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At least 451 records · Page 25Linked to original sources
PubMed2005

[Anesthesia for aesthetic surgery].

Anesthesia for aesthetic surgery has changed along with the development in plastic surgery during the last two decades. This is the first report of a large series of anesthesia conducted for aesthetic surgery in Israel. The article presents the experience of ten thousand procedures performed during the last four years. Although the prevalence of extensive surgery and complicated patients has increased, no anesthetic-related mortality and only minor morbidity have occurred. Methods of anesthesia and prevention of complications are described. Specific approaches for some potentially dangerous procedures are discussed.

Anesthesia↗
PubMed1990

[Usefulness of midazolam for premedication before local anesthesia].

The optimal dose and adverse effects of midazolam for premedication were evaluated in 45 patients undergoing local anesthesia. The patients were divided into 3 groups and administered midazolam intramuscularly: group-A 0.075 mg.kg-1, group-B 0.1mg.kg-1, group-C 0.125 mg.kg-1. In this study, concerning sedative and hypnotic effects, the administration of midazolam (0.075-0.1mg.kg-1) showed satisfactory results except in conduction anesthesia of upper extremities (brachial plexus block). However, severe decrease in PaO2 was observed in relatively younger patients. Therefore, it is necessary to observe patients carefully during perioperative period.

Adolescent↗
PubMed1991

[Pharmacokinetics of articaine in mandibular nerve block].

Up to now, mandibular nerve blocks have been carried out without knowing the exact blood concentrations resulting from the use of the local anesthetics. Due to the high vascularity a rapid increase in serum local anesthetic levels is to be expected. Due to analytical problems, the literature provides controversial statements about the pharmacokinetics of articaine which is generally used for this block. The given half-life periods following intramuscular application range from 39 min [8] to 31 h [6]. For this reason, mandibular nerve blocks with 2 ml 4% articaine with 1:200,000 epinephrine were carried out in 10 awake patients and 10 patients during intubation anesthesia. RESULTS. Blood samples from peripheral veins showed an average maximum concentration of 2.1 +/- 1.3 mg/l after 12.5 +/- 2.5 min. After 8 h the value had fallen below the minimum detection limit of 0.05 mg/l. In the present study, a half-life of approximately 20 min was determined for articaine after conduction anesthesia. This local anesthetic holds an exceptional position because as an amide-type local anesthetic it contains an additional ester group that is hydrolytically metabolized in the blood. The concentration of the resulting metabolite reaches a maximum value of 2.6 +/- 1.6 mg/l after 40 to 50 min. CONCLUSIONS. Compared to other amide-type local anesthetics, whose terminal plasma half-life varies between 1 and 3.6 h [5], the value of 20 min found for articaine is very low. This is in part due to its structure, as the ester group is rapidly metabolized by plasma esterases. Because of its rapid breakdown articaine is very suitable for use in oral surgery. The HPLC method represents an uncomplicated analytical technique for the determination of local anesthetics levels in blood and other body fluids.

Carticaine↗
PubMed1989

[Hemodynamic and respiratory changes in cervical peridural anesthesia].

Regional anesthesia as a method of avoiding stress and preserving the immunological system has found a solid place in the armamentarium of anesthesia departments. Its applicability for anesthesia of higher segments is controversial. In order to test the reliability of this method, at 7 perioperative measuring points we studied respiratory and circulatory parameters of 17 patients undergoing breast surgery. Access to the peridural space was via C6/7 or C7/T1 by catheterization with the hanging-drop method. The respiratory and circulatory parameters were determined by direct measurement of arterial and pulmonary-arterial pressures and by arterial and mixed-venous blood samples. The main criterion was determination of the arterio-venous oxygen difference. It was shown that the cardiovascular and respiratory integrity of the organism remained unaffected. The most marked changes in relation to the starting point were seen at measuring point 5 (40 min after beginning anesthesia): heart rate -22.4% (p less than 0.05), mean arterial pressure -35.1% (p less than 0.05), mean pulmonary-arterial pressure + 18.1% (NS), mixed-venous oxygenation -5.5% (NS), arteriovenous oxygen difference +25.9% (NS) arterial pO2 -4.4% (NS) and pCO2 +7.9% (p less than 0.05). --In the hands of an anesthetist fully acquainted with conduction anesthesia, cervical peridural anesthesia for appropriate indications may be proposed as an alternative anesthesiological method.

Aged↗
PubMedDate not supplied

[Anesthesia in severe combined gunshot and mine blast injuries].

An experience with 350 anesthesias in severely wounded patients is analyzed. Two main tasks had to be solved for successful treatment. The first one is the creation of compensation by the infusion-transfusion therapy. The second one is the defense of compensatory processes from the inhibition by pathological afferentation. The second task was being solved by combination of conductive anesthesia and rationalization of analgesia with phentanyl. This approach resulted in 13% less lethality of the patients.

Adult↗
PubMed1984

Site of action of intravenous regional anesthesia.

The principal site of action of intravenous regional anesthesia was studied using both prilocaine HC1 0.5% and technetium pertechnetate to define their distribution in the upper limb during this method of anesthesia. Using a single upper arm tourniquet and injecting technetium pertechnetate into a cubital fossa vein, the isotope spread to the finger tips. When a double tourniquet system was used to isolate the hand from the forearm, the following results were obtained: for up to 20 min after injection of the 40 ml of normal saline and radioisotope there was no leakage into the general circulation nor into the hand; after injection of 40 ml prilocaine HCl 0.5% into a cubital fossa vein, there was no anesthesia in the hand except for a small area on the dorsum corresponding to the area of sensory distribution of the radial nerve; while the tourniquets were inflated there was cramping pain in the hand. The results indicate that the initial analgesia obtained with the intravenous regional technique was due to blockade of small nerves or possibly nerve endings and not of the major nerve trunks at the elbow as has been suggested previously.

Adult↗
PubMed1986

Oculocardiac reflex and the anesthesiologist.

Oculocardiac reflex is one of the trigemino-vagal reflexes, and is frequently observed during anesthesia for pediatric strabismus surgery. The reflex is greatly exaggerated in the presence of hypoventilation, hypoxemia and acidosis. The reflex is important as a cause of cardiac arrest during eye surgery. Several related reflexes are known, such as blepharocardiac reflex, oculorespiratory reflex, and the sudden infant death syndrome. Although the reflex can be prevented by a retrobulbar block or the administration of parasympatholytic drugs, well conducted anesthesia and cooperation with the surgeon is much more important.

Anesthesia, General↗
PubMed1990

Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries.

Third- and fourth-degree perineal lacerations occur frequently during operative vaginal deliveries. To identify risk factors for lacerations, 2832 consecutive forceps and vacuum extraction deliveries were analyzed. Third- and fourth-degree lacerations occurred in 30% of deliveries. Multiple logistic regression was used to control for intercorrelation between potential risk factors. Factors associated with increased risk for third- and fourth-degree lacerations were midline episiotomy, nulliparity, second-stage arrest, occipitoposterior position, low or mid station, use of forceps instead of vacuum, use of local anesthesia, and Asian race. When these factors were controlled, there was no effect of birth weight, faculty versus resident operator, gestational age, abnormalities of first-stage labor, or several other factors. Prevention of perineal lacerations requires that the operator identify the patient at risk. Possible options for management of high-risk patients include use of mediolateral episiotomy or no episiotomy, use of vacuum extraction instead of forceps, and use of conduction anesthesia.

Anesthesia, Obstetrical↗
PubMed1992

State of the art: regional anesthesia using anesthetic admixtures.

Aging, high-risk, and ambulatory patients comprise a growing population of surgical candidates. The advantages of regional anesthesia for these patients has promoted technological and pharmacological advances. As new anesthetic agents are developed, methods to improve existing local anesthetics continue. This article reviews the current practice of local anesthetic admixtures. The physiological action of the local anesthetics and their additives is explained relative to their chemical properties. The advantages and risks when adding bicarbonate and epinephrine are described. Nursing implications for the care of the patient receiving regional anesthesia using admixtures are reviewed. An actual case report is presented to demonstrate the clinical application of local anesthetic admixtures.

Action Potentials↗
PubMed1977

Why can't you achieve adequate regional anesthesia in the presence of infection?

Observed in this study were morphologic changes in inflamed nerves, along with biochemical changes, which appear to act concurrently to deactivate or prevent activation of the local anesthetic solution. Morphologic changes were observed along the nerve fiber distant from the inflammatory site. These neuro-degenerative changes were seen at the axon and myelin sheaths level. The biochemical data support the presence in the inflamed nerve of amino acids which may be the product of lysosomal rupture and proteolytic enzyme release. These inflammatory mediators may affect either the local anesthetic or the environment of the nerve fiber. The precise mechanism of action of these catalytic products cannot be determined from this study.

Amino Acids↗
PubMedDate not supplied

Safety of spinal and epidural anesthesia in parturients with chorioamnionitis.

BACKGROUND AND OBJECTIVES: The safety of spinal and epidural anesthesia in patients with chorioamnionitis was explored. METHODS: A retrospective study was made of the charts of 517 parturients who had received epidural anesthesia and 14 who had received spinal anesthesia before delivery and whose placentas had subsequently been found to be positive for chorioamnionitis. RESULTS: Of the 146 blood culture results that were reported, 13 were positive. Of these 13 blood cultures, 5 had been drawn within 6 hours after placement of the epidural block, and four of the five bacteremic patients did not receive antibiotics until after the regional anesthetic was administered. One quarter (11/45) of the patients who were febrile and three quarters (174/229) of those who had leukocytosis before their block received no antibiotics before the block was placed. After the epidural block was performed, the catheter was left in place for over 24 hours in 18% (46/260) of the women who spiked a fever and in 14% (18/130) of those who exhibited leukocytosis during that period. There was no report of an epidural or spinal abscess or of meningitis in any of the women in the study. CONCLUSION: Conduction anesthesia may be safe in parturients with chorioamnionitis without prior antibiotic therapy.

Anesthesia, Epidural↗
PubMed1982

Fetal lactic acidosis with epidural anesthesia.

Three hundred thirty-six consecutive cesarean deliveries performed under epidural anesthesia were reviewed. Twenty per cent of mothers suffered at least a 20% fall in blood pressure following administration of epidural anesthesia. An additional 24% required ephedrine, a vasopressor with predominantly beta activity, when other corrective measures failed. Thus, 44% of these patients suffered significant hypotension. Forty-one percent of all elective repeat cesarean sections were treated wih ephedrine because of maternal hypotension. Fifty-one patients delivered by scheduled repeat cesarean section were divided into ephedrine-treated and untreated groups. There were no differences in Apgar scores among infants of both groups. Fetal acidosis was proportional to the severity of hypotension and the ephedrine dose. The metabolic abnormalities were most pronounced when severe hypotension, requiring over 15 mg of ephedrine, was present. Following restoration of blood pressure with conventional measures and ephedrine therapy, lactic acidosis persisted until delivery, whereas PO2 and PCO2 reverted toward normal values. The hypoperfusion of the intervillous space was the most likely cause of the observed significant umbilical venous and arterial lactic acidosis. Maternal hypotension remains a significant problem complicating conduction anesthesia.

Acidosis↗