Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Balanced Anesthesia”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed1991

Butorphanol tartrate (stadol): a review.

Butorphanol tartrate (Stadol; Anaquest, Madison, WI/Bristol-Meyers Squibb, Evansville, IN) is an analgesic possessing mixed agonist-antagonist activity at opiate receptors. Receptor specificity has been used to limit respiratory depression, gastrointestinal side effects, and reduce the risk of dependency. Theoretically it offers an advantage over traditional opiates such as morphine and meperidine in the treatment of moderate pain. Butorphanol has been used as a preoperative sedative and analgesic, as a supplement to balanced anesthesia, and for suppression of postanesthesia shaking. Other recognized uses include obstetric analgesia during labor and relief of moderate postpartum pain. In addition, butorphanol has been used effectively for conscious sedation. Its lack of euphoric effects may be useful in emergency medicine for clinical populations prone to drug-seeking behavior. Butorphanol has been used more recently for epidural analgesia or for intravenous patient-controlled analgesia when allergies to opiates exist. Since butorphanol is not a controlled substance, its use can reduce administrative liability for abuse and can lower the number of distribution records associated with Schedule II narcotics.

Butorphanol↗
PubMed1990

[Muscle relaxants for kidney transplantation. A comparison between vecuronium and atracurium].

A total of 26 patients with end-stage renal failure were assigned randomly to receive either atracurium (A) or vecuronium (V) for intra-operative relaxation during kidney transplantation. Following the induction of balanced anesthesia an initial bolus dose of A 0,5 mg/kg body weight (BW) or V 0,1 mg/kg BW was administered. Relaxation was maintained by repeated doses of A 0,1 mg/kg BW or V 0,02 mg/kg BW whenever the twitch height (T1) recovered to 20% of the control value. Neuromuscular function was monitored throughout using the train-of-four twitch technique. There were no significant differences in time of onset (A: 219 +/- 87 s, V: 206 +/- 70 s), initial clinical duration (T1 = 0% to T1 = 20%; A: 39 +/- 12 min, V 39 +/- 8 min) or recovery index (A: 19 +/- 6 min, V: 22 +/- 7 min). The clinical duration (T1 = 20% to T1 = 20%) was significantly different for A, with 27 +/- 9 min than for V, with 32 +/- 7 min (P less than 0.05, Wilcoxon-Mann-Whitney U-Test; all values means +/- standard deviation). Reversal of relaxants was mandatory according to electromyographic and clinical criteria in only one patient in the A group but in 5 in the V group (P less than 0.05, Fisher's exact test). We conclude that A might be more suitable in patients with renal insufficiency and that monitoring of neuromuscular transmission is highly valuable in this risk group.

Adult↗
PubMed1990

[Use of dalargin in complex anesthesiological protection during operations on the abdominal organs].

The authors analyse experience in the use of the synthetic analogue of ++leu enkephalin dalargin in multicomponent balanced anesthesia in operations on the abdominal organs in 36 patients. With the use of the suggested method the intraoperative expenditure of narcotic analgesics is 6 times less but the efficacy of the anesthesia remains the same. Study of the activity of the liver-specific enzymes (histidase and urokinase) in blood plasma and biopsy material taken from the liver and the content of malonic dialdehyde in the hepatic biopsy specimen revealed hepatoprotective properties of dalargin. The decrease of the total peripheral resistance and increase of the elasticity of the arterial reservoir++ in the main group as compared to these values in patients treated by the traditional method were considered by the authors to be the consequence of the autonomic priming effect of the opiopeptide used. It is concluded that the use of synthetic analogues of endogenous opioids (dalargin) in the anesthesiological protection complex in operations on the abdominal organs is expedient.

Adult↗
PubMed1987

Histamine release by four narcotics: a double-blind study in humans.

Histamine release and hemodynamic changes associated with four narcotics were studied in 60 adults (28 men, 32 women) scheduled for general surgery under balanced anesthesia. Under double-blind conditions, incremental equipotent doses of meperidine, morphine, fentanyl, or sufentanil were administered IV for induction of anesthesia, prior to thiopental, succinylcholine, and intubation. Arterial blood samples were drawn before and 1, 6, and 20 min after narcotic administration. Of the 16 patients given meperidine (mean dose 4.3 +/- 0.2 (SEM) mg/kg), five (31%) had clinical signs (hypotension, tachycardia, erythema) and elevations in plasma histamine levels ranging from 3.2 to 49.7 ng/ml 1 min after narcotic administration. Plasma epinephrine levels at this time were also elevated in these five patients. One of the ten patients given morphine (0.6 +/- 0.02 mg/kg) developed hypotension, tachycardia, and an increase in plasma histamine level to 12.4 ng/ml. None of 34 patients given either fentanyl (7 +/- 0.4 micrograms/kg) or sufentanil (1.3 +/- 0.1 microgram/kg) had clinical signs of histamine release or elevations of plasma histamine levels. In the six patients in whom histamine release occurred, there was a significant correlation between the histamine levels at 1 min and the magnitude of change in heart rate, blood pressure, and plasma epinephrine level. All six histamine releasers were young women, ranging in age from 18 to 35 yr. Histamine release occurred more frequently after meperidine than after the other narcotics, including morphine, and the degree of hemodynamic compromise was related to the increase in plasma histamine concentration.

Adolescent↗
PubMed1989

Low dose sufentanil for major intracranial surgery.

The use of intravenous sufentanil in a single dose of 3 to 5 micrograms/kg body weight, was evaluated in 41 patients anesthetised for major intracranial surgery. It was assessed in a technique of balanced anesthesia which allowed controllable alteration in cardiovascular parameters and rapid postoperative recovery and neurological evaluation. It was concluded that the 4 micrograms/kg dose was superior regarding peroperative stability and recovery. The delayed recovery in aneurysm and fossa posterior surgery should be explained by several factors not involving the anesthetic technique.

Adult↗
PubMed1989

[The clinical significance of drug interactions between opiates and calcium antagonists. A randomized double-blind study using fentanyl and nimodipine within the framework of postoperative intravenous on-demand analgesia].

It is widely accepted that the nociceptive state and opiate-induced nociception are regulated at least in part by calcium ions. Animal experiments suggest that systemically or intracerebroventricularly applied calcium antagonizes analgesic effects, whereas calcium chelating agents or calcium channel blockers enhance them. Recently, von Bormann et al. [3] reported a fentanyl-saving effect in cardiovascular patients who had received an intraoperative infusion of nimodipine; this finding was discussed as a possible synergistic analgesic interaction. Since doubts remained as to whether this interpretation was justified, the present study aimed to verify, in awake postoperative patients, whether nimodipine increased the analgesic efficacy of fentanyl. Forty ASA I-II patients (mean age 43-44 years) undergoing elective hysterectomy under standardized balanced anesthesia were investigated. In the recovery room, they were allowed to self-administer fentanyl by means of the On-Demand Analgesia Computer (ODAC). Demand dose was 34.5 micrograms, infusion rate 4 micrograms/h, lockout time 1 min, hourly maximum dose 250 micrograms. The patients were randomly and double-blindly assigned to have an additional infusion of either placebo (P) or nimodipine (N: 15 micrograms/kg/h during the first 2 h, 30 micrograms/kg/h from the 3rd to the 12th h). Fentanyl consumption, pain scores (actual and retrospective), blood pressure, heart rate, respiratory rate, and side-effects were monitored. The mean duration of patient-controlled analgesia was 16 (P) to 19 (N) h, during which time 0.64 +/- 0.46 (N) to 0.79 +/- 0.43 (P) micrograms fentanyl/kg/h was demanded. Pain relief was very satisfactory in 92.5% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Failure of proglumide, a cholecystokinin antagonist, to potentiate clinical morphine analgesia. A randomized double-blind postoperative study using patient-controlled analgesia (PCA).

The potential clinical utility of drug interactions between morphine and the cholecystokinin antagonist proglumide was examined in 80 postoperative patients suffering from moderate to severe pain. Four groups of ASA I-III patients (mean age 51 years, mean weight 72 kg) recovering from major abdominal or gynecological surgery (mean duration of surgery 141 minutes) performed under balanced anesthesia (midazolam, droperidol, fentanyl, N2O, enflurane) were randomly assigned to self-administer morphine-proglumide mixtures on the first postoperative day (ODAC; morphine demand dose 3 mg; infusion rate 0.36 mg/hr; lockout time 2 minutes; hourly maximum dose 15 mg/hr; proglumide doses per demand 0, 50 micrograms, 100 micrograms, or 50 mg). Morphine consumption, actual as well as retrospective pain scores (0-5) and side effects were evaluated. Mean duration of patient-controlled analgesia (PCA) in the subgroups was 17-19 hours, during which time 24.6 +/- 9.5 to 28.0 +/- 3.4 micrograms morphine.kg-1.hr-1 was given. There were no statistically significant differences between the groups either for drug consumption, pain scores, or side effects. It is therefore concluded that proglumide does not potentiate morphine analgesia in a clinical (postoperative) setting.

Adult↗
PubMed1989

Maintenance of oxygenation during one-lung ventilation. Effect of intermittent reinflation of the collapsed lung with oxygen.

The aim of this study was to evaluate the effect on oxygenation of intermittent inflation with oxygen of the collapsed lung during one-lung ventilation (OLV). Sixteen patients were studied during pulmonary surgery. Balanced anesthesia with nitrous oxide and an inspired oxygen fraction of 0.5 was used. The control group (N = 8) had a median PaO2 of 19.2 (range 11.2-30.2) kPa before OLV, and 10.2 (8.2-16.0) kPa after 9 minutes of OLV without further reduction in PaO2 for another 10 minutes. In the treatment (inflation) group, the collapsed lung was manually inflated with 2 liters of oxygen and was then immediately allowed to collapse again. This procedure was repeated every 5 minutes during OLV. PaO2 increased more than 4 kPa following each inflation in seven patients. In the eighth, PaO2 remained high throughout OLV. Although PaO2 decreased between inflations, it never reached the level observed in controls during 19 minutes of OLV.

Adult↗
PubMedDate not supplied

[Transcutaneous measurement of gas exchange parameters in anesthesiologic practice].

pO2 and pCO2 were studied transcutaneously (tcpO2 and tcpCO2) in 36 patients during reconstructive surgery performed under various multicomponent balanced anesthesia techniques. The results, in the absence of hemodynamic disturbances, serve as a reliable indication of changes in arterial blood pO2 and pCO2 (PaO2 and PaCO2), however, it is impossible to identify transcutaneous PaO2 and PaCO2 values. A decrease in tcpO2 and an increase in tcpCO2 during their dynamic study may give evidence of the inadequacy of controlled lung ventilation. At the same time, with normal PaO2 and PaCO2 values, hypoxia and hypercarbia, recorded, using transcutaneous transducers, may serve as an early index of central and peripheral hemodynamic disturbances. It is advisable to use the results of transcutaneous pO2 and pCO2 measurements as additional tests, characterizing O2 and CO2 transport.

Adult↗
PubMed1988

Use of intramuscular butorphanol for the treatment of postoperative orthopedic pain in adolescents: a pilot study.

A pilot study was conducted to evaluate the use of butorphanol, administered intramuscularly in 0.7-mg to 3-mg doses, in 27 adolescents with postoperative orthopedic pain. Butorphanol provided good or excellent pain relief in 24 (89%) patients. The duration of the relief was about three to four hours. The only adverse effect experienced in more than one patient was urinary retention, possibly associated with the use of fentanyl, which was administered for balanced anesthesia, and/or with the surgical procedure (spinal fusion). Tolerance and safety were rated as good or excellent in 100% of the patients.

Adolescent↗
PubMed1987

[Comparative clinical study of nalbuphine and fentanyl. Effects and side effects with special reference to the induction phase].

In a previous study concerning balanced anesthesia we realized that the adrenergic sympathetic reaction caused by intubation could not be suppressed by nalbuphine-HCl (NAL), a new narcotic agonist-antagonist in the same way as by fentanyl (FE). The aim of the study was to investigate whether the observed autonomic reaction could be overcome by: (a) varying the interval between injection of NAL and intubation or (b) increasing the induction-dose of NAL. MATERIALS and METHODS. After receiving institutional approval and the patients' written informed consent, a two-part randomized trial arrangement was made using two groups of 10 surgical patients each. During the first part the induction-dose of NAL was 1.5 mg/kg BW and that of FE was 0.005 mg/kg BW. Midazolam 0.15 mg/kg BW was the induction hypnotic. Orotracheal intubation was performed 15 min after NAL and 10 min after FE injection. During the second part, the NAL dosage was 2.5 mg/kg BW and intubation was carried out 10 min after opiate injection. Induction conditions in the FE group were unchanged. RESULTS. NAL causes adrenergic sympathetic hemodynamic and autonomic reactions immediately after injection (Figs. 1a + b, 2a + b). The rate-pressure product increase during intubation is significantly higher after NAL than after FE administration and cannot be suppressed by increasing the dosage or increasing the injection-intubation interval. In contrast, the postoperative period is characterized by long-lasting analgesia (114 min vs 82 min in the FE group) and sedation, especially after administration of 2.5 mg/kg BW NAL. CONCLUSION. These results may be explained by the agonist-antagonist activity of NAL at the opiate receptor sites.

Adult↗
PubMed1987

[Transdermal scopolamine or droperidol in the prevention of postoperative nausea and vomiting in cholecystectomy patients].

Scopolamine, applicable without severe side effects as a transdermal therapeutic system (TTS), has a pronounced postoperative antiemetic effect. In one publication there was found even a 50% reduction of emetic symptoms compared with placebo. In this study TTS-Scopolamine was compared with a single dose of 7.5 mg Droperidol in a group of 40 Patients undergoing cholecystectomy under standardised balanced anesthesia. After cholecystectomy patients are very much inclined for postoperative nausea and vomiting since it is an abdominal operation and it is more often necessary in women than in men. In this randomized, one-side-blind study the antinausea and antiemetic effect of transdermal Scopolamine was insufficient and significantly less than with Droperidol. In the Droperidol-group there were 45% of patients without emetic symptoms, in the Scopolamine-group only 15%. Vomiting occurred in 25% of patients in the Droperidol-group and in 50% of patients in the Scopolamine-group. Unfavourable CNS-side-effects could not be found either with transdermal scopolamine or with Droperidol. As favourable side-effects there was found a more even postoperative blood-pressure-curve in the Droperidol-group and a better scoring of preoperative sleep in the Scopolamine-group. Overall there is need for an exact indication for transdermal Scopolamine as a postoperative antiemetic. In this study Droperidol turned out to be a much stronger antiemetic for patients undergoing cholecystectomy.

Administration, Cutaneous↗
PubMed1988

Isofluorane inhibits early mouse embryo development in vitro.

In vitro development of 2-cell mouse embryos to the blastocyst stage was used to assess the toxicity of isofluorane, nitrous oxide, fentanyl, and meperidine. Isofluorane at concentrations similar to those employed during human oocyte recovery for IVF significantly inhibited mouse embryo development. Since the other agents were without effect, balanced anesthesia with nitrous oxide and narcotics may be preferable to isofluorane for IVF and GIFT.

Animals↗
PubMed1986

Spontaneous recovery of neuromuscular function after atracurium in pediatric patients.

Spontaneous recovery of neuromuscular function after a bolus dose of 0.40 mg/kg atracurium was assessed in 60 newborn to adolescent patients during balanced anesthesia. Each patient was allowed to recover spontaneously until complete recovery of the single twitch (T1) response and the train-of-four ratio measured from the hypothenar muscle evoked compound EMG. The recovery times of T1 from the onset of relaxation to 10% recovery and to 100% recovery were significantly longer in patients under 10 kg of body weight than in the heavier patients (25 and 56 min vs 19 and 45 min, respectively, P less than 0.01). The rate of recovery, calculated as the recovery index (time between 25% recovery and 75% recovery of T1) was significantly longer in patients under 2 months of age than in older infants or children and adolescents. Atracurium remains, nevertheless, a relaxant of intermediate duration of action even in small infants.

Adolescent↗
PubMed1983

Beta-adrenergic agonists and antagonists.

Beta adrenergic antagonists are a complex group of agents. The profusion of newer agents will allow us to discover nuances of difference between them, but that will be a future development. Currently, our concerns should be obtaining extensive experience with propranolol, controlling intraoperative and postoperative tachycardia; using beta blockade as adjunctive therapy during vasodilator administration; using beta blockade as part of "balanced" anesthesia, especially in patients with coronary artery disease; and learning sophisticated ways of preoperatively and intraoperatively evaluating hemodynamics so as to be able to decide when and how to best utilize the drugs. Beta agonists recently introduced include dopamine and dobutamine. Differences and similarities are numerous. Overriding in adults, at least, may be the ability of dopamine to stimulate renal dopaminergic receptors to increase renal blood flow.

Adrenergic beta-Agonists↗
PubMed1983

Continuous opioid infusion for scoliosis fusion surgery.

Paraplegia is the major risk involved in reconstructive surgery for scoliosis with fusion. To detect spinal cord dysfunction intraoperatively, somatosensory cortical-evoked potential (SCEP) monitoring and a wake-up test or a combination of the two is generally used. Our pilot studies indicated that a balanced anesthesia technique consisting of nitrous oxide, narcotics, and a muscle relaxant is well-suited both for SCEP monitoring as well as for wake-up tests. However, at times the intermittent administration of narcotics adversely affected SCEP interpretation and wake-up tests. To facilitate both SCEP interpretation and wake-up tests, we employed N2O/O2 with continuous infusion of narcotics and compared it with intermittent bolus administration of narcotics in 35 patients. For our purposes fentanyl (FE) was assumed to be 100 times more potent than morphine (MS). Our first 13 patients were studied using bolus increments of either MS (5-10 mg) every 30-40 minutes or FE (50-100 micrograms) every 20-30 minutes. The remaining 22 patients were studied during continuous infusions of either MS at a rate ranging from 150-250 micrograms X kg-1 X hr-1 or FE at a rate ranging from 1.5 to 2.5 micrograms X kg-1 X hr-1. Continuous infusions reduced total narcotic requirements (P less than 0.005). In addition, the technique produced stable suppression of SCEPs and made it easier to interpret surgically induced SCEP changes. Wake-up tests were smooth and repeatable. Patients who received fentanyl infusions fared better than those receiving MS in that they did not require postoperative respiratory support. Continuous infusions of fentanyl are useful in reconstructive spinal surgery for scoliosis with monitoring.

Adolescent↗
PubMed1982

A double-blind clinical trial comparing alcuronium with pancuronium.

Alcuronium and pancuronium were compared as muscle relaxants in a randomized and double-blind trial in routine clinical circumstances during combined balanced anesthesia in 40 female patients. The course of endotracheal intubation at 2 min. was statistically significantly better (p less than 0.001) in the pancuronium group than in the alcuronium group. There were no differences between the two groups regarding relaxation, maintenance of anesthesia and postoperative recovery. In the pancuronium group the systolic blood pressure was significantly higher than in the alcuronium group at 2 minutes after induction (p less than 0.01), at 2 minutes after intubation (p less than 0.05) and before incision (p less than 0.05). Also the diastolic blood pressure was significantly higher in the pancuronium group at 2 minutes after induction (p less than 0.001), before incision (p less than 0.01) and at 2 minutes after incision (p less than 0.05) than in the alcuronium group. Thus alcuronium is preferable when hypertensive episodes are to be avoided whereas pancuronium would be more suitable when hypotension can be expected.

Adult↗
PubMed1982

Peripheral postcapillary venous pressure--a new hemodynamic monitoring parameter.

Peripheral postcapillary venous pressure (PCVP) appears to be an indicator of peripheral perfusion (cutaneous blood flow) in the experimental animal. Eighteen male mongrel dogs under balanced anesthesia were subjected to either slow, continuous hemorrhage 0.65 ml/kg/min) or plasma expansion with dextran 40 (0.80 ml/kg/min) over a period of 1 hour. Peripheral PCVP, cental venous pressure arterial pressure, cardiac output (CO), mixed venous oxygen saturation, pulmonary arterial pressure, and pulmonary wedge pressure were monitored on a continuous basis. The only parameter that consistently gave a predictable measure of the degree of induced volume change without requiring pulmonary arterial catheterization was PCVP. PCVP showed a close correlation with CO (r = 0.96).

Animals↗