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PubMed1981

Antiemetic effectiveness of intramuscular hydroxyzine compared with intramuscular droperidol.

In a double-blind randomized study 150 outpatients receivng the same anesthetic for first trimester therapeutic abortions were equally divided into three groups: control; droperidol, 2.5 mg IM; or hydroxyzine, 100 mg IM. The injection was given immediately after thiamylal (Surital) induction of anesthesia, and the incidence of nausea, retching, or vomiting (NRV) was recorded at 15-minute intervals for 3 hours after surgery. NRV occurred in 56% of control patients, in 44% of patients given droperidol, and in 10% of patients given hydroxyzine. The patients receiving hydroxyzine and droperidol were more sedated and experienced a delay in return of hand-eye coordination as measured by the time for the Trieger motor test to reach preoperative levels. All patients equaled their preoperative performance during the 3rd hour after surgery and were discharged 4 hours following general anesthesia. We conclude that intramuscular hydroxyzine hydrochloride, 100 mg, is a significantly better antiemetic than intramuscular droperidol, 2.5 mg.

Abortion, Induced↗
PubMed1995

[The plasma concentration measurement of local anesthetics, thiobarbiturates and mexiletine by HPLC with automatic pre-treatment system].

The concentrations of lidocaine, its metabolites (MEGX, GX), mepivacaine, bupivacaine, thiamylal, thiopental and mexiletine in plasma have been determined by HPLC method with automatic pre-treatment system. The drugs carried by pre-treatment mobile phase are trapped by hydrophobic interaction on the pre-treatment column (4 mm i.d. x 30 mm L., tetramethylolmethanetriacrylate resin packing). As sending analytical mobile phase which was conditioned with 0.1 M sodium phosphate buffer (pH 2.1) and acetonitrile by switching the flow changeover valve, the absorped drugs were eluted quickly and introduced to the analytical column (6 mm i.d x 150 mm L., octadecylsilan chemical bond sillica packing). On this column, the drugs were separated and analyzed, then measured by a UV spectrophotmetric detector. The time of switching valve, the wave length of detector for measurement and the buffer/acetonitrile ratio of analytical mobile phase were specific for the drugs, respectively. And high recovery and reproducibility were obtained for using auto-injector, so it has been possible to determine the concentrations of drugs in plasma with absolute calibration curves.

Anesthetics, Intravenous↗
PubMed1995

[Transient tracheal obstruction during surgical correction of scoliosis in a patient with Marfan's syndrome].

A 13-yr-old male with Marfan's syndrome underwent surgical correction of severe scoliosis. He had not manifested dyspnea previously in any position. Under anesthesia with thiamylal and vecuronium, his trachea was intubated with a reinforced endotracheal tube without any difficulty. Anesthesia was maintained with nitrous oxide and fentanyl, 8 micrograms.kg-1. The patient was placed in a prone position. Thirty min after the start of operation, when orthopedists compressed the thoracic vertebrae vertically, positive pressure ventilation became impossible abruptly, even with a high airway pressure. Three min later, ventilation became possible after cessation of compression and by mouth-to-tube insufflation. SpO2 monitored with a pulse oximeter recovered immediately from 61% to 99%. A capnogram showed a lengthy retardation of an inspiratory phase. Emergency fibreoptic bronchoscopy revealed that the trachea had been compressed vertically; the compression was reduced by moving the chest supporters laterally. After the apneic episode, the operation continued uneventfully, and he was discharged a month later. A severe deformity of the thorax due to severe scoliosis and weak tracheal tissue due to connective tissue defect caused partial tracheal compression before the surgery, and made his trachea susceptible to complete obstruction by vertical external compression on the thorax. Patients with Marfan's syndrome and scoliosis should have careful preoperative airway evaluation. The selection and positioning of endotracheal tubes should be done with care. During surgery, the patient's body position and the condition of the trachea should be checked frequently. Capnography and fiberoptic bronchoscopy seem to be mandatory for early detection of tracheal stenosis and prevention of tracheal obstruction.

Adolescent↗
PubMed1995

Isoflurane anesthesia in a rhinoceros.

During surgical exploration of the reproductive tract of a 15-year-old female white rhinoceros, anesthesia was maintained by administration of isoflurane in oxygen. Anesthesia was induced with IM administration of etorphine, and, to facilitate endotracheal intubation, muscle relaxation was achieved by IV administration of additional etorphine, acepromazine maleate, guaifenesin, and thiamylal sodium. Minor complications encountered during the anesthetic monitoring period included hypoventilation and ventilation/perfusion inequality, which contributed to hypoxemia. Recovery was not evaluated because the rhinoceros was euthanatized at the end of the surgical procedure.

Anesthesia, General↗
PubMed1995

[Anesthesia for a patient with Creutzfeldt-Jakob disease].

We reported anesthetic as well as perioperative management for a patient with Creutzfeldt-Jakob disease, a very rare transmissible neuropathy. A 51 year-old woman was scheduled for extirpation of recurrence of acoustic neurinoma. Three months before the operation, she had complained vertigo. After admission to our hospital, she had become progressively dementiated and developed disturbed consciousness. Anesthesia was induced with thiamylal and maintained with 0.7-1.5% isoflurane, nitrous oxide and oxygen. The anesthetic course was uneventful and the recovery from anesthesia was smooth. Postoperatively dementia progressed and myoclonus of extremeties appeared sixth weeks after the operation. Two months after the operation, a diagnosis of Creutzfeldt-Jakob disease was established by characteristic EEG and clinical course. Anesthesia for a patient with dementia was discussed.

Adult↗
PubMed1994

[Effects of in vivo pretreatment with various barbiturates on lidocaine metabolism in rat liver microsomes].

In male Wistar rats, we studied the effects of in vivo pretreatment with phenobarbital (PB), amobarbital (AB), hexobarbital (HB), pentobarbital (PT) or thiamylal (TI) on hepatic microsomal enzymes, and on deethylation of lidocaine in the microsomes. The rats of pretreatment groups received 0.1 ml of the above barbiturates (320 mumol.kg-1) and the control group received intramuscular injection of 0.9 % NaCl solution for 4 days. NADPH-cytochrome C reductase of the PB and AB groups increased significantly in activity and cytochrome b5 of only PB group increased in content. After the pretreatment with PB, TI produced higher microsomal cytochrome P-450 contents than in the control group. The potency of P-450 induction was in descending order of PB, TI, AB, HB and PT. Also we found the positive linear relationship between the potency of P-450 induction and the elimination half time (t1/2 beta) of the barbiturates. The activities of lidocaine deethylase with microsomes per P-450 of the pretreated rats with these five barbiturates (PB, AB, HB, PT and TI) were 2.4, 1.9, 2.2, 1.5 and 2.2 times of control values, respectively. Based on these results, we conclude that lidocaine deethylase activity of P-450 is increased by these five barbiturates whether levels of P-450 are increased quantitatively, or not.

Animals↗
PubMed1994

[High dose epidural fentanyl suppresses the increase in cortisol levels during open chest surgery].

We investigated the effect of high dose epidural fentanyl (HEF) on plasma levels of epinephrine (E), norepinephrine (NE) and cortisol (C) during open chest surgery (OCS). Twenty five patients undergoing open chest surgery was divided randomly into two groups. Thirteen patients had HEF (F-Group) and the rest of 12 patients had epidural mepivacaine (M-Group). Epidural puncture (Th5-6) and catheterization were performed before anesthetic induction. Anesthesia was induced with thiamylal (5 mg.kg-1) and trachea was intubated after injection of vecuronium (0.1 mg.kg-1). Anesthesia was maintained with 50% N2O and isoflurane as needed. After 0.2 ml.kg-1 of fentanyl was injected through the epidural catheter, fentanyl was infused continuously (0.05 mg.h-1) in F-Group. In M-Group, after 0.2 ml.kg-1 of 1% mepivacaine was injected through the epidural catheter, 1% mepivacaine was infused continuously (10 ml.h-1). For the measurement of E, NE and C, blood samples were collected at following points; 1) before anesthetic induction, 2) before incision, 3) during open chest and 4) in the recovery room. In both groups, E and NE levels did not change significantly. In F-Group, plasma C levels decreased significantly when chest was opened. C levels in F-Group, were significantly lower than in M-Group before incision and during open chest.

Aged↗
PubMed1994

[Hemodynamic responses to nitrous oxide during isoflurane anesthesia in humans].

Isoflurane often produces tachycardia during clinical anesthesia. We examined the effect of a stepwise increase of isoflurane concentration on hemodynamic parameters in the absence or presence of nitrous oxide (N2O). After induction with thiamylal (3 mg.kg-1), isoflurane in oxygen or in 66% N2O-oxygen was administered with mask ventilation. Inspired isoflurane concentration was increased in a stepwise fashion (1, 2, 3 and 4%) every 5 minutes and manual ventilation was performed to maintain ETCO2 within 35-40 mmHg. Blood pressure (BP), heart rate (HR) and cardiac output (CO) were measured before and at every minute after isoflurane administration until 20 minutes. Systolic BP decreased gradually with increasing isoflurane concentration, but was transiently elevated for 3%. HR increased in a dose-related manner. CO decreased significantly at 1-3%. N2O and this seemed to magnify the isoflurane-induced decrease in BP and increase in HR at 1% and 2%. CO increased from baseline at 4%. Isoflurane tended to increase HR in a dose-related manner and induced a hyperdynamic response during rapid increasing of isoflurane concentration. This response may have beed caused by the irritating effect of isoflurane on the airways. Addition of N2O attenuated this response because it increases the speed of induction and the depth of anesthesia.

Adult↗
PubMed1994

[Effects of pressure support ventilation (PSV) or PSV+PEEP on the respiratory function during general anesthesia under spontaneous ventilation].

This study was performed to examine the hypothesis that PSV with PEEP compared to spontaneous breathing with a circle anesthesia system may have beneficial effects on gas exchange and work of breathing during inhalational anesthesia. Nine patients (age; 58 +/- 20 yr) scheduled to receive general anesthesia for orthopedic (n = 3) or ENT (n = 6) surgery were randomly assigned in a triple cross-over manner to breathe with a standard anesthesia circle system, 5 cmH2O PSV, and 5 cm H2O PSV above 5 cmH2O PEEP. General anesthesia was induced with thiamylal (5 mg.kg-1) and succinylcholine (1 mg.kg-1), followed by tracheal intubation. General inhalation anesthesia was maintained with 1% isoflurane and nitrous oxide in 40% oxygen. Patients were permitted to breathe spontaneously. A BiPAP-S Ventilatory Support System was connected to a standard anesthesia machine instead of a reservoir bag to deliver PSV or PSV with PEEP. Respiratory parameters were measured with a C-P 100 Pulmonary Monitor. After breathing for 20 minutes with the assigned mode, measurements and blood gas sampling were performed. Statistical analysis was performed with ANOVA. There were no statistical differences in PaO2 within the three groups (table). PaCO2 was lower during PSV+PEEP, but the difference was not significant. This level of PSV or PSV with PEEP may have little beneficial effects on gas exchange in our study condition. The mean WOBp was smaller in the PSV with PEEP group but the difference was not statistically significant.

Adult↗
PubMed1993

Hemorrhagic myelomalacia following general anesthesia in a horse.

An 18-month-old male Belgian horse was anesthetized and placed in dorsal recumbency for cryptorchidectomy. Xylazine was used for sedation and guaifenesin with thiamylal for induction of anesthesia. A surgical plane of anesthesia was maintained with halothane. During anesthesia, second-degree atrio-ventricular blocks, hypoventilation and a 1-minute duration rise of mean arterial pressure (80 to 130 mm Hg) occurred. Total anesthesia time was 1 hour. On recovery from anesthesia, the horse exhibited flaccid paralysis of the hind limbs and was only able to elevate himself to a dog sitting position. The horse was humanely euthanized 22 hours postoperatively due to a lack of improvement in clinical signs. Hemorrhagic poliomyelomalacic lesions of the spinal cord were observed on histopathological examination of the spinal cord.

Anesthesia, General↗
PubMed1994

[Effects of succinylcholine on neuromuscular transmission during recovery from vecuronium].

Effects of succinylcholine (SCC), 1 mg.kg-1, given following incomplete recovery from muscle paralysis induced by vecuronium were investigated in 27 female patients undergoing elective surgery, which was performed under epidural anesthesia. Anesthesia was induced with thiamylal 5 mg.kg-1 followed by SCC to facilitate orotracheal intubation. Vecuronium bromide 0.08 mg.kg-1 was given and the lungs were ventilated with 67% N2O in O2 and 0.6% sevoflurane. Neuromuscular function was monitored by means of the induced EMG. The ulnar nerve was stimulated at the wrist. Supramaximal trains of four stimuli (2 Hz for 2 s: pulse width 0.2 ms) were administered every 20 s. The effect of SCC varied depending upon the degree of recovery from vecuronium. At the 25% recovery point, the response to SCC was biphasic, showing an initial reversal followed by an increase of the partial vecuronium block which recovered showing a fade phenomenon on train-of-four stimulation. At the 50% recovery point, an initial reversal was slight. Administered at 75% recovery from vecuronium, SCC produced total neuromuscular blockade without initial recovery. The overall duration of the SCC effect (time from the administration to 90% recovery) was 7-18 min. No prolonged paralysis from SCC occurred.

Adult↗
PubMed1994

[Preemptive analgesia produced with epidural analgesia administered prior to surgery].

The effect of epidural analgesia administered before or during surgery on postoperative pain relief using continuous epidural infusion of the mixture of local anesthetics and narcotics was studied. Ninety patients undergoing abdominal hysterectomy were randomly allocated to three groups; thirty patients of group 1 who received general anesthesia alone, thirty patients of group 2 with epidural analgesia 20 min before the end of surgery under general anesthesia and thirty patients of group 3 with epidural analgesia plus general anesthesia before surgery. Epidural analgesia was induced with 2% mepivacaine solution 15 ml without epinephrine in group 2 and 3, and in group 3 followed with 5 ml of the same solution at one-hour intervals. General anesthesia was induced with thiamylal and maintained with nitrous oxide, oxygen and sevoflurane. Immediately after surgery, 5 ml of the mixture of 0.225% bupivacaine and 0.0005% fentanyl was injected epidurally and followed with continuous infusion of the same mixture at the rate of 2.1 ml.h-1 over 24 h. Visual analogue score and Prince-Henry score were significantly less in group 3 than in group 1 and group 2 at 4 hours and 24 hours after surgery (P < 0.01, P < 0.05 respectively). These results suggest that postoperative continuous epidural analgesia is more effective if the entrance of noxious stimuli into the central neural system is prevented by preincisional epidural block.

Analgesia, Epidural↗
PubMed1994

[Neuromuscular blockade with vecuronium and its reversal with edrophonium during total intravenous anesthesia, neuroleptanalgesia and sevoflurane anesthesia].

The neuromuscular blocking effect of vecuronium and its reversibility ith edrophonium were studied under total intravenous anesthesia (TIVA) and compared with those under NLA or sevoflurane anesthesia (SA) in 30 surgical patients. The degree of neuromuscular blockade was evaluated by acceleration of thumb adduction in response to supramaximal stimulation of the ulnar nerve using Accelograph (Biometer). TIVA was induced with droperidol 0.25 mg.kg-1, fentanyl 2-4 micrograms.kg-1 and ketamine 2 mg.kg-1, and maintained with continuous infusion of ketamine 2 mg.kg-1.h-1 with 30-35% O2 in air. NLA was induced with droperidol 0.25 mg.kg-1 and fentanyl 5-10 micrograms.kg-1 and maintained with 66% nitrous oxide in oxygen. SA was induced with thiamylal 5 mg.kg-1 i.v. and maintained with 66% nitrous oxide in oxygen supplemented with sevoflurane (1 MAC). A single bolus intravenous injection of vecuronium 0.1 mg.kg-1 was used for paralysis and reversed with edrophonium 0.75 mg.kg-1 followed by atropine 0.015 mg.kg-1 when the TOF ratio returned to 25%. The times required from administration of vecuronium to completion of maximal block with TIVA, NLA and SA were 196.5 +/- 52.2 sec, 182.5 +/- 47.6 sec and 166.0 +/- 69.0 sec, respectively. There was no significant difference among them. The times from completion of maximal block to 25% recovery of the twitch height in TIVA and NLA were 39.5 +/- 11.0 min and 37.4 +/- 5.8 min without significant difference. Those values, however, were significantly shorter than 64.5 +/- 35.2 min of SA.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1994

Total intravenous anesthesia. Midazolam-fentanyl vs enflurane-nitrous oxide.

This study was done to compare the hemodynamics, serum catecholamine levels and postoperative analgesia in total intravenous anesthesia with inhalation anesthesia. Thirteen patients for elective upper abdominal surgery, aged from 40 to 75 years, were studied. In the total intravenous anesthesia group (TIVA group, 7 patients), anesthesia was induced with 0.3 mg.kg-1 midazolam and maintained with 0.68 mg.kg-1.hr-1 midazolam for 15 minutes followed by 0.125 mg.kg-1.hr-1. Fentanyl was also administered as necessary. In the inhalation anesthesia group (inhalation group, 6 patients), anesthesia was induced with 5 mg.kg-1 thiamylal and maintained with 0.5-2.0% enflurane and 66% nitrous oxide in oxygen. In the TIVA group, the blood pressure and heart rate were as stable as those in the inhalation group. The serum concentration of catecholamines in the TIVA group rose significantly 60 minutes after intubation, in particular, the serum epinephrine level was higher than in the inhalation group. The time for extubation, respiratory rate and PaCO2 were not different between the two groups. The postoperative analgesic duration in the TIVA group was significantly longer than that in the inhalation group. The elimination half-life of midazolam was 1.675 +/- 0.281 hours in the TIVA group. In this study, TIVA failed to suppress the elevation of serum catecholamine levels, but it achieved stable hemodynamics during upper abdominal surgery and enough postoperative analgesia without affecting the extubation time, the respiratory conditions and the elimination half-life of midazolam.

Adult↗
PubMed1994

[Potentiation of pancuronium induced neuromuscular blockade by nitrous oxide].

To evaluate in man the potentiation by nitrous oxide of the neuromuscular blockade produced by pancuronium, pancuronium 0.025, 0.035, 0.049 or 0.068 mg.kg-1 was given during thiamylal-fentanyl anesthesia with and without nitrous oxide, and the evoked electromyography (EMG) of hypothenar muscle was measured. In the group receiving nitrous oxide the ED50 and ED95 were 0.0359 and 0.0691 mg.kg-1. In the group not receiving nitrous oxide, these values were 0.0389 and 0.0849 mg.kg-1. The dose-response curve (DRC) constructed from log-probit transformation for the group not receiving nitrous oxide shifted to the right for 10.3% (P < 0.05). It was also revealed that the magnitude of the blockade was influenced by dose, gender, nitrous oxide, lean body mass and body surface area by the multiple regression analysis. DRS for the female patients shifted to the left, and the differences between both sexes seemed to decrease in the group receiving nitrous oxide. It is concluded that the results of the present study appears to be similar to those obtained in the previous study on vecuronium using EMG.

Adolescent↗
PubMed1994

[Anesthesia for a pregnant patient with ruptured cerebral arterio-venous malformation].

A 29 year old woman suffered sudden hemiplegia, vomiting and headache during the 28th week of her first pregnancy. She was diagnosed as the intracranial hemorrhage due to the ruptured arteriovenous malformation, and emergency operation was performed. Anesthesia was induced with crush induction using thiamylal, fentanyl, pancuronium and suxamethonium, and maintained with fentanyl, isoflurane and nitrous oxide in oxygen. During and after surgery, fetal heart rate and uterine contraction were monitored continuously. Intense hypotension was not chosen because it may place a fetus at risk of intrauterine asphyxia. Ventilation was controlled to maintain PaCO2 between 30 and 35 mmHg. During surgery, D-mannitol 60 g was infused slowly to prevent fetal dehydration, and after surgery no osmotic diuretics were used. Ritodrine hydrochloride, which prevented premature delivery, was continuously infused after surgery. Her neurological symptom was improved and her baby was delivered vaginally at 41st gestational week.

Adult↗
PubMed1994

[Antagonism to neuromuscular effect of subcutaneous administration of pancuronium by neostigmine].

It has been reported that subcutaneous administration of pancuronium produces prolonged neuromuscular blockade. The purpose of this study was to evaluate the antagonistic effect of neostigmine on neuromuscular blockade following subcutaneous injection of pancuronium in anesthetized patients. Fourteen male patients aged 32-67 yr, weighing 50-58 kg, and scheduled for surgical operation lasting more than 6 hr were included in the study. None of the patients had paresis. Anesthesia was induced with thiamylal and SCC. Patients under N2O-oxygen-enflurane (1.0-1.5%) anesthesia, were divided into two groups (n = 7 in each group). Group A was given an intravenous bolus of pancuronium 6 mg. Group B received pancuronium 6 mg subcutaneously in the ankle. Train-of-four responses were evaluated every 12s by measuring the force of thumb adduction produced in response to supramaximal stimulation of the ulnar nerve at the wrist. When the train-of-four ratios recovered to approximately 0.2 in groups A and B, a mixture of neostigmine 1.0 mg and atropine 0.5 mg was administered. The onset of fade in train-of-four responses was significantly more rapid in group A (intravenous administration) than in group B (subcutaneous administration). Time intervals to maximum train-of-four depression from pancuronium administration in groups A and B averaged 2.6 and 125.4 min, respectively. No significant differences in the recovery times of the train-of-four ratios from 0.2 to 0.7 following neostigmine administration in groups A and B were demonstrated. None of the patients who received pancuronium subcutaneously showed recurarization following neostigmine administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Pharmacodynamics of vecuronium in the kidney transplant recipient and the patient with normal renal function].

Pharmacodynamics of vecuronium were evaluated in seven kidney transplant recipients and compared with seven patients with normal renal function. Vecuronium 0.12 mg.kg-1 was used for the initial dose and 0.03 mg.kg-1 for the second dose for each patient under general anesthesia with either isoflurane, sevoflurane or halothane plus nitrous oxide after induction by thiamylal. The effect of vecuronium was evaluated by a muscle relaxation monitor. The time to the maximum blockade (onset time) and the time of 25% recovery of the first twitch height (duration time) were measured after each administration of vecuronium in patients of both groups. The onset times after the initial and second doses were similar in both groups (180.0 +/- 15.5 sec for recipients versus 185.7 +/- 14.9 sec for patients of normal renal function). However, duration was significantly longer in recipients than in patients of normal renal function. Durations after the initial and second doses were 130 +/- 19 min for the initial dose and 86 +/- 12 min for the second dose in recipients, whereas they were 51 +/- 5 min and 37 +/- 5 min in patients of normal renal function. The prolonged durations of vecuronium in the kidney transplant recipient were speculated to be mainly due to delayed elimination of the drug and effect of cyclosporin, an immunosuppressive agent in the recipients. These results suggest that the titrated administration of vecuronium by keen monitoring of muscle relaxation is needed in the kidney transplant recipient to avoid unnecessary prolongation in duration of action.

Adolescent↗