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PubMed1990

[Hemodynamics and myocardial energy balance in coronary surgery patients during high-dose fentanyl-pancuronium anesthesia and modified neurolept-pancuronium anesthesia].

In 8 patients with coronary artery disease (CAD) classed as NYHA II or III, anesthesia was induced with high-dose fentanyl (0.05 mg/kg) and pancuronium (0.1 mg/kg). The patients were ventilated normally with the aid of a mask (O2: air 1:1, tidal volume 10 ml/kg with a rate of 10/min) for 5 min and then intubated. In 8 further patients with CAD NYHA class II or III, anesthesia was induced with 0.02 mg/kg flunitrazepam, N2O/O2 1:1 and isoflurane 0.5 vol%; they were relaxed with pancuronium (0.1 mg/kg) in combination with a bolus of 0.005 mg/kg fentanyl. These patients were also ventilated normally for 5 min and then intubated. Measurements of cardiovascular dynamics included cardiac output (CO), heart rate (HR), arterial pressure (AP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), myocardial blood flow (MBF), and arterial and coronary sinus oxygen and lactate contents. Cardiac index (CI), stroke volume index (SVI), total peripheral resistance (TPR), myocardial oxygen consumption (MVO2), coronary vascular resistance (CVR), coronary perfusion pressure (CPP), myocardial oxygen content difference (AVDO2cor) and myocardial lactate extraction rate (LE) were calculated from standard formulas. Measurements and an electrocardiogram were taken before anesthesia, after induction of anesthesia and after intubation. The hemodynamic parameters HR, AP, CI, CPP were relatively stable in patients anesthetized with high-dose fentanyl and pancuronium, whereas we found greater decreases in these parameters with the balanced anesthesia technique. Determinants of myocardial oxygen demand were higher in the high-dose fentanyl group; therefore, myocardial blood flow and oxygen consumption did not decrease to the same extent as in the balanced anesthesia group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Risk factors for postoperative nausea and vomiting.

Knowledge of postoperative nausea and vomiting (PONV) risk factors allows anesthesiologists to optimize the use of prophylactic regimens. Modern PONV risk research began in the 1990s with publication of studies using logistic regression analysis to simultaneously identify multiple independent PONV predictors and publication of meta-analyses and systematic reviews. This literature shows that female gender post-puberty, nonsmoking status, history of PONV or motion sickness, childhood after infancy and younger adulthood, increasing duration of surgery, and use of volatile anesthetics, nitrous oxide, large-dose neostigmine, or intraoperative or postoperative opioids are well established PONV risk factors. Possible risk factors include history of migraine, history of PONV or motion sickness in a child's parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, decreased perioperative fluids, crystalloid versus colloid administration, increasing duration of anesthesia, general versus regional anesthesia or sedation, balanced versus total IV anesthesia, and use of longer-acting versus shorter-acting opioids. Early-phase menstruation, obesity and lack of supplemental oxygen are disproved risk factors. Current risk scoring systems have approximately 55%-80% accuracy in predicting which patient groups will suffer PONV. Further research examining genetic and under-investigated clinical patient characteristics as potential risk factors, and involving outpatients and children, should improve predictive systems.

Humans↗
PubMed1987

Total body oxygen supply-demand balance in burned patients under enflurane anesthesia.

The effects of enflurane anesthesia on the oxygen supply-demand balance have been studied in nine hypermetabolic-hyperdynamic burned patients undergoing debridement and skin-grafting procedures. Mean burn size was 55% of total body surface area. The patients were without cardiac, lung, hepatic, and kidney dysfunction and were not septic. Anesthesia was induced with sodium pentothal and maintained with enflurane and nitrous oxide in oxygen. Ventilation was controlled to maintain PaCO2 within normal limits. Crystalloid solutions and blood were administered to maintain adequate heart filling pressures. Serial measurements of cardiac output, arterial and mixed venous blood gases, and oxygen content were made before, during, and after anesthesia. Following induction of anesthesia and enflurane administration, cardiac output, oxygen delivery, and oxygen consumption decreased in a parallel fashion to approximately 60% of control. These variables did not change significantly throughout the procedure and returned to control values when enflurane was discontinued. Arteriovenous oxygen content difference did not increase and metabolic acidosis did not develop, suggesting that tissue perfusion remained adequate. Under anesthesia, oxygen consumption in burned patients was similar to that observed in normal subjects, indicating that enflurane blunts the hypermetabolic effects of thermal injury. It is concluded that in burned patients enflurane decreases metabolic rate and cardiac output, and maintains an adequate oxygen supply-demand balance.

Adolescent↗
PubMed1992

Effect of type of anesthesia on blood loss at elective repeat cesarean section.

It has recently been reported that the use of halogenated agents during balanced general anesthesia may result in an increase in blood loss associated with cesarean section. This report has been criticized for failure to control for a variety of other factors that may have contributed to the increased blood loss, particularly the indication for and type of cesarean section. The present study was designed in an attempt to resolve this criticism. Blood loss was evaluated in uncomplicated patients undergoing elective repeat cesarean section under either general anesthesia using a halogenated agent (isoflurane) or regional anesthesia (spinal/epidural). All 117 singleton term, nonlaboring women underwent repeat low transverse cesarean section performed through a midline abdominal incision. Exclusion criteria included maternal medical complications, abnormal placentation, polyhydramnios, presence of uterine leiomyomas, and intraoperative complications. Seventy-five patients (64%) received regional and 42 (36%) received general anesthesia. A greater proportion of women undergoing general anesthesia experienced a postoperative decrease in hematocrit of 5 vol% or more compared with patients receiving regional anesthesia (10 of 42 versus 5 of 75, p = 0.018). Thus, we conclude that women undergoing uncomplicated elective repeat cesarean section under general anesthesia supplemented with a halogenated agent are at risk for increased blood loss compared with those women receiving regional anesthesia. However, the increased blood loss was not clinically significant in this study, since none of the patients required transfusion.

Anesthesia, Conduction↗
PubMedDate not supplied

Prolonged general anesthesia for experimental craniofacial surgery in fetal swine.

A protocol utilizing high preoperative doses of altrenogest (Regu-Mate) and a "balanced" general anesthesia regimen consisting of isoflurane at subanesthetic doses supplemented with intravenous doses of sodium thiopental was developed to prevent preterm labor, minimize intracranial fetal cerebral edema, and decrease postpartum mortality of fetal swine after undergoing complex in utero craniofacial procedures. A total of 20 fetal piglets at 75% gestation were exposed to prolonged (> 3 h) anesthesia conditions of which 7 piglets were randomly selected to undergo experimental craniofacial procedures consisting of periosteal stripping of frontal and parietal bone segments with/without extensive coronal suture fusion procedures. Neither sows nor piglets were lost to anesthetic complications during the initial laparotomy or subsequent cesarean delivery. None of the sows experienced uterine sepsis or underwent preterm labor. The overall survival rate for all piglets exposed to prolonged anesthesia conditions was 95% at 4 weeks and 45% at 11 weeks after surgery. The experimental group's survival was 85.7% at 4 weeks and 28.5% at 11 weeks after surgery.

Anesthesia, General↗
PubMed1996

Ondansetron prevents postoperative emesis in male outpatients. S3A-379 Study Group.

STUDY OBJECTIVES: To determine (1) the efficacy and safety of ondansetron in the prevention of postoperative nausea and vomiting (PONV) in male outpatients; (2) prognostic factors for PONV in male outpatients; and (3) patients' perceptions of the debilitating effects of PONV in the ambulatory surgery setting. DESIGN: Prospective, randomized, stratified, double-blind study. SETTING: Multicenter-24 medical centers. PATIENTS: 468 ASA physical status I and II males at least 12 years of age scheduled for general anesthesia. INTERVENTIONS: All patients received intravenous ondansetron 4 mg or placebo prior to undergoing general balanced (opioid) anesthesia. MEASUREMENTS AND MAIN RESULTS: In the postanesthesia care unit (PACU), the number of emetic episodes, vital signs, adverse events, and nausea assessments were recorded by a blinded observer. After discharge, and until the end of the 24-hour study period, patients completed a diary that collected emetic episodes, adverse events, nausea, and pharmacoeconomic data. There were no differences in patient demographics or safety profiles between groups. The number of patients with no emesis and no nausea during the 24-hour study period was significantly greater (p < 0.05) with ondansetron 4 mg compared with placebo. Prognostic factors for an increased likelihood of developing PONV in males included a history of motion sickness or previous PONV, patients undergoing nonorthopedic procedures, and surgeries lasting longer than one hour. Finally, 38% of patients experiencing PONV perceived PONV to be as, or more debilitating than, the aftereffects of surgery itself. CONCLUSIONS: Ondansetron 4 mg was more effective than placebo in preventing PONV in male outpatients. Males at potential risk for developing PONV include: (1) those with a history of motion sickness and/or PONV; (2) patients undergoing nonorthopedic procedures; and (3) procedures lasting longer than one hour. Such patients may benefit from receipt of a prophylactic antiemetic. Postoperative nausea and vomiting has a debilitating effect that can be differentiated by patients from the effects of surgery itself.

Adult↗
PubMedDate not supplied

Epidural analgesia versus intravenous patient-controlled analgesia. Differences in the postoperative course of cancer patients.

BACKGROUND AND OBJECTIVES: This study evaluated 462 consecutive surgical cancer patients who underwent uncomplicated surgeries of the thorax or abdomen, or both, of more than 3 hours duration between 1989 and 1991. METHODS: Patients received either epidural analgesia (EA group) with 0.1% bupivacaine, 0.01% morphine sulfate after combined general-epidural anesthesia, or parenteral morphine therapy via intravenous patient-controlled analgesia (IV-PCA) after balanced general anesthesia after the operation. Patients in both the EA (n = 352) and IV-PCA (n = 100) groups were compared for demographics, length of surgical intensive care unit (SICU), and hospital stays. Moreover, the same comparisons were performed when patients were allocated into surgical subgroups: thoracic (TH), upper abdominal (UA), lower abdominal (LA), radical hysterectomies (RH), and RH with colon resection (RHCR). RESULTS: No differences existed with respect to age or sex between the EA and IV-PCA groups. All patients reported adequate dynamic pain control as evaluated with visual analog pain scores (VAS < 4/10), during the treatment periods (5 +/- 3 versus 5 +/- 2 days, EA versus IV-PCA). Overall, 262 (58%) patients were admitted to the SICU after the operation, 205 (58%) from the EA group and 57 (57%) from the IV-PCA group. Patients in the EA group required less ventilatory support than did those in the IV-PCA group (0.5 +/- 0.8 versus 1.2 +/- 0.9 days, P < .05). Patients in the EA group also spent less time in both the SICU (1.3 +/- 0.8 versus 2.8 +/- 0.6 days, P < .05) and in the hospital (11 +/- 3 versus 17 +/- 5 days, P < .05) than did their counterparts in the IV-PCA group. Significant differences were also found when subgroup comparisons were made. CONCLUSIONS: The use of both analgesic techniques was associated with satisfactory postoperative pain control. However, patients receiving epidural anesthesia and analgesia experienced faster recovery as judged by shorter mechanical ventilation time, and decreased SICU and hospital stays, resulting in significantly lower hospitalization costs. The use of perioperative epidural techniques should be considered to expedite recovery of surgical patients, and has the added benefit of being cost effective by reducing hospital stays.

Adolescent↗
PubMedDate not supplied

[Caudal epidural anesthesia in children operated on in the area of the lumbosacral segments].

Analgesia of children operated on the lumbosacral segments is discussed. Balanced total anesthesia was used with caudal epidural blocking by a combination of alpha 2-agonist clofelin, local amide anesthetic bupivacaine, and narcotic analgesic promedol. Injection of a combination of clofelin (0.01% solution) in a dose of 1 microgram/kg, standard dose of 0.25% bupivacaine solution with adrenaline (1:200,000) in a dose of 0.3 ml/kg, and promedol in a dose of 0.2 mg/kg into the epidural space via the caudal approach in the presence of superficial anesthesia with halothane (0.2-0.4 vol/%), nitrogen oxide and oxygen in 2:1 ratio ensured adequate analgesia and effective neurovegetative protection both during the operation and the first 25 h after it.

Adolescent↗
PubMed1997

Risk factors for mild intraoperative hypothermia.

In this study, the authors prospectively followed one-hundred thirty patients undergoing surgery in order to investigate the influence of age, surgery time, surgical room temperature, major surgery, blood transfusion, gender, and anesthetic method in the occurrence of mild intraoperative hypothermia (MIH). Sixty-one patients (47%) were female and 69 (53%) were male, and patient's mean age was 42 +/- 20 years. Fifty-three patients (41%) developed MIH. Fifty-two (40 %) underwent major surgery, 65 (50%) patients were scored as ASA I (American Society Anesthesia), 52 (40%), ASA II and 13 (10%), ASA III or IV. Sixty-four (49.2%) received balanced general anesthesia, 22 (17%), spinal lumbar anesthesia, 20 (15.3%), epidural lumbar anesthesia and 24 (18.5%), miscellaneous anesthesia. Thirteen (10%) received blood transfusion, mean surgery time was 83 +/- 59 min and mean surgical room temperature was 22.9 +/- 1.2 degrees C. Regression logistic with backward elimination method was employed to determine the impact of all variables over development of MIH. Only major surgery (Odds Ratio 2.8) and blood transfusion (Odds Ratio 6.7) were identified as risk factors for MIH.

Adolescent↗
PubMed1976

Cardiorespiratory effects of a balanced anesthetic technique in outpatient general anesthesia.

Detailed measures have been made of the cardiorespiratory effects of a balanced general anesthetic technique on ten young patients undergoing oral surgery. The combination of fentanyl, diazepam, and atropine followed by N2O/O2 and methohexital resulted in a respiratory hyperoxic state throughout surgery and there was no evidence of hypercardia at any anesthesia stage. Cardiovascular stability was judged to be generally superior to that reported for techniques that have relied on methohexital without premedication. This balanced general anesthetic technique offers the oral surgeon-anesthetist a safe, effective, and practical alternative to techniques that rely on more potent anesthetic gases.

Adult↗
PubMed1975

Flexible fiberoptic bronchoscopy with general anesthesia in the poor-risk patient.

A study is presented of seven poor-risk patients who had bronchoscopy with a flexible fiberoptic bronchoscope and balanced general anesthesia. The cardiorespiratory status, as evidenced by arterial blood gas determinations, electrocardiographic findings, and blood pressure measurements, was improved and stabilized in all patients. Flexible fibeoptic bronchoscopy, combined with general anesthesia, has proved to be a reliable and safe procedure useful for both diagnosis and treatment in poor-risk patients.

Adult↗