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PubMed1994

[Sevoflurane anesthesia for a patient with facioscapulohumeral muscle dystrophy].

We gave anesthesia to a patient with facioscapulohumeral muscle distrophy (FSHMD). Patient was an 18 year old male, having no peculiar complaint and without family history nor past history relating to FSHMD. The restriction of right arm lifting was pointed out in medical examination. Diagnosis of FSHMD was made by muscle biopsy. The thoraco-scapula fixation was scheduled. Four hours prior to the induction, dantrolene 50 mg was administered per os. Before the induction, to estimate the effect of neuromuscular blockade, we applied Datex Relaxograph to the upper and lower extremities. Anesthesia was induced with thiamylal 200 mg and vecuronium 4 mg, and maintained with sevoflurane and nitrous oxide monitoring ETCO2. The time for the onset of muscular relaxation after the administration of vecuronium was quite different between upper and lower extremities (200 sec. and 407 sec.). Neostigmine and atropine for the reversal of neuromuscular blockade was administered evaluating the extent of neuromuscular relaxation obtained from Datex Relaxograph. We concluded that Relaxograph is essential as a monitor of muscular relaxation, especially in the case of neuromuscular disease.

Adolescent↗
PubMed1993

[The relation of vertebral artery blood flow velocity to mean arterial pressure during anesthesia with enflurane or isoflurane].

The relation of vertebral artery blood flow velocity (VABFV) to mean arterial pressure (MAP) during anesthesia with enflurane or isoflurane was examined. The subjects were 17 patients on the knee-chest position. Anesthesia was induced with thiamylal and fentanyl. The patients were placed on the knee-chest position after tracheal intubation. Ventilation was adjusted to maintain a constant level of PaCO2 (30-40 mmHg). The patients were divided into two groups. Anesthesia was maintained with enflurane and 67% N2O in group E (8 patients), or with isoflurane and 67% N2O in group I (9 patients). VABFV was measured with a transcranial Doppler sonography (TCD), and MAP was measured through a radial artery catheter. The mean VABFV and MAP were recorded at five-minute intervals. VABFV was found to change with the change in the MAP for the same degree in both groups. The results suggest that cerebral autoregulation is disturbed during either isoflurane-N2O or enflurane-N2O anesthesia.

Adult↗
PubMed1993

Effect of preanesthetic medication on ease of endoscopic intubation of the duodenum in anesthetized dogs.

The effects of preanesthetic medication on ease of duodenal endoscopic intubation in dogs was evaluated. One of 12 combinations of preanesthetic medications (using atropine, glycopyrrolate, morphine, meperidine, acepromazine, and 0.9% NaCl solution) was administered IM to each of 12 dogs in a trial. Twelve endoscopic trials were performed so that each dog received each treatment combination once. Anesthesia was induced with thiamylal administered IV and maintained with halothane vaporized in oxygen. Electrocardiographic recordings, indirect blood pressure measurements, end-tidal carbon dioxide partial pressures, and halothane concentrations were monitored during the anesthetic period. The ease with which the fiberoptic endoscope was passed into the proximal portion of the duodenum was qualitatively score on the basis of time and maneuvering effort. None of the preanesthetic combinations made intubation of the duodenum significantly easier than that with 0.9% NaCl solution (control). Only the combination of morphine and atropine induced gastro-pyloric conditions that resulted in significantly higher (more difficult) endoscopic scores than those after preanesthetic medication with 0.9% NaCl solution.

Animals↗
PubMed1994

[Anesthesia for the intraoperative electrocorticography of patients with uncontrollable epilepsy].

For the surgical treatment of uncontrollable epilepsy, it is essential to delineate the epileptogenic focus by the use of intraoperative electrocorticography. Most general anesthetic agents, however, suppress the epileptogenic focus. Therefore, such a patient is usually kept awake during the procedure using local anesthesia. We experienced 15 cases for these procedures. Anesthesia was induced with thiamylal and pancuronium was administered for tracheal intubation. Anesthesia was maintained with nitrous oxide, oxygen and enflurane or isoflurane. After the brain was exposed, volatile anesthetics were discontinued and replaced with intermittent fentanyl administration. Approximately 15 minutes before the start of intraoperative electrocorticography, nitrous oxide concentration was reduced to 30% or less. A resective epileptogenic focus was identified in every patients. In 2 patients, electrocorticographical focal seizure status was identified following the intraoperative electrocorticography. After the focus resection, seizure attacks were controlled only by the application of regular medical regimen in these patients. Low nitrous oxide and intermittent fentanyl administration can be recommended as a superior anesthesia technique for intraoperative electrocorticography.

Anesthesia, General↗
PubMed1993

Vaporizer in circle for delivery of isoflurane to dogs.

An in-circuit vaporizer for delivery of isoflurane was evaluated. The isoflurane concentration within an isolated circle breathing circuit was determined for 1 hour in 6 in-the-circuit vaporizers with the wicks removed. A mechanical ventilator and artificial lung were connected to the circuit. Isoflurane concentration increased as vaporizer setting increased, and delivered concentration (%) at 60 minutes (mean +/- SEM) ranged from 0.46 +/- 0.10 at tap setting 1 to 3.67 +/- 0.30 at setting 5. Temperature of the isoflurane did not change. Cardiovascular and respiratory function were maintained within a clinically acceptable range in 6 dogs anesthetized with thiamylal and maintained with 1.87% end-tidal isoflurane delivered from the in-circuit vaporizer during spontaneous ventilation, controlled ventilation, and closed-circuit anesthesia. The range of vaporizer tap settings (mean +/- SEM) was lower during closed-system anesthesia (2.5 +/- 0.1 to 3.5 +/- 0.6) and during controlled ventilation (2.6 +/- 0.2 to 3.3 +/- 0.2) than during semi-closed system anesthesia (5.4 +/- 0.3 to 6.8 +/- 0.4). The in-circuit vaporizer was used to deliver isoflurane to 36 dogs anesthetized for a variety of surgical and medical procedures. Ventilation was spontaneous, assisted, and in 1 instance, controlled. Cardiovascular function, respiratory function, and recovery times were within clinically acceptable ranges. The initial vaporizer tap setting (mean +/- SEM) was 8.2 +/- 0.4, and this corresponded to an end-tidal isoflurane concentration of 3.5 +/- 0.6. The range of vaporizer settings during the maintenance phase (mean +/- SEM) was 2.8 +/- 0.5 to 4.6 +/- 1.9.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1993

[The anesthetic management of Arnold-Chiari malformation with spinal cord injury].

A rare case of spinal cord injury at C3 level associated with Arnold-Chiari malformation is reported. A 33 year old male was admitted with a complaint of walking difficulty. MRI revealed cerebellar herniation, and a plain X-ray showed spinous process adhesion of C2-3 and slight scoliosis. Percent vital capacity was reduced to 69%, and blood cell count showed a slight anemia. The patient was anesthetized for an orthopedic surgery with pethidine 70 mg, thiamylal 200 mg, 60% nitrous oxide, 40% oxide, and 0.5-1.2% isoflurane. There was a mild decrease in arterial blood pressure during surgical procedures, but this could be easily treated by fluid therapy, and there was no episode of autonomic hyperreflexia. Postoperative course of the patient was uneventful, except a transient pneumonia and urinary tract infection. The key in the anesthetic management of Arnold-Chiari malformation with spinal cord injury is the control of intracranial pressure, care for respiratory dysfunction and the prevention of infection as well as autonomic hyperreflexia.

Adult↗
PubMed1995

[Subdural catheterization uncovered by severe hypotension during epidural plus general anesthesia].

We experienced three cases of accidental subdural catheterization during epidural combined with general anesthesia. In each case, epidural catheterization was performed before induction of general anesthesia. Aspiration through the catheter and a response to a test dose were negative. Then anesthesia was induced with thiamylal IV and the trachea was intubated with vecuronium IV. Hypotension, which was not easily treated by vasopressors and volume load, occurred after administration of 3 to 8 ml mepivacaine with 1: 200,000 epinephrine through the catheter. We examined position of the catheter by injecting iohexol 240 and confirmed subdural catheterization after surgery. It is often difficult to identify subdural placement of an epidural catheter under general anesthesia since signs of massive sensory blockade are masked by general anesthesia. In each case, we suspected malpositioning of the catheter by severe hypotension due to sympatholysis which was difficult to treat. Subdural catheterization is a complication of epidural anesthesia that probably occurs more frequently than previously recognized and is usually unpredictable during general anesthesia.

Anesthesia, Epidural↗
PubMed1995

[Anesthesia with transesophageal echocardiography for removal of pheochromocytoma].

A 45-year-old female was scheduled for left adrenalectomy because of a pheochromocytoma. Preoperative general condition was well controlled with alpha- and beta-blockers. Anesthesia was induced with thiamylal and vecuronium, and maintained with isoflurane (0.5-3%) and nitrous oxide in oxygen. Blood pressure was controlled with nicardipine and alpha-blocker during the manipulation of the tumor. After removal of the tumor, dopamine and norepinephrine were used. We used transesophageal echocardiography (TEE) to determine the fluid administration rate and doses of catecholamine. We could observe the wall motion and the mass of the heart, and see changes of the left ventricular enddiastolic volume, the cardiac output and the stroke volume. TEE monitoring seems to be very useful during the resection of pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1995

[The effect of clonidine on the duration of vecuronium-induced neuromuscular blockade in humans].

The clinical duration of a bolus of vecuronium 0.1 mg.kg-1 was measured in two groups of patients between 31-55 years of age undergoing elective general surgery. Eight patients received no premedication and eight others clondine 4.0-5.5 micrograms.kg-1 orally 90 minutes before arriving at the operating room. Neuromuscular blockade was continuously quantitated by recording the acceleration response to stimulation of the ulnar nerve train-of-four. Anesthesia was induced with thiamylal 5 mg.kg-1 and maintained with 50% nitrous oxide and isoflurane (Fet 0.5%) in oxygen. Supplementary doses of fentanyl (2 micrograms.kg-1 for the control group and 1 microgram.kg-1 for the clonidine group) were given before intubation and when anesthesia was considered to be insufficient. The clinical duration of vecuronium, defined as recovery to 25% of the control first twitch in the train-of-four sequence, was significantly longer in the clonidine group (51.2 +/- 7.5 minutes compared with 40.5 +/- 5.1 minutes in the control group, P < 0.01). In the duration of blockade there were no significant differences between groups for mean SBP, DBP and HR. Patients in the clonidine group required significantly less fentanyl to maintain hemodynamic stability. We conclude that clonidine prolongs the clinical duration of vecuronium by 26.4%, most probably by a pharmacokinetic interaction.

Administration, Oral↗
PubMed1995

[Potential of succinylcholine-induced neuromuscular blockade by nitrous oxide].

To evaluate the potentiating effect of nitrous oxide on the succinylcholine (SCh)-induced neuromuscular blockade, 0.16, 0.20, 0.25 or 0.31 mg.kg-1 of Sch was given during thiamylal-fentanyl anesthesia with or without nitrous oxide, and the evoked electromyograph of hypothenar muscles was measured. ED50 and ED95 in the group receiving nitrous oxide were 0.187 and 0.301 mg.kg-1, and 0.218 and 0.389 mg.kg-1 in the group not receiving nitrous oxide respectively. In the presence of nitrous oxide, the dose-response curve (DRC) was shifted to the left significantly (P < 0.01). By the multiple regression analysis, the degree of the neuromuscular blockade was shown to be affected by dose and nitrous oxide. It was demonstrated that nitrous oxide decreased electromyographically measured SCh requirements by 16.1%. In addition, the dose-effect relationship for SCh-induced neuromuscular blockade varied widely, and gender did not affect the degree of block.

Adolescent↗
PubMed1995

Quantitative relationship between structure and peritoneal membrane transport based on physiological pharmacokinetic concepts for acidic drugs.

To describe quantitatively the peritoneal transport of drugs, the kinetic model, which involves changes in the volume and osmolality of the dialysate as well as the diffusion and convection of drugs across the peritoneum, was applied. The apparent peritoneal permeability (Pd) of unbound drugs in rats and the partition coefficient (Papp) in an octanol:water system at pH 7.4 were estimated among acidic drugs. Using the values of unbound fraction (fS), the Pd values of the drugs were estimated from concentration-time profiles in serum and the peritoneal dialysate after intraperitoneal administration of drugs. The intrinsic membrane permeability (Pdm) was calculated based on a physiological pharmacokinetic model. The fS.Pdm values of thiopental and thiamylal (6.5 and 5.4 ml/min) were 2-3 times greater than the effective peritoneal blood flow, indicating that the peritoneal transport of the barbiturates with high lipophilicity was dominantly blood flow-limited. Evidence shows a high degree of correlation between log Pdm and log Papp. By considering the relationships, we estimated the Pdm of quinolonecarboxilic acids. The fS.Pdm values of quinolonecarboxilic acids were < 10% of the peritoneal effective blood flow rate, indicating that the peritoneal transport of quinolonecarboxilic acids was dominantly diffusion-limited because of low lipophilicity. In conclusion, there was a good correlation between log Pdm and log Papp. The prediction of Pdm can be useful to describe the peritoneal pharmacokinetics.

Acids↗
PubMed1996

[The effects of sevoflurane and isoflurane on hepatic blood flow in man].

The influences of sevoflurane and isoflurane on hepatic blood flow (HBF) in man were investigated employing the method of continuous infusion of indocyanine green. HBF and cardiac output (CO) were measured in patients before and after induction of anesthesia with thiamylal, fentanyl, and N2O, and again during isoflurane (n = 9) or sevoflurane (n = 8) anesthesia before the start of surgery. HBF after administration of volate anesthetics increased significantly with 1MAC isoflurane, and decreased with 1 MAC sevoflurane. Although CO decreased similarly in both groups during anesthesia, the HBF/CO ratio in isoflurane group increased significantly, and the ratio in sevoflurane group did not change significantly. We conclude that whereas isoflurane increases HBF, sevoflurane does not change it in anesthetized patients.

Adult↗
PubMed1996

[Acute brain expansion during emergency neck clipping surgery for cerebral aneurysms in a patient with dilated cardiomyopathy].

A 61-year-old male with coma and undiagnosed dilated cardiomyopathy received emergency cerebral aneurysm surgery. Anesthesia was induced with thiamylal, fentanyl and vecuronium and maintained with 66% N2O and 1.0% isoflurane. Five hundred ml of 20% mannitol was infused in 30 min. At the end of the infusion, hypotension occurred. Immediately after the injection of ephedrine, acute brain swelling was observed. The operation was switched to external decompression. Post-operative echocardiography revealed the presence of dilated cardiomyopathy (DCM). The ejection fraction was 34%. Two weeks later, the second operation was scheduled. The anesthesia was induced with fentanyl, midazolam and vecuronium and maintained with N2O and 0.7% isoflurane. Nitroglycerine, lidocaine, PGE1, dopamine and dobutamine were infused throughout the operation. Five hundred ml of 20% mannitol was infused in 60 min. There were no considerable hemodynamic changes and no episode of brain expansion during operation. We conclude that the rapid infusion of mannitol can trigger acute cardiac failure and brain edema in patients with DCM.

Acute Disease↗
PubMed1996

[Pre-emptive analgesia from intravenous administration of opioid: no effect with pentazocine].

The influence of timing of administration of preoperative pentazocine on pain and analgesic requirements after surgery was studied in 46 patients undergoing total abdominal hysterectomy. Twenty-three patients received thiamylal 5 mg.kg-1 on induction of anesthesia, followed by pentazocine 30 mg or 60 mg before surgical incision (group A). Twenty-three control patients received pentazocine 30 mg or 60 mg, 5 min after abdominal incision (group B). The visual analogue scales for pain 24 h after operation were 6.0 cm at 30 mg dose in group A or 5.3 cm at 60 mg dose in group A and 5.7 cm at 30 mg dose in group B or 4.7 cm at 60 mg dose in group B. There were no differences in the visual analogues scales. Pentazocine consumption in the first 24 h after surgery was 67.5 mg at 30 mg dose in group A or 52.5 mg at 60 mg dose in group A and 70.9 mg at 30 mg dose in group B or 51.8 mg at 60 mg dose in group B. We conclude that postoperative pentazocine consumption and pain scores are no different when pentazocine is given before or after skin incision for abdominal hysterectomy and that there is no clinically useful pre-emptive analgesic effect with these doses of pentazocine.

Adult↗
PubMed1996

[Anesthetic management of a patient with ornithine transcarbamylase deficiency].

A 6-year-old female with disturbance of consciousness (JCS: 3 points) due to hyperammonemia caused by ornithine transcarbamylase deficiency is presented. She underwent an emergency insertion of a catheter for peritoneal dialysis under general anesthesia. Anesthesia was induced by intravenous administration of thiamylal sodium and maintained with inhalation of sevoflurane and oxygen after tracheal intubation. One percent mepivacaine was infiltrated around the surgical field to diminish the dose of sevoflurane. The operation proceeded uneventfully, although her consciousness could not recover rapidly to the normal level during the emergence from anesthesia. Peritoneal dialysis was started immediately after the operation and her consciousness recovered to the normal level gradually during the following six days with decreasing plasma ammonia levels. Ten days later, extirpation of the peritoneal catheter was scheduled. The course of anesthesia and operation was uneventful using the same anesthetic method as with the former anesthesia. In the anesthetic management for a patient with ornithine transcarbamylase deficiency, we have to be careful about the nitrogen balance, which can be affected by the kind and doses of anesthetic drugs, to avoid hyperammonemia. From this point of view, local anesthesia combined with general anesthesia might be useful to prevent the serum ammonia level from increasing.

Ammonia↗
PubMed1996

[Anesthetic management of a patient with thymoma presenting superior vena cava syndrome].

We report a case of thymoma presenting superior vena cava syndrome. Anesthesia for biopsy or excision of an anterior mediastinal mass has been associated with major airway and cardiac complications. Therefore, careful anesthetic management is necessary. The patient was kept on Fowler's position, and anesthesia was induced with thiamylal. The patient was intubated with succinylcholine and allowed to breath spontaneously until the sternal incision. Thereafter we used vecuronium and controlled ventilation was maintained. Intraoperatively, arterial pressure, central venous pressure, and right- and left-brachiocephalic vein pressures were monitored. After bypasses between right atrium and right- and left-brachiocephalic vein had been made, the venous pressures decreased remarkably. Various methods for preventing side effects resulted in good control during the perioperative period.

Anesthesia, General↗
PubMed1996

[A case of coronary artery spasm during burr hole opening for craniotomy].

We report a rare case of coronary artery spasm during burr hole opening for craniotomy in a patient with no past history of coronary artery disease. A 52-year-old man was scheduled for the removal of the brain tumor under general anesthesia. Anesthesia was induced with fentanyl, thiamylal, and vecuronium, and maintained with sevoflurane plus nitrous oxide in oxygen. When burr holes were made for the craniotomy, the heart rate decreased suddenly and the ECG in lead II demonstrated the elevation of the ST segment (0.3mV). After about 1 min, the ST segment elevation returned to normal without any treatment. The dura mater was rather tense with inspection. Despite many reported cases of coronary artery spasm during general anesthesia, coronary artery spasm during burr hole opening for craniotomy has not been reported. In the present case, since the heart rate decreased and the elevation of the ST segment occurred at the time of the burr hole opening for craniotomy, the activated vagal tone reflex induced by the stimulation of the dura mater seemed to have caused the coronary artery spasm.

Anesthesia, General↗
PubMed1996

[A case of adult Reye's syndrome with favorable outcome despite status epilepticus].

A case of adult Reye's syndrome is described. A previously healthy 17-year-old man developed convulsions 2 days after resolution of an upper respiratory infection with parainfluenza virus type 3. During the preceding infection, he took aspirin. On admission, he was drowsy. There was no focal signs. Cranial CT scan was unremarkable. A lumbar puncture revealed an opening pressure of 180 mm H2O; the cerebrospinal fluid was acellular with normal protein level. Serum chemistry showed elevated transaminase activities and normal bilirubin level. Blood ammonia level was high; urea and citrulline levels were abnormally low. These abnormalities disappeared later, suggesting transient cysfunction of mitochondrial urea-cycle enzymes. Free and acyl carnitine levels were unremarkable. Both metabolic acidosis and ketonuria were absent. Thus, a variety of aminoacidurias and organic acidemias are unlikely. All these findings meet diagnostic criteria for Rye's syndrome proposed by the CDC of the USA. Status epilepticus was treated with intravenous infusion of thiamylal sodium. He was treated with hypertonic glucose solution and osmotic diuretic. Three months after the onset of the illness, his convulsions were controlled only with zonisamide, clonazepam, and carbamazepine. He had motor dysfunctions. This case is unique in that a patient with adult Reye's syndrome and status epilepticus favorably recovered.

Adolescent↗