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PubMed1991

The effect of intraoperative retrobulbar block on anesthetic management of enucleation under general anesthesia.

This case chronicles the effect of a retrobulbar block on a coincident general anesthetic for enucleation in an elderly man. This ASA II patient had a medical history of insulin-dependent diabetes with few apparent cardiovascular complications and mild chronic obstructive pulmonary disease. Induction of anesthesia was accomplished with small doses of midazolam, droperidol, and alfentanil followed by thiamylal. The patient was intubated and maintained on isoflurane and nitrous oxide. A retrobulbar block was administered according to the surgeon's instructions without immediate, untoward consequences. Within 10 minutes the patient suffered a profound decrease in blood pressure and pulse requiring repeated doses of glycopyrrolate, phenylephrine, and ephedrine to maintain effective perfusion. These effects do not appear to have resulted from direct elicitation of the oculocardiac reflex, but rather from the loss of surgical stimuli from the block that essentially resulted in inadequate sympathetic tone. The author concludes that anesthetists in similar circumstances should anticipate the possibility of hypotension and lessened anesthetic requirements following retrobulbar block when coincident general anesthesia is planned.

Aged↗
PubMed1990

Effects of in vivo pretreatment with various barbiturates on anaerobic halothane metabolism in rat liver microsomes.

The effects of in vivo pretreatment with phenobarbital (PB), thiopental (TP), thiamylal (TA), pentobarbital (PT), and secobarbital (SB) on hepatic microsomal enzymes, and the effects on anaerobic halothane dehalogenation, aminopyrine N-demethylation, and aniline hydroxylation in the microsomes were studied in male Wistar rats. Three hundred twenty mumol/kg (0.1 ml) of PB, TP, TA, PT, SB, or 0.1ml of 0.9% saline were administered daily, intramuscularly, for periods of one day up to ten days. Daily administration of PB, TP, TA, or PT induced cytochrome P-450, NADPH-cytochrome P-450 reductase and/or cytochrome b5. However, administration of SB did not induce these enzymes. The potency of these enzyme inductions ranged in descending order as follows: PB, TP, TA, and PT. After five days of daily administration of PB, TP, or TA, the production of the anaerobic halothane metabolite, CDFE, increased to 187%, 134%, and 130% of the control, respectively. The production of another halothane metabolite, CTFE, likewise increased to 197%, 168%, and 163%. However, pretreatment with PT or SB had no effect on anaerobic halothane dehalogenation. Aminopyrine N-demethylation also increased after five days of daily administration of PB, TP, and TA. However, aniline hydroxylation decreased after five days of daily administration of TA. Other barbiturates had no effect on aniline hydroxylation. In this study we showed that whereas PT and SB did not enhance anaerobic halothane dehalogenation, PB, TP and TA did. We conclude that not only PB, and also TP and TA, may be enhancing factors in halothane hepatotoxicity. We recommend that, if barbiturates are necessary, SB and PT be used in the preadministration of halothane anesthesia.

Anaerobiosis↗
PubMed1990

Hemodynamic effects of carbon dioxide during intermittent positive-pressure ventilation in horses.

The hemodynamic effects of high arterial carbon dioxide pressure (PaCO2) during anesthesia in horses were studied. Eight horses were anesthetized with xylazine, guaifenesin, and thiamylal, and were maintained with halothane in oxygen (end-tidal halothane concentration = 1.15%). Baseline data were collected while the horses were breathing spontaneously; then the horses were subjected to intermittent positive-pressure ventilation, and data were collected during normocapnia (PaCO2, 35 to 45 mm of Hg), moderate hypercapnia (PaCO2, 60 to 70 mm of Hg), and severe hypercapnia (PaCO2, 75 to 85 mm of Hg). Hypercapnia was induced by adding carbon dioxide to the inspired gas mixture. Moderate and severe hypercapnia were associated with significant (P less than 0.05) increases in aortic blood pressure, left ventricular systolic pressure, cardiac output, stroke volume, maximal rate of increase and decrease in left ventricular pressure (positive and negative dP/dtmax, respectively), and median arterial blood flow, and decreased time constant for ventricular relaxation. These hemodynamic changes were accompanied by increased plasma epinephrine and norepinephrine concentrations. Administration of the beta-blocking drug, propranolol hydrochloride, markedly depressed the response to hypercapnia. This study confirmed that in horses, hypercapnia is associated with augmentation of cardiovascular function.

Animals↗
PubMed1990

[Assessment of the autonomic nervous activities under nitrous oxide-enflurane anesthesia by heart rate fluctuation analysis].

For numerical expression of the autonomic nervous activities during 60% nitrous oxide (N2O), enflurane (Enf) and oxygen anesthesia, heart rate fluctuations were studied in 13 female patients undergoing a laparoscopic examination. Atropine (0.5 mg im) and hydroxidine (50 mg im) were given one hour prior to induction of anesthesia with thiamylal (5 mg.kg-1 iv). Following the induction, succinylcholine (1 mg.kg-1 iv) was administered, and the trachea was intubated. Enf concentration was monitored throughout the study and expressed by the end-tidal values. An electrocardiogram in lead 2 was recorded on a magnetic tape for 3 minutes each time, before the induction of anesthesia (baseline value), during anesthesia with both 1.9% Enf and 1.0% Enf, then 5 and 20 min after tracheal extubation. These data were subjected later to computer analysis for heart rate fluctuations. At 1.9% Enf and after the skin incision, the R-R intervals and the coefficient variation of R-R interval (CV-RR) were significantly reduced to 90% (P less than 0.05) and 32% (P less than 0.01) of the baseline values respectively. A significant reduction (P less than 0.01) was also observed in both the high frequency component (HFC: 0.15-0.4 Hz) and the low frequency component (LFC: 0.05-0.15 Hz) of the power spectrum of heart rate fluctuations. The peak amplitude and the band area of the HFC were reduced to 20 and 35% of the baseline values, while those of the LFC was reduced to around 14%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Effects of intratracheal lidocaine spray on circulatory responses to endotracheal intubation].

The effect of intratracheal lidocaine spray (0.5, 1.0, 2.0 mg.kg-1) on blood pressure and heart rate changes to endotracheal intubation was evaluated in 20 ASA I-II patients. After thiamylal induction, 15 patients received lidocaine spray with LTA kit. Mean arterial blood pressure and heart rate were recorded for 10 min every 30 sec and analysis of plasma lidocaine concentrations were also performed. In the control group, mean arterial blood pressure increased significantly compared with the pre-anesthetic values for one min, and with all spray groups at one min after intubation. Heart rate increased significantly at 30 sec after intubation only in the control group. Since the plasma lidocaine concentrations at intubation were below 1.5 micrograms.ml-1, we conclude that intratracheal lidocaine spray depresses the circulatory response to intubation by its local surface analgesic effect.

Administration, Inhalation↗
PubMed1990

Influence of preinduction methoxamine, lactated Ringer solution, or hypertonic saline solution infusion or postinduction dobutamine infusion on anesthetic-induced hypotension in horses.

A controlled study of the cardiovascular responses in horses anesthetized with acepromazine (0.05 mg/kg of body weight, IV), guaifenesin (100 mg/kg, IV), thiamylal (5.0 mg/kg, IV), and halothane in O2 (1.2 to 1.4% end-expired concentration) was performed to determine whether hypotension could be prevented by use of various treatments. Six horses were given 5 treatments in a randomized sequence: no treatment (control), methoxamine (0.04 mg/kg, IV), lactated Ringer solution (20.0 ml/kg, IV), 7.5% hypertonic saline solution (4.0 ml/kg, IV), or constant infusion of dobutamine (5.0 mg/kg/min, IV) during anesthesia. Heart rate, ECG, blood pressure, central venous pressure, cardiac output, blood gas analysis, PVC, and plasma total protein concentration were measured during the study. Compared with the control value, an increase in blood pressure during halothane administration was observed after administration of lactated Ringer solution, hypertonic saline solution, or dobutamine (P less than 0.05). The improved blood pressure response to hypertonic saline solution and dobutamine was related to an increase in cardiac output, which was statistically significant (P less than 0.05). Other statistically significant differences in cardiopulmonary responses among treatments were not observed during anesthesia. The PCV was increased in response to dobutamine infusion, and plasma total protein concentration was reduced in response to administration of hypertonic saline or lactated Ringer solution.

Acepromazine↗
PubMed1990

Comparison of three techniques on time to awakening, time to orientation and incidence of nausea and vomiting using alfentanil in balanced anesthesia in an outpatient surgical setting.

Maximizing patient safety and comfort while minimizing adverse sequelae are continuing anesthetic challenges. The purpose of this study was to examine three anesthetic techniques utilizing alfentanil with regard to time to awakening, time to orientation and incidence of nausea and vomiting. Surgical procedures were limited to knee arthroscopy, laparoscopy and dental extractions. Unpremedicated ASA I/II outpatients (n = 74) between the ages of 18 and 59 were randomly assigned to one of three groups: Group I: alfentanil + 67% N2O + 33% O2 Group II: alfentanil + 67% N2O + 33% O2 + droperidol 0.015 mg/kg Group III: alfentanil + 100% O2 + 0.7% isoflurane Anesthesia was induced with alfentanil 40 micrograms/kg, atracurium 0.4 mg/kg, thiamylal 4 mg/kg and 100% O2 and was maintained according to group assignment. The anesthetic was supplemented as clinically indicated with incremental boluses of alfentanil 10 micrograms/kg. Upon completion of surgery, muscle relaxation was reversed with edrophonium 0.75 mg/kg and atropine 0.015 mg/kg. Analyses indicated that the three groups were comparable in terms of potentially confounding variables including gender, race, surgical procedure, age, percent of ideal body weight, case length and dose of alfentanil in micrograms/kg/hr. Time to awakening was significantly shorter in the two N2O groups by approximately 1.5 minutes, as compared to the O2 and isoflurane group (p = .0060). Time to orientation was significantly shorter in the N2O groups by approximately 1.5 minutes also, as compared to the O2 and isoflurane group (p = .0142). The two N2O groups did not differ significantly in either measure. The incidence of vomiting in the postanesthesia recovery room (PARR) indicated a significant difference (p = .0317) among groups with vomiting occurring 45.8% of the time in Group I, 28.8% of the time in Group II and 8% of the time in Group III. Total emetic score (nausea and vomiting) in the PARR indicated a significant difference (p = .03) among groups with symptoms occurring 50% of the time in Group I, 28% of the time in Group II, and 16% of the time in Group III.

Alfentanil↗
PubMed1990

Cardiopulmonary effects of butorphanol tartrate intravenously administered for placement of duodenal cannulae in isoflurane-anesthetized yearling steers.

Cardiopulmonary effects of IV administered butorphanol tartrate (BUT) were assessed in 7 yearling steers medicated with atropine and anesthetized with guaifenesin, thiamylal sodium, and isoflurane in O2 for surgical placement of duodenal cannulae. Heart rate, respiratory rate, arterial blood pressures, pHa, PaCO2, PaO2, arterial [HCO3-], esophageal temperature, and end-tidal isoflurane concentrations were measured before and after IV administration of BUT (10 mg). Mean respiratory rate increased significantly (P less than 0.05) only at 45 and 60 minutes after BUT administration. Mean respiratory rate was 26 +/- 6.3 breaths/min before BUT administration and 46 +/- 12.1 breaths/min 60 minutes after BUT administration. Arterial blood pressures were increased significantly (P less than 0.05) at all times, except 5 minutes after BUT administration. The mean value for mean arterial pressure was 76 +/- 9.6 mm of Hg before BUT injection and 117 +/- 12.6 mm of Hg 60 minutes after BUT injection. Mean values for pHa and arterial [HCO3-] were significantly (P less than 0.05) higher at 60 minutes after BUT administration (baseline, pH = 7.25 +/- 0.04 and [HCO3-] = 29.9 +/- 3.5 mEq/L; 60 minutes after BUT, pH = 7.28 +/- 0.03 and [HCO3-] = 33.0 +/- 1.8 mEq/L). Although some statistically significant changes were recorded, IV administration of BUT to these steers did not have a marked effect on the cardiopulmonary variables measured.

Anesthesia↗
PubMed1989

[Influences of respiratory frequency on breathing mechanics during artificial ventilation in man and animal].

Effects of respiratory frequency on breathing mechanics were examined on 11 surgical patients during artificial ventilation with inhalation of nitrous oxide, oxygen and halothane (GOF). When the respiratory frequency was increased stepwise from 10 to 30/min, the total compliance was significantly reduced stepwise (from 55.42 +/- 9.55 ml/cmH2O to 47.38 +/- 9.31, p less than 0.01). In animal experiment, the respiratory frequency was similarly increased from 10 to 30/min in 11 mongrel dogs under sodium thiamylal anesthesia with air breathing. The total pulmonary compliance decreased significantly from a control level of 13.62 +/- 5.04 ml/cmH2O to a value of 10.96 +/- 3.00 ml/cmH2O which was obtained under the administration of synthetic histamine (betazole hydrochloride) (p less than 0.01). However, the decreases in compliance with histamine were parallel with the control values without the drug treatment. From these results it was assumed that the reduction of the total pulmonary compliance under increased respiratory frequency was due not to changes in small airway but to those in large airway.

Adolescent↗
PubMed1989

[Death after delayed recovery and respiratory failure following injection sclerotherapy in a small infant under general anesthesia].

A 12 month old boy weighing 6.4kg with esophageal varices caused by congenital biliary hypoplasia was scheduled for emergency sclerotherapy under general anesthesia. Anesthesia was induced with thiamylal sodium 3mg.kg-1 i.v. and then maintained with nitrous oxide, oxygen and a low concentration of enflurane, paralysed with pancuronium bromide. As soon as a small dose of sclerosant (5% ethanolamine oleate) was injected, transient moderate bradycardia and hypotension occurred. As his spontaneous breathing was very weak and the movements of extremities convulsive and his consciousness drowsy, prophylactic respiratory care was carried out. He had pneumonia and manifestation of DIC 4 days after sclerotherapy. He died of a massive tracheal hemorrhage. The cause of the patient's death seemed largely due to the several toxicities of sclerosant itself. We stress that although this therapy is effective for the child with portal hypertension, the incidence of complications might be high in patient with severely damaged liver function. Therefore, anesthetic and postoperative management in injection sclerotherapy should be performed very carefully.

Anesthesia, General↗
PubMed1989

Cardiovascular effects of vasopressors in halothane-anesthetized dogs before and after hemorrhage.

Exogenously administered vasopressors (sympathomimetics) were evaluated in halothane-anesthetized dogs to determine the effects of these drugs on cardiovascular function before and after hemorrhage. Six dogs were anesthetized with thiamylal sodium (20 mg/kg of body weight) and halothane (1.25 minimal alveolar concentration) in 100% oxygen. After instrumentation, cardiac output, systemic arterial blood pressure (SAP), heart rate (HR), left ventricular pressure, pulmonary arterial pressure, and an index of cardiac contractility (dP/dT) were measured. Stroke volume, cardiac index (CI), stroke index (SI), rate-pressure product, and systemic vascular resistance (SVR) were calculated. Epinephrine (0.1, 0.3, and 0.5 micrograms/kg/min [low, medium, and high doses, respectively]) and dobutamine (1, 5, and 10 micrograms/kg/min [low, medium, and high doses, respectively]) were infused. Methoxamine was given in a bolus of 0.22 mg/kg, IV. All measurements were taken at 2.5 minutes after infusion, and were repeated after removal of 40% of the estimated blood volume. Dobutamine administered at the low dose before hemorrhage increased SAP and dP/dT. At the high and medium dose, dobutamine significantly increased CI, dP/dT, and SAP, with no significant change in HR or SVR. The medium dose of epinephrine was the most effective dose of epinephrine at increasing key variables (CI, SI, dP/dT). The response of CI and SI to this dose was not significantly different from the changes seen with high-dose administration of dobutamine. The dP/dT was significantly lower with epinephrine than with dobutamine, and SVR and HR were unchanged with epinephrine, except at the low dose, which decreased SVR.

Anesthesia, Inhalation↗
PubMed1989

Cardiovascular effects of vasopressors in isoflurane-anesthetized dogs before and after hemorrhage.

Exogenously administered vasopressors (sympathomimetics) were evaluated in isoflurane-anesthetized dogs to determine the effects of these drugs on cardiovascular function before and after hemorrhage. Six dogs were anesthetized with thiamylal sodium (20 mg/kg of body weight) and isoflurane (1.25 minimal alveolar concentration) in 100% oxygen. After instrumentation, cardiac output, systemic arterial blood pressure, heart rate (HR), left ventricular pressure, pulmonary arterial pressure, and an index of cardiac contractility (dP/dT) were measured. Stroke volume, cardiac index (CI), stroke index (SI), rate-pressure product, and systemic vascular resistance (SVR) were calculated. Epinephrine (0.1, 0.3, and 0.5 micrograms/kg/min [low, medium, and high doses, respectively]) and dobutamine (1, 5, and 10 micrograms/kg/min [low, medium, and high doses, respectively]) were infused. Methoxamine was given in a bolus of 0.22 mg/kg, IV. All measurements were taken at 2.5 minutes after infusion, and were repeated after removal of 40% of the estimated blood volume. Before hemorrhage, administration of high doses of dobutamine and medium and high doses of epinephrine were equally effective at increasing CI and SI. The dP/dT was increased to the greatest degree by administration of high doses of dobutamine. Administration of the low dose of dobutamine increased dP/dT, whereas administration of the low dose of epinephrine increased CI, HR, and SI, and decreased SVR. The HR and SVR were not increased by administration of any dose of dobutamine or of the medium and high doses of epinephrine. However, methoxamine increased SVR and decreased HR. Methoxamine decreased CI, SI, and dP/dT, but increased systemic arterial pressure to the same degree as that attributed to administration of high doses of dobutamine and epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1989

[Anesthesia for Shy-Drager syndrome; effects of elastic bandage, phenylephrine, and IPPV].

A 57-year-old man with Shy-Drager syndrome underwent plastic surgery for decubitus on the buttocks under general anesthesia. Before induction of anesthesia, an elastic bandage was applied to the legs, and its effects were examined by raising the upper body. The fall in mean blood pressure decreased from 49% to 39%, and the symptoms of cerebral hypoxia disappeared. However, the induction of anesthesia with 5 mg diazepam, 0.05 mg fentanyl, and 100 mg thiamylal reduced blood pressure abruptly from 150/88 mmHg to 95/68 mmHg. Continuous infusion of phenylephrine was then started, and blood pressure became stable at around 150/90 mmHg. In this state, IPPV did not reduce the blood pressure in the supine position, and did not intensify its fall when the upper body was raised. Anesthesia was maintained with nitrous oxide 70% in oxygen, fentanyl and pancuronium. During the surgery, ventilation was controlled, and phenylephrine was infused at the rate of 5-15 micrograms.min-1 to maintain systolic blood pressure above 100 mmHg. Phenylephrine was infused during the two postoperative days, because blood pressure fell whenever the patient's posture was changed to prevent pressure on the operative site.

Anesthesia↗
PubMed1989

[Pharmacokinetics and the lung uptake of lidocaine during epidural anesthesia].

In order to investigate the pharmacokinetics of lidocaine especially the lung uptake during epidural anesthesia, we measured the lidocaine concentrations of arterial and central venous blood simultaneously using a homogeneous enzyme immunoassay. Then the lung extraction ratio was calculated as (1-arterial lidocaine concentration/central venous lidocaine concentration) X 100%. With only epidural anesthesia, the lung uptake of lidocaine was above 30% during the first 40 minutes, but was less after additional administration. After general anesthesia with thiamylal, enflurane, nitrous oxide and oxygen, the lung uptake was 30 approximately 40% following initial and additional administrations. There was a positive correlation between the lung extraction ratio and the central venous lidocaine concentration 5 minutes after the initial administration. Having used laryngotracheal lidocaine spray during endotracheal intubation, the lung extraction ratio could not be calculated since this resulted in direct lidocaine administration to the lungs. In conclusion, the lung plays an important role in keeping the arterial lidocaine concentration low.

Adult↗
PubMed1989

[Prolonged respiratory depression following general anesthesia in a patient with dystrophia myotonica].

A case of general anesthesia for a 52 year old female with previously undiagnosed dystrophia myotonica was reported. The patient was diagnosed as flaccid paralysis of the bilateral lower extremities but myotonic symptoms were not found preoperatively. The patient underwent duodenal resection to have a benign tumor removed. Anesthesia was induced with thiamylal 250 mg and pancuronium bromide 4 mg intravenously to facilitate tracheal intubation. Anesthesia was maintained with enflurane (0.6-1.0%) in nitrous oxide (50%) and oxygen (50%). The course of anesthesia was uneventful except for a transient hypotension of 80 mmHg systolic for about 10 minutes. The patient did not recover smoothly from anesthesia and prolonged apnea was observed. 90 minutes after the end of surgical procedure, spontaneous ventilation appeared. Then the tidal volume increased gradually but it still remained around 100-150 ml even 3 hours after the end of the operation. She was on ventilator and observed carefully. The endotracheal tube was removed four days after the operation. The patient was examined again by a neurologist and a final diagnosis of dystrophia myotonica was made. Prolonged recovery from anesthesia and postoperative respiratory depression observed in this patient was due to preoperatively undiagnosed dystrophia myotonica. A careful preoperative examination should be made to minimize possible complication related to anesthesia in the disease.

Anesthesia Recovery Period↗
PubMed1989

[Anesthetic management of thrombotic thrombocytopenic purpura].

A 46-year-old man, with TTP and renal failure, received splenectomy because complete remission was not achieved after the treatments such as plasma exchange, antiplatelet agents and corticosteroid. After the administration of methylprednisolone, anesthesia was induced with thiamylal and succinylcholine chloride and maintained with nitrous oxide, enflurane, fentanyl and vecuronium. Total blood loss was 1710 gram. Four units of packed red cell and 9 units of fresh frozen plasma were infused. The anesthetic course was uneventful. TTP is a rare and usually fatal disease and its etiology is unknown. Careless infusion of platelet or fresh blood may accelerate the disease process and multiorgan dysfunction may present other anesthetic problems. In this report, problems of anesthetic management for TTP were discussed.

Anesthesia, Inhalation↗
PubMed1989

[A case of retrograde amnesia of 22 years, continued for 4 days following a general anesthesia accompanied by a permanent amnesia of these 4 days after the complete recovery from the retrograde amnesia].

A case of global amnesia which continued for 4 days following a general anesthesia and recovered without any neurological deficits was reported. The patient was a 38-year-old woman suspected of lung cancer, and scheduled for pulmonary lobectomy. She had a history of appendectomy under spinal anesthesia 22 years before. She was premedicated with diazepam (10mg), atropine (0.5mg) and pentazocine (30mg). Anesthesia was induced with thiamylal (500mg) and succinylcholine (140mg) iv and 100% oxygen. Anesthesia was maintained with enflurane and nitrous oxide with oxygen for 3 hours. After her recovery from anesthesia, a retrograde amnesia of 22 years was observed and continued for 4 days. Then the memory was restored completely, but the amnesia during these 4 postoperative days remained permanently. We have documented the case of amnesia in the immediate postoperative period which is similar to transient global amnesia. It seems likely that this amnesia was caused by drug interaction, hypoxia, decreased cerebral perfusion or psychogenic effects of general anesthesia.

Adult↗
PubMed1989

[Anesthetic management of caesarean section in a patient with idiopathic thrombocytopenic purpura and placenta praevia].

A 24-year-old female with idiopathic thrombocytopenic purpura (ITP) and total placenta praevia was scheduled for caesarean section. Anesthetic management during caesarean section with ITP and placenta praevia is critical because of possibility of massive intra- and postpartal bleeding. The patient received prednisolone 30 mg per day for 10 days before surgery. Bleeding time and value of platelet count returned to normal range on the operative day. Hydrocortisone 100 mg and atropine sulfate 0.3 mg were given intravenously just before the start of anesthesia. Anesthesia was induced with thiamylal 4 mg.kg-1 and SCC 1 mg.kg-1 and maintained with N2O-O2-enflurane. A baby girl was delivered after 7 min, and the Apgar score was 9 at 1 min after delivery. Intraoperative bleeding totaled 1,314 ml, but we could avoid total hysterectomy.

Adult↗