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At least 343 records · Page 19Linked to original sources
PubMed1992

[Plasma catecholamine levels during air-oxygen-enflurane anesthesia compared with those during nitrous oxide-oxygen-enflurane anesthesia].

This study was designed to investigate the differences in plasma levels of epinephrine, norepinephrine and dopamine during air-oxygen-enflurane anesthesia (AOE) and those during nitrous oxide-oxygen-enflurane anesthesia (GOE). These catecholamine levels were measured at 8 carefully defined points before and during hysterectomy or ovariectomy in two groups of each ten patients. Plasma levels of epinephrine decreased significantly immediately after intubation in both groups. In the AOE group, epinephrine levels increased significantly 30 and 60 minutes after the beginning of the operation. In the GOE group, however, epinephrine levels decreased significantly 15 and 30 minutes after the beginning of the operation. The difference between the two groups was statistically significant. Plasma levels of norepinephrine increased significantly after the beginning of the operation in the GOE group but no significant differences were found in the AOE group except the levels 60 minutes after the operation. The difference between the two groups was statistically significant 15 minutes after the operation. Plasma levels of dopamine remained unchanged in the two groups. Mean arterial pressure changed with intubation and surgical stress in the two groups. The arterial pressure was significantly higher 30 minutes after the operation in the GOE group compared with AOE group. Pulse rate increased significantly during anesthesia and surgery in the GOE group. It is concluded that AOE induces more increase of plasma epinephrine and less release of plasma norepinephrine compared with GOE.

Adult↗
PubMed2006

[Safe management of anesthesia with total intravenous anesthesia using propofol, fentanyl and ketamine for a patient treated with intraoperative radiotherapy].

A 3-year-old girl with neuroblastoma was scheduled for intraoperative radiation therapy. Prior to surgery, meetings were held to ensure the safety during transfer between the operating room and the radiation unit because those units were placed on the different floors in our hospital. In the operating room the patient was anesthetized with propofol, fentanyl and ketamine (PFK). After the resection of the tumor, the patient was moved to the radiation unit. All personnel had to leave the treatment room while the radiation was administered, which required 3 minutes. During the transfer and treatment, the following apparatus were effective to ensure the patient's safety; mobile respiratory and cardiovascular monitors, closed-circuit television to observe the monitors and patient, and a portable gas powered ventilator. The total intravenous anesthesia with PFK was used throughout all scheduled procedures. For patients treated with intraoperative radiation therapy, the administration of inhalation anesthetics should be discontinued to supply 100% oxygen, which enhances the effect of irradiation, and to avoid the complexity of the transfer with an anesthetic machine. This discontinuation, however, may cause the cardiovascular instability. It seems that total intravenous anesthesia has advantages over inhalation anesthesia for patients who undergo intraoperative radiation therapy.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Low-dose thoracic epidural anesthesia induces discrete thoracic anesthesia without reduction in cardiac output.

The sensory spread and hemodynamic effects of low-dose thoracic epidural anesthesia were closely studied in 13 elective preoperative patients undergoing thoracotomy. An epidural catheter was inserted at the T4-5 or T5-6 intervertebral space and 5 ml 0.5% plain bupivacaine was injected. Cardiac output was measured by suprasternal Doppler method in all patients and also by thermodilution method with a Swan-Ganz catheter in six subjects. The cardiac outputs measured by suprasternal Doppler (Y) and thermodilution (X) methods showed a high correlation (Y = 0.74X + 0.99, r = 0.90, n = 24). Cephalad and caudad levels of hypesthesia at 15 minutes after bupivacaine injection were C8.4 +/- 2.1 (mean +/- SD) and T7.8 +/- 2.6, and those of anesthesia, T1.9 +/- 2.4 and T5.7 +/- 2.6, respectively. After epidural injection of 0.5% plain bupivacaine, a mean decrease in heart rate of 12 was observed in 15 minutes, which while clinically insignificant, was statistically significant (p less than 0.001). The decreased heart rate returned to control level after endotracheal intubation. Mean arterial blood pressure decreased slightly and only a slight elevation was seen after endotracheal intubation. Cardiac index and pulmonary capillary wedge pressure were essentially unchanged during the study period. Central venous pressure increased gradually and significantly, but within the normal range. Pulmonary vascular resistance slightly decreased in 15 minutes and returned to the control level after endotracheal intubation. Thus, low-dose thoracic epidural anesthesia was associated with minimal cardiovascular changes.

Aged↗
PubMed1991

AANA Journal course. 15: new technologies in anesthesia: update for nurse anesthetists--continuous spinal anesthesia.

The production of microcatheters small enough to be threaded through 22- to 26-gauge spinal needles has focused renewed attention on the technique of continuous spinal anesthesia. This technique has a specific combination of advantages which cannot be duplicated by any other method of regional blockade. The most important of these advantages is that sensory blockade can be produced quickly and precisely with small doses of local anesthetic, that the duration of anesthesia can be extended indefinitely, and that recovery is rapid when short-acting local anesthetics are used. Inadequate anesthesia, failure to thread the catheter, catheter breakage, prolonged neurologic deficits (e.g., cauda equina syndrome), and postdural puncture headache are uncommon complications. This installment of the AANA Journal Course will explore the latest developments regarding this emerging regional technique.

Anesthesia, Spinal↗
PubMedDate not supplied

Posterior peribulbar anesthesia: an alternative to retrobulbar anesthesia.

Peribulbar anesthesia is a safe alternative to retrobulbar anesthesia for ophthalmic surgery. Because the anesthetic is deposited outside the muscle cone, the potential for intraocular or intradural injection is greatly minimized. Furthermore, intraconal hemorrhage and direct optic nerve injury is avoided. We illustrate the details of our technique for posterior peribulbar anesthesia and describe our experience in over 3,000 cases.

Anesthesia, Local↗
PubMed1989

[EEG analysis of high-dose fentanyl anesthesia--a comparison of rapid sequence anesthesia and the conventional method].

Twenty-one patients who underwent cardiac surgery were assigned to receive high-dose fentanyl rapid sequence anesthesia or conventional high-dose fentanyl anesthesia. In conventional method group, power of delta wave decreased with respect to time. But in rapid sequence group, no decrease was seen until the end of operation. Good maintenance of delta wave in rapid sequence group may be achieved by higher plasma fentanyl concentration and the absence of acute tolerance. In conclusion, high-dose fentanyl rapid sequence anesthesia is a useful method for cardiac surgery.

Adolescent↗
PubMedDate not supplied

The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary.

Anesthesia, General↗
PubMed1979

[Course of ether anesthesia and the post-anesthesia period against a background of prior vibration].

The experiment on albino rats showed that three-hour vibration (46.6 Hz, 1mm amplitude) decreases the functional activity of the central nervous system as well as that of the respiratory and circulatory apparatus. Ether anesthesia against this background aggravates the animals condition and they die during the post-anesthesia period (60% of cases). Survival of the animals under conditions of extreme actions (vibration, anesthesia) is estimated by the cerebral cortex resistance level.

Alpha Rhythm↗
PubMedDate not supplied

Extended unilateral anesthesia. New technique or paravertebral anesthesia?

BACKGROUND AND OBJECTIVES: The authors previously reported a case in which injection of local anesthetic posterior to the endothoracic fascia at the T11 vertebral level gave rise to extended analgesia in thoracic and lumbar dermatomes. They now report a study in which this type of anesthesia was used in patients undergoing herniorrhaphy. METHODS: A 12-mL dose of 2% mepivacaine was injected at the T11 level posterior to the endothoracic fascia in 15 patients. RESULTS: On average, seven dermatomes could be blocked with this dose and with a single injection. Nine patients experienced adequate analgesia and underwent operation with no additional sedation. In three patients the block resulted in inadequate analgesia, and additional sedative drugs were used. Three patients experienced no analgesia and were given general anesthesia CONCLUSION: Injection of local anesthetic posterior to the endothoracic fascia resulted in extended unilateral anesthesia that was adequate for herniorrhaphy in 9 of the 15 patients (60%) studied.

Adult↗
PubMed2004

A comparison of selective spinal anesthesia with hyperbaric bupivacaine and general anesthesia with desflurane for outpatient knee arthroscopy.

In this randomized and controlled trial, 64 adult ambulatory knee arthroscopy patients received either selective spinal anesthesia (SSA) with 4 mg of hyperbaric bupivacaine or general anesthesia (GA) with desflurane. We conducted the study to determine whether SSA with small-dose bupivacaine provides equal fast-tracking possibilities, a shorter stay in the postanesthesia care unit, and earlier discharge home compared with GA with desflurane. Patients with a high risk for postoperative nausea and vomiting received prophylaxis in the GA group. No difference was seen in the fast-tracking possibilities or time in the postanesthesia care unit between the groups. Home readiness was achieved after 114 (31-174) and 129 (28-245) min (NS) in the SSA and GA groups, respectively. In the hospital, the pain scores were significantly (P < 0.001) lower in the SSA group compared with the GA group and the need for postoperative opioids was significantly (P = 0.008) larger after GA. The incidence of postoperative nausea and vomiting was 0% versus 19% in the SSA and GA groups (P = 0.024), respectively. We conclude that for outpatients undergoing knee arthroscopy, SSA with hyperbaric bupivacaine provides equal recovery times with less frequent side effects compared with GA with desflurane.

Adult↗
PubMedDate not supplied

[Epidural anesthesia in surgical interventions on the spine and spinal cord. I. Comparative analysis of the effectiveness of anesthesiological protection under conditions of epidural anesthesia and neuroleptanalgesia in surgery of the spine and and spinal cord].

The study was carried out in 22 patients operated on for vertebral disk hernias and spinal tumors at lumbosacral level. The patients were divided in 2 groups depending on the type of anesthesia (epidural or neuroleptanalgesia-EA and NLA). In the test group all patients were operated under EA with local anesthetics combined with intravenous sedative drugs (diprivan + relanium) under conditions of spontaneous respiration and O2 inhalation through a mask. In the control group combined total intravenous anesthesia by myorelaxants and tracheal intubation were carried out (relanium + diprivan: induction dose 1.95 +/- 0.5 mg/kg, maintenance dose 5.3 +/- 0.4 mg/kg/h, and phentanyl). The purpose of the study was to compare the efficiency of anesthesiological protection under EA and traditional NLA in interventions on the spine, when surgical injury is inflicted in the immediate vicinity to the central structures responsible for pain impulsation. Only EA ensured adequate protection of the patients from surgical stress, as was seen from hemodynamic (arterial pressure and heart rate) and endocrine metabolic parameters (glucose, epinephrine, norepinephrine, hydrocortisone, and prolactin levels). Hence, EA fully demonstrated its protective properties during operations on the spine, and therefore can be regarded as a method of choice in this patient population.

Adjuvants, Anesthesia↗
PubMed2004

Perioperative management for one day hospital admission: regional anesthesia is better than general anesthesia.

The past ten years have showed real and considerable growth in the number and complexity of ambulatory surgeries. The remaining real problems are the postoperative pain and the adverse effects due to parenteral opioids promoting hospital readmissions and increasing costs. This events limit the expansion of outpatient surgery. Regional anesthesia techniques such as spinal anesthesia and peripheral nerve blocks are ideal techniques for one day hospital admissions surgical procedures. It is now fully demonstrated that these techniques allowed rapid and complete anesthetic blocks, a limitation of adeverses events and unplanned hospital admissions and increased the quality of prolonged optimal postoperative pain relief if continuous peripheral nerve blocks are used.

Ambulatory Surgical Procedures↗
PubMed1990

[Causes and risk factors of intraoperative anesthesia complications. A prospective study of 14,735 anesthesias].

Identification of risk factors is an essential part of our efforts to minimize problems during anesthesia. 14,735 patients were included in a prospective study in order to assess the magnitude of risk and identify risk factors. The rate of complications increased substantially after the age of 40, due mainly to a large number of patients with poor preoperative physical condition. High age in itself was not associated with increased risk of complications. Contrary to former belief, the maintenance period of anesthesia does represent a considerable risk of complications requiring emergency intervention by an anesthesiologist. The complications were related to the conduct of anaesthesia in 70% of the total number of cases and to poor physical status and the surgery in 30%. However, poor physical condition and the surgery were responsible for 50% of the very serious complications and for all the four deaths on the table. The results of the survey confirm that thorough preoperative preparation of the patient is extremely important in order to reduce intraoperative risk, especially in emergency surgery.

Adolescent↗
PubMed1981

[Combined spinal-epidural anesthesia as a variant of conduction anesthesia during surgery].

A method of associated subarachnoid and peridural infusion of subblocking dose of local anesthetic and its solution of low concentration respectively is described. Results of such anesthesia in 210 patients are presented. The associated spino-peridural anesthesia is shown to have advantages as compared with traditional methods of a one-time radicular block.

Adolescent↗
PubMed1996

[Combined loco-regional anesthesia and intravenous anesthesia with propofol (Diprivan--Zeneca)].

It is the purpose of the study to outline the superiorities of combined anesthesia in 100 patients undergoing orthopaedic (25 cases) and orthopaedic surgery (75 cases) interventions. The average duration of the operation is 90 +/- 25 min, performed under continuous peripheral (40 patients) and central (60 patients) nerve block, using Propofol against the background of continuous i.v. infusion and spontaneous ventilation. Nerve block is done according to routinely adopted techniques. The initial infusion rate for propofol (Diprivan) is 5 +/- 1.3 mg/kg/h, followed by infusional rate securing sedation II-III degree according to Ramsey's scale (mean 4 +/- 1.2 mg/kg/h). In 92 per cent of patients the sedation level is estimated as very good. In 8 per cent switching over to TIVA (total intravenous anesthesia) is necessitated because of the incomplete nerve block. No cases of hypotension or other essential secondary effects are recorded. Subjectively the anesthesiological technique is accepted as very good by most of the patients.

Adolescent↗
PubMed2000

Effect of national seminar on AIDS and anesthesia upon knowledge, attitude and practice concerning HIV among Thai anesthesia personnel.

In the national seminar of AIDS and Anesthesia which was a short course educational program in all aspects of HIV medicine, 195 questionnaires about knowledge, attitude and practice concerning HIV were distributed among the participants (anesthesiologists and nurse anesthetists) in 3 periods, pretest, post test (at the end of 2 days seminar) and post test 2 (at 4 months after the seminar). There were 177 (90.76%) respondents who completed both pretest and post test 1 questionnaires. About 12 questions of knowledge; mean scores were statistically significantly increased; 7.95 (0.98) vs 9.5 (0.78), P < 0.001. Two thirds (8 out of 12 questions) were answered correctly in post test 1 more than in the pretest by Mc Nemar Chi-square test; P < 0.05. About attitude; 2 out of 5 answers changed significantly by Mc Nemar Chi-square test; P < 0.05. The post test 2 questionnaires were mailed to all 177 participants twice asking to reply only once. All questionnaires were to be completed anonymously. The post test 2 with a response rate of 65.5 per cent revealed that universal precautions were frequently used among Thai anesthesia personnel but not universally followed. At least one-third of the respondents admitted recapping before disposal of used needles. Fifty six per cent of respondents (vs 22.8% in pretest) admitted re-using one syringe for more than one patient. In conclusion, this study showed that a short course educational program may improve knowledge about HIV and partly change attitude, but can not change behaviour. Changing the practice of anesthesia health care workers needs continual education and appropriate training.

Acquired Immunodeficiency Syndrome↗
PubMed1984

One-lung anesthesia--a comparison of pulmonary gas exchange during anesthesia with ketamine or enflurane.

Twenty-four men undergoing elective pulmonary resection with a period of one-lung ventilation were studied to compare the effects of ketamine-O2 and enflurane-O2 anesthesia on arterial oxygen tension (PaO2) and intrapulmonary shunting (Qs/Qt). No statistically significant differences were demonstrated between ketamine and enflurane in mean peak Qs/Qt, 43% and 42%, respectively, or minimum PaO2 values, 169 torr and 127 torr, respectively. Stroke volume index, left ventricular stroke work index, and cardiac index were, however, significantly greater with ketamine. No emergence hallucinations were observed in either group. These findings suggest that ketamine affords no advantage over enflurane anesthesia in terms of Qs/Qt, and arterial oxygen desaturation during endobronchial anesthesia.

Adult↗
PubMed1988

Automated charting of physiological variables in anesthesia: a quantitative comparison of automated versus handwritten anesthesia records.

Eight physiological variables--tidal volume, breathing rate, end-tidal carbon dioxide fraction, oxygen fraction in the anesthetic circuit, oxygen saturation by pulse oximetry, systolic and diastolic blood pressure, and heart rate--recorded on-line by a commercially available automated system were compared with the same variables recorded on handwritten anesthesia records. We quantified the differences between the automated and handwritten records generated from the same 30 patients (2,412 minutes of general anesthesia for elective eye surgical procedures). Considering the design of the study, we claim that the differences between both records were caused by the incompleteness or inaccuracy of the handwritten records, except in two instances. The amounts of missing or erroneous data for these eight physiological variables were expressed as fraction ("error fractions") of the time being recorded, designated EFm and EFe, respectively. For the first five variables the EFm on the handwritten records ranged between 0.23 and 0.31, and the EFe ranged between 0.01 and 0.06. For the last three variables the EFm range was 0.08 to 0.13, and the EFe range was 0.05 to 0.11. Most of these missing or erroneous data occurred during the period of induction (first 15 minutes) and at the end of the case (last 10 minutes). The EFm and EFe during induction had increased to 0.62 and 0.26, respectively, and to 0.76 and 0.06, respectively, at the end of the case. Erroneous data were observed on the automated records for the tidal volume during induction (EFe = 0.0044) and for the oxygen fraction during maintenance (EFe = 0.0024). The effect of averaging by the recordkeeper is discussed. The results of this study indicate the clinical relevance of automated record keeping.

Anesthesia↗