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PubMed1994

[Anesthesia with isoflurane in air and with isoflurane and nitrous oxide].

BACKGROUND: The aim of this study is to control the depth, the quality of recovery of total inhalation isoflurane anesthesia with or without nitrous oxide. DESIGN: Controlled comparative study was carried out on 51 patients, aged 40-54 yr, ASA 1, undergoing saphenectomy, in an University Clinic. METHODS: Induction: thiopental (3.5 mg kg), atracurium (0.6 mg kg) i.v. Patients were randomly assigned to: group 1 (26 patients), 5% isoflurane in air, by mask; group 2 (25 patients), 3% isoflurane and 60% N2O, by mask. Maintenance: group 1, 2% isoflurane in air; group 2, 1.2% isoflurane and 60% N2O. During anesthesia, consciousness and analgesia level were monitored by EEG Compressed Spectral Array, and clinical signs of pain by Evans' test; arousal time evaluation by "Time to correct response test". The subjective impressions, eventual dreams and recalls were collected using a standard set of questions one hour after the end of anesthesia and 24 hours later. One hour before anesthesia and two hours after the end of surgical procedures, a psychomotor performance recovery evaluation was performed using Zazzo's "deux barrages" test. DATA ANALYSIS: Student's "t" test. RESULTS: Adequate anesthetic depth was documented in all patients. Recovery time was statistically longer in isoflurane group (group 1 16.7 sd 2.2 minutes vs 10.3 sd 1.9 minutes group 2, p < 0.01). No patient reported recalls relative to anesthetic period. Two hours after recovery no significant differences in psychomotor performance tests were recorded. CONCLUSIONS: Isoflurane anesthesia in air, in adequate concentrations, provides a sufficient level of analgesia, hypnosis, amnesia, without clinical side effects.

Adult↗
PubMed2006

[The effects of continuous infusion of landiolol on heart rate changes after neostigmine-atropine administration during recovery from general anesthesia].

BACKGROUND: On reversal of muscle relaxants when neostigmine-atropine mixture is used, heart rate changes occurr. We examined whether landiolol attenuate the initial increases in heart rate after intravenous injections of a neostigmine-atropine mixture. METHODS: Twenty-four patients were assigned to one of two groups (n=12 each): control group and landiolol group. Anesthesia was induced with propofol and was maintained with isoflurane-nitrous oxide-pentazocine. A mixture of neostigmine 2 mg and atropine 1 mg was injected intravenously over 30s in the control group. In the landiolol group, 0.125 mg x kg)-1) x min(-1) of landiolol for 1 minute was administered immediately after neostigmine-atropine injection. Blood pressure and heart rate were measured noninvasively. RESULTS: Heart rate was significantly increased after neostigmine-atropine administration compared with that at pre-administration in both groups. At 2 and 3 minutes after neostigmine-atropine administration, heart rate in the landiolol group was significantly lower than that in the control group. The maximum increase in heart rate after the neostigmine-atropine injections was significantly less in the landiolol group than that in the control group. Blood pressure showed no significant changes in both groups during the observation period. CONCLUSIONS: Landiolol was useful for heart rate control after neostigmine-atropine administration during recovery from general anesthesia.

Adrenergic beta-Antagonists↗
PubMed1989

New discharge criteria decrease recovery room time after subarachnoid block.

The authors completed a two-phase study to determine criteria that might predict hemodynamic stability during recovery from subarachnoid block (SAB). Patients' supine and sitting (2 min) blood pressures were determined at 30-min intervals in the recovery room (RR). In the first group of 26 patients, retrospective analysis revealed that the orthostatic decrease in mean arterial pressure (MAP) never exceeded 15% following two successive orthostatic decreases of 10% or less. This finding was validated prospectively in a second group of 26 patients. Following two successive orthostatic MAP decreases of 10% or less, none of 65 orthostatic challenges resulted in an MAP decrease of more than 15%; conversely, in the absence of two successive MAP decreases of less than 10%, 5 of 51 orthostatic challenges resulted in an MAP decrease of greater than 15% (P less than 0.02). Had patients been discharged from the RR based on two successive MAP decreases of less than 10%, 35 of 52 patients could have been discharged from the RR 76 +/- 6 min (mean +/- SE) sooner than they would have under usual empirical discharge criteria of supine hemodynamic stability, regression of sensory level to T10, and return of toe movement. Following SAB, hemodynamic stability may return before sensory and motor function; for many patients, orthostatic testing following SAB may safely decrease the amount of time spent in the RR.

Aged↗
PubMed1999

Management of the postoperative anesthetic period.

While anesthetic methods and drugs have undergone many changes in the last 100 years, the incidence of complications during the postanesthesia recovery period remains constant. Prompt recognition and treatment of the complications observed during the postoperative period decreases unexpected hospital admissions and the undesirable mortality or morbidity associated with surgery and anesthesia.

Airway Obstruction↗
PubMed1999

Perioperative rehydration in ambulatory anesthesia for dentoalveolar surgery.

OBJECTIVE: Patient recovery after anesthesia is dependent not only on the lingering pharmacologic effects of sedatives but also on the physiologic effects that patients experience after surgery. Preoperative fasting results in a perioperative dehydration that may contribute to these physiologic effects, resulting in complaints of headache, nausea, vomiting, fatigue, lightheadedness, dizziness, and thirst. The purpose of this study was to investigate the effects of perioperative hydration in the ambulatory oral and maxillofacial surgery patient who receives deep sedation or general anesthesia (nonintubated). STUDY DESIGN: This was a prospective, randomized, blinded study that administered either a high volume (16-17 mL/kg) or a low volume (1-2 mL/kg) of an isotonic solution to each of 77 patients who were scheduled to have their third molars extracted with deep sedation or general anesthesia. Each patient completed 3 postoperative questionnaires designed to evaluate potential adverse outcomes. RESULTS: Nonparametric analysis of the data demonstrated a more favorable outcome with respect to subjective feelings for the high volume hydration group; this was evident both during the immediate postoperative period and in the evening of the day of surgery, and it persisted into the first postoperative day. CONCLUSIONS: This study demonstrated that appropriate perioperative rehydration decreases postoperative adverse outcomes and improves the patient's perception of the postoperative period.

Ambulatory Surgical Procedures↗
PubMed1993

[Excessive nitrous oxide exhalation by postoperative patients in the recovery room].

Expired nitrous oxide from patients in the recovery room is considered to be the major source of air pollution. We measured expired concentrations of nitrous oxide in three patients and three volunteers. After only 5 minute inhalation of 50% nitrous oxide, it took over 2 hours for exhaled N2O concentration to decrease to 25 ppm in volunteers and after 30 minute inhalation, it took over 4 hours. The patients inhaled 50% nitrous oxide for 60, 165, 150 minutes, respectively and all patients expired nitrous oxide, the concentrations of which exceed 100 ppm over 3 hours. As to the patient who inhaled nitrous oxide for 150 minutes, expired nitrous oxide over 25 ppm was detected 10 hours after the end of anesthesia, and it was 4 ppm even after 20 hours. Any personnel including anesthesiologists and nurses working in the operating room can be exposed to high concentrations of nitrous oxide exceeding the permissible limit of 25 ppm, whenever they take care closely of their patients. We do not have any effective measures to protect us from this kind of air pollution except employing total intravenous anesthesia.

Adult↗
PubMed1986

An investigation of factors affecting postoperative rewarming of adult patients.

Aural canal temperature was measured for one hour after arrival in the recovery room in 200 adult patients who underwent one of the following types of major surgery: abdominal, pelvic, vascular, orthopaedic or prostatic. One group of 100 patients was studied in the recovery room of Hammersmith Hospital which was not equipped with a controlled system for constant ventilation and humidification, while the other 100 patients were studied in the recovery room of Edgware General Hospital, which had a constant ambient temperature and controlled relative humidity with 20 air changes/hour. The rate of rewarming was found to be similar in both groups. Within the range of ambient temperatures and relative humidities measured, patients over 60 years of age rewarmed more slowly than did patients under 60 years (p less than 0.05). General anaesthesia was associated with significantly faster rewarming than was local anaesthesia (p less than 0.01).

Age Factors↗
PubMed2002

A comparison of three anesthetic techniques in patients undergoing craniotomy for supratentorial intracranial surgery.

UNLABELLED: Several anesthetic techniques have been used successfully to provide anesthesia for resection of intracranial supratentorial mass lesions. One technique used to enhance recovery involves changing anesthesia from vapor-based to propofol-based for cranial closure. However, there are no data to support a beneficial effect of this approach in the immediate postoperative period after craniotomy. We evaluated 3 anesthetic techniques in 60 patients undergoing elective surgery for supratentorial mass lesions. Patients were randomly assigned to three anesthesia study groups: propofol infusion, isoflurane inhalation, and these two techniques combined. In the combination group, once the dura was closed, isoflurane was discontinued and propofol infusion simultaneously started. We studied intra- and postoperative hemodynamics and several recovery variables for 2 h after the end of anesthesia. Baseline and average intraoperative blood pressure and heart rate values did not differ among the groups. Heart rate and blood pressure increased similarly in all groups in response to intubation and pin placement and postoperatively. None of the recovery event times (open eyes, extubation, follow commands, oriented, Aldrete score) or psychomotor test performance differed significantly. We conclude that the sequential administration of isoflurane and propofol did not provide earlier recovery and cognition than the intraoperative use of isoflurane alone. IMPLICATIONS: We evaluated three anesthetic techniques with and without propofol in patients undergoing elective surgery for supratentorial mass lesions by using a prospective, randomized clinical study design and found that the three anesthetics did not differ in intra- or postoperative hemodynamic stability or early postoperative recovery variables.

Adult↗
PubMed1998

The induction, maintenance, and recovery characteristics of spinal versus general anesthesia in elderly patients.

STUDY OBJECTIVE: To compare the induction and recovery profiles of three combinations of general anesthesia when used as an alternative to spinal anesthesia for elderly patients. DESIGN: Randomized, prospective, open-label study. SETTING: Large referral hospital. PATIENTS: 100 [ASA physical status I, II, and III] patients over 60 years of age undergoing brief transurethral surgery. INTERVENTIONS: In Groups Propofol-Propofol (P-P), Propofol-Isoflurane (P-I), and Propofol-Desflurane (P-D), anesthesia was induced with fentanyl (1 to 2 micrograms/kg i.v.) and propofol (1.0 to 2.0 mg/kg i.v.) and maintained with 70% nitrous oxide in oxygen and either a propofol infusion (75 to 150 micrograms/kg/min) or isoflurane (end-tidal 0.7% to 1.2%) or desflurane (end-tidal 1% to 4%), respectively. After induction, a laryngeal mask airway was placed and spontaneous ventilation was maintained. In Group Spinal (S), 1.5 ml 4% lidocaine (60 mg), in an equal volume of 10% dextrose, was administered intrathecally. MEASUREMENTS AND MAIN RESULTS: Induction and recovery characteristics were compared. Induction with propofol was technically easier and significantly (medp < 0.0001) faster (4.6 +/- 1.7 min, 4.7 +/- 2.2 min, and 3.8 +/- 1.4 min for Groups P-P, P-I, and P-D, respectively) than induction of spinal anesthesia (9.3 +/- 3.4 min). During the induction period, mean arterial blood pressure and heart rate were significantly higher in Group S. Emergence, extubation, and orientation times were similar among the general anesthesia treatment groups. In Group S, patient-generated pain scores were lower (p < 0.05) and recovery room admission longer (p < 0.001). Time to return to baseline digit symbol substitution test (DSST) scores was marginally improved in Groups P-P and P-D when compared to Group P-I. Postoperative nausea, sleepiness, anxiety, and coordination were unaffected by the treatment modality. CONCLUSION: General anesthesia with propofol and desflurane facilitates shorter induction and recovery times without adversely affecting patient comfort. Therefore, this technique may be preferable to spinal anesthesia for elderly patients undergoing short transurethral surgical procedures.

Aged↗
PubMed1986

[Cardiac arrest during anesthesia and the recovery period. Data from the INSERM survey 1978-1982].

This report analyses rate, predisposing factors, causes and outcome of 458 cardiac arrests occurring during anaesthesia and the following 24 hours and collected in France by a national prospective survey between 1978 and 1982. The overall rate of cardiac arrests was 1 per 433 anaesthetics, resulting in death before the 24th postoperative hour in 79% of cases, i.e. 1 per 547 anaesthetics. Cardiac arrests not related to anaesthesia were three times more frequent than those related to anaesthesia. Among these, one half is partially related to anaesthesia and the other totally. The prognosis of cardiac arrests totally related to anaesthesia is six times better than that of not related arrests (64% of recoveries without sequelae vs 10%). The cardiac arrests not related to anaesthesia occur mainly at the end of surgery and the following 24 hours. The main causes are hypovolaemia, sepsis and severity of surgical illness. Among cardiac arrests related to anaesthesia, a quarter occurred during induction, another during maintenance and a half during recovery from anaesthesia. The first were mainly related to histamine release and had the lowest mortality rate. The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. The authors underline the necessity of better preoperative detection of high risk patients, smooth induction of anaesthesia, continuous clinical monitoring of the patient during surgery and the recovery period.

Age Factors↗
PubMed1984

Delayed recovery of behavior after anesthesia in rats.

UNLABELLED: Early, complete recovery from general anesthesia is of importance for outpatients, in resuscitation research and in behavior testing of neonates. A model was designed to study behavior during the first week of recovery from anesthesia in rats, using two methods: spontaneous and unrestrained locomotor activity was tested and passive avoidance of electroshock was studied in a two session, one trial model. Neurologic deficit and ease of handling were also tested. After anesthesia with halothane 1-2% in N2O/O2 for 30 min, spontaneous activity was reduced, compared with unanesthetized rats, for up to at least 48 h. On day 6 post-anesthesia, locomotor activity was recovered, and, on days 4 and 5, passive avoidance was unchanged. Neurologic deficits were absent after the first hour of recovery and ease of handling was unchanged. CONCLUSION: Halothane and nitrous oxide have prolonged effects on locomotor behavior beyond the immediate post-anesthesia recovery period, at a time when neurologic deficit testing does not reveal any abnormalities. The model is suitable for the comparison of recovery from different anesthesia techniques in rats.

Anesthesia, General↗
PubMedDate not supplied

[Continuous spectrum analysis during anesthesia and the recovery period in infants under 1 year of age].

Continuous spectral EEG activity monitoring has been used in adults as a monitor of brain activity during anesthesia. It has not been used in infants. We studied 22 infants less than 7 months old undergoing minor surgery. Halothane alone or minimal Halothane anesthesia associated with caudal epidural anesthesia were used. Life-Scan analysis, in spite of wide individual variations, allowed us to detect infraclinical hypoxia episodes, it provided informations about operative confort, depth of anesthesia and added in the post-operative period an objective criteria to clinical evaluation of pain. A wide use of such a monitoring is warranted in infants.

Age Factors↗
PubMed2004

Adding dexmedetomidine to lidocaine for intravenous regional anesthesia.

UNLABELLED: Dexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It decreases anesthetic requirements by up to 90% and induces analgesia in patients. We designed this study to evaluate the effect of dexmedetomidine when added to lidocaine in IV regional anesthesia (IVRA). We investigated onset and duration of sensory and motor blocks, the quality of the anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative-postoperative pain and sedation. Thirty patients undergoing hand surgery were randomly assigned to 2 groups to receive IVRA. They received 40 mL of 0.5% lidocaine and either 1 mL of isotonic saline (group L, n = 15) or 0.5 microg/kg dexmedetomidine (group LD, n = 15). Sensory and motor block onset and recovery times and anesthesia quality were noted. Before and after the tourniquet application at 5, 10, 15, 20, and 40 min, hemodynamic variables, tourniquet pain and sedation, and analgesic use were recorded. After the tourniquet deflation, at 30 min, and 2, 4, 6, 12, and 24 h, hemodynamic variables, pain and sedation values, time to first analgesic requirement, analgesic use, and side effects were noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, prolonged tolerance for the tourniquet, and improved quality of anesthesia were found in group LD. Visual analog scale scores were significantly less in group LD in the intraoperative period and 30 min, and 2, 4, and 6 h after tourniquet release. Intra-postoperative analgesic requirements were significantly less in group LD. Time to first analgesic requirements was significantly longer in group LD in the postoperative period. We conclude that the addition of 0.5 microg/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects. IMPLICATIONS: This study was designed to evaluate the effect of dexmedetomidine when added to lidocaine for IV regional anesthesia. This is the first clinical study demonstrating that the addition of 0.5 microg/kg dexmedetomidine to lidocaine for IV regional anesthesia improves quality of anesthesia and intraoperative-postoperative analgesia without causing side effects.

Adrenergic alpha-Agonists↗
PubMed2003

An analysis of reintubations from a quality assurance database of 152,000 cases.

STUDY OBJECTIVE: To determine if the majority of reintubations, a potentially preventable adverse event, were predominantly due to residual muscle relaxant effects, we analyzed our quality assurance database to identify the causes of reintubation. DESIGN: Retrospective study. SETTING: University of Michigan Department of Anesthesiology Quality Assurance (QA) database. MEASUREMENTS: We analyzed QA records from 152,939 anesthetic cases performed from 1994 to 1999 at our institution. Of these cases, 107,317 were performed with a general anesthetic. The medical record of each patient requiring reintubation was obtained and reviewed to determine the cause of the reintubation. RESULTS: A total of 191 reintubation events were identified. One hundred twelve of the 191 (59%) reintubations were due to respiratory problems; 11 of the 191 (6%) reintubations were due to complications of neuromuscular blocking drug use. Other causes were unintentional extubation, surgical complication, endotracheal tube problems, and cardiac problems. One hundred five reintubations (105/191, 55%) occurred in the operating room and 86 (86/191, 45%) occurred in the postanesthesia care unit. CONCLUSION: Respiratory complications were the most common cause of reintubation in the perioperative period. Complications related to the neuromuscular blocking drugs were the fourth most common cause of reintubation. More reintubations occurred in the operating room than the postanesthesia care unit. Muscle relaxant effect and opioid effect are rare causes of respiratory failure in the anesthetized patient in the immediate postoperative period.

Aged↗
PubMed2001

Do anaesthetized patients recover better after Bispectral Index Monitoring?

Could Bispectral Index (BIS) monitoring during anaesthesia improve the recovery characteristics of patients? Previous studies have shown conflicting results. To eliminate bias, a control group of 75 cases anaesthetized by the authors was compared to a reference group of 141 cases anaesthetized by other anaesthetists. A study group of 71 cases was then anaesthetized by the authors titrating to BIS 40-50 and this was compared with the control group. Recovery characteristics were assessed using a Modified Aldrete score. BIS monitored cases had improvements in blood pressure stability (P = 0.023) and respiratory score (P = 0.016) throughout the study period. Activity and consciousness levels were higher on arrival in PACU in the BIS monitored group (P = 0.015 and P = 0.017) but were not maintained. There was no significant difference in mean oxygen saturation scores. The improved recovery characteristics in BIS monitored patients may have positive implications for safety, nursing workload, staffing, and cost savings in the PACU.

Anesthesia Recovery Period↗