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PubMed1996

[Sevoflurane or halothane in inhalational anesthesia induction in childhood. Anesthesia quality and fluoride level].

UNLABELLED: Due to its low blood:gas partition coefficient (0.69) and its neutral odor, sevoflurane (S) is suitable for inhalational induction of anaesthesia. At the moment halothane (H) is preferentially used for this purpose due to its non-irritating odor and the smoothness of anaesthetic action. However, experience is limited with the use of S in children, and concern exists about potential renal toxicity of its metabolite, i.e. fluoride. Therefore, we compared S and H in an open, randomized phase III trial. MATERIAL AND METHODS: With approval of the ethics committee and written informed parental consent, 40 children (age 1-10, mean 5.3 years, ASA class I and II) had anaesthesia induced without premedication (fresh gas flow 6 l/min, N2O/O2 = 65/35). Concentration of volatile anaesthetics was increased every 3-5 breaths (S: 0.8...3.2 vol%, H: 0.4...1.6 Vol%). The ciliary reflex was tested until it disappeared. Airway reflexes and excitation were quantified using a score. Upon venipuncture, relaxation and intubation, anaesthesia was maintained with S (Fi: 2.4 vol%) or H (Fi: 1.2 vol%) in N2O/O2 (3 l/min, etCO2 35-38 mm HG). Alfentanil was supplemented in repeated doses of 20 micrograms/kg. ECG, NIBP, SpO2, Fi and Fet of CO2 and volatile anaesthetics were continuously recorded. At the end of surgery anaesthetics were terminated abruptly and fresh gas flow was increased to 6 l/min O2. Time to the first purposeful movement was registered. Serum fluoride levels were determined immediately after venipuncture, at the end of surgery and 70 min later. Time to possible discharge from the PACU was quantified using a modified Aldrete score. Data were analysed with descriptive methods, Student's t-test or non-parametric tests as appropriate. RESULTS: Groups did not differ with respect to age, weight, sex, or type of surgery. Total dose of anaesthetics was 1.60 MACxh for S and 1.77 MACxh for H (p = 0.68). Table 6 shows the essential data. Mean arterial blood pressures and heart rate remained within +/- 20% of age-related normal values (Table 7). Mean serum fluoride level was 23.1 +/- 1.2 mumol/l at the end of surgery and decreased to 18.6 +/- 0.970 min later (Fig. 3). CONCLUSIONS: Sevoflurane is an alternative to halothane in pediatric inhalational anaesthesia, with a comparable, low incidence of airway irritation and smoothness of induction. Because of the significantly faster induction and recovery it seems superior to halothane. With the fluoride levels measured, an impairment of renal function is unlikely.

Anesthesia Recovery Period↗
PubMed1996

[Cost aspects in anesthesia. Propofol versus isoflurane anesthesia].

UNLABELLED: Cost control is no longer an option, but a necessity. Propofol anaesthesia is expensive, however, the true differences in comparison to volatile anaesthetics (isoflurane) are not known. METHODS: Sixty patients undergoing either thyroidectomy (n = 30) or laparoscopic cholecystectomy (n = 30) were randomly divided into 3 groups of 20 patients. In group I propofol and fentanyl were used for anaesthesia, in group II isoflurane ('standard' isoflurane anaesthesia), and in group III isoflurane using a low-flow system (fresh gas flow 2 l/min) was given. All patients were ventilated using 70% N2O in oxygen. Vecuronium was used in all cases for muscle relaxation. Isoflurane consumption was measured by weighing the isoflurane vaporizer. RESULTS: Biometric data and time of administration of the anaesthetic were similar in the three groups. Propofol patients stayed significantly shorter than isoflurane patients in the postanaesthesia care unit (PACU). Costs of additional drugs (antiemetics, analgesics) in the PACU were least in the propofol patients. Costs were without differences between the propofol (78.30 DM/patient) and 'standard' isoflurane groups (81.69 DM/patient). Patients in group III showed the lowest overall costs (57.46 DM/patient) (P < 0.05). CONCLUSION: A climate of cost-consciousness and cost-containment prevails at the present time. The costs of propofol and 'standard' isoflurane anaesthesia were without differences; however, isoflurane used in a low-flow system had the lowest cost in this study. Doubts are justified, however, as to whether the choice of anaesthetic agents may considerably lower the costs of an anaesthesia department.

Adult↗
PubMed1997

[Combination anesthesia and bronchial tranport velocity. Effects of anesthesia with isoflurane, fentanyl, vecuronium and oxygen-nitrous oxide breathing on bronchial mucus transport].

UNLABELLED: The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. In general, it is assumed that anaesthetics inhibit mucociliary clearance [3,5,6,19,27]. In the present prospective study the effect of combination anaesthesia with isoflurane, fentanyl, vecuronium, and nitrous oxide-oxygen mixture on bronchial mucus transport velocity (BTV) was investigated. PATIENTS AND METHODS: 10 patients undergoing major abdominal surgery were included in the study. The study was approved by the ethics committee of our hospital. In all patients anaesthesia was induced with propofol (1-2 mg/kg), fentanyl (0.2-0.3 mg/kg) and vecuronium (0.1 mg/kg). After intubation anaesthesia was maintained with 1.5 MAC isoflurane and repeated doses of fentanyl (0.1-0.2 mg) and vecuronium. Ventilation was assisted with a 2:1 mixture of nitrous oxide and oxygen. The BTV was measured preoperatively in the conscious patients one day before surgery while they received local anaesthesia with 10 ml of 1 percent lidocaine and postoperatively while they received intubation anaesthesia. BTV was determined with a small volume of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope [15]. RESULTS: Table 1 provides information about age, application of anaesthetics and duration of mechanical ventilation of the patients. The preoperative and postoperative BTV values showed no significant differences (Fig. 1). CONCLUSIONS: Combination anaesthesia with isoflurane, fentanyl, vecuronium, and O2:N2O does not influence BTV in patients with healthy lungs.

Adult↗
PubMed1997

[Thoracic epidural anesthesia--more than an anesthesia technique].

Thoracic epidural anaesthesia (TEA) faces growing interest as an adjuvant anaesthetic and postoperative analgesic regimen. The procedure allows a specific blockade of nociceptive reflex arches and may exert beneficial effects on stress-induced alterations of organ function. Myocardial blood flow to areas at risk is improved, and paradoxical reactions of atherosclerotic coronary arteries after sympathetic stimulation are suppressed. After cardiac surgery, TEA improved postoperative recovery and resulted in better haemodynamic stability and allowed earlier extubation. During vascular surgery, the graft occlusion rate was significantly decreased. The improved pulmonary function after TEA is due to superior pain relief which allows the patients to breathe and cough sufficiently. After upper abdominal surgery, TEA leads to improved recovery of gastrointestinal function which reduces the risk of bacterial translocation. Although lumbar epidural anaesthesia is preferred by many anaesthesiologists as there is no risk of traumatizing the spinal cord, many positive effects are forgone. With insufficient rostral spread of a lumbar epidural block above the fifth thoracic level, cardiac complications can occur due to reflex activation of sympathetic outflow in unblocked thoracic regions. When the contraindications are carefully observed, TEA can be safely performed in most patients.

Anesthesia, Epidural↗
PubMed1997

[Ambulatory anesthesia practice in a University Hospital Center: what is done; what could be done. Ambulatory Anesthesia Study Group].

OBJECTIVES: To estimate the number and type of patients, who could be managed on a day-care basis in a University Hospital. Cases of ambulatory anaesthesia (AA) which could be managed in optimal conditions and current AA practice. To assess patients' opinion on inpatient or outpatient practices. STUDY DESIGN: Prospective survey over 8 weeks in 21 medical units potentially concerned by ambulatory practice. PATIENTS: Series of 1,396 patients undergoing an operation included in a previously established list of outpatient procedures. METHOD: A questionnaire was completed for each patient, from preoperative anaesthesia consultation until discharge. Thereafter patients were contacted after home discharge by telephone or mail. RESULTS: In the group of the 1,396 selected patients, 301 (22%) were contra-indicated for AA. In optimal conditions AA was indicated in 20% of all patients treated in these units. At the time of the survey there were 285 outpatients (26% of potential AA, 5% of all patients). Complications were uncommon. Ninety-eight percent of them would choose day surgery again. Among the 810 inpatients, 279 responded: 53% would prefer to be an ambulatory patient. CONCLUSION: At the time of this survey only one fourth of the possible oupatients for AA had in fact been treated on a day-case basis. Its development requires an improvement of the structures, team organisation and patients' information.

Adolescent↗