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At least 973 records · Page 54Linked to original sources
PubMed2005

Distorted perception of smell by volatile agents facilitated inhalational induction of anesthesia.

BACKGROUND: Unpleasant smell of halogenated volatile agents is one of the frustrating factors for inhalational induction. We developed a new modification that might enable children to enjoy the smell itself while incrementally elevating sevoflurane concentration. Troposmia is usually a pathological quality change of smell perception and an olfactory stimulus is distortedly perceived in this state, which we applied to inhalational induction. METHODS: At the preoperative visit an anesthetist told the children that the smell of a facemask could be magically changed from strawberry into anything and promised to change the smell as they requested. In the operating room, a strawberry scented facemask was fitted to the face and the anesthetist announced to them that the magical change of the smell would begin when sevoflurane was added. Whether children perceived the change of the smell as they requested was investigated in the troposmia group, and resistance to fit a facemask was compared between the troposmia group and a control group. RESULTS: Significantly fewer children resisted the facemask in the troposmia group (1 of 32 vs 9 of 32; P = 0.0059). In the troposmia group 18, 22 and 25 of the 32 children said the smell of the facemask changed as they requested before they fell asleep, at the postoperative visit or both, respectively. CONCLUSIONS: Troposmia can be intentionally induced to perceive the smell of sevoflurane on request. Troposmia might contribute to promote children's participation in anesthesia induction and facilitate inhalational induction.

Anesthesia, General↗
PubMed2005

Physiological monitoring of small animals during magnetic resonance imaging.

Maintaining a stable physiologic state is essential when studying animal models of epilepsy with simultaneous electroencephalograph (EEG) and functional magnetic resonance imaging (fMRI) or EEG and magnetic resonance spectroscopy (MRS). To achieve and maintain such stability in rats in the MRI environment, a minimally invasive but comprehensive system was developed to monitor body temperature, heart rate, blood pressure, blood oxygen saturation and end-tidal CO2 (ETCO2) of expired gas. All physiologic parameters were successfully monitored in Sprague-Dawley rats without interfering with EEG recordings during simultaneous fMRI and MRS studies. Body temperature, heart rate, blood pressure, blood oxygen saturation, and ETCO2, were maintained between 36.5 and 37.5 degrees C, 250-450 beats/min, 136+/-17 mmHg, >90%, and 20-35 mmHg, respectively for 6-8 h under inhalational anesthesia. This set-up could be extended to study in vivo applications in other laboratory animals with only minor modifications.

Anesthetics, Inhalation↗
PubMedDate not supplied

[Sevoflurane in airway management using fibrobronchoscopy: apropos of 2 difficult orotracheal intubation cases].

We report two cases of difficult orotracheal intubation in which intubation with a fiberoptic bronchoscope was performed after induction with an inhalational anesthetic. Mild inhalational anesthesia with sevoflurane was started fairly rapidly, with no respiratory incidences. The tubes were then inserted through a fiberoptic bronchoscope, with no airway management problems.

Anesthetics, Inhalation↗
PubMed1999

Facial laser resurfacing with the propofol-ketamine technique: room air, spontaneous ventilation (RASV) anesthesia.

BACKGROUND: Multiple anesthetic approaches exist for full-face laser resurfacing. The propofol-ketamine technique is reviewed as a reasonable alternative to providing adequate anesthesia for full-face laser resurfacing in the office environment. OBJECTIVE: To report outcomes using propofol-ketamine opioid avoidance, room air, spontaneous ventilation monitored anesthesia care (MAC). METHOD: A retrospective chart review of 95 consenting adult patients receiving propofol-ketamine anesthesia in a private practice, office-based setting. RESULTS: An average of 6 (200 mg) ampules of propofol, including waste, were used per patient. All patients received adequate anesthesia as evidence by a lack of movement during surgery. There were no hallucinations, no postoperative nausea or vomiting (PONV), no cardiovascular instability or seizures (clinical signs of lidocaine toxicity), and no hospital admissions for either PONV or pain. CONCLUSION: The propofol-ketamine technique appears to be an excellent alternative anesthetic approach to EMLA cream, tranquilizer-opioid regimens, or general inhalational anesthesia for facial laser resurfacing.

Adult↗
PubMed1986

Hypoxemia after general anesthesia in children.

Postoperative hypoxemia has been well documented in adults but not in infants and children, although they are potentially more susceptible to airway closure and to disturbances in pulmonary gas exchange. In a prospective study, we measured arterial oxygen saturation (SaO2) with a pulse oximeter in 97 ASA class I infants and children breathing room air before and after general anesthesia for superficial surgical procedures. Mean preoperative SaO2 was 97.6 +/- 0.15% (SEM). On arrival in the recovery room after anesthesia mean SaO2 in room air had decreased significantly (P less than 0.01) to 93.0 +/- 0.49% (range 100-71%), corresponding to calculated arterial oxygen tension (PaO2) of about 66 mm Hg. The second reading, 5-15 min later, also showed a statistically significant (P less than 0.01) decrease in SaO2 (94.1 +/- 0.35%). There was no statistical difference in SaO2 between patients who received inhalation anesthesia alone and those who were given narcotics. There was also no correlation between postoperative reduction in SaO2 and duration of anesthesia or patient age. Of 67 patients who were asleep on arrival in the recovery room, 47 who remained asleep at the second SaO2 reading had an average increase in SaO2 of less than 1%. In contrast, in those patients who awoke, average SaO2 increased more than 4% during a similar time period--a difference that was statistically significant (P less than 0.02).

Adolescent↗
PubMed1995

Inhaled nitric oxide in anesthesia and critical care medicine.

Inhaled NO is an exciting new drug and has enormous potential in the therapy of a wide variety of acute, and possibly chronic, cardiopulmonary disorders. No reports of controlled, randomized, and blinded trials have been published concerning the use of inhaled NO in any clinical condition. In the United States, use of inhaled NO currently requires an investigational new drug approval from the Food and Drug Administration. Physicians involved in anesthesia and critical care medicine have a unique opportunity to validate a new mode of therapy in acute care, and optimal evaluation should be undertaken so that the real therapeutic role of inhaled NO may be defined.

Administration, Inhalation↗
PubMed1999

[Changes in SpO2 during total intravenous anesthesia combined with propofol and SpO2 during one-lung anesthesia ventilation].

We retrospectively examined SpO2 during one-lung anesthesia (OLA). One hundred and fifty patients of ASA 1 or 2 for thoracoscopic surgery were anesthetized with propofol and fentanyl (n = 93) or pentazocine (n = 57) and mechanically ventilated with FIO2 = 0.6 in the lateral decubitus position. Twelve patients (8%) developed SpO2 < or = 95% in the first 20 minutes of OLA. It has been reported that hypoxemia during OLA occurs in 13-40% of patients under inhalation anesthesia with FIO2 = 1.0. Our results show the total intravenous anesthesia using propofol is useful to maintain SpO2 during OLA. SpO2 during OLA tended to fall in the patients for right side operation, with lower SpO2 during two-lung ventilation and higher body mass index (BMI). However BMI has never been reported as a predictor of hypoxemia during OLA. A gravity-dependent mechanism is considered to be more responsible for the dependent regional volume reduction during OLA in patients in the lateral decubitus position.

Adolescent↗
PubMedDate not supplied

[Doctoral theses and memoirs about anesthesia. Documents for a history of Spanish anesthesia].

Based on the importance of document files and first-hand bibliographic sources for studying the history, we have recently investigated the chapter of Doctoral Thesis and Reports on anesthetic topics since we believe that these are fundamental to gain insight into the knowledge of our history. This investigation was planned to find such documents by reviewing the data of several Spanish archives and libraries. We collected 80 works: 14 Reports and 66 Doctoral Theses performed during a period of 95 years (heuristic limits 1847-1942). These papers were classified in several subgroups according to the subjects they deal with: 21 works on inhalation anesthesia, 7 on intravenous general anesthesia, 20 on spinal anesthesia, 10 on locoregional, 7 on anesthesia and metabolism, 12 on obstetric anesthesia, and 3 works on varied anesthesia issues. Analysis of these documents revealed that the authors (physicians and Spanish medical corporations) undertook an accurate consideration of the more relevant scientific subjects at the time of their investigation. We conclude that the works analyzed in the present study represented the beginning of the Spanish investigation on anesthesia. Further investigations may contribute to enrich our historiography.

Academic Dissertations as Topic↗
PubMed2005

The effect of using different values for the effect-site equilibrium half-time on the prediction of effect-site sevoflurane concentration: a simulation study.

UNLABELLED: We have developed a predictive display that allows effect-site concentration (Ceff) to be used as a target for administration of inhaled anesthesia. Ceff is dependent on the half-time for plasma effect-site equilibrium [t 1/2 1/2(ke0)]. The t 1/2(ke0) used in the predictive display is fixed and may differ from that in the patient. We wished to explore the effect of this difference on predictions of Ceff. In a computer simulation, fresh gas flow and vaporizer settings required to achieve a predefined time profile for Ceff were determined for t 1/2(ke0) of 2.5, 3.5, and 5 min. The end-tidal values for each simulation were used to recalculate Ceff with each t 1/2(ke0). The maximal deviation at predetermined points, measures of global fit, and the delay in "recovery" were calculated. With a predictive display t 1/2(ke0) of 3.5 min, the maximal error in Ceff was 0.18 vol%, occurring during the wash-in phase and disappearing within 2-3 min. The difference in time for Ceff to decrease from 1.0 to 0.7 vol% was 1.3 min. Results with a display t 1/2(ke0) of 2.5 min or 5 min and simulated patient t 1/2(ke0) of 5 min or 2.5 min were approximately twice as large. These results suggest that Ceff is relatively insensitive to large (50%-100%) variations in t 1/2(ke0). IMPLICATIONS: A model-based predictive display to guide effect site targeting of volatile anesthesia is described. The effect of using different values for the rate of transfer of sevoflurane between central and effect site compartments is explored. The results suggest effect site concentration is relatively insensitive to 50-100% variations in half-time for plasma effect-site equilibrium.

Anesthetics, Inhalation↗
PubMed2005

The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children.

BACKGROUND: Laryngospasm is a well-known problem typically occurring immediately following tracheal extubation. Propofol is known to inhibit airway reflexes. In this study, we sought to assess whether the empiric use of a subhypnotic dose of propofol prior to emergence will decrease the occurrence of laryngospasm following extubation in children. METHODS: After approval from the Institutional Ethics Committee and informed parental consent, we enrolled 120 children ASA physical status I and II, aged 3-14 years who were scheduled to undergo elective tonsillectomy with or without adenoidectomy under standard general anesthesia. Before extubation, the patients were randomized and received in a blinded fashion either propofol 0.5 mg.kg(-1) or saline (control) intravenously. Tracheal extubation was performed 60 s after administration of study drug, when the child was breathing regularly and reacting to the tracheal tube. RESULTS: Laryngospasm was seen in 20% (n = 12) of the 60 children in the control group and in only 6.6% (n = 4) of 60 children in the propofol group (P < 0.05). CONCLUSIONS: During emergence from inhalational anesthesia, propofol in a subhypnotic dose (0.5 mg.kg(-1)) decreases the likelihood of laryngospasm upon tracheal extubation in children undergoing tonsillectomy with or without adenoidectomy.

Adenoidectomy↗
PubMed2006

Severe bronchospasm during laryngeal mask airway placement in an infant.

A 35-day-old male infant was scheduled for bilateral inguinal herniorrhaphy. No history of recent upper airway infection or other reactive respiratory disease was noted before anesthesia. Breath holding was noted immediately after laryngeal mask airway (LMA) insertion. Removal of the LMA and positive pressure ventilation via face mask did not solve the problem. On suspicion of laryngospasm, tracheal intubation facilitated by muscule relaxant was performed. However, when the patient was ventilated, high airway pressure, absence of chest wall movement and elevated end-tidal CO2 were noted. Despite visual confirmation of correct placement of tracheal tube, oxygen desaturation and bradycardia developed rapidly. After deepening the inhalational anesthesia of sevoflurane and concomitant administration of intravenous lidocaine, the patient's respiratory condition turned for the better and became compliable. Respiratory dysfunction may be caused by severe bronchospasm induced by placement of the LMA. The pathophysiology and risk factors of bronchospasm related to the LMA placement are discussed in the text.

Bronchial Spasm↗
PubMed1996

Physiology of respiratory system related to anesthesia.

All inhalational anesthetic agents depress respiratory function. They also depend largely on the respiratory system to facilitate an induction and emergence from anesthesia. The other anesthetic agents, such as intravenous agents, also depress respiration. Much of the morbidity and mortality that occurs in the perioperative period can be attributed to an alteration in lung mechanics and dysfunctions in airway dynamics. In fact, it is postulated that 70% to 80% of the morbidity and mortality occurring in the perioperative period is associated with some form of respiratory dysfunction. Consequently, a detailed discussion of the many facets of respiratory anatomy and physiology will be presented. If the CRNA incorporates this information into anesthesia practice, care of the surgical patient will be enhanced.

Anesthesia, Inhalation↗
PubMed1980

Pulsatile cardiopulmonary bypass: failure to influence hemodynamics or hormones.

In a randomized trial of pulsatile vs nonpulsatile cardiopulmonary bypass for coronary artery surgery, we studied hemodynamic and hormonal responses. Anesthesia did not produce a response but, from the time of the incision, cortisol and antidiuretic hormone levels and plasma renin activity all increased. Cortisol levels continued to rise after surgery, whereas the other began to fall. Systemic vascular resistance fell dramatically during cardiopulmonary bypass but rapidly rose after bypass with a reciprocal change in cardiac index. We did not see the changes ascribed to nonpulsatile bypass by others. There ws no difference between our pulsatile and nonpulsatile cases. High-flow cardiopulmonary bypass, vasodilating inhalation anesthesia and continuation of Inderal therapy may account for our results.

Body Temperature↗
PubMed1989

Does choice of anesthetic agent significantly affect outcome after coronary artery surgery?

A prospective study of 1094 consecutive adult patients undergoing coronary revascularization was undertaken to determine the effect of anesthetic technique on outcome. Patients received one of five primary techniques: high-dose fentanyl (greater than 50 micrograms/kg), moderate-dose fentanyl (less than 50 micrograms/kg), sufentanil (3-8 micrograms/kg), diazepam (0.4-1 mg/kg) with ketamine (3-6 mg/kg) or halothane (0.5-2.5% inspired concentration after thiopental induction). Supplemental inhalation anesthesia (enflurane, halothane, or isoflurane) was used in 60% of cases where the primary technique was intravenous based. Patients in the above anesthetic groupings had similar perioperative demographic and risk classifications. The overall incidence of postoperative myocardial infarction, postoperative low cardiac output state, and in-hospital death were 4.1, 5.6, and 3.1%, respectively. There were no significant differences in the incidence of these occurrences or in the incidence of serious pulmonary, renal, or neurologic morbidity or length of ICU stay among primary anesthetic techniques nor among supplemental inhalation agent groups. Multivariate discriminant analysis of this data suggests that a multitude of factors are significantly more important than anesthetic technique as determinants of outcome after coronary artery surgery.

Adult↗
PubMed1998

The development of a new mouse model of global ischemia: focus on the relationships between ischemia duration, anesthesia, cerebral vasculature, and neuronal injury following global ischemia in mice.

A new model for mouse global ischemia is presented, and the relationship of ischemia duration, cerebral vasculature, and ischemic neuronal injury has been determined. CD-1 mice anesthetized by chloral hydrate were subjected to global ischemia by bilateral common carotid artery occlusion under controlled ventilation for 3, 5, and 10 min. After evaluating the patency of the posterior communicating artery (PcomA) as hypoplastic or normoplastic, neuronal injury was independently determined in the striatum, cortex, and hippocampus in each hemisphere. Ischemic injury was strongly correlated with not only ischemia duration, but also with the patency of the PcomAs. Furthermore, neuronal injury developed in a delayed fashion after 3-min ischemia, while it was maximized at 24 h after 10-min ischemia. Physiological studies showed the induction of slight hypotension as compared with inhalation anesthesia, and improvement of blood gas data relative to spontaneous respiration. These data demonstrate the usefulness of this method to induce selective vulnerability and delayed neuronal cell death in mice, and to provide a useful model to study the detailed mechanism of global ischemia using transgenic or knockout mutant mice.

Anesthesia↗