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PubMedDate not supplied

Cardiac arrest caused by coronary spasm in two patients during recovery from epidural anesthesia.

BACKGROUND AND OBJECTIVES: In order to reduce the surgical stress on the heart, anesthesiologists frequently use regional anesthesia in patients with coronary artery disease. METHODS: Two patients underwent reconstructive peripheral vascular surgery under continuous epidural anesthesia with bupivacaine. During the surgery and later in the recovery room, they received continuous electrocardiographic (ECG), invasive arterial blood pressure, and oxyhemoglobin saturation monitoring. RESULTS: In both patients, the anesthetic course during surgery was uneventful, but while recovering from the anesthesia, they developed ECG changes consistent with myocardial ischemia, followed by malignant dysrhythmias and cardiac arrest. The clinical pictures, ECGs, coronary angiogram, and (in one patient) autopsy findings suggested coronary artery spasm as the cause of the malignant dysrhythmias and cardiac arrests. CONCLUSIONS: It is possible that the coronary spasms were caused by an altered balance between sympathetic and parasympathetic nervous activity during recovery from epidural anesthesia. Therefore, patients with coronary artery disease must be closely monitored for signs and symptoms of myocardial ischemia during the entire recovery period from epidural anesthesia.

Aged↗
PubMed1997

Neostigmine requirements for reversal of neuromuscular blockade following an infusion of mivacurium.

PURPOSE: To study the efficacy of neostigmine compared with placebo for the antagonism of neuromuscular blockade at the end of a mivacurium infusion, and to determine its optimal dose. METHODS: One hundred adult patients undergoing an elective surgical procedure received a standardized anaesthetic with 20-30 micrograms.kg-1 alfentanil, a propofol infusion and nitrous oxide. Muscle relaxation was maintained at 90-95% T1 depression with 0.2 mg.kg-1 mivacurium followed by an infusion. Neuromuscular blockade was measured with an integrated evoked electromyogram in response to train-of-four (TOF) stimuli at the ulnar nerve every 20 sec. Patients were randomized into four groups. At the end of surgery, the mivacurium infusion was stopped and patients received, immediately, in a double-blind manner, neostigmine (10, 20, or 40 micrograms.kg-1) or placebo according to a random number table. The T1 and TOF ratio were recorded until adequate recovery of neuromuscular function (TOF ratio > 0.70). During the reversal period, non-invasive blood pressure and heart rate were recorded every minute. The incidence of postoperative nausea and vomiting (PONV) was recorded in the recovery room. RESULTS: Data from 94 patients who completed the protocol were analysed. Compared with placebo, neostigmine 10 micrograms.kg-1 did not reduce the time to TOF > 0.70 (17.0 +/- 5.1 vs 14.6 +/- 4.2 min respectively). However the time was decreased with neostigmine 20 micrograms.kg-1 and 40 micrograms.kg-1 (P < 0.001), but with no difference between these last two groups (11.4 +/- 3.0 and 11.4 +/- 3.5 min respectively). Changes in systolic blood pressure and heart rate were not different between the four groups. Very few PONV events were observed in all groups (global incidence 7.4%). CONCLUSION: Recovery of neuromuscular blockade following a mivacurium infusion is accelerated by neostigmine. A dose of neostigmine 20 micrograms.kg-1 appears optimal with no further reduction in recovery time obtained from a larger dose.

Adult↗
PubMed2004

Comparison of the immediate with the 24-hour postoperative prism and cover measurements in adjustable muscle surgery: is immediate postoperative adjustment reliable?

PURPOSE: Immediate postoperative adjustment after adjustable-suture strabismus surgery has been suggested as a viable alternative to the classic adjustment that is performed, usually within 6 to 24 hours after surgery. The purpose of this study was to compare the immediate postoperative eye measurements with those taken 24 hours postoperatively and to determine whether there was any significant difference between the 2 measurements. METHODS: This was a prospective study of strabismus patients who were candidates for muscle surgery using the adjustable-suture technique. All patients received a total intravenous general anesthesia, which allowed rapid recovery of consciousness. Measurements using the simultaneous prism cover test were obtained in the recovery room immediately after the patients regained consciousness and again 24 hours after surgery. Both measurements were taken before adjustment and were compared. RESULTS: A total of 25 patients were studied. The postoperative alignment changed significantly during the first 24 hours in 84% of our patients. The mean drift in alignment during the first 24 hours measured 7.2 +/- 4.3 prism diopters and was significantly different from 0 ( P < 0.001). CONCLUSION: The immediate postoperative ocular alignment after adjustable strabismus surgery is significantly different from the 24 hours postoperative alignment. This difference was noticed despite using an anesthesia protocol that allowed rapid recovery and full regaining of consciousness shortly after the conclusion of surgery. This early drift should be taken into consideration if adjustment is to be made in the immediate postoperative period.

Adolescent↗
PubMed1989

Atracurium--a post-marketing surveillance study: U.K. study and discussion.

Two companion post-marketing studies have evaluated the frequency of adverse events amongst patients receiving atracurium. In this second report, we describe the Scottish study and discuss findings in both centres. In this study we compare the frequency of adverse events in 477 patients receiving atracurium with those in 484 patients who received vecuronium. The frequency of reported serious adverse events was low during surgery and in the recovery room. Although the overall incidence of adverse experiences was slightly lower after atracurium, there were no significant difference between the groups in frequency of major adverse events. This type of study is believed to be of value in the future surveillance of new drugs for hospital use.

Anesthesia Recovery Period↗
PubMed2000

[Dyspnea attack due to hysteria after general anesthesia].

A 30-year-old female was scheduled for an expander insertion of the breast under local anesthesia. Thirty minutes after infiltration anesthesia with lidocaine and bupivacaine mixture, she suffered from dyspnea. She was intubated and transferred to our hospital. As her vital signs were stable and consciousness was clear, she was extubated in the emergency room. However, she was reintubated at night and ventilated mechanically for two days. Three months later, breast expander insertion was performed under general anesthesia. After extubation, dyspnea attack occurred and midazolam was injected. Seven months later, the reconstruction of TRAM flap was performed under general anesthesia and continuous subcutaneous injection of morphine was used for the postoperative analgesia. After extubation, she was sedated deeply and dyspnea attack did not occur. A month later, she was scheduled for the debridment and the resuture. Then, dyspnea attack occurred in the ward at night. The apnea monitor was attached to her in recovery room after extubation following the operation of debridment and resuture. Dyspnea attack appeared and was diminished with midazolam injection. We diagnosed her as hysteria with CMI and MMPI psychologic tests.

Adult↗
PubMed1996

The effect of laryngeal mask cuff pressure on postoperative sore throat incidence.

STUDY OBJECTIVE: To study the effect of laryngeal mask airway (LMA) cuff pressure on the incidence of postoperative sore throat. DESIGN: Prospective, randomized, observational study. SETTING: Operating room of a university hospital. PATIENTS: 200 consecutive adult patients requiring anesthesia for gynecologic procedures. INTERVENTIONS: Anesthesia was induced with thiopental 3-5 mg/kg, fentanyl 2 micrograms/kg, vecuronium bromide 0.05mg/kg, and enflurane 0.8% to 2% and maintained with nitrous oxide and oxygen (65%/35%) and enflurane. MEASUREMENTS AND MAIN RESULTS: In Group 1, cuff pressure measurement was continuously performed until the end of the operation. In Group 2, 5 minutes after induction of anesthesia and 2 minutes after insertion of the LMA, cuff pressure was also continuously observed and reduced to the minimal pressure required for airtightness. In the recovery room, after the operation, patients were questioned for postoperative sore throat 4, 8, and 24 hours after the operation following a scoring protocol (score 0 = no complaints, score 1 = minimal sore throat, score 2 = moderate sore throat, score 3 = severe sore throat: "never a LMA again". Continuous monitoring of cuff pressure revealed a steady increase of pressure (during the first 60 minutes increases of 43 cm H2O) in Group 1. In Group 2, after release of air, cuff pressures were significantly lower through the entire operation when compared with Group 1. In Group 1, 8 patients claimed to have a sore throat (Score 1, n = 4; Score 2, n = 3; Score 3, n = 1). In Group 2, no patient complained of sore throat. CONCLUSIONS: A significant increase in cuff pressure is seen during the first 60 minutes. Three minutes after insertion of the laryngeal mask, cuff pressure can significantly be reduced without any major gas leakage. Postoperative sore throat can be reduced when cuff pressure is continuously monitored and kept on low-pressure values.

Adult↗
PubMed2006

Anesthesiologist-controlled versus patient-controlled propofol sedation for shockwave lithotripsy.

PURPOSE: To compare anesthesiologist-controlled sedation (ACS) with patient-controlled sedation (PCS), with respect to propofol requirements, sedation, and recovery, in patients undergoing extracorporeal shockwave lithotripsy for urinary calculi. METHODS: Sixty-four patients were randomized, in this double-blind study, to receive propofol sedation according to one of two regimens: infusion of 200 microg.kg(-1) .min(-1) for ten minutes reduced thereafter to 50-150 microg.kg(-1) .min(-1) titrated by an anesthesiologist, according to patient response (group ACS), or propofol administered by patient-controlled analgesia (bolus dose 300 microg.kg(-1), lockout interval three minutes, no basal infusion), (group PCS). All patients received midazolam 10 microg.kg(-1) iv and fentanyl 1 microg.kg(-1) iv preoperatively, followed by fentanyl infused at a rate of 0.5 microg.kg(-1) .hr(-1) throughout the procedure. Sedation and analgesia were assessed using the A-line ARX index and visual analogue scale, respectively. Psychomotor recovery and readiness for recovery room discharge were assessed using the Trieger dot test and postanesthesia discharge score, respectively. Patient satisfaction was assessed on a seven-point scale (1-7). RESULTS: In comparison to group PCS, patients in group ACS received more propofol (398 +/- 162 mg vs 199 +/- 68 mg, P < 0.001), were more sedated (A-line ARX index: 35 +/- 16 vs 73 +/- 16, P < 0.001), experienced less pain (visual analogue scale: 0 +/- 0 vs 3 +/- 1, P < 0.001), and were more satisfied (median [Q1, Q3]: 7 [7, 7] vs 6 [6, 7], P < 0.001). In contrast, patients in group PCS had faster psychomotor recovery (Trieger dot test median [Q1, Q3]: 8 [4, 16] vs 16 [12, 26] dots missed, P = 0.002) and achieved postanesthesia discharge score >/=9 earlier (median [Q1, Q3]: 40 [35, 60] vs 88 [75, 100] min, P < 0.001) compared with group ACS. CONCLUSION: In comparison to PCS for patients undergoing extracorporeal shockwave lithotripsy, propofol/fentanyl ACS is associated with increased propofol administration, deeper sedation levels, and greater patient comfort. However, ACS is associated with slower recovery and a longer time to meet discharge criteria, when compared to PCS.

Adjuvants, Anesthesia↗
PubMed2000

Gastroenterologist-administered propofol for therapeutic upper endoscopy with graphic assessment of respiratory activity: a case series.

BACKGROUND: Traditional methods of sedation and analgesia for advanced endoscopic procedures can be inadequate and frequently prolong recovery room observation. Propofol is a rapidly acting agent that produces an excellent hypnotic state, but its use is typically limited to anesthesiologist-assisted cases because of the inadequacy of current monitoring standards to reliably detect early stages of respiratory depression. METHODS: Ten patients undergoing advanced upper endoscopic procedures (endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, esophageal stent placement) received a propofol infusion under the control of a second qualified gastroenterologist with advanced cardiac life support skills. Graphic assessment of respiratory activity was made by using a sidestream carbon dioxide detecting cannula. Patient satisfaction was measured with a 100 mm visual analog scale. Recovery scores were measured by standardized scoring of discharge criteria. RESULTS: Monitoring with graphic assessment of respiratory activity detected early phases of respiratory depression, resulting in a timely decrease in the propofol infusion without significant hypoxemia, hypercapnia, hypotension, or arrhythmias. Satisfaction scores were extremely high (median score 92 of 100) and 9 of 10 patients met discharge criteria at 15 minutes after discontinuation of the propofol infusion. CONCLUSIONS: With the use of monitoring by graphic assessment of respiratory activity, propofol infusion by a second qualified gastroenterologist for prolonged upper endoscopic procedures is safe and results in high levels of patient satisfaction with rapid recovery times.

Adult↗
PubMed2005

Peroperative depth of anaesthesia may influence postoperative opioid requirements.

BACKGROUND: Studies on monitoring the depth of anaesthesia have shown that with the use of these monitors the peroperative consumption of anaesthetics can be reduced. Studies have also indicated that the peroperative depth of anaesthesia may affect the postoperative course. The purpose of this study was to evaluate a possible relation between the depths of anaesthesia and the postoperative pain score and consumption of morphine. METHODS: We used middle latency auditory evoked potentials (MLAEPs) for monitoring the depth of anaesthesia. The study was prospective, observer blinded and included 50 women scheduled for elective abdominal hysterectomy. Anaesthesia was induced using propofol and remifentanil. Before leaving the recovery room the patients were provided with a programmed patient-controlled pump (PCA), which was only activated on demand. Auditory evoked potentials were registered from just before induction of anaesthesia and during the whole procedure, but the anaesthetist did not have access to the monitor. RESULTS: Fifty patients were included and seven were excluded. The remaining 43 patients were divided into two groups: Group High (n=12) with an AAI>28 for >5% of the registration time and Group Low (n=31) with an AAI>28 for <5% of the registration time. Group High had significantly higher morphine requirements in the recovery and activated the PCA-pump more frequently during the first 24 postoperative hours. CONCLUSION: The results indicate that the peroperative depth of anaesthesia may have effects on the postoperative analgesic requirements.

Adult↗
PubMed2005

Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication.

BACKGROUND: Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and side effect profile. The aim of our study was to investigate and compare the efficacy of oral midazolam alone with a low-dose combination of oral midazolam and ketamine. METHODS: We performed a prospective randomized double-blind study in 100 children who were randomly allocated into two groups. Group M received 0.5 mg.kg(-1) oral midazolam and group MK received 0.25 mg.kg(-1) oral midazolam with 2.5 mg.kg(-1) oral ketamine. The preoperative sedation score, ease of parental separation and ease of mask acceptance were evaluated on a 4-point scale. The time to recovery from anesthesia and to achieve satisfactory Aldrete score was also noted. RESULTS: Uniform and acceptable sedation scores were seen in both the groups (group M 95.9%; group MK 97.96%), without any serious side effects. However, the combination offered significantly more children in an awake, calm and quiet state, who were easily separated from their parents (73.46% in MK vs 41% in group M). The induction scores were comparable between the groups. The recovery room characteristics and time to achieve satisfactory Aldrete score were also comparable between the two groups. CONCLUSIONS: Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more children in an awake, calm and quiet state who could be separated easily from parents.

Adjuvants, Anesthesia↗
PubMed2006

Intercurrent medical diseases: incidence and effects on the course of anaesthesia in a tertiary hospital.

AIM: A prospective study was carried out to determine the incidence of intercurrent medical diseases and peri-operative course of such patients presenting for surgery under anaesthesia at the University of Benin Teaching Hospital, Benin City, for a period of twelve months.(March 2002 - February 2003). PATIENTS AND METHODS: All patients presenting for surgery at our general modular operating rooms formed the subjects for this study. A standardized form was used to document patients characteristics, presence of medical diseases, level of control, indication for surgery, type of anaesthesia, perioperative complications and outcome. RESULTS: Five hundred patients had surgery under anaesthesia. Our data showed incidence of intercurrent medical diseases (IMD) to be 19.6% . The prevalent age of intercurrent medical diseases was 60 years and above. The incidence of common illnesses was: hypertension (41.86% ), diabetes (14.2% ), upper respiratory tract infection (11.22% ), obesity (9% ) and anaemia (6.1% ). The most frequent observed intraoperative complications in patients with IMD were cardiovascular (hypertension-19.04% , bradycardia-19.04% , hypotension- 14.29% and tachycardia-14.29% . In recovery room, the common documented complications were hypertension-30% , tachycardia-22.5% , hypotension- 12.5% and prolonged unconsciousness-10% . The incidence of perioperative adverse events was higher in patients with IMD than in those without IMD. It was extremely significant. (P=0.0006; Odds ratio=0.5115; 95% CI: 0.3510 - 0.7455 using the approximation of Woolf). Patients aged over 60 years were more likely to present for surgical treatment with intercurrent medical conditions. (p < 0.0001, Odds ratio=0.03843, 95% CI: 0.2141 - 0.06900). CONCLUSION: Intercurrent medical disease was commonly found in patients above 60years and is a predictor of both intraoperative and postoperative adverse events.

Age Factors↗
PubMed1991

Outpatient cholecystectomy simulated in an inpatient population.

This prospective clinical trial evaluates the feasibility and safety of elective cholecystectomy in a simulated outpatient protocol in 40 patients. Results were compared with a 19-patient control group managed by conventional postoperative methods. Oral liquids were begun in the recovery room, intravenous fluids were discontinued 4 hours after surgery, and enteral analgesics and antiemetics were provided on the ward. Protocol patients were randomized in a double-blind fashion to receive metoclopramide or placebo after surgery to assess its influence on the early tolerance of oral intake. In the protocol group, nausea without emesis occurred in nine patients (23%); 11 others (28%) had nausea with emesis. This was not significantly different from the control group. Metoclopramide-treated patients did not demonstrate a lower incidence of nausea or emesis but did tolerate oral liquids earlier after surgery than the placebo group (P less than 0.05). After release from recovery, eight protocol patients (20%) requested parenteral narcotics for relief of pain. Postoperative urinary catheterization was required in nine protocol patients (23%) and five control patients (26%). No major complications occurred. Outpatient cholecystectomy is both feasible and safe. Metoclopramide may allow earlier tolerance of enteral liquids postoperatively.

Abdomen↗
PubMed1998

Maintenance and recovery characteristics of sevoflurane anaesthesia in adult patients. A multicenter, randomized comparison with isoflurane.

BACKGROUND: The goal of the present multicenter, prospective, randomized clinical investigation was to compare the clinical efficacy and safety of sevoflurane and isoflurane during maintenance of and recovery from general anaesthesia in adult patients. METHODS: With the approval of the Ethical Committee and the patient informed consent, 143 ASA physical status I-II patients, aged 18-65 years, were randomized in order to receive either isoflurane (n = 71) or sevoflurane (n = 72) as the main general anaesthetic. After an oral diazepam (0.1-0.2 mg kg-1) and atropine (0.007-0.01 mg kg-1) premedication and a standardized intravenous induction, general anaesthesia was maintained by adjusting the end-tidal concentrations of the inhalational agent for the maintainance of cardiovascular stability. At the end of surgery the anaesthetic vapours were discontinued, and the neuromuscular block was reversed; the following times were recorded: time of eyes opening, time of command response and suitability for discharge from the recovery area. The occurrence of any untoward event was also recorded. Preoperatively and 24 hr after surgery, blood was collected in order to assess renal an hepatic functions. RESULTS: No differences in demography, duration of surgery, exposure to the inhalational agent and haemodynamic effects were observed between the two groups. Patients receiving sevoflurane showed shorter times for the achievement of extubation (median: 9 min versus 13 min, p = 0.002), eyes opening (median: 10 min versus 13 min, p = 0.002), command response (11 min versus 15 min, p = 0.002) and suitability for discharge from recovery room (median: 19 min versus 22 min, p < 0.05) than those receiving isofluorane. No intra- and intergroup differences were observed in pre- and post-operative laboratory testing of renal and hepatic function. DISCUSSION: We conclude that sevoflurane, when compared to isoflurane, provides a similarly safe maintenance but allows for a more rapid emergence from general anaesthesia.

Adolescent↗
PubMed1992

[Gastroesophageal reflux with combined caudal and halothane anesthesia in children].

Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Caudal↗
PubMed2004

Multiple casualty terror events: the anesthesiologist's perspective.

UNLABELLED: In a 28-mo period 14 multiple-casualty terror events occurred in Jerusalem, challenging the Department of Anesthesiology and Critical Care Medicine of the city's sole Level 1 trauma center. We performed a retrospective review of the response of the department to evaluate staff activities, resource use (emergency department, operating rooms, and intensive care unit [ICU]), and patient flow. A total of 1062 people were injured in the 14 multi-casualty terror incidents. The emergency department treated 355 victims; 108 of them were hospitalized, and 58 underwent surgery during the first 8 h. Only two surgeries were performed during the first hour, and the average time to the first surgery was 124 min. Fifty-one patients were admitted to the ICU an average of 5.5 h after the terror event. After a terrorist act, multiple, simultaneous efforts were required of the anesthesiology department, including taking part in the initial resuscitation in the emergency department, anesthetizing victims for surgery and angiographies, and caring for them in the recovery room and ICU. Therefore, anesthesiology departments are greatly impacted by such events and must plan for them to maximize the use of available personnel and to have the appropriate equipment and supplies available. IMPLICATIONS: Anesthesiologists provide essential care to patients injured in terror events, from the initial resuscitation through therapeutic/diagnostic procedures and surgeries. Operational issues faced by a department of anesthesiology during the initial 8 h after terrorist actions were examined. Multiple, and often parallel, efforts were required of the department.

Anesthesiology↗
PubMed1996

Observation of early postoperative hypoxaemia in children undergoing elective plastic surgery.

The incidence, severity and duration of early postoperative hypoxaemia were determined in 420 healthy infants and children undergoing elective plastic surgery. Mean value of preoperative SpO2 was 98.3 +/- 0.87%. However, it decreased significantly to 92.7 +/- 4.01% immediately following anaesthesia in the postanaesthesia recovery room (PAR) when children breathed room air. Then SpO2 gradually increased to 93.8 +/- 4.25% at 10 min, 95.4 +/- 3.14% at 30 min, 96.6 +/- 2.25% at 60 min, 96.9 +/- 1.69% at 120 min, and 97.4 +/- 1.55% at 180 min, respectively. The incidence of hypoxaemia and severe hypoxaemia, which were 14.8% and 6.2% respectively on arrival in the PAR, decreased significantly to 6.6% and 1.9%, 30 min later. The hypoxaemia occurred most commonly within 1 h, particularly the first 30 min following anaesthesia. The hypoxaemia was more common and more severe in children undergoing cleft palate repair than other kinds of plastic surgery. A significant correlation was found between low SpO2 levels on admission to the PAR and children's age, fentanyl doses, and the infants' recovery score.

Adolescent↗
PubMed2000

The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy.

BACKGROUND: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies, would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning, anesthesia, and increased intra-abdominal pressure. METHODS: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane-fentanyl anesthesia during laparoscopic cholecystectomy. Before laparoscopy, the patients received an intravenous (IV) infusion of colloid solution if cardiac filling pressures were low, and their legs were wrapped from toes to groin with elastic bandages. Measurements were taken while the patients were awake in the supine (baseline) and head-up tilt (15-20 degrees) positions, and after the induction of anesthesia in the same positions. Measurements were repeated at regular intervals during laparoscopy (intra-abdominal pressure at 13-16 mm Hg), after deflation of the gas, and in the recovery room. RESULTS: With the passive head-up tilt in awake and anesthetized patients, the cardiac index (CI), stroke index (SI), central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) decreased, and systemic vascular resistance increased. With the patient under anesthesia, SI decreased, but CI did not change significantly as a result of the compensatory increase in heart rate. Carbon dioxide (CO2) insufflation at the start of laparoscopy produced increases in CVP and PCWP as well as mean systemic and mean pulmonary arterial pressures without changes in CI or SI. Toward the end of the laparoscopy, CI decreased by 15%. The hemodynamic values returned to nearly prelaparoscopic levels after deflation of the gas, and CI was elevated during the recovery period, whereas systemic vascular resistance was decreased in comparison with the baseline. CONCLUSIONS: By correcting relative dehydration and preventing the pooling of blood, CI decreased less than 20% during pneumoperitoneum as compared with the baseline awake level. The head-up positioning accounts for many of the adverse effects in hemodynamics during laparoscopic cholecystectomy.

Abdomen↗
PubMed2002

Sevoflurane and propofol decrease intraocular pressure equally during non-ophthalmic surgery and recovery.

BACKGROUND: To provide good control of intraocular pressure (IOP) during anaesthesia and surgery, we conducted a study comparing the effects on IOP during maintenance and recovery of sevoflurane vs propofol anaesthesia in 33 patients (ASA I-II) undergoing elective non- ophthalmic surgery. METHODS: Anaesthesia was induced with propofol 2 mg kg(-1), fentanyl 2 micro g kg(-1) and vecuronium 0.1 mg kg(-1). Patients were allocated randomly to receive either propofol 4-8 mg kg(-1) h(-1) (group P; n=16) or 1.5-2.5 vol% sevoflurane (group S; n=17) for maintenance of anaesthesia. Fentanyl 2-4 micro g kg(-1) was added if necessary. The lungs were ventilated with 50% air in oxygen. Blood pressure, heart rate, oxygen saturation and end-tidal carbon dioxide were measured before and throughout anaesthesia and in the recovery room. IOP was determined with applanation tonometry (Perkins) by one ophthalmologist blinded to the anaesthetic technique. RESULTS: There was a significant decrease in IOP after induction and during maintenance of anaesthesia in both groups. No significant differences in IOP between the two groups was found. CONCLUSION: Sevoflurane maintains the IOP at an equally reduced level compared with propofol.

Adolescent↗