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PubMed1993

Anesthesia pharmacology for general endotracheal anesthesia.

The multiple of pharmacological agents and the proliferation of new anesthetic drugs make it incumbent on the perioperative nurse to keep abreast of those areas of pharmacology that impact on their care of the surgical patient. This article provides relevant information about agents used in a general anesthetic technique. Included is the pharmacodynamics of induction agents, skeletal muscle relaxants, inhalation agents, and opioids.

Anesthesia, Endotracheal↗
PubMed1995

[French Society of Anesthesia and Intensive Care. Arterial catheterization and invasive measurement of blood pressure in anesthesia and intensive care in adults].

A group of 13 experts appointed by the French Society of Anaesthesia and Intensive Care has produced the following guidelines for arterial catheterisation and invasive measurement of systemic arterial blood pressure in adults. Teflon or polyurethane catheters are recommended with a maximal size of 18 gauge for femoral and axillary arteries and 20 gauge for the others. For small arteries (radial and pedious arteries) a maximal length of 3-5 cm should be preferred. The benefit of heparin-coating is not documented. Incorporation of salts for radiopacity is useless and increases thrombogenicity. Use of a flush device with a constant flow of 2 mL.h-1 and a fast flush valve connected to normal saline under pressure is recommended. Manual intermittent flushing with a syringe is contra-indicated. Addition of heparin (2500 IU.500 mL-1 of flush solution) increases the duration of catheter patency and is recommended for catheterisations of more than 24 h duration. Ready for use devices are to be preferred. Distortion of pressure wave may be minimized by employing low volume, low compliance, low resistance devices. The number of connections should be as low as possible and all of Luer-lock type. The stopcocks should be clearly identified to minimize the risk of accidental intra-arterial injection. The device should be transparent for disclosure of bubbles, which lead to waveform distortion. For catheter placement the operator should follow the usual preparation as for any aseptic surgical procedure with cap, mask, gloves and sterile towel. The insertion site is prepped either with chlorhexidine or povidone-iodine. In the conscious patient, local anaesthesia by injection and/or topical application (EMLA) is recommended. Direct arterial puncture should be preferred rather than transfixion. Catheterisation of deep vessels is facilitated by Seldinger technique, which is recommended whatever the site of placement when long term monitoring and/or difficulties of insertion are foreseen. The radial artery is the site of choice for elective cases. The non-dominant hand should be preferred. Puncture must be preceded by assessment of adequacy of the collateral flow by the Alien test. The femoral artery is a valuable site for emergency situations. Before catheterisation, the artery should be auscultated for a murmur. Puncture of a vascular prosthesis is contra-indicated. The dressing should be changed every four days only. Sites of blood withdrawal should be manipulated with compresses soaked with chlorhexidine or povidone-iodine. The arterial catheter is only changed in case of evidence of local infection or ischaemia. The catheter removal should be considered as an aseptic surgical procedure. The catheter completeness has to be checked. A systematic culture of the catheter is not required.

Adult↗
PubMed1996

[Anesthesia for cesarean section: drug transfer to fetus during anesthesia].

One case of prenatally diagnosed congenital diaphragmatic hernia was reviewed in terms of the anesthetic managements. Concentrations of diazepam, pancuronium and fentanyl were measured in maternal, fetal and umbilical serum. As expectedly, the transition of diazepam through the placenta was large and the concentration of diazepam in the fetal serum was equal to that of maternal serum, but only a small amount of pancuronium was transferred.

Adult↗
PubMed1997

[Stress free anesthesia induction ZESTRANI (ZEro STRess ANesthesia Induction) in Göttingen minipigs. An experimental method].

The Göttingen Mini-pig is a popular laboratory animal, that is used i.a. in experimental surgery and anaesthesia. For ethical and scientific reasons it is mandatory to minimize the stress the laboratory animals are exposed to. The presented stress-free experimental anaesthesia induction (ZESTRANI) is based on innovative means to achieve adequate analgesia using different substances appropriate for the animal's state of consciousness. Markedly lower heart rates and mean arterial pressures are seen when the ZESTRANI-method is used as compared retrospectively to the previously used "conventional" anaesthesia induction. With the ZESTRANI method no "fight or flight"-reactions are seen.

Anesthesia, General↗
PubMed1998

[Comparative investigations on inhalation anesthesia with isoflurane (Forene) and sevoflurane (SEVOrane) in racing pigeons (Columba livia Gmel., 1789, var. domestica) and presentation of a reference anesthesia protocol for birds].

A conventional inhalation anaesthesia using an isoflurane and sevoflurane-oxygen-nitrous oxide-mixture was performed in each six domestic pigeons (Columbia livia Gmel., 1789, var. domestica). Over a period of 60 minutes routine anaesthetic monitoring including reflex score (12 reflexes, cloacal body temperature and pulse oximetry) was performed. For anaesthesia maintainance 4.0 +/- 0.3 Vol. % sevoflurane compared to 2.0 +/- 0.2 Vol. % isoflurane were used. The induction period using sevoflurane was shorter (95 +/- 9 sec) than by using isoflurane (154 +/- 12 sec). The recovery period was significantly shortened using sevoflurane (162 +/- 12 sec) compared to isoflurane with 186 +/- 12 sec. Results show, that the use of sevoflurane is indicated especially in patients bearing anaesthesia risks, but has a number of advantages, though anaesthetic potency is approximately 50% lower than in isoflurane, causing higher costs. Furthermore low toxicity of sevoflurane leads to a lower burden for the surgical staff through so-called "waste gases", which play an important role in avian anaesthesia using a head chamber for application. Beside a review on current techniques in avian anaesthesia this paper includes a standardised detailed anaesthesia protocol description of avian inhalation anaesthesia regarding the technical equipment as well as its practice, which allows an exact documentation of the anaesthetic, meeting legal requirements, too. The results show that inhalation anaesthesia with isoflurane or sevoflurane has to be preferred even in birds when compared to ketamine anaesthesia, the future use of which has to be restricted to sedation and immobilisation partly due to animal welfare grounds.

Anesthesia, Inhalation↗
PubMed1998

[Effect of remifentanil on clinical and electroencephalographic parameters of depth of anesthesia in balanced anesthesia with propofol, enflurane or isoflurane].

UNLABELLED: Electrophysiological parameters are well-suited to detect changes in cerebral function. The present study investigates whether balanced anaesthesia with remifentanil during nociceptive stimulation is associated with changes in clinical and electrophysiological parameters indicating inadequate depth of anaesthesia. Following IRB approval and written informed consent, 23 patients (ASA: I; age: 36 +/- 11) scheduled for elective gynaecological laparoscopy were included in the study. Without any premedication, anaesthesia was induced with remifentanil (1.0 microgram/kg bolus injection), propofol (0.5 mg/kg added by repetitive (10 mg) bolus injections every 10 s until unconciousness) and vecuronium (0.1 mg/kg). Following endotracheal intubation (normoventilation: PetCO2: 36 bis 38 mmHg), remifentanil infusion was started with continuous doses of 0.5 microgram/kg/min over 5 minutes and maintained with 0.25 microgram/kg/min during surgery. Remifentanil was randomly combined with propofol (group 1: 100 micrograms/kg/min; n = 7), enflurane (group 2: 0.5 MAC; n = 8) or isoflurane (group 3: 0.5 MAC; n = 8). Monitoring included: heart rate (beats/min), mean arterial pressure (mmHg), oxygen saturation (%), endtidal CO2 (mmHg) and endtidal enflurane and isoflurane (%). EEG: 2-channel recordings of Fz versus mastoid and ECG (artefact control) during steady-state anaesthesia and surgery. Following fast-fourier-transformation (4 s; 256/s; 0.5 to 35.0 Hz), spectral power densities were calculated for the selected frequency bands. Auditory evoked potentials (AEP; middle latency) were registered simultaneously after binaural stimulation via head-phones click-stimulation (6 Hz; 75 dB above hearing threshold; 512 stimulations per average). Bandpass was 0.01 to 2.0 kHz. ANALYSIS: Na, Pa, Nb (latencies; ms) and peak-to-peak amplitudes (NaPa, PaNb; microV). EEG and AEP recording technique [15]. The study protocol included baseline values from pre-intubation, pre-surgery, the respective post-stimulation values (1 min, 3 min, 5 min) and all data at five-minute intervals during surgery until emergence from anaesthesia. During steady-state study conditions with defined remifentanil applications, mean data indicate that in response to nociceptive stimuli no changes in clinical or electrophysiological parameters were observed. In contrast to other studies using different anaesthetic techniques, the present data from remifentanil indicate very stable haemodynamic and electrophysiological parameters (EEG, AEP) during noxious stimulations. Adjustable and with no plasma accumulation, remifentanil demonstrates potent antinociceptive effects resulting in signs of adequate anaesthesia.

Adult↗