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PubMedDate not supplied

The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary.

Anesthesia, General↗
PubMedDate not supplied

[Treatment of acute ischemia of the hand].

Among numerous non-traumatic vascular disorders of the hand, only embolism and arterial thrombosis present acute characteristics, exceptional cases of extensive and sudden venous thrombosis apart. These signs are neurological and indicate extreme clinical urgency. Paresis and anesthesia indicate direct arterial surgery, embolectomy, thrombectomy, reconstruction by grafting or prosthesis. When ischemia affects only part of the hand, anticoagulant and vasodilative treatment is often sufficient and upper thoracic sympathectomy is unnecessary.

Acute Disease↗
PubMed1979

Halothane anesthesia in calves.

Because of the calf's popularity as an experimental animal and its often noted sensitivity to anesthetics and anesthesia, the potency of halothane was studied in eight, young (x = 5.85 weeks), healthy, male Holstein-Friesian calves. The minimal alveolar halothane-O2 concentration (MAC) which just prevented calf movement in response to a tail clamp was 0.76 +/- SEM 0.03 vol% and is less than predictions based on studies in man. The addition of 50% N2O to inspired gases decreased the halothane MAC to 0.59 +/- 0.03%. In the absence of common modifying factors of anesthesia, halothane-O2 caused cardiopulmonary depression in these calves in proportion to anesthetic dose. Only two (total protein and albumin) of 17 selected blood clinical biochemical values were significantly (P less than 0.05) altered from base line within seven days of anesthesia, indicating insults to major organ systems did not occur.

Anesthesia, Inhalation↗
PubMed1980

Serum inorganic fluoride and renal function in dogs after methoxyflurane anesthesia, tetracycline treatment, and surgical manipulation.

Effects of 2 hours of methoxyflurane-induced anesthesia in 25 dogs were determined by serum inorganic fluoride, serum urea nitrogen, serum creatinine, water intake, urine excretion, and urine specific gravity measurements; arterial concentrations of the anesthetic were also determined. The dogs were allotted to 5 groups (PTM, CTM, PTML, CTML, ML) of 5 dogs in each group and were anesthetized (M, in group designations) for 2 hours. The dogs were injected with chemically pure tetracycline or commercial tetracycline (PT and CT, in group designations) before, on the day of, and after anesthesia. In 3 groups, laparotomy (L, in group designations) was done; group ML did not receive tetracycline but a laparotomy was performed. Serum inorganic fluoride increased (P less than 0.05) in all groups 24 hours after anesthesia when compared with the base-line values; the highest mean serum concentration was 81.1 +/- 7.91 mumol/L (group PTM) and the lowest was 32.7 +/- 4.53 mumol/L (group PTML). There was no difference (P greater than 0.05) seen in serum urea nitrogen concentrations between groups. Methoxyflurane and tetracycline treatment caused no difference (P greater than 0.05) on serum concentrations of inorganic fluoride and urea nitrogen. Serum creatinine concentrations differed (P less than 0.05) only for groups PTM, CTM, PTML, and CTML vs group ML. Water intake reached peak at 48 hours after anesthesia. Arterial concentrations of methoxyflurane determined at 60 and 120 minutes of anesthesia indicated no difference (P greater than 0.05) among groups. Neither clinical nor laboratory signs of severe kidney dysfunction were detected in any of the experimental dogs during a 5-day observation period after anesthesia.

Anesthesia, Inhalation↗
PubMed1980

[A review technique: the interscalene brachial plexus block in orthopedic surgery (author's transl)].

The paper is dedicated to the description of a technique now new but also not very used, of regional anesthesia, indicated for surgery of upper limbs: the interscalene brachial plexus block. In Author's experience this type of anesthesia has many indications, related especially to orthopedic and traumatologic surgery, in patients with high anesthesiologic danger. This type of regional anesthesia by interscalene technique is, in Author's opinion, much better than the axillar technique, now moore frequently used.

Adolescent↗
PubMedDate not supplied

Analysis of heart rate dynamics as a measure of autonomic tone in obstetrical patients undergoing epidural or spinal anesthesia.

BACKGROUND AND OBJECTIVES: The purpose of this study is to determine if spectral analysis of beat-to-beat heart rate variability will provide important data on autonomic nervous system function during either spinal or epidural anesthesia that is not apparent from the monitoring of mean heart rate and blood pressure. METHODS: Twelve ASA I patients presenting for elective cesarean delivery (7 epidural and 5 spinal anesthetics) were prospectively selected for study. Control and postblock 10-minute segments of instantaneous heart rates were analyzed for each patient. The total spectral power (Ps, 0.02-0.5 Hz), low frequency spectral power (PLF, 0.02-0.12 Hz), and high frequency spectral power (PHF, 0.12-0.5 Hz) were calculated for each data segment. The complexity of the heart rate time series was estimated by calculating the approximate entropy. RESULTS: Neither spinal or epidural anesthesia had any effect on heart rate or blood pressure. Both spinal and epidural anesthesia did produce a significant decrease in PS, PLF, and PHF. Although there were significant decreases in both the PLF and PHF, there was no change in the PLF/PHF ratio. There was a significant reduction in approximate entropy with spinal and epidural anesthesia, indicating a decrease in complexity of the heart rate dynamics. CONCLUSIONS: These data suggest that autonomic tone decreased with spinal and epidural anesthesia but the sympathetic-parasympathetic balance (expressed as PLF/PHF) did not change. Spectral measures, as well as approximate entropy, provide an independent evaluation of the integrity of the autonomic nervous system and cardiovascular control mechanisms that cannot be discerned from mean heart rate and blood pressure.

Adult↗
PubMedDate not supplied

Management of cervical disk syndrome utilizing manipulation under anesthesia.

Although there is an abundance of material in the literature regarding manipulation under anesthesia for the lumbar spine, there is little concerning the cervical spine. This article discusses a case of traumatically induced cervical disk syndrome accompanied by degenerative disk and joint disease that resolved after a series of manipulations to the cervical spine under anesthesia. Indications for the procedure are presented as well as a description of the procedure.

Adult↗
PubMed1996

[Carotid endarterectomy without angiography].

Duplex scanning has emerged as an accurate noninvasive method of evaluating patients with extracranial cerebrovascular disease; it has research, clinical and economic implications. The risks associated with cerebral angiography are numerous and well-known. During 1990-1995, 227 carotid endarterectomies (CEA) were performed without preoperative arteriography in 192 patients. 91% were performed under local anesthesia. Indications for surgery without angiography were: renal insufficiency (in 5), allergy to contrast material (11), and need for urgent surgery (25). In 81% CEA was performed due to the preference of both the neurologist and surgeon. In only 2 cases there was a discrepancy in duplex evaluation. 3 patients had postoperative strokes (total stroke rate 1.56%), only 1 of which was disabling (0.52%). 2 died during the immediate postoperative period (mortality 1.04%): 1 on the 2nd postoperative day due to asphyxia caused by a huge neck hematoma which appeared suddenly after discharge (related death, 0.52%); the other died several days after coronary surgery which followed CEA (unrelated death). Our study confirms that patients with well-defined symptoms, appropriate physical findings, and concurrent CT and duplex scans, can safely undergo CEA without preoperative angiography. It is extremely important however, that the duplex scan be a reliable study from a laboratory which has validated its results by sequential comparison of previous duplex and angiographic data. Angiography remains appropriate in patients with atypical symptoms; with conflicting findings between history, physical and duplex data; when there is proximal disease; or in an asymptomatic patient when the duplex scan suggests total occlusion.

Aged↗
PubMed1997

Evaluation of five agents/methods for anesthesia of neonatal rats.

Although neonatal altricial rodents are frequently used in experimental projects in which they must undergo survival surgical procedures, there are few published guidelines for anesthetizing them. Many of the drugs and methods that are commonly used to anesthetize newborn rodents provide inadequate anesthesia or are associated with problems, such as excessively high mortality. A two-part study was undertaken with the intention of identifying agents or methods that can be used to provide humane, safe, and effective anesthesia for neonatal rats. In part I, 1- to 3-day-old rat pups were anesthetized with methoxyflurane or one of several injectable agents, or by induction of hypothermia (immersion in ice water). Times to loss of the righting reflex, surgical anesthesia (indicated by loss of the pedal reflex and failure to respond to a skin incision), and recovery of the righting reflex were measured, and heart rate, respiratory rate, and oxygen saturation were monitored. Ketamine (100 mg/kg of body weight, i.p.), pentobarbital (30 to 40 mg/kg, i.p.), and fentanyl-droperidol combination (0.16 mg of fentanyl and 8.0 micrograms of droperidol/g, i.p.) proved unsafe (> 50% mortality) and/or ineffective at inducing short-term surgical anesthesia. In contrast, methoxyflurane and hypothermia were safe and effective. On the basis of subjective observations that they struggled and vocalized less, pups placed in protective latex sleeves prior to immersion in ice water appeared to be less distressed than pups immersed unprotected. In part II of the study, it was possible to safely maintain 1- to 3-day-old pups at a surgical plane of anesthesia for 30 min with either methoxyflurane or hypothermia. Supplementation with pentobarbital (20 mg/kg, i.p.) offered no advantages but significantly prolonged time to recovery. Surviving pups in both studies grew at similar rates during the month after testing. It was concluded that methoxyflurane or hypothermia are good choices for short- or long-term anesthesia of neonatal rats, and that use of a protective sleeve appears to reduce distress associated with induction of profound hypothermia.

Anesthesia, General↗
PubMed1998

Laser treatment of large cavernous hemangiomas of the penis.

PURPOSE: Cavernous hemangiomas of the penis are rare benign tumors commonly excised for cosmesis and bleeding. Reports of laser treatment of these lesions with the patient under local anesthesia indicate good functional and cosmetic results. We report our experience with 4 cavernous hemangiomas treated with the neodymium:YAG laser. MATERIALS AND METHODS: Four patients, 8, 16, 31 and 50 years old, had a total of 8 hemangiomas, which were treated with the neodymium:YAG laser at 5 to 15 watts of power for 3-second pulse durations. RESULTS: All patients had excellent cosmetic and functional results. These treatments were done with essentially no blood loss, on an outpatient basis and without complications. CONCLUSIONS: The treatment of choice for hemangiomas of the penis in the pediatric and adult population is neodymium:YAG laser coagulation.

Adolescent↗
PubMed1983

Opinion: [on anesthesia for outpatient female sterilization].

In actual practice, the choice of anesthesia is more likely to be decided by the personal preference of the surgeon or anesthesiologist rather than by considerations of safety. Most gynecologists in the US and Canada, working in hospitals or surgicenters, choose general anesthesia becaused skilled anesthetists are available, and it is easier for them to operate if their patients are asleep. Most anesthesiologists prefer it that way also, since their services are being fully utilized. During residency training, gynecologists need the benefit of general anesthesia to learn surgical techniques. Because they learned that way, it is the course of least resistance for them to continue to favor general anesthesia. Thus hundreds of thousands of general anesthetics are given each year to suit the convenience and skills of the gynecologist. But minilaparotomy or laparoscopy may be performed with fewer potential complications under local anesthesia, provided the patient receives proper counseling and supportive care, and provided the gynecologist's surgical technique is gentle and precise. Unfortunately, most residency programs do not provide training in such techniques, so they are learned, if at all, during practice years.

Anesthesia↗