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At least 973 records · Page 54Linked to original sources
PubMed1998

An open, randomized comparison of alfentanil, remifentanil and alfentanil followed by remifentanil in anaesthesia for craniotomy.

We studied 52 adults undergoing elective craniotomy, allocated randomly to one of three opioid treatments: alfentanil 50 micrograms kg-1 followed by 0.833 microgram kg-1 min-1 until dural closure (group Alf.); alfentanil 50 micrograms kg-1 followed by 0.833 microgram kg-1 min-1 for 2 h, then remifentanil 0.25 microgram kg-1 min-1 (group Alf.-Remi.); or remifentanil 1 microgram kg-1 followed by 0.5 microgram kg-1 min-1 reducing to 0.25 microgram kg-1 min-1 after craniotomy (group Remi.). Anaesthesia was maintained with infusion of propofol and 66% nitrous oxide in oxygen. Infusions of propofol and remifentanil were stopped at head bandaging. Group Remi. had the least intraoperative haemodynamic responses and group Alf. the most (P < 0.05). Times to tracheal extubation and obey commands were similar in all groups. In all patients in group Alf.-Remi. and group Remi., the trachea was extubated 27 min from the end of anaesthesia; three patients in group Alf. were slower to recover. Use of analgesia in the recovery room and time to transfer to the neurosurgical unit were similar in the three groups.

Adult↗
PubMed1990

Metoclopramide reduces the incidence of vomiting following strabismus surgery in children.

This randomized, double-blind study evaluated the efficacy of metoclopramide administered at the completion of surgery as an antiemetic agent in pediatric patients undergoing ambulatory strabismus surgery; 126 unpremedicated ASA Physical Status 1 and 2 children ranging in age from 2 to 18 yr served as subjects. All received general anesthesia with halothane, N2O, and O2; tracheal intubation was facilitated with intravenous (iv) atracurium 0.5 mg/kg. Intravenous atropine 0.02 mg/kg and lactated Ringer's solution with 5% dextrose equivalent to 4 h of maintenance fluids were administered during surgery. Neither opioids nor droperidol were given intraoperatively. At the completion of surgery, residual muscle paralysis was reversed with atropine 0.02 mg/kg (maximum dose 1.0 mg) and neostigmine 0.07 mg/kg (maximum dose 5.0 mg), and the stomach was decompressed prior to tracheal extubation. After the patient had been transferred to the postanesthesia recovery room (PARR) either metoclopramide 0.15 mg/kg or normal saline was administered intravenously to the children over a 1-min period. A research associate monitored the children for the incidence of post-operative vomiting and the time required for each child to meet discharge criteria from Short Stay Recovery Unit (SSRU). If a child vomited more than three times in both the PARR and SSRU, the vomiting was construed to be severe and the patient was offered further antiemetic treatment with iv droperidol 70 micrograms/kg. The incidence of postoperative vomiting in the metoclopramide group was 37% versus 59% in the placebo group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2007

Prevention of hypothermia in children under combined epidural and general anesthesia: a comparison between upper- and lower-body warming.

BACKGROUND: Children receiving combined epidural and general anesthesia may be at greater risk of hypothermia. Active warming should be undertaken to combat heat loss. With combined epidural and general anesthesia heat loss from the lower body may be greater than from the upper body because of shift of blood towards the vasodilated lower body. We assumed that application of the warming blanket to the lower body might provide better protection against hypothermia. To test this hypothesis, lower-body warming (LBW) was compared with upper-body warming (UBW) in a randomized comparative study. METHODS: Children subjected to open urologic surgery under combined epidural and general anesthesia were randomly allocated to either UBW n = 38 or LBW n = 35 using a forced-air warming blanket. Core and peripheral skin temperatures were monitored. Temperature gradients between forearm and fingertip during LBW and between leg and toe during UBW were calculated. The warmer was set at 32 degrees C, room temperature was around 22 degrees C and fluids were infused at ambient room temperature. RESULTS: The changes in core temperature were comparable and parallel in both groups. Core temperature decreased significantly in each group at 1 h after induction compared with basal values. Temperature gradients at forearm-fingertip and at leg-toe were also comparable in both groups. Recovery was uneventful and no patient shivered in the recovery room. CONCLUSIONS: Lower body warming is as effective as UBW in prevention of hypothermia in children subjected to combined epidural and general anesthesia.

Adolescent↗
PubMed1999

[The value of music in postoperative care].

During the immediate postoperative period good monitoring, adequate analgesia and competent, comprehensive care are of paramount importance. The effect of music in the recovery room raised my interest as an additional "instrumentarium". It is my intent to motivate to take advantage of the many-fold uses of music in the postoperative phase.

Anesthesia Recovery Period↗
PubMed1990

Low-dose sufentanil in major surgery.

The purpose of this study was to assess the efficacy of sufentanil 1 micrograms.kg-1 during N2O-O2 and intermittent isoflurane anaesthesia in major non-cardiac surgery. Thirty-one patients (18 females, 13 males; mean age 47 yr), undergoing cholecystectomy received a 1 microgram.kg-1 bolus of sufentanil before the induction of anaesthesia with thiopentone. On average, three sufentanil increments were administered, to a total (bolus + maintenance) dose of 1.5 micrograms.kg-1. Cardiovascular stability was not achieved in eleven patients who then were given isoflurane. The arterial pressure decreased after sufentanil (P less than 0.05), reaching a nadir (mean 108/65 mmHg, heart rate 63 bpm) at one minute post-incision. Clinically important hypertension or hypotension did not occur in any patient. One patient, receiving beta-blocker therapy, required atropine to control bradycardia. Postoperative respiratory depression did not occur in patients who received less than one micrograms.kg-1.hr-1 with the last increment being given more than 20 minutes before the end of anaesthesia. Slight respiratory depression in the recovery room was reported in one patient, who had received a total of 1.3 micrograms.kg-1.hr-1 of sufentanil, and the last sufentanil increment 24 min before the end of surgery. The most frequently reported side-effects were nausea (35 per cent) and vomiting (23 per cent). Induction, maintenance and recovery from anaesthesia were rated as "good" in 87, 87, and 74 per cent of the cases, respectively, and "satisfactory" in the remainder. We conclude that this technique is valuable to assure good protection of the cardiovascular system without undue respiratory depression during recovery.

Adolescent↗
PubMed1991

Respiratory problems in emergence from anesthesia.

In conclusion, anesthesia and mechanical ventilation have major effects on respiratory function, both intraoperatively and postoperatively. Recognition that mechanical ventilation represents a major departure from spontaneous ventilation should enable anesthesiologists to compensate for the increases in dead space ventilation and the propensity for alveolar collapse that accompany low volume mechanical ventilation. The use of postoperative regional analgesic techniques to alleviate respiratory compromise constitutes both current clinical practice and an area of active, ongoing investigation. Gone are the days when the anesthesiologist's responsibility stopped at the recovery room door. Today, anesthesiologists with expertise in postoperative pain management, cardiovascular physiology, and intensive ventilatory care are able to provide patients an improved likelihood of avoiding postoperative respiratory complications.

Anesthesia Recovery Period↗
PubMed2005

[Negative pressure pulmonary edema. Post-obstructive lung edema after use of a laryngeal mask].

A 31-year-old male patient was scheduled for surgical treatment of a distal radius fracture under general anaesthesia using a laryngeal mask airway and spontaneous ventilation. The intraoperative course was uneventful. During recovery, the patient strongly bit the laryngeal mask, producing a complete obstruction of the artificial airway in combination with very forceful inspiratory efforts until the mask was removed. In the recovery room the patient developed dyspnea and desaturation. A portable chest radiograph demonstrated bilateral alveolar infiltration suggesting pulmonary edema. The patient was transferred to the intensive care unit where drug therapy (furosemide and hydrocortisone) and treatment with the continuous flow continuous positive airway pressure (CF-CPAP) system led to complete recovery within 24 h.

Adult↗
PubMed2004

Preoperative intravenous midazolam: benefits beyond anxiolysis.

STUDY OBJECTIVE: To evaluate the effect of midazolam on the global perioperative experience, including patient satisfaction, postoperative nausea and vomiting, postoperative pain, and perioperative anxiety and amnesia. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Ambulatory surgical center affiliated with a tertiary-care hospital. PATIENTS: 88 ASA physical status I, II, and III patients scheduled for outpatient surgery. INTERVENTIONS: Patients were randomized into two groups to receive either 0.04 mg/kg of midazolam or placebo intravenously (IV) 20 minutes preoperatively. MEASUREMENTS: Perioperative measurements included blood pressure, heart rate, and oxygen saturation and the patient's level of anxiety; type of anesthetic administered; the anesthesiologist's guess at the treatment arm; perioperative dosages of fentanyl, morphine, and ondansetron; recovery room length of stay; frequency of nausea and vomiting, and level of postoperative pain in the 24 hours after surgery; the patient's overall satisfaction with the anesthetic, and whether the patient would recommend the premedication to a friend. MAIN RESULTS: Patient demographics, type of surgery/anesthesia, vital signs, case duration, recovery duration, and postoperative pain were all similar between the midazolam and placebo groups. As expected, IV midazolam was an effective anxiolytic. There was no evidence of retrograde amnesia. Fewer patients in the midazolam group suffered from postoperative nausea than did those in the placebo group (25%vs. 50%;p = 0.03), despite receiving similar perioperative antiemetic and opioid administration. Similarly, fewer patients in the midazolam group experienced postoperative vomiting than placebo group patients (8%vs. 21%), although this difference did not reach statistical significance. Only 42% of patients in the placebo group would recommend their premedication to a friend, compared with 85% of patients in the midazolam group (p < 0.001). CONCLUSIONS: In addition to the known anxiolytic effects of midazolam, midazolam premedication is an effective way to reduce the frequency of postoperative nausea, and perhaps vomiting, and increase patient satisfaction.

Adolescent↗
PubMed1998

General anaesthesia for surgery can influence circulating melatonin during daylight hours.

BACKGROUND: Both melatonin and anaesthetics have been shown to affect sleep and behaviour. The effect of general anaesthesia on circulatory melatonin has not been reported, but anaesthetic-related alterations in hormone profiles are known. We hypothesize that differences in recovery from anaesthesia may be associated with differences in circulatory melatonin levels because of melatonin's sedative effect in humans. METHODS: The influences of general anaesthesia and surgery on circulating melatonin, prolactin, and cortisol concentration were investigated in 32 female patients scheduled for elective gynaecological surgery to study differences in hormone profiles and responses during anaesthesia and the recovery period. Patients were randomly assigned to one of two groups. General anaesthesia was induced with either thiopentone/fentanyl (Group 1: n = 16) or propofol/fentanyl (Group 2: n = 16). Maintenance of anaesthesia was achieved with either isoflurane (0.8-1.0 vol%)/fentanyl (Group 1) or propofol (6 mg.kg-1.h-1)/fentanyl (Group 2) with a N2O/O2 flow ratio of 2:1 in both groups. During anaesthesia, patients' eyes were carefully taped shut to prevent light effects. Blood samples were taken before and after premedication, immediately before induction of anaesthesia, every 15 min during anaesthesia, and hourly in the recovery room for 8 h. The control group consisted of 6 healthy women who were not subjected to surgery, but who were in a similar environment, including light conditions, as the study groups. RESULTS: Isoflurane and propofol anaesthesia as well as darkness elicited elevated plasma melatonin levels that persisted in the recovery period in patients anaesthetized with isoflurane, but gradually decreased during the recovery of patients anaesthetized with propofol. Circulating prolactin and cortisol values were also elevated during anaesthesia and had similar decreases during the recovery period. CONCLUSION: Higher plasma levels of melatonin during the recovery period following isoflurane anaesthesia may, in part, explain increased sedation in these patients compared with patients who received propofol anaesthesia. However, the relationship between recovery from anaesthesia and plasma melatonin levels may not be simple and straightforward.

Adult↗
PubMed2005

For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia.

BACKGROUND: Both general and nerve block anesthesia are effective for shoulder surgery. For outpatient surgery, it is important to determine which technique provides more efficient recovery. The authors' goal was to compare nerve block with general anesthesia with respect to recovery profile and patient satisfaction after rotator cuff surgery. METHODS: In this clinical trial, 50 consenting outpatients (aged 18-70 yr) were randomly assigned to receive either fast-track general anesthesia followed by bupivacaine (0.25%) wound infiltration or interscalene brachial plexus block (0.75% ropivacaine), each under standardized protocols. Blinded recovery room nurses assessed the need for pain treatment and rated patient eligibility for bypass of the phase 1 postanesthesia care unit and for discharge home. Patients were followed up for 2 weeks postoperatively. The primary outcome measures were postanesthesia care unit bypass and same-day discharge. Other same-day recovery outcomes included severity of and treatment for pain and time to ambulation. Postoperative outcomes at home included satisfaction with the anesthesia technique and absence of complications (at 2 weeks). RESULTS: Patients who received nerve block (vs. general anesthesia) bypassed the postanesthesia care unit more frequently (76 vs. 16%; P < 0.001), reported less pain, ambulated earlier, were ready for home discharge sooner (123 vs. 286 min; P < 0.001), had no unplanned hospital admissions (vs. 4 of 25 patients who underwent general anesthesia; P = 0.05), and were more satisfied with their care. No complications were reported in either treatment group. CONCLUSIONS: Nerve block anesthesia for outpatient rotator cuff surgery provides several same-day recovery advantages over general anesthesia.

Adolescent↗
PubMed1992

Double-blind comparison of patient recovery after induction with propofol or thiopentone for day-case relaxant general anaesthesia.

Postoperative recovery after induction with either propofol or thiopentone has been compared in forty ASA I unpremedicated day surgery patients undergoing surgical extraction of third molar teeth under relaxant general anaesthesia. Mean recovery times in the propofol group, required for patients to sit out of bed (44.8 minutes; SD 18.6) and meet discharge criteria (113.1 minutes; SD 34.5) were significantly (P less than 0.05) shorter than those in the thiopentone group (59.7 minutes; SD 21.4 and 133.5 minutes; SD 34.5). Fewer patients in the propofol group were treated in the recovery room for nausea and vomiting and the incidence of mild nausea not requiring treatment was less in the propofol group, but these differences were not statistically significant. Postoperative mental performance, measured by the FAST index, a new test of mental speed, was reduced on average by 1.7% of preoperative levels, during the recovery period tested, with no significant difference between the groups.

Adult↗
PubMed1996

Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique.

We have compared, in a randomized study in 26 patients, immediate and late postoperative recovery after elective laparoscopic cholecystectomy using the gasless, mechanical abdominal wall lift method with conventional carbon dioxide pneumoperitoneum. After the gasless method, tracheal extubation was performed significantly earlier than after the conventional method (P < 0.01). End-tidal carbon dioxide concentrations were significantly higher after pneumoperitoneum for 30 min after operation (P < 0.01). In the conventional group, deviation in Maddox-Wing recordings from preoperative values remained at a significantly higher level during the 3-h recovery room period (P < 0.01). There was a positive correlation between the total amount of carbon dioxide used and duration of drowsiness (r = 0.61, P < 0.001) and the Maddox-Wing deviation (r = 0.62, P < 0.001). Postoperative nausea and vomiting, and right shoulder pain occurred less often after the gasless method (P < 0.05). Late recovery criteria (ability to drink, void and walk) in patients in the gasless group were fulfilled approximately 7 h earlier than in those in the pneumoperitoneum group (P < 0.01). Gasless laparoscopic cholecystectomy resulted in more uneventful and faster immediate and late postoperative recovery than conventional carbon dioxide pneumoperitoneum.

Adult↗
PubMedDate not supplied

[Arterial oxygen desaturation during transport of the post-surgery patient from operation site to recovery ward].

BACKGROUND: One of the most frequent complications in the immediate post-operation period is the fall in arterial oxygen saturation due to different factors, outstanding of which is the time that the patient remains disconnected from the oxygen supply during transport from the operation site to the recovery ward. The aim of the present paper is to measure the proportion of arterial desaturation in patients who arrive in the recovery room proceeding from the operation site without oxygen provision during transport. MATERIAL AND METHOD: The study was made with a sample of 208 cases corresponding to the patients who underwent operations in the period from March 20th to April 19th 2000. Saturation was measured by pulse oximeter at the moment of arrival in the recovery unit prior to the provision of oxygen. Patients were classified in four groups according to average saturation and they were grouped by ASA and the anaesthetic technique employed. The statistical treatment was carried out with Student's t and variance analysis. RESULTS: The sixty three per cent of patients showed a saturation of > or =95%; 26.4% slight desaturation; 6.3% moderate desaturation and 1% severe desaturation. The average of saturation of the ASA III patients showed significant differences with the ASA II and ASA I patients (p=0.004). Patients with general anaesthetic showed a desaturation with significant differences with respect to the other anaesthetic techniques employed (p<0.05). CONCLUSIONS: ASA III patients and those subjected to general anaesthetic require oxygen provision during transport from the operation site to the recovery ward.

English Abstract↗
PubMed1996

When is ICU care warranted after carotid endarterectomy? A three-year retrospective analysis.

The purpose was to determine the valid indications for Surgical Intensive Care Unit (SICU) admission after carotid endarterectomy (CEA). The indications for admission to the SICU after CEA were studied over a 3-year period (4/89-3/92). Absolute indications for ICU admission (AIA) included mechanical ventilation, a pulmonary artery catheter, and intravenous vasoactive or antiarrhythmic drug infusion. Patients were grouped according to presence of an AIA (Group A), absence of an AIA and a one day SICU length of stay (Group B), or absence of an AIA and a SICU length of stay > 1 day (Group C). A total of 305 patients were admitted to the SICU during the study. There were 55 patients in Group A. Of the 250 patients without an AIA, 239 were in Group B and 11 comprised Group C. Group A patients had a significantly higher severity of illness compared with Groups B and C (P < 0.05). Group B patients demonstrated no need for SICU care. Group C patients received ongoing SICU care due to postoperative neurological changes, arrhythmias, angina, incisional bleeding, vocal cord paresis, and unavailability of a ward room. None of these conditions was life-threatening, and only vocal cord paresis would have required SICU admission. Two patients in Group A died; no patients died in Group B or C. Only patients with an AIA, perioperative neurological changes, or early hemodynamic instability require SICU admission after CEA. An observation period in the recovery room allows for selection of nearly all patients who will eventually require SICU care.

Adult↗
PubMed1992

[Pneumothorax and cardiac arrest as complications of postoperative nasopharyngeal administration of oxygen].

An unusual but life-threatening complication to nasopharyngeal oxygen administration is described. Following an unsuccessful attempt to advance nasogastric tube during anesthesia for cholecystectomy, the same nostril was used for an oxygen catheter at the end of operation. Within a few minutes after the oxygen supply had been opened following extubation, the patient developed submucous pharyngeal and mediastinal emphysema with subsequent bilateral pneumothorax and cardiac arrest. The patient was reintubated, received close-chest cardiac compressions for a brief period, and the pneumothoraces were drained. She recovered completely within a few hours and was extubated uneventfully the following day. With the increasing--and justified--use of oxygen postoperatively in and during transport to the recovery room, this complication is likely to occur more often. In this case, the anesthetist's previous experience of this complication and consequent rapid therapeutic intervention was probably responsible for the favorable outcome.

Aged↗
PubMed1998

The induction, maintenance, and recovery characteristics of spinal versus general anesthesia in elderly patients.

STUDY OBJECTIVE: To compare the induction and recovery profiles of three combinations of general anesthesia when used as an alternative to spinal anesthesia for elderly patients. DESIGN: Randomized, prospective, open-label study. SETTING: Large referral hospital. PATIENTS: 100 [ASA physical status I, II, and III] patients over 60 years of age undergoing brief transurethral surgery. INTERVENTIONS: In Groups Propofol-Propofol (P-P), Propofol-Isoflurane (P-I), and Propofol-Desflurane (P-D), anesthesia was induced with fentanyl (1 to 2 micrograms/kg i.v.) and propofol (1.0 to 2.0 mg/kg i.v.) and maintained with 70% nitrous oxide in oxygen and either a propofol infusion (75 to 150 micrograms/kg/min) or isoflurane (end-tidal 0.7% to 1.2%) or desflurane (end-tidal 1% to 4%), respectively. After induction, a laryngeal mask airway was placed and spontaneous ventilation was maintained. In Group Spinal (S), 1.5 ml 4% lidocaine (60 mg), in an equal volume of 10% dextrose, was administered intrathecally. MEASUREMENTS AND MAIN RESULTS: Induction and recovery characteristics were compared. Induction with propofol was technically easier and significantly (medp < 0.0001) faster (4.6 +/- 1.7 min, 4.7 +/- 2.2 min, and 3.8 +/- 1.4 min for Groups P-P, P-I, and P-D, respectively) than induction of spinal anesthesia (9.3 +/- 3.4 min). During the induction period, mean arterial blood pressure and heart rate were significantly higher in Group S. Emergence, extubation, and orientation times were similar among the general anesthesia treatment groups. In Group S, patient-generated pain scores were lower (p < 0.05) and recovery room admission longer (p < 0.001). Time to return to baseline digit symbol substitution test (DSST) scores was marginally improved in Groups P-P and P-D when compared to Group P-I. Postoperative nausea, sleepiness, anxiety, and coordination were unaffected by the treatment modality. CONCLUSION: General anesthesia with propofol and desflurane facilitates shorter induction and recovery times without adversely affecting patient comfort. Therefore, this technique may be preferable to spinal anesthesia for elderly patients undergoing short transurethral surgical procedures.

Aged↗
PubMed2003

The effect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy.

UNLABELLED: We designed this prospective, randomized, double-blinded, placebo-controlled, crossover study to evaluate the effect of different doses of remifentanil on the acute hemodynamic response and duration of seizure activity after a standardized electroconvulsive therapy (ECT) stimulus. Twenty consenting patients with major depressive disorders receiving maintenance ECT participated in this study. Eighty ECT treatments were evaluated. All patients were premedicated with glycopyrrolate 0.2 mg IV, unconsciousness was induced with methohexital 1 mg/kg IV, and muscle paralysis was produced with succinylcholine 1.2 mg/kg IV. Subsequently, patients received 1 of 3 different doses of remifentanil 25, 50, and 100 microg or saline (control) in a random sequence immediately after methohexital at 4 consecutive ECT treatments. Labetalol, in 5-mg IV boluses, was used as a rescue antihypertensive medication. A fixed suprathreshold electrical stimulus was administered to elicit a seizure, and the times from the stimulus to the cessation of the motor and electroencephalographic (EEG) seizure activity were noted. Pre- and post-ECT blood pressure values were significantly decreased in the 100- microg remifentanil group compared with the control group. The durations of motor (38 +/- 9 s to 43 +/- 15 s) and EEG (55 +/- 29 s to 60 +/- 21 s) seizure activity were not significantly different among the four groups. Similarly, recovery times to eye opening, obeying commands, and discharge from the recovery room did not differ among the four study groups. The requirement for labetalol after ECT was nonsignificantly decreased in the remifentanil groups. In conclusion, remifentanil 100 microg IV attenuated the acute hemodynamic response to ECT. Furthermore, remifentanil had no adverse effect on the duration of ECT-induced seizure activity. Finally, adjunctive use of remifentanil did not prolong recovery times or increase post-ECT side effects. IMPLICATIONS: Remifentanil (100 microg IV) attenuated the acute hemodynamic response after electroconvulsive therapy (ECT) without adversely affecting the length of the ECT-induced seizure activity or prolonging recovery times.

Adult↗
PubMed1994

The intensity of postoperative shivering is unrelated to axillary temperature.

The relationship between axillary temperature and postoperative shivering was examined in 302 patients who entered one recovery room in the Derbyshire Royal Infirmary over a one-month period. No relationship was found between temperature and the occurrence of shivering, or between conscious level and the occurrence of shivering.

Anesthesia Recovery Period↗