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At least 415 records · Page 23Linked to original sources
PubMed2001

[The effects of intravenous nicardipine on jugular venous oxygen saturation].

We investigated the effects of intravenous nicardipine on jugular venous oxygen saturation (SjO2) in patients undergoing superficial temporal artery-middle cerebral artery anastomosis. Anesthesia was induced with intravenous thiamylal and fentanyl, and maintained by isoflurane and nitrous oxide in oxygen. In the presence of stable condition after the induction, nicardipine 0.5 microgram.kg-1.min-1 was administered intravenously for 180 minutes. Mean arterial pressure, heart rate, SjO2 and bladder temperature were recorded. Three hours after continuous infusion of nicardipine, plasma levels of nicardipine in artery and jugular vein were measured by liquid chromatography. The arterial concentration of nicardipine reached 23.9 +/- 8.06 ng.ml-1. The area under the curve between the arterial and jugular venous nicardipine during infusion was significantly different. Mean arterial pressure was reduced in response to administration of nicardipine. There were no significant changes in heart rate, bladder temperature and SjO2. We concluded that the current dose of nicardipine reached effective concentration for systemic hypotension without influencing SjO2.

Adult↗
PubMed1975

Absence of sensitization to epinephrine-induced cardiac arrhythmia and fibrillation in dogs and cats anesthetized with CI 744.

Ci 744 (20 mg/kg, given intramuscularly (IM) produced a reliable level of surgical anesthesia in both dogs and cats. Animals anesthetized in this way did not have an increased sensitivity to cardiac fibrillation after they were given epinephrine. Epinephrine-induced ventricular arrhythmia observed in C1 744-anesthetized animals was eliminated in cats and was markedly reduced in dogs by bilateral vagotomy. Myocardial fibrillation was not produced by epinephrine (0.1 to 100 mug/kg, intravenously (IV) in dogs and cats anesthetized with C1 744 alone. Pentobarbital anesthesia, like C1 744 anesthesia, did not sensitize the heart, whereas a significant number of thiamylal-halothane-anesthetized animals died from cardiac fibrillation after they had been given epinephrine. Additional dogs were anesthetized with C1 744 or pentobarbital and given a series of pressor and depressor agents (isoproterenol, epinephrine, tyramine, 1, 1-dimethyl-4-phenylpiperazium iodide (DMPP) plus bilateral carotid occlusion) before and after vagotomy. The responses with either anesthetic were similar with the exception that the reflex bradycardia to pressor agents was more evident in C1 744- than in pentobarbital-anesthetized dogs.

Anesthesia, General↗
PubMed2001

[Stump pain relieved by continuous intravenous ketamine infusion therapy].

We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. On examination, we found his left foot skin hard, lustrous, and with sweating disturbance, allodynia and hyperpathia. As intravenous administrations of ketamine 10 mg and thiamylal 50 mg were positive as a drug challenge test, we performed intravenous ketamine infusion at 1 mg.kg-1.hr-1 for 1 hour and a half. After this treatment, his visual analogue scale (VAS) improved dramatically to 0 mm, and night pain, allodynia and hyperpathia disappeared for three days. Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.

Excitatory Amino Acid Antagonists↗
PubMed2001

[Anesthesia for electroconvulsive therapy during pregnancy--a case report].

We experienced anesthetic management for ECT in a patient with psychiatric disease during the third trimester of pregnancy. The 24 year-old patient had been on oral antipsychotics prescribed to treat schizophrenia for ten years. Her signs and symptoms deteiorated during pregnancy in spite of increased doses of antipsychotics. With tocolytic agent administered intravenously, anesthesia was induced by intravenous thiamylal immediately followed by intravenous suxamethonium for muscle relaxation. Alternative current was applied on both side of the head after the sufficient anesthesia had been obtained. The patient received intermittent mandatory ventilation by breathing mask with 100% oxygen during the procedure. Along with monitoring of maternal hemodynamic variables and arterial oxygen saturation (Spo2), fetal heart rate and uterine contraction were recorded by cardiotocogram throughout the procedure. At the first two treatments, the patient showed neither significant uterine contraction nor fetal heart rate changes. At the third treatment, continuous uterine contraction refractory to tocolysis was recorded for six minutes, resulting in fetal bradycardia. At the sixth treatment, general anesthesia was induced and maintained by sevoflurane in oxygen followed by suxamethonium for muscle relaxation. The uterine contraction was remarkably diminished and fetal heart rate remained unchanged during the procedure. In conclusion, inhalation anesthesia is beneficial for ECT in the last stage of pregnancy to reduce uterine contraction by potential uterine relaxation effect of anesthetics.

Adult↗
PubMed2001

[Anesthetic management of a patient with Dyggve-Melchior-Clausen syndrome].

The Dyggve-Melchior-Clausen syndrome (DMCS) is a rare autosomal recessive skeletal dysplasia characterized by short-trunk dwarfism and mental retardation. A 49-year-old male with DMCS underwent resection arthroplasty for contracture of the right hip joint under general anesthesia using thiamylal, nitrous oxide, sevoflurane, and vecuronium. Although he was assumed to have difficult airway due to short neck, macroglossia, and disturbance of neck flexion, tracheal intubation was not difficult. No complications including malignant hyperthermia were observed during the 95 min of the operation.

Abnormalities, Multiple↗
PubMed2001

A modified method for intubation of a patient with ankylosing spondylitis using intubating laryngeal mask airway (LMA-Fastrach)--a case report.

We present an instance of successful use of an intubating laryngeal mask airway (LMA-Fastrach) and a Cook airway exchanger (CAE) for ventilation and intubation in a patient with severe ankylosing spondilitis (AS) receiving total hip arthroplasty. This measure may serve as an effective alternative for airway management in patients with difficult airway. A 61-year-old male was scheduled for right total hip arthroplasty because of degenerative osteoarthritis. He had been suffering from extensive ankylosing spondylitis, with the cervical spine markedly fixed in anterior flexion. Besides he could not open his mouth widely (35 mm when fully open) also because of ankylosis of jaw. Although we advised an awake fiberoptic tracheal intubation for anesthesia but he refused owing to a previous painful experience. After induction of anesthesia with glycopyrrolate, fentanyl, thiamylal sodium and succinylcholine, we inserted a # 5 Fastrach ILMA for primary airway maintenance. Then through the lumen of the ILMA we introduced the CAE as a guide for endotracheal tube (ETT) intubation. After applying the RAPI-FIT adapter to the CAE, we connected it to the capnography monitor for the confirmation of airway. We finally inserted an endotracheal tube into the trachea using the CAE as a guide. The whole procedure was uneventful and smooth. In sum, the modified Fastrach intubation method may facilitate tracheal intubation in patients with severe ankylosing spondilitis. It may be an alternative way for successful airway management in patients with difficult airway.

Arthroplasty, Replacement, Hip↗
PubMed1975

A comparison of the potencies of a series of barbiturates at the neuromuscular junction and on the central nervous system.

The ability of a series of barbiturates to depress the depolarizing action of carbachol at the end-plate of guinea-pig lumbrical muscle was studied. The compounds studied were: amorbarbital, aprobarbital, barbital, barbituric acid, butabarbital, butalbital, dimethylbutylethyl barbituric acid, hexobarbital, mephobarbitak, secobarbital, thiamylal, and thiopental. The depressant activity was sensitive to small changes in structure of the compounds strongly suggesting that a specific receptor site was involved in the interaction of the drug with the tissue. The observed relative potencies on the motor end-plate were compared with their anesthetic potencies assayed on tadpoles. The two potencies went hand-in-hand for all the compounds studied, including the convulsant member of the series.

Animals↗
PubMed2002

["Cannot-ventilate" after anesthetic induction in a patient with rapidly increased laryngeal tumor].

A 76-year-old male patient with laryngeal tumor was scheduled for elective laryngo-microsurgery. He had no dyspnea nor symptoms of obstructive lung disease detected by spirometry. Preoperative finding by laryngoscopy showed decreased movement of the left vocal cord. However, no significant narrowing was found in the glottis. Following anesthetic induction with fentanyl and thiamylal, the lungs could not be ventilated with anesthesia circuit even by use of oral airway device. After his resuming spontaneous breathing, assisted ventilation became possible. However, the lungs could not be ventilated again after vecuronium i.v. The vocal cords could not be visualized by direct laryngoscopy with a Macintosh blade. The trachea was intubated with a tracheal tube (I.D. 6.0 mm) by blind technique, and mechanical ventilation was established. The intraoperative laryngomicroscopy showed that the laryngeal tumor had grown rapidly occupying the glottis except posterior commissure. We should be careful of rapid preoperative growth of the laryngeal tumor.

Aged↗
PubMed2002

Barbiturates induce mitochondrial depolarization and potentiate excitotoxic neuronal death.

Barbiturates are widely used as anesthetics, anticonvulsants, and neuroprotective agents. However, barbiturates may also inhibit mitochondrial respiration, and mitochondrial inhibitors are known to potentiate NMDA receptor-mediated neurotoxicity. Here we used rat cortical cultures to examine the effect of barbiturates on neuronal mitochondria and responses to NMDA receptor stimulation. The barbiturates tested, secobarbital, amobarbital, and thiamylal, each potentiated NMDA-induced neuron death at barbiturate concentrations relevant to clinical and experimental use (100-300 microm). By using rhodamine-123 under quenching conditions, barbiturates in this concentration range were shown to depolarize neuronal mitochondria and greatly amplify NMDA-induced mitochondrial depolarization. Barbiturate-induced mitochondrial depolarization was increased by the ATP synthase inhibitor oligomycin, indicating that barbiturates act by inhibiting electron transport sufficiently to cause ATP synthase reversal. Barbiturates similarly amplified the effects of NMDA on cytoplasmic free calcium concentrations. The cell-impermeant barbiturate N-glucoside amobarbital did not influence mitochondrial potential or potentiate NMDA neurotoxicity or calcium responses. However, all of the barbiturates attenuated NMDA-induced calcium elevations and cell death when present at millimolar concentrations. Whole-cell patch-clamp studies showed that these effects may be attributable to actions at the cell membrane, resulting in a block of NMDA-induced current flux at millimolar barbiturate concentrations. Together, these findings reconcile previous reports of opposing effects on barbiturates on NMDA neurotoxicity and show that barbiturate effects on neuronal mitochondria can be functionally significant. Effects of barbiturates on neuronal mitochondria should be considered in experimental and clinical application of these drugs.

Amobarbital↗
PubMed2002

[Anesthetic management of a patient with Evans syndrome--benefit of perioperative hemodilutional autologous blood transfusion].

The combination of idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia is termed Evans syndrome. We experienced the anesthetic management of a patient with this syndrome undergoing laparoscopic splenectomy. After induction of general anesthesia using thiamylal, fentanyl and vecuronium, hemodilutional autologous transfusion was employed to minimize the immune hemolytic process against the transfused blood throughout the surgical procedure. The anesthetic course was uneventful, and neither massive hemorrhage nor any complications related to bleeding occurred. We therefore recommend the use of hemodilutional autologous transfusion for the anteshetic management of patients with Evans syndrome.

Adult↗
PubMed2002

[Anesthetic management for elective cesarean section due to placenta previa in a patient with moyamoya disease].

We report the anesthetic management of a 31-year-old female patient with moyamoya disease using general anesthesia combined with epidural anesthesia for a cesarean section due to placenta previa. Epidural anesthesia with 10 ml of 2% lidocaine was first used. Then general anesthesia was induced with thiamylal 200 mg and succinylcholine 60 mg just before starting operation and was maintained with 60% nitrous oxide in oxygen. After the delivery, propofol was administered at 3-5 mg.kg-1.hr-1. Except for temporary hypotension due to massive bleeding, systolic blood pressure was maintained between 100 and 120 mmHg. Arterial carbon dioxide tension was maintained at about 40 mmHg. Intracranial blood velocity and regional oxygen saturation were also measured to monitor cerebral blood flow. There was no postoperative pain, and no postoperative neurological defects. On the basis of these findings, it was concluded that general anesthesia combined with epidural anesthesia for elective cesarean section due to placenta previa is effective for perioperative management of a patient with moyamoya disease.

Adult↗
PubMed2003

[Perioperative management for cesarean section in a patient with corrected transposition of the great arteries].

We report anesthetic management for cesarean section in a pregnant (36 weeks) woman with corrected transposition of the great arteries, associated with Ebstein's anomaly and atrial septal defect. She had not received any surgical procedure, and had orthopnea and chest pain which were the signs of congestive heart failure before pregnancy. Her heart failure was ongoing through 34 th week of gestation. Central venous pressure and invasive arterial pressure were monitored perioperatively. A low-dose of fentanyl (3.5 micrograms.kg-1) was injected intravenously 5 minutes before induction, followed by anesthesia induced by thiamylal and suxamethonium chloride. Continuous infusion of propofol and continuous epidural anesthesia were started after delivery, supplemented by isoflurane. No significant cardiovascular changes were observed in the mother during the operation. The infant showed no respiratory dysfunction at birth.

Adult↗
PubMed1992

[Vecuronium-induced neuromuscular blockade in two patients with hyperparathyroidism and a patient with hypoparathyroidism].

Vecuronium-induced neuromuscular blockade was evaluated in two patients with primary hyperparathyroidism and in a patient with hypoparathyroidism. A 39 year old male with typical primary hyperparathyroidism was scheduled for surgical removal of the parathyroid adenoma. Serum levels of calcium and ionized calcium were 15.0 mg.dl-1 and 1.95 mmol.l-1, respectively. A 44 year old female suffering from primary hyperparathyroidism was also scheduled for surgical removal of the adenoma. Serum levels of calcium and ionized calcium were 12.5 mg.dl-1 and 1.51 mmol.l-1, respectively. A 63 year old male, suffering from postoperative secondary hypoparathyroidism and treated with calcium, was scheduled for surgical removal of the recurrent pharyngeal cancer. Serum levels of calcium and ionized calcium were 9.0 mg.dl-1 and 1.15 mmol.l-1, respectively. Anesthesia was induced with thiamylal 4-5 mg.kg-1 and vecuronium 0.08 mg.kg-1 and was maintained with 70% nitrous oxide in oxygen and fentanyl in all three patients. Neuromuscular blockade following the administration of vecuronium was measured by a big toe abduction evoked by supramaximal stimulation of the tibial nerve (Myograph 2000, Biometer, Denmark). In order to evaluate the effect of serum calcium level on vecuronium neuromuscular blockade, ten patients with normal serum levels of calcium, were examined in the same fashion. In only one patient with hyperparathyroidism, whose serum calcium was 15.0 mg.dl-1, the onset and the duration of vecuronium were later and shorter than those of other patients with normal serum levels of calcium. In conclusion, we should pay attention to the antagonistic responses to vecuronium in patients with severely high levels of serum calcium.

Adult↗
PubMed1992

[Interaction of nicardipine and inhalational anesthetics--comparison between enflurane and isoflurane].

The effects of nicardipine 1 mg bolus injection under enflurane anesthesia were compared with those under isoflurane anesthesia. Twelve neurosurgical patients were divided into 2 groups, enflurane group (n = 6) and isoflurane group (n = 6). In all patients anesthesia was induced with midazolam, thiamylal, fentanyl and vecuronium. Anesthesia was maintained with fentanyl, nitrous oxide, pancuronium plus enflurane (enflurane group) or plus isoflurane (isoflurane group). After incision of dura mater, nicardipine 1 mg was given through forearm venous line. For about 30 minutes before and after nicardipine injection, concentration of inhalational anesthetics was kept constant and no drugs were given. Blood pressure (BP), heart rate (HR), rate pressure product (RPP), and serum concentrations of catecholamine and nicardipine were monitored for 30 minutes after nicardipine injection. In isoflurane group, BP decreased more and longer, and increases of HR and serum concentration of catecholamine continued longer compared with enflurane group. Elimination half life of nicardipine was shorter, area under the curve (AUC) was smaller and clearance of nicardipine was larger in isoflurane group than in enflurane group. It was concluded that isoflurane increased the effects of nicardipine, which were BP depression and reflex sympathetic stimulation, than enflurane and that metabolism and elimination of nicardipine were accelerated more by isoflurane than by enflurane.

Anesthesia, Inhalation↗
PubMed1992

[The effects of preanesthetic oral clonidine upon heart rate response to intravenous atropine in patients during general anesthesia].

In awake subjects the positive chronotropic effect of intravenously administered atropine 10 micrograms.kg-1 has been demonstrated to be blunted by preanesthetic medication of oral clonidine 5 micrograms.kg-1. The aim of the present study is to investigate whether general anesthesia could alter the clonidine-induced attenuation of positive chronotropic effect by atropine. Thirty-two patients were randomly assigned to one of the two groups; patients of the clonidine group received oral clonidine 5 micrograms.kg-1 (n = 12), whereas those of the control group received no clonidine. General anesthesia was induced with intravenous thiamylal 4-5 mg.kg-1, and was maintained with enflurane and nitrous oxide in oxygen after endotracheal intubation. Following the stable circulatory period of 10 min, hemodynamic measurements were made at 1 min intervals for 10 min after atropine 10 micrograms.kg-1 was administered intravenously as a bolus in both groups. A significant attenuation in heart rate response to intravenous atropine 10 micrograms.kg-1 was observed in patients receiving clonidine 5 micrograms.kg-1, as compared with that in the control group (P less than 0.01); maximal increases in heart rate were 15 +/- 8 and 22 +/- 6 beats.min-1 (mean +/- SD) in the clonidine and control groups, respectively. It is concluded that clonidine 5 micrograms.kg-1 blunts the heart rate response to intravenous atropine 10 micrograms.kg-1 in patients anesthetized with enflurane and nitrous oxide in oxygen.

Administration, Oral↗
PubMed1992

[Effects of sevoflurane and isoflurane on intraocular pressure in adult patients].

We investigated effects of two anesthetic agents, sevoflurane and isoflurane, on intraocular pressure (IOP). Forty adult patients were allocated randomly to two groups; Group S (sevoflurane) or Group I (isoflurane). All patients were given a bolus of thiamylal (4-5 mg.kg-1) and vecuronium (0.1-0.2 mg.kg-1) and maintained with 1-3% sevoflurane or isoflurane supplemented with nitrous oxide. Ventilation was controlled and ETCO2 was monitored. IOP, blood pressure and heart rate were measured before induction of anesthesia (control) and at the 7 points of 5, 10, 15, 30, 45, 60 and 120 minutes after intubation. In Group S, IOP was reduced significantly until 30 min compared with control IOP and the maximum decrease was 40% at 10 min. In Group I, IOP was consistently lower than control and the maximum decrease was 40% at the same time as in Group S. But there were no significant differences between the two groups at each point. It seems that the remarkable reductions of IOP after inductions are mainly caused by induction agents. In both groups, hemodynamic parameters showed no remarkable changes during maintenance. These results suggest that both sevoflurane and isoflurane are useful anesthetics for elderly patients receiving ophthalmic surgeries.

Adult↗
PubMed1992

Platelet aggregation in dogs after sedation with acepromazine and atropine and during subsequent general anesthesia and surgery.

Platelet aggregation and adenosine triphosphate (ATP) release were measured by use of the impedance method in blood samples obtained from 25 adult female Beagles before and after sedation with acepromazine (0.13 mg/kg of body weight) and atropine (0.05 mg/kg), and during general anesthesia. General anesthesia was induced by IV administration of thiamylal (average dosage, 2.1 mg/kg; range, 1.2 to 4.2 mg/kg) and was maintained with halothane in oxygen. Samples of jugular venous blood were obtained from each dog, using citrate as anticoagulant. Platelet count was done on each sample. Platelet aggregation and ATP released from the aggregating platelets were measured within 2.5 hours of sample collection, using a whole-blood aggregometer. Adenosine diphosphate (ADP) or collagen was used as aggregating agent. For each aggregating agent, platelet aggregation and ATP release were measured over 6 minutes. After sedation with acepromazine and atropine, significant (P < 0.01) reduction was observed in platelet count (from median values of 341,000 cells/microliters to 283,000 cells/microliters) and in the ability of platelets to aggregate in response to ADP (from 14.0 to 7.0 omega). During the same period, maximal release of ATP in response to collagen also was reduced (from 5.56 mumol to 4.57 mumol; P < 0.01); however, this difference ceased to be significant when ATP release was normalized for platelet count. During general anesthesia and surgery (200 minutes after sedation), platelet count and aggregation responses to ADP and collagen had returned to presedation values. None of the dogs in this study appeared to have hemostasis problems during surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Acepromazine↗
PubMed2004

[Lockjaw caused by induction of anesthesia in a volunteer bone marrow donor].

A 43-year-old healthy female volunteer donor was scheduled for bone marrow harvesting. In the operating room her mouth opening was ascertained to be 5 cm. Anesthesia was induced with thiamylal 250 mg, fentanyl 0.1 mg and vecuronium 6 mg i.v. Her mouth opening was found reduced to 2 cm that was not improved by additional vecuronium 2 mg. A consulted oral surgeon diagnosed temporomandibular disorder. After she was awakened once with resumed mouth opening, anesthesia was reinduced with a bite block placed and with her jaw held open by the oral surgeon, which brought the same results. Laryngoscopy was performed with the jaw forcefully opened and with cricoid pressure applied and the trachea was intubated. The surgical procedure and anesthesia thereafter were uneventful. Postoperative MRI was coincident with the diagnosis of temporomandibular disorder. It was speculated that in the donor patient with preexisted type II temporomandibular disorder, muscle relaxation induced by anesthesia caused the mandibular head fall behind the articular disk and dislocated the disk forwardly ending up in closed lock of temporomandibular joint.

Adult↗