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At least 307 records · Page 17Linked to original sources
PubMed1999

[Epidural anesthesia and general anesthesia using the cuffed oropharyngeal airway for an obese patient with Duchenne's muscular dystrophy].

Duchenne's muscular dystrophy is a genetic disorder whose features include abnormal responses to muscular relaxants and possible respiratory dysfunction after general anesthesia. The purpose of this report is to describe one management strategy used successfully to anesthetize an obese man with this disorder for atypical mastectomy. The anesthetic management during surgery involves epidural anesthesia using 2% mepivacaine and general anesthesia using the cuffed oropharyngeal airway. Postoperatively 0.25% bupivacaine was infused for epidural analgesia. The patient was observed in the intensive care unit until the first postoperative day and showed an uncomplicated intra- and post-operative course.

Analgesia, Epidural↗
PubMed2001

Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair.

One hundred and fifty-five patients scheduled for inguinal hernia repair (IHR) were given the choice of either general anesthesia (GA) (n = 53) or spinal anesthesia (SP) (n = 47) or nerve stimulator guided paravertebral blockade (PVB) (n = 55). The incidence of postoperative nausea and vomiting (PONV), duration of hospital stay and need for postoperative analgesia were recorded. Apart from a difference in the age of patients in the GA group who were found to be slightly younger, all groups were found similar with regard to weight, height, duration of surgery, sex, type of hernia and ASA class. The incidence of PONV (0%) v/s 19% and 21% was significantly reduced in patients treated with the PVB compared to patients receiving SA and GA respectively. The length of hospital stay was also found to be shorter in the PVB group (mean 1.2 days) v/s SA (mean 2.4 days) and GA (mean 2.9 days). The need for supplemental postoperative analgesics was also found to be higher in both SA and GA when compared to PVB patients who were managed without any analgesics during the first 24 postoperative hours. The described technique appears to be an attractive alternative method to provide adequate anesthesia for IHR.

Anesthesia, General↗
PubMed1992

[Subarachnoid anesthesia and peridural anesthesia: which are the causes of total failure? A clinical case].

The paper reports the case of patient undergoing cystoscopy and subsequently radical cystectomy suffering from BPCO and pulmonary emphysema who received sub-arachnoid anesthesia during the first operation and peridural anesthesia during the second, with total failure both times. The techniques were correctly performed and on both occasions it was necessary to resort to general anesthesia in order to perform the operation.

Aged↗
PubMed2004

[A comparison of combined spinal-epidural anesthesia with epidural anesthesia for postoperative pain relief after transurethral resection of the prostate].

BACKGROUND: We compared combined spinal-epidural anesthesia (S group) and epidural anesthesia (E group) in terms of pain control after transurethral resection of the prostate (TUR-P). METHODS: All 32 patients received 0.2% ropivacaine at a rate of 2 ml x hr(-1) by a portable disposable pump postoperatively. RESULTS: S group was superior to E group in urethral pain control within three hours after operation. E group was superior to S group in decrease of back pain over six hours after operation. Fifteen patients (47%) suffered from irritability or low back pain and needed rescue analgesics. CONCLUSIONS: Our result indicates that 0.2% ropivacaine at a rate of 2 ml x hr(-1) is not satisfactory to relieve the postoperative pain. Long acting local anesthetics for spinal anesthesia are not suitable for TUR-P. Supplemental administration of opioid to epidural space or higher rate of continuous epidural infusor after operation might be better analgesic choice for TUR-P.

Aged↗
PubMed2005

[A patient with Shy-Drager syndrome managed under general anesthesia with thoracic epidural anesthesia].

A 61-year-old man with Shy-Drager Syndrome underwent partial pulmonary lobectomy under general anesthesia combined with thoracic epidural anesthesia. The blood pressure decreased from 140/ 100 mmHg to 80/50 mmHg after thoracic epidural anesthesia. It increased after intravenous ephedrine. The blood pressure decreased when he was returned to the supine position postoperatively. It did not increase as expected with intravenous ephedrine. Intravenous etilefrine promptly raised the blood pressure. There was no postoperative cardiorespiratory complications.

Anesthesia, Epidural↗
PubMed1992

[Randomized study on the use of propofol for anesthesia in intracranial tumors. Comparison with balanced anesthesia].

There is currently no anesthesiological technique which enables volume, cerebral blood flow and spinal fluid pressure to be kept constant. The aim of the present study was to compare two techniques of anesthesia in patients with cerebral tumours: one of a balanced type (AB) and the other of a continuous ev type (AEC) using propofol in order to assess which guaranteed the greatest cerebral protection. The results of the study have shown that the use of propofol may represent a useful alternative in intracranial tumour surgery since changes in systolic pressure and heart rate observed during AEC anesthesia were statistically lower in comparison to AB anesthesia. No statistically significant differences were observed in relation to changes in diastolic pressure, PVC, ApCO2 and the incidence of bleeding or cerebral edema. The quality of awakening was better in patients in the AEC group in terms of renewed breathing and spontaneous motility, verbal response and space-time orientation.

Adult↗
PubMed2005

[Comparison of total intravenous anesthesia and inhalation anesthesia regarding hormonal responses during lung lobectomy].

BACKGROUND: Anesthetic techniques can modulate surgical stress responses. We studied the response of plasma epinephrine, norepinephrine, dopamine, adrenocorticotrophic hormone (ACTH), and serum cortisol during lung lobectomy under sevoflurane, propofol and fentanyl anesthesia. METHODS: Fifty patients with lung cancer were of ASA physical status 1 or 2 and aged 50-75 yr. Blood samples were drawn before anesthetic induction, 5 min after tracheal extubation, and 24 h as well as 72 h after operation. RESULTS: Five min after tracheal extubation, plasma levels of epinephrine, norepinephrine and dopamine were significantly lower in the group that had received propofol - fentanyl anesthesia (P-F group) compared with the group that had received sevoflurane-fentanyl anesthesia (S-F group). In the P-F group, plasma levels of norepinephrine and dopamine 5 min after tracheal extubation were the same as the pre-induction levels. The increase in ACTH levels was significantly less in the P-F group in comparison with the group S-F. CONCLUSIONS: Propofol-fentanyl anaesthesia prevents the increase in catecholamines and reduces the ACTH response during lung lobectomy.

Adrenocorticotropic Hormone↗
PubMed1991

[Continuous spinal anesthesia versus continuous epidural anesthesia in surgery of the lower extremities. A prospective randomized study].

Continuous epidural anesthesia (CEA) is generally accepted as a routine method of regional anesthesia while there has been only limited application of continuous spinal anesthesia (CSA), due mainly to a lack of adequate spinal catheters. With the introduction of a new, ultra-thin spinal catheter (32 G) inserted via a thin puncture needle, some of the complications reported after CSA can be eliminated. We studied CSA versus CEA in lower-extremity operations. METHODS. We evaluated 33 patients in a prospective, randomized study. All were comparable with respect to age, anesthetic risk (ASA II-III), and pre-existing diseases. The only exclusion criterium was the presence of a coagulation disturbance. The CSA group consisted of 17 patients (mean age 75.5 +/- 0.1 year); 26 G puncture needle and 32 G catheter were used. The CEA group consisted of 16 patients (mean age 73.8 +/- 11.0 years); an 18 G puncture needle and 22 G epidural catheter with a stylet were inserted with the loss-of-resistance technique. Both catheters were placed with the patient in a sitting position and left in place for 24 h in order to administer local anesthetics (LA) for postoperative analgesia as required. Hemodynamic parameters-mean arterial pressure (MAP) and heart rate (HR)-were compared in each group at 5-min intervals for 30 min after administration of local anesthetic and at 10-min intervals during the operation. Additionally, the ECG, pulse oximetry, respiratory rate, diuresis, and blood gases were monitored. After placement of the catheter, patients in the CSA group received 1.9 ml (+/- 0.2) bupivacaine HCl 0.5%. Patients in the CEA group received 12.6 ml (+/- 2.5) bupivacaine HCl 0.5%. For statistical evaluation of the data we used mean values, standard deviation (+/-), the Kruscal-Wallis procedure, and Student's t-test for unpaired data. P less than 0.05 was considered significant. RESULTS. The mAPs in the CSA group generally remained lower than those of the CEA group. However, over the course of the operation as well as after repeated injections, the difference between the two groups decreased. Only at 5 min after administration of the initial dose was a statistically significant difference in blood pressures between the two groups observed. A clinically relevant, rapid decrease in blood pressure due to relatively high doses of LA was seen in 1 case in each group. The first reinjection of LA after the initial dose was after 1.9 h in the CSA group (bupivacaine HCl 0.5% 1 +/- 0.3 ml) and after 1.8 h in the CEA group (bupivacaine HCl 0.5% 4.5 +/- 1 ml). The total dose of bupivacaine in the CSA group was 0.18 ml/kg per hour versus 0.8 ml/kg in the CEA group. No post-dural puncture headache was observed in the CSA group. DISCUSSION. The catheter designed for CSA is easy to use, although because of its small diameter a certain manual dexterity is required. In addition, CSA resulted in a more rapid onset of action and more pronounced sensorimotor blockade than did CEA. Hemodynamic alterations and side effects were comparably low in both groups.

Aged↗
PubMed1990

[Comparative evaluation of the effectiveness of epidural anesthesia with spontaneous respiration and general anesthesia in aorto-femoral bifurcation shunt].

Results of aorto-femoral bifurcation shunts (AFBSh) were compared with special reference to the methods of anesthesia (general anesthesia--GA and epidural anesthesia--EA) with spontaneous respiration and minimum sedation. It was found that use of GA gave lethality 4 times as high as after EA. In addition, GA was followed by considerably greater incidence of pneumonias and atelectases, myocardial infarctions, enteropareses, acute renal insufficiency. The results obtained allow to think EA with spontaneous respiration to be the method of choice in operations on the abdominal aorta in patients with a severe concomitant pathology.

Adult↗
PubMed1989

Combined epidural and general anesthesia versus general anesthesia in patients having colon and rectal anastomoses.

Three retrospective studies were conducted at St. Vincent's Hospital to compare the outcomes of colorectal anastomoses, with and without resections, with respect to anesthetic technique. Operations were performed upon patients anesthetized with either combined regional (epidural) and general anesthesia (CRAG) or general anesthesia alone (GA). Postoperative pain relief was achieved with either continuous epidural analgesia (CEA) in the CRAG group or with postoperative narcotics in the GA groups (GA/PN). In one group, a different regimen was introduced: combined epidural and general anesthesia with postoperative epidural morphine (CRAG/EDM). Overall, anastomotic leak rates and death rates were lower in the CRAG group, and the lowest incidence of anastomotic leak was reported in the patients receiving CEA. Thus the reduced leak rate was associated more with the postoperative analgesia regimen than with the anesthetic technique. An increased incidence of wound dehiscence occurred with postoperative epidural morphine analgesia.

Analgesia, Epidural↗
PubMedDate not supplied

[Chemonucleolysis. Peridural anesthesia versus general anesthesia].

A prospective comparative study was carried out between two anesthetic techniques for chemonucleolysis. Patients were divided into 2 groups of 50 patients each. Group A were submitted to general anesthesia and group B to epidural anesthesia with 0.5% bupivacaine, 2% mepivacaine and buprenorphine. Group B was divided into 2 subgroups: in B1, buprenorphine was administered with the local anesthetics, while in B2 buprenorphine was administered postoperatively when pain appeared. Postoperative pain and side effects like anaphylaxis were evaluated. No anaphylactic reactions occurred. Severe lumbar pain appeared in 22% of patients in group A in spite of systematic analgesics, while group B lumbalgia was not severe in any case. Patients in subgroup B1 did not have pain during the 24 first hours and 47.8% of patients in subgroup B2 needed in most of the cases only a dose of buprenorphine. We conclude that epidural anesthesia is a good technique in chemonucleolysis and that the association bupivacaine, mepivacaine and buprenorphine provides a good postoperative pain relief.

Adult↗
PubMed1988

Debate on use of spinal anesthesia in obstetrics: spinal anesthesia has definite indications in obstetrics.

Spinal anesthesia has the advantages of speed of onset, reliability and lack of toxicity over lumbar epidural block. Against this must be offset several disadvantages, but these can be largely eliminated by careful choice of equipment and meticulous attention to details of technique. Only experienced obstetric anesthetists should perform spinal anesthesia, especially for Caesarean section. Given these conditions, spinal block has a most important part to play in obstetric anesthesia.

Anesthesia, Obstetrical↗
PubMed1981

Learning from anesthesia mishaps: analysis of critical incidents in anesthesia helps reduce patient risk.

Human error and mechanical failure in anesthesia frequently cause incidents which, if not detected and corrected in time, could lead to increased patient morbidity or mortality. A study was conducted to analyze the human and technical factors that contribute to such incidents. The data thus obtained proved useful in reducing preventable anesthesia mishaps in specific institutions and generated recommendations for improving anesthesia practice in general.

Accidents↗
PubMed1993

[Hemodynamic changes secondary to overload infusion during cadaveric renal transplantation--comparison between nitrous oxide-isoflurane anesthesia and continuous epidural anesthesia].

The hemodynamic status of renal transplant patients is important for achieving early diuresis. Many reports have demonstrated that overload infusion can reduce the frequency of acute tubular necrosis (ATN). We studied the effect of overload fluid infusion using pulmonary arterial pressure (PAP) and pulmonary wedge pressure (PCWP) monitoring on forty patients undergoing cadaveric renal transplantation. Patients were divided into two groups. Group 1 received general anesthesia by nitrous oxide-isoflurane. Group 2 received continuous epidural anesthesia. Mean PAP > 15 mmHg and mean PCWP > 10 mmHg were achieved with the infusions of normosmotic saline, colloid solution and human albumin. Systolic arterial pressure (SAP) > 150 mmHg was achieved by intravenous administration of dopamine when required. Hemodynamic stability and diuresis in the early postoperative period were maintained in both groups. Group 1 required lower doses of dopamine than Group 2. Blood loss and infusion requirements were lower in group 1 than in group 2. No patient in either group developed pulmonary edema. We conclude that overload infusion using PAP and PCWP monitoring during general anesthesia can achieve safe diuresis immediately after cadaveric renal transplantation.

Adult↗
PubMed1996

[Impact of anesthetic technic (general anesthesia versus intradural anesthesia) on the immune status].

OBJECTIVE: To study changes in the immune system appearing after general and regional (intradural anesthesia). PATIENTS AND METHODS: Fifty patients scheduled for elective surgery to repair inguinal hernias were studied. The patients were randomly assigned to 2 groups: group A patients received general anesthesia and group B patients received intradural anesthesia. Blood was extracted 5 times to determine levels of lymphocytes, activated T cells and B lymphocytes, and T-suppressant activity: t0 (before surgery), t1 (1 h), t2 (4 h), t3 (24 h) y t4 (7 days). RESULTS: The patients in group A showed slight increases in T lymphocytes, activated T lymphocytes and B lymphocytes, whereas T-suppressant activity decreased significantly. All lymphoid population decreased in group B. Baseline levels had recovered in both groups by 7 days after surgery. CONCLUSION: Anesthetic procedures have an effect on immune responses but the impact is only temporary.

Adult↗
PubMed1997

[Anesthesia management for a patient with pulmonary eosinophilic granuloma associated with bilateral pneumothorax--general anesthesia with positive pressure ventilation].

Pulmonary eosinophilic granuloma (PEG) is a rare fibroinflammatory disorder and is characterized by a mixed interstitial infiltrate of eosinophils, lymphocytes and Langerhans cells. We experienced anesthetic management for a patient with PEG associated with bilateral pneumothorax. Anesthesia was maintained with epidural anesthesia and general anesthesia using positive pressure ventilation. At first we ventilated with a low airway pressure, but recognized an increase in endtidal CO2. Then we switched to a high airway pressure (= 22 cmH2O) and decreased the concentration of carbon dioxide. No new air leaks were observed by ventilating with the high airway pressure. It was concluded that in anesthetic management for PEG we must be careful about the airway pressure during operation.

Adult↗
PubMedDate not supplied

Electronic dental anesthesia versus topical anesthesia for the control of pain caused by nasopalatine block injections.

Topical anesthetics are routinely used to reduce the pain and discomfort that patients may experience during dental injections. Just recently, however, an anesthesia (Electronic Dental Anesthesia or EDA) which works by transcutaneous electrical nerve stimulation (TENS) was introduced to the dental profession. The purpose of this study was to determine whether an electrical signal as provided by an EDA is more effective than topical anesthesia in reducing pain and discomfort caused by local anesthetic injections. Two nasopalatine block injections, one using and EDA as the adjunct, and the other using a topical anesthetic ointment of Xylocaine 5% were performed on thirty-four patients. The volunteers were asked on the spot to report the level of the pain they felt during the penetration of the needle to the mucosa, during the deposition of local anesthetic solution, and their overall evaluation of the injections. The results of this investigation showed that the EDA is the more effective adjunct for local anesthetic injections compared to the traditional topical anesthetics.

Adult↗