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At least 1,063 records · Page 59Linked to original sources
PubMed1990

Anaesthesia for renal transplantation in sickle cell disease.

Sickle cell disease (SCD) is associated with many pathological and functional abnormalities affecting all organ systems. Renal manifestations of SCD may result in end-stage renal disease (ESRD), which can be treated by chronic haemodialysis or renal transplantation. Renal transplantation was successfully performed in a 25-yr-old male with sickle cell beta-thalassaemia and nephrotic syndrome. We present a case report of this patient, a discussion of the renal complications associated with SCD and the perioperative management of a patient with SCD undergoing renal transplantation.

Adult↗
PubMed1990

The prophylactic use of octreotide in a patient with ovarian carcinoid and valvular heart disease.

This case report describes the use of octreotide, a long-acting somatostatin analogue, in the management of a patient with an ovarian carcinoid tumour and severe cardiac valvular disease. This patient underwent laparotomy and tumour resection without complication. Anaesthesia was induced with midazolam, fentanyl, and vecuronium, and maintained with isoflurane as well as additional fentanyl and vecuronium. However, we feel that it was the use of octreotide that prevented a life-threatening crisis intraoperatively, and recommend its use in patients with carcinoid syndrome undergoing anaesthesia and surgery.

Anesthesia, Inhalation↗
PubMed1990

Thoracic epidural anaesthesia combined with enflurane anaesthesia reduces atrioventricular conduction in dogs.

Cardiac electrophysiological variables during thoracic epidural lidocaine (TEL) were compared with those during continuous intravenous lidocaine (IVL) infusion in 14 mongrel dogs anaesthetized with enflurane in order to investigate the combined effects of thoracic epidural anaesthesia (TEA) and enflurane anaesthesia on intracardiac conduction. Thoracic epidural lidocaine suppressed intracardiac conduction. Sinus cycle length (SCL) and Atrium-His (AH) interval increased by 9 and 11 per cent respectively (P less than 0.05), 30 min after TEL. Intravenous lidocaine did not increase either SCL or AH. The functional refractory period of the atrioventricular node increased five per cent above the control value 15 min after TEL (P less than 0.05), while it was unchanged in the IVL group. The mean plasma concentrations of lidocaine ranged from 0.48 +/- 0.07 to 1.00 +/- 0.14 micrograms.ml-1 in the TEL group and from 0.98 +/- 0.13) to 1.21 +/- 0.15 micrograms.ml-1 in the IVL group. There were no significant differences in plasma concentrations of lidocaine in both groups during the observation period. Therefore, it is concluded that the depressant effects of TEA on intracardiac conduction were caused by blocking of the sympathetic efferent activity. Caution may be advised in administering TEA when cardiac conduction is already compromised.

Analysis of Variance↗
PubMed1977

The influence of intravenous anaesthetics on enflurane-induced central nervous system seizure activity.

This study assesses the effects of agents commonly used in anaesthesia on enflurane-induced seizure threshold and on established seizure activity, during steady state enflurane anaesthesia. EEG seizure activity was monitored in cats from chronic cortical and subcortical recording sites. Diazepam, thiopentone, methohexitone and ketamine all enhanced established EEG seizure challenge. This latter effect was most evident under conditions of lowered PaCO2. The effects of these intravenous agents on established enflurane seizure patterns exceeded in duration the expected EEG effect of the agent when used alone. The limited number of experiments, however, precluded statistical verification of our findings. The similarities between centrencephalic minor motor seizures and enflurane seizure pattern in terms of EEG and convulsive expression, including drug response, are noted.

Anesthesia, Inhalation↗
PubMed1977

Anaesthesia for dilatation, evacuation and curettage in outpatients: comparison of subanaesthetic doses of ketamine and sodium methohexitone-nitrous oxide anaesthesia.

Sub-dissociative doses of ketamine compared unfavourably with methohexitonenitrous oxide anaesthesia for dilatation, evacuation and curettage. We could not separate the desirable effects of analgesia and amnesia from the unwanted dream effects and visual disturbances. Although the time of clinical recovery was similar, the Trieger Motor Test revealed a delay in return to normal in both groups.

Adolescent↗
PubMed1983

The effect of halothane anaesthesia on the asphyxiated foetal lamb in utero.

In a previous study, we examined the effects of halothane on the normal foetal lamb in utero. The most significant finding was a 33 per cent fall in foetal mean arterial blood pressure (MABP). Cardiac output and placental blood flow were not affected. To determine if the asphyxiated foetus would respond similarly, the following study was performed. Seven pregnant ewes were surgically prepared two days prior to study with maternal and foetal indwelling arterial and venous cannulas. An inflatable occlusion loop was secured around the umbilical cord. On the day of study, a tracheostomy was performed on each ewe. Microspheres were injected into the foetal circulation during the control period. The occlusion loop was inflated to produce foetal asphyxia and microspheres were again injected. The ewe was then anesthetized with halothane; and after 15 minutes, microspheres were injected into the asphyxiated foetus and halothane levels were measured. The asphyxiated foetuses showed a significant rise in MABP, fall in heart rate and fall in cardiac output from control. Blood flow to the brain was significantly increased and flow to the placenta and gut decreased. Exposure of the asphyxiated foetus to halothane resulted in a fall of MABP to control but no significant change in cardiac output or brain blood flow. The mean halothane level in the foetus was 46.0 mg X l-1 or 0.32 vol%. Exposure of the asphyxiated foetus to halothane for 15 minutes does not produce significant further deterioration of the foetal lamb in utero.

Acid-Base Equilibrium↗
PubMed1991

The pharmacodynamics and pharmacokinetics of Org 9426, a new non-depolarizing neuromuscular blocking agent, in patients anaesthetized with nitrous oxide, halothane and fentanyl.

The pharmacodynamics and pharmacokinetics of a new non-depolarizing neuromuscular blocking agent, Org 9426, were investigated. Ten patients undergoing elective head and neck surgery and anaesthetized with nitrous oxide, halothane and fentanyl, received a bolus dose of Org 9426 (1 mg.kg-1, 3 x ED90). The isometric contractions of the adductor pollicis muscle following ulnar nerve stimulation (0.1 Hz and intermittent TOF) were measured. Blood and urine were sampled over 8 and 24 hr, respectively. Concentrations of Org 9426 and its possible metabolites in plasma and urine were determined using HPLC. Pharmacokinetic variables were calculated by iterative linear least square regression analysis. Intubation conditions were excellent one minute after administration at a neuromuscular block of 88 (13)% (Mean (CV]. Onset time until maximum block, duration until 25% recovery of twitch height, and recovery from 25 until 75% of twitch height were 1.7 (32), 53 (19) and 20 (37) min, respectively. The TOF reached a ratio of 0.7 after 87 (19) min. Half lives were 1.8 (33), 19 (34), 131 (62) min, respectively, in a three exponential decay; distribution volume at steady-state and plasma clearance were 0.264 (56) L.kg-1 and 4.0 (21) ml.kg-1.min-1, respectively. Plasma concentration at 25% recovery of the twitch height was 1.0 mg.L-1. Within 24 h, 33 (37)% of Org 9426 was excreted unchanged in the urine. Metabolites were absent both in plasma and urine. We conclude that the difference in potency between Org 9426 and vecuronium is similar to the difference between their effective concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Scopolamine patch reduces postoperative emesis in paediatric patients following strabismus surgery.

Scopolamine patch was evaluated for the prevention of postoperative emesis in 50 children undergoing strabismus surgery. All subjects were premedicated, with none receiving narcotic premedicants. Anaesthesia included controlled ventilation with the use of muscle relaxants, atropine, and halothane. Before operation, the subjects were randomly assigned to one of two groups: a treatment group received a scopolamine patch at a dose of either 0.75 mg or 0.375 mg, and a control group received no patch. Both the incidence and frequency of vomiting in the scopolamine-treated group were significantly (P less than 0.05) lower than in the control group.

Administration, Cutaneous↗
PubMed1991

Safety and efficacy of alfentanil and halothane in paediatric surgical patients.

Alfentanil, a congener of the opioid fentanyl, possesses properties that make it an attractive choice for use during short operative procedures. Since the pharmacodynamic aspects of alfentanil have not been well documented in children, this study was undertaken to evaluate the safety, efficacy, and dose requirements of alfentanil when used with nitrous oxide or halothane in paediatric patients. Eighty unpremedicated patients, ASA physical status I or II and aged 2-12 yr were studied. Patients were randomly assigned to one of four groups. After induction of anaesthesia with nitrous oxide, oxygen, and halothane, the groups were treated as follows. In Group 1 (n = 19), after halothane was discontinued, alfentanil 50 micrograms.kg-1 was infused over 30 sec. In Group 2 (n = 20), the end-tidal halothan was maintained at 0.5% and alfentanil 25 micrograms.kg-1 was infused. In Group 3 (n = 20), the end-tidal halothane concentration was maintained at 1% and alfentanil 12.5 micrograms.kg-1 was infused. In Group 4 (n = 21), the end-tidal halothane concentration was maintained at 1.5% and no alfentanil was administered. Patients in Groups 1, 2, and 3 received bolus doses of alfentanil 12.5 micrograms.kg-1 as needed to maintain haemodynamic stability. After alfentanil administration, there were transient decreases in systolic blood pressure in Groups 1 and 2, and in heart rate in Group 2. With surgical stimulation, haemodynamic stability was well maintained except in patients in Group 1, who had an increase in systolic blood pressure. Children Group 1 were alert sooner and their tracheas were extubated earlier than those in Groups 2, 3, and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗
PubMed1991

Mechanical obstruction to ventilation from an ovarian cyst during pregnancy.

This report documents the danger of the gravid uterus fixing a large ovarian cyst in a position disadvantageous to diaphragmatic excursion and thereby obstructing ventilation. A 34-year-old pregnant patient presented at 18 weeks amenorrhoea with a large ovarian cyst. She gave a history of exertional dyspnoea and orthopnoea. Clinical examination revealed a grossly enlarged abdomen and a respiratory rate of 28 breaths.min-1. Intraoperatively, ventilation was markedly impaired resulting in cyanosis and bradycardia. This was relieved by drainage of the ovarian cyst. A left lateral tilt with manual traction on the tumour may have avoided this problem. Should the above measures be inadequate, immediate drainage of the cyst is essential. Severe respiratory distress may require ultrasound-guided, percutaneous, aspiration of the cyst preoperatively. However, as in this patient, the absence of gross signs of respiratory failure does not preclude acute ventilatory failure after induction of anaesthesia.

Adult↗