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PubMed1991

[Cytotoxic activity of natural killer cells during balanced anesthesia with isoflurane versus total intravenous anesthesia].

Using two different anaesthetic techniques, the author have investigated the cytotoxicity in process during abdominal surgery. In these investigations, no significant differences have been demonstrated in the behaviour of the NK with the two techniques adopted. The increase noted in traceable to the mobilization of the N.K. of the extra vascular deposits. The increase of the cytotoxic activity is probably traceable to the action of the endogenous opiate substances.

Adult↗
PubMed1990

Comparison of three techniques on time to awakening, time to orientation and incidence of nausea and vomiting using alfentanil in balanced anesthesia in an outpatient surgical setting.

Maximizing patient safety and comfort while minimizing adverse sequelae are continuing anesthetic challenges. The purpose of this study was to examine three anesthetic techniques utilizing alfentanil with regard to time to awakening, time to orientation and incidence of nausea and vomiting. Surgical procedures were limited to knee arthroscopy, laparoscopy and dental extractions. Unpremedicated ASA I/II outpatients (n = 74) between the ages of 18 and 59 were randomly assigned to one of three groups: Group I: alfentanil + 67% N2O + 33% O2 Group II: alfentanil + 67% N2O + 33% O2 + droperidol 0.015 mg/kg Group III: alfentanil + 100% O2 + 0.7% isoflurane Anesthesia was induced with alfentanil 40 micrograms/kg, atracurium 0.4 mg/kg, thiamylal 4 mg/kg and 100% O2 and was maintained according to group assignment. The anesthetic was supplemented as clinically indicated with incremental boluses of alfentanil 10 micrograms/kg. Upon completion of surgery, muscle relaxation was reversed with edrophonium 0.75 mg/kg and atropine 0.015 mg/kg. Analyses indicated that the three groups were comparable in terms of potentially confounding variables including gender, race, surgical procedure, age, percent of ideal body weight, case length and dose of alfentanil in micrograms/kg/hr. Time to awakening was significantly shorter in the two N2O groups by approximately 1.5 minutes, as compared to the O2 and isoflurane group (p = .0060). Time to orientation was significantly shorter in the N2O groups by approximately 1.5 minutes also, as compared to the O2 and isoflurane group (p = .0142). The two N2O groups did not differ significantly in either measure. The incidence of vomiting in the postanesthesia recovery room (PARR) indicated a significant difference (p = .0317) among groups with vomiting occurring 45.8% of the time in Group I, 28.8% of the time in Group II and 8% of the time in Group III. Total emetic score (nausea and vomiting) in the PARR indicated a significant difference (p = .03) among groups with symptoms occurring 50% of the time in Group I, 28% of the time in Group II, and 16% of the time in Group III.

Alfentanil↗
PubMedDate not supplied

[Drug dosage during balanced anesthesia in children with urinary tract diseases].

To determine principles of choosing individual fentanyl and ketamin doses the data on the course of general anesthesia in 120 children were processed by regression analysis. It has been established that individual anesthetic dose titration should take into consideration the child's age, efficacy of premedication, renal function and circulatory pattern The infusion rate is determined with regard to anesthesia-induced circulatory changes. Regression analysis made it possible to work out formulas which enable individual dose titration and determination of the infusion rate.

Adolescent↗
PubMed1988

Age-dependence of the dose-response curve of vecuronium in pediatric patients during balanced anesthesia.

The effect of age on the log-based cumulative dose-response curve of vecuronium was determined in ten age groups of 80 pediatric patients ranging from neonates to adolescents during thiopental-fentanyl-N2O/O2 anesthesia. Neuromuscular block was recorded as the evoked thenar electromyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 20-second intervals). The dose-response curves were parallel to each other in all ten age groups studied. In neonates and infants, the ED95 of vecuronium was 47 +/- 11 (SD) micrograms/kg. This was significantly lower than the ED95 of 81 +/- 12 micrograms/kg in children between 3 and 10 years of age (P less than 0.01). In patients aged 13 years or older, the ED95 was 55 +/- 12 micrograms/kg, which did not differ from the neonatal and infant values but was significantly lower than the ED95 of children between 3 and 10 years of age. The results indicate that the dose of vecuronium necessary for tracheal intubation is age-dependent. The individual ED95 values varied between 22 and 103 micrograms/kg. This suggests that an individually optimal dose of vecuronium can be administered to pediatric patients only if neuromuscular block is adequately monitored.

Adolescent↗
PubMed1988

[Clinical experiences with alfentanil for balanced anesthesia in upper abdominal surgery].

METHODS: Three randomized groups of patients scheduled for upper abdominal surgery received either an initial large bolus of alfentanil combined with low concentrations of isoflurane (group 1), an initial small bolus of alfentanil combined with 50% higher isoflurane concentrations than group 1 (group 2), or isoflurane without opioids (group 3). Blood pressure, heart rates, and anesthetic consumptions were measured and recorded, as were side-effects such as thoracic rigidity, bradycardia, and nausea, and postoperative recovery time. RESULTS: The mean isoflurane concentration in group 1 was 0.8 vol% combined with an average alfentanil bolus of 6.8 mg and three additional doses of 1.1-1.4 mg. Group 2 received a mean isoflurane concentration of 1.3 vol% combined with four additional doses of 1.3-1.7 mg alfentanil. Group 3 needed an average isoflurane concentration of 1.5 vol%. Side effects of alfentanil were prevented by atropine administration; severe complications were not observed. Postoperative recovery time showed significant differences between groups 1 und 2: group 1 patients were awake within 7.5 min and group 2 within 17 min after the operation. No respiratory depression was detected. CONCLUSIONS: Alfentanil combined with volatile anesthetics produced no severe side-effects in patients scheduled for upper abdominal operations. The pharmacokinetics of alfentanil are advantageous with regard to the postoperative period.

Alfentanil↗
PubMed1987

Nalbuphine as an analgesic component in balanced anesthesia for cardiac surgery.

The efficacy and safety of nalbuphine hydrochloride as an IV analgesic used in combination with pretreatment and supplemental doses of diazepam with and without N2O were assessed in 15 patients scheduled to undergo aortocoronary bypass (n = 11) or valve replacement surgery (n = 4). The loading infusion of 3.0 mg/kg nalbuphine given in 20 min 5 min after conclusion of IV injection of 0.4 mg/kg/5 min diazepam caused no significant changes in systolic or diastolic systemic and pulmonary arterial blood pressures or in heart rate, cardiac index, stroke index, systemic and pulmonary vascular resistance, or right and left ventricular stroke work index. After the initial 1-hr loading infusion of 6.66 +/- 0.89 mg/kg nalbuphine (mean +/- SE), additional nalbuphine infusion maintenance doses of 4.73 +/- 0.77, 1.87 +/- 0.31, 2.16 +/- 0.23, 1.65 +/- 0.22, and 2.35 +/- 0.44 were used in the subsequent hourly periods to maintain a pain-free state throughout surgery. Hemodynamic changes during the three most stressful periods, tracheal intubation, skin incision, and sternotomy, were not statistically significant. Normal plasma catecholamine and cortisol levels indicate that these patients experienced neither stress nor pain during the maintenance of anesthesia. Nalbuphine caused no significant histamine release. All patients had uncomplicated maintenance of and emergence from anesthesia.

Adult↗