0.3, P < 0.05), and a higher incidence (15/15 vs 5/15, 3/15, and 2/15, P < 0.05) of PCA use was observed in Group I compared to Groups II-IV. VAS was significantly higher in Group I than in Groups II-IV at zero and ten minutes (P < 0.05). Unexpected delayed emergence anesthesia (> 30 min) was observed in Group III (n = 1) and in Group IV (n = 2). Sedation was more important in Groups III and IV than in Groups I and II (P < 0.05). CONCLUSION: When considering efficacy and side-effect profile, 2.5 mg x kg(-1) of tramadol is the optimal intraoperative dose of this drug to provide effective postoperative analgesia with minimal sedation.

Aged↗