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At least 829 records · Page 46Linked to original sources
PubMed1998

[Augmentation of the neuromuscular blocking effect of mivacurium during inhalation anesthesia with desflurane, sevoflorane and isoflurane in comparison with total intravenous anesthesia].

To evaluate the enhancement of mivacurium-induced neuromuscular block by potent inhalational anaesthetic agents, dose-effect curves for mivacurium were determined in 84 patients scheduled for minor elective surgery during anaesthesia with 1.5 MAC (70% N2O) desflurane, sevoflurane and isoflurane and compared with those under total intravenous anaesthesia (TIVA). Acceleromyography (TOF-Guard) and train of four (TOF) stimulation of the ulnar nerve were used (2 Hz every 12 s). Mivacurium was administered in increments of 25 micrograms kg-1 until a depression of T1 > 95% was reached. ANOVA was used for statistical analysis (alpha = 0.05, beta = 0.2). The depression of T1 during potent inhalational anaesthesia was enhanced compared with TIVA. The ED50 and ED95 of mivacurium were 27 +/- 11 (SD) and 58 +/- 26 micrograms kg-1 for desflurane; 28 +/- 10 and 64 +/- 23 micrograms kg-1 for sevoflurane; and 27 +/- 13 and 55 +/- 27 micrograms kg-1 for isoflurane and were significantly lower than the 35 +/- 7 and 71 +/- 20 micrograms kg-1 for TIVA. The duration 25% revealed a significant difference between the volatile anaesthetic groups (10 +/- 2, 11 +/- 3, 11 +/- 3 min respectively) and the TIVA control group (8 +/- 3 min). The recovery index 25/75 and TOFO.80 were significantly prolonged by desflurane, sevoflurane and isoflurane compared with TIVA (RI25/75 9 +/- 4, 9 +/- 4, 10 +/- 5 respectively vs. 5 +/- 2 min; TOFO.80 27 +/- 10, 28 +/- 9, 29 +/- 9 respectively vs. 18 +/- 4 min). We conclude that the neuromuscular blocking effect of mivacurium is enhanced during anaesthesia with desflurane, isoflurane and sevoflurane compared with TIVA. The duration of action and the recovery time are prolonged. The dose of mivacurium used should be reduced if anaesthesia is maintained with volatile anaesthetics.

Adolescent↗
PubMed2003

Noxious stimuli do not modify myogenic motor evoked potentials by electrical stimulation during anesthesia with propofol-based anesthesia.

PURPOSE: To investigate whether motor evoked potentials (MEP) to transcranial electrical stimulation under constant blood propofol concentration are affected by the arousing effect of surgical noxious stimuli. METHODS: Twenty patients who underwent elective spinal surgery were studied. Patients were anesthetized with 50% nitrous oxide in oxygen, fentanyl, and propofol to maintain the bispectral index (BIS) score around 50. MEP in response to a multipulse transcranial electrical stimulation at stimulus sites of C3-C4 were recorded over the right abductor pollicis brevis muscle. Changes of peak-to-peak amplitude and onset latency of MEP, BIS score before and after surgical stimuli were evaluated. Propofol plasma concentration was measured at the same time points. RESULTS: Both MEP amplitude and latency did not change significantly after surgical stimuli although BIS increased significantly (48 +/- 6 to 58 +/- 5; P < 0.05). Plasma propofol concentration was maintained at the same level between the two measurement points (3.3 +/- 0.7 to 3.3 +/- 0.7 micro g*mL(-1)). There was no relation between BIS change and changes of MEP amplitude and latency, and propofol plasma concentration. CONCLUSION: MEP to the transcranial electrical stimulation under a constant and clinically appropriate blood propofol concentration are not affected by surgical noxious stimuli.

Anesthesia, General↗
PubMed2001

[Latex allergy. Perioperative management in anesthesia and cardiac anesthesia].

The frequency of perioperative allergic responses to latex has markedly increased over the last 10 years. High risk groups to develop sensitivity to latex include healthcare workers, workers in the latex industry, children suffering from congenital malformations such as spina bifida or urogenital deformities and patients who have undergone multiple surgical procedures. During surgery, patients have contact to a variety of products containing latex. To prevent anaphylactic reactions, all hospitals have to develop strategies to identify and manage patients sensitised to latex or belonging to high risk groups. The aim of this paper is to describe safe perioperative management in a latex-free environment.

Anesthesia↗
PubMed2002

[Participation--oriented analysis of the anesthesia workplace. A work system for anesthesia in a multidisciplinary operating room].

INTRODUCTION: The aim of this study was the detection and understanding of weak points in the ergonomic design of anaesthesia workplaces in a multidisciplinary operating room facility. METHODS: Analysis of workplaces and of working processes by means of observations, computer-supported task recording and video-photo documentation. During guided interviews the participants were provided with material for naming-by-pointing and drawing. Subsequently, the background of the problems encountered and possible improvements were visualised. RESULTS: Important deficits were devices not positioned within reach and view, difficulties in operating the lines connecting the patient and the devices, and inconsistent workplace layouts. These were caused by erroneous planning of the facility and disregarding ergonomic principles in equipment design. The initial improvements implemented were the development of a new concept for a flexible equipment positioning and the design of a tool for cable handling. DISCUSSION AND CONCLUSION: Although from the very beginning of the study the anaesthesia personnel quoted the handling of the lines connecting patients and devices as the main cause for working difficulties, the external ergonomist could contribute to a broader view of the problems. The method presented here initiated a mutual learning process between ergonomist and users and resulted in a common understanding of the problems and their causes. Compared to the traditional consulting process, more time and efforts were necessary but were offset by the users' acceptance of the improvements and the prevention of design errors.

Anesthesia↗
PubMed1994

[No inhibition of intestinal motility following ketamine-midazolam anesthesia. A comparison of anesthesia with enflurane and fentanyl/midazolam].

Postoperative intestinal atonia is a complication which is likely to occur in patients predisposed for constipation and in patients after intra-abdominal operations. The postoperative delay of bowel movement, however, is often also related to the type of anaesthesia being used. In order to evaluate the magnitude of an anaesthetic-induced postoperative delay of bowel movement, two types of intravenous-based anaesthesia using fentanyl/midazolam (1 mg/25 mg; dosage 0.1 ml/kg/h), and ketamine/midazolam (250 mg/25 mg; dosage 0.1 ml/kg/h) respectively were compared with a volatile anaesthetic technique (enflurane; mean concentration 1.5 vol%). METHODS. In three groups of patients (each n = 15) undergoing elective surgery of the lower extremities, induction of anaesthesia was accomplished with methohexital (1-1.5 mg/kg) to facilitate intubation. For the maintenance of muscle relaxation vecuronium bromide was used. All patients were given droperidol to prevent postoperative emesis, and they were artificially ventilated with N2O/O2 (60:40) to normal end-expiratory CO2 concentrations. No anticholinergic agents were used at the end of operation since they are known to interfere with bowel motility. In order to determine gastro-intestinal motility, the H2 exhalation test was used. For this purpose 40 g lactulose in 100 ml of water was given to all patients via a gastral tube shortly before extubation. Lactulose is broken down by bacteria once it enters the colon, and H2 is released, taken up by the vascular system and exhaled. Postoperatively, patients were asked to exhale into a 20-ml syringe every 10 min. The content was analysed for hydrogen (ppm), using an electrochemical sensor (GMI exhaled hydrogen monitor). From the time of lactulose instillation to a threefold increase in end-expiratory hydrogen concentration (compared to the preoperative value), gastro-coecal transit time was computed. RESULTS. All three groups of patients were comparable in age, height and body weight. Also, the duration of operation was comparable in all three groups. Mean gastro-coecal transit time was 204 (+/- 19.6, SD) min following enflurane, 302 (+/- 32.8 SD) min following fentanyl/-midazolam and 210 (+/- 28.8 SD) min following ketamine/midazolam anaesthesia. The gastro-intestinal inhibition after the opioid-based anaesthetic technique was significantly prolonged (p < 0.001, Kruskal-Wallis test). There was no significance between patients after ketamine-based anaesthesia and those who had the volatile anaesthetic. DISCUSSION AND CONCLUSION. When using intravenous anaesthesia with an opioid, gastro-intestinal inhibition, especially in patients prone to have constipation, is likely to develop postoperatively. In classical neuroleptanaesthesia and in analgosedation in the ICU, the simultaneous use of the butyrophenone droperidol seems to counteract the inhibition of opioid-related gastrointestinal motility. In cases of opioid-related gastrointestinal atonia a gastrokinetic compound may be necessary to overcome this effect on intestinal motility.

Adult↗