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PubMed1995

[Quality of psychomotor recovery after colonoscopy under general anesthesia using propofol. Value of tests of awakening].

Achieving colonoscopy under general anaesthesia entails the problem of ambulatory-care anaesthesia, in particular because perception of patient's recovery determines to some extent the length of monitoring following colonoscopy. The aims of the study was to assess the quality of patient's recovery after a colonoscopy under general anaesthesia while using propofol, by means of psychomotor-tests. METHODS--Colonoscopy was performed in 40 patients according to the following anaesthetic protocol: induction: propofol 2 mg/kg, continuous support: propofol 10 mg/kg/h i.v. with a 50 mg bolus in case of insufficient sedation; series of 3 psychomotor-tests were performed the day before and 1 hour, 3 hours and 6 hours after colonoscopy. The 3 psychomotor-tests studied: coordination (Newman test), time-space orientation and short-term memory. RESULTS--Forty patients, 25 females and 15 males, underwent colonoscopy with general anaesthesia for an average time-period of 22 +/- 11 min. The mean dose of propofol used was 286 +/- 102 mg. Awakening was complete in all patients, according to physical criteria such as consciousness and cardiovascular status, 20 min after receiving colonoscopy. The average psychomotor-tests results over time were (as percentages of original values) (*P < 10(-3); **P < 0.05): [table: see text] At 6 hours, 35 patients (87.5%) had recovered to their original performance and at 3 hours, 30 patients (75%) retained 90% their former state as measured with 3 psychomotor-tests. Neither by age or sex nor by propofol doses used or length or anaesthesia, the study population differed significantly. CONCLUSION--Three hours after colonoscopy under general anaesthesia using propofol, 30 patients (75%) had recovered at least 90% to their initial performances. Newman test was the most disturbed but there was no predictive factor for the quality of recovery. Psychomotor-tests may be useful before authorizing early discharge after colonoscopy under general anaesthesia but other recommendations about conditions of discharge after sedation must be also implemented.

Anesthesia Recovery Period↗
PubMed1997

Use of the laryngeal mask airway as an alternative to the tracheal tube during ambulatory anesthesia.

UNLABELLED: We designed a prospective, randomized, multicenter study to compare anesthetic requirements, recovery times, and postoperative side effects when a laryngeal mask airway (LMA) was used as an alternative to the tracheal tube (TT) during ambulatory anesthesia. After induction of anesthesia with midazolam 2 mg, fentanyl 1 microg/kg, and propofol 2 mg/kg, 381 patients were randomly assigned to receive either an LMA (n = 207) or TT (n = 174) for airway management. In patients assigned to the TT group, succinylcholine 1 mg/kg or a nondepolarizing muscle relaxant was administered to facilitate tracheal intubation. Anesthesia was maintained with volatile anesthetics in combination with nitrous oxide 60% and oxygen. The average time to placement of the two airway devices (5 min) and the failure rates (1%) were similar in the two groups. Although there was a significant decrease in the intraoperative fentanyl requirement in the LMA group, the difference was of little clinical significance. Furthermore, there were no differences in the volatile anesthetic requirements. The time from end of surgery to removal of the airway device (5 min) was also similar in the two study groups. Although duration of the postanesthesia care unit stay and time to ambulation were significantly shorter in the LMA group, there were no differences in the times to "home readiness." The incidence of nausea and vomiting and the need for rescue antiemetic treatments in the postoperative period were similar in the two airway management groups. However, the incidence of postoperative sore throat was significantly greater in patients receiving the TT (versus the LMA). In conclusion, this study suggests that the LMA is a useful alternative to the TT for airway management during ambulatory anesthesia. IMPLICATIONS: Use of the laryngeal mask airway can obviate the need for insertion of a tracheal tube for many ambulatory surgery procedures, and thereby decrease the incidence of postoperative sore throats.

Adult↗
PubMed2003

Neural nets and prediction of the recovery rate from neuromuscular block.

BACKGROUND AND OBJECTIVE: The aim was to train artificial neural nets to predict the recovery of a neuromuscular block during general anaesthesia. It was assumed that the initial/early neuromuscular recovery data with the simultaneously measured physical variables as inputs into a well-trained back-propagation neural net would enable the net to predict a rough estimate of the remaining recovery time. METHODS: Spontaneous recovery from neuromuscular block (electrically evoked electromyographic train-of-four responses) were recorded with the following variables known to affect the block: multiple minimum alveolar concentration, end-tidal CO2 concentration, and peripheral and central temperature. RESULTS: The mean prediction errors, mean absolute prediction errors, root-mean-squared prediction errors and correlation coefficients of all the nets were significantly better than those of average-based predictions used in the study. The root-mean-squared prediction error of the net - employing minimum alveolar concentrations from the whole recovery period (the recovery time from E2/E1 = 0.30 to E4/E1 = 0.75; E1 = first response of train-of-four, E2 = second response of train-of-four, etc.)--were significantly smaller than those of other nets, or the same net employing minimum alveolar concentrations only from the initial recovery period (from E2/E1 = 0.30 to E4/E1 = 0.25). CONCLUSIONS: Neural nets could predict individual recovery times from the neuromuscular block significantly better than the average-based method used here, which was supposed to be more accurate than guesses by any clinician. The minimum alveolar concentration was the only monitored variable that influenced the recovery rate, but it did not aid neural net prediction.

Anesthesia Recovery Period↗
PubMed1996

The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers.

BACKGROUND: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation. METHODS: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography. RESULTS: The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermoperception was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P < 0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables. CONCLUSION: Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.

Adult↗
PubMed1996

[Etomidate versus propofol for anesthesia in ambulatory cardioversion].

OBJECTIVE: This study compared the two short-acting intravenous anaesthetic agents, etomidate in lipid emulsion and propofol, for anaesthesia during elective outpatient cardioversion. METHODS: After institutional approval and informed consent, 40 patients (ASA II/III) scheduled for cardioversion were studied. Patients with a left ventricular ejection fraction < 30% were excluded. The anti-arrhythmic medication was not discontinued, and no patient was given pharmacological premedication. Anaesthesia was induced either with etomidate (in lipid emulsion) 0.25 mg/kg or propofol 1.5 mg/kg. Both agents were administered over 30 seconds. Subsequent increments were given until the patients no longer followed verbal commands and the lid reflex was absent. Patients were allowed to breathe 40% oxygen via face mask. Artificial ventilation was performed if a patient became apnoeic for more than 20 seconds. The blood pressure was monitored continuously with the Finapres noninvasive blood pressure monitor, and the heart rate was recorded simultaneously. All data were collected electronically. The duration of anaesthesia was taken as the period from the start of induction until the opening of the eyes on command. For assessment of recovery from anaesthesia, patients were asked to perform a series of psychomotor tests. RESULTS: The two groups were similar in their demographic and haemodynamic baseline data. In both groups, a significant decrease in blood pressure occurred 120 seconds after anaesthesia induction, which was due to the performance of the cardioversion. Five minutes after induction, the blood pressure returned to baseline in the etomidate group, while it remained below baseline in the propofol group. Propofol caused a significant decrease in heart rate. Significantly more patients needed artificial ventilation after propofol administration because of apnoea. Involuntary muscle movements occurred only in patients receiving etomidate. The immediate emergence from anaesthesia was faster after propofol. However, 15 minutes after awakening there was no difference in psychomotor skills between the two groups. No residual psychomotor impairment was evident 60 minutes after anaesthesia in any patient. All patients were discharged four hours after the cardioversion. CONCLUSIONS: Because the recovery characteristics were similar in both groups, the occurrence of side effects may be a major factor when choosing between etomidate and propofol for outpatient cardioversion.

Adult↗
PubMed2001

Ketamine for short ambulatory procedures in children: an audit.

BACKGROUND: The purpose of this audit was the evaluation of recovery and discharge times and the identification of perioperative events related to anaesthetics with intravenous ketamine and midazolam. METHODS: In our institution, we use this method as a routine technique for short ambulatory emergency or elective procedures. Two hundred children, aged 1-16 years, were included. Ninety percent of the study patients underwent emergency procedures. RESULTS: Most perioperative events were minor and easily corrected. Intraoperatively, most events were related to respiration, including oxygen desaturation, apnoea or laryngospasm. Vomiting, vertigo, visual disturbances, nightmares and hallucinations were observed in the postoperative period. Serious complications requiring hospital admission or further interventions in the postoperative period were rare. Mean recovery time was 100 min (range 20-325) and mean discharge time 130 min (range 25-360). CONCLUSIONS: Intravenous ketamine plus midazolam is a suitable, simple and fast anaesthetic technique for short, painful ambulatory procedures. Considering the possibility of potentially serious respiratory complications, it should be performed only by qualified anaesthesia staff who are trained in advanced airway management.

Adolescent↗
PubMed1987

Pharmacokinetics of propofol in female patients. Studies using single bolus injections.

The pharmacokinetics of propofol in a dose of 2.5 mg kg-1 given via a vein in the antecubital fossa were studied in 18 patients. Anaesthesia was maintained with nitrous oxide in oxygen in all patients. The effects of pretreatment with fentanyl (n = 6) and maintenance with halothane (n = 6) on the pharmacokinetics of propofol were also investigated. Pretreatment with fentanyl resulted in prolonged apnoea in four patients. No serious side effects occurred. The pharmacokinetics of propofol in unpretreated patients who were maintained with nitrous oxide in oxygen only can be described by a three-compartment open mammalian model with very rapid distribution (T1/2 alpha about 3 min), rapid elimination (T1/2 beta 45 min) and a slower final phase (T1/2 gamma about 300 min). The total body clearance of propofol was rapid (1.91 litre min-1). Propofol was initially distributed into a relatively large central compartment (41.3 litre) and was extensively redistributed (Vss 305 litre; V gamma 722 litre). Throughout the sampling period the mean blood concentrations of propofol for the patients pretreated with fentanyl were about 50% higher than the mean concentrations for patients maintained with nitrous oxide only. Mean propofol concentrations for the patients maintained with halothane were intermediate between those of the other two groups.

Adult↗
PubMed1988

[Treatment of pulmonary hypertension in the immediate period after general anesthesia and surgical correction of patent ductus arteriosus and heart septal defects].

Surgical correction of the arterial duct and defects of the cardiac septa is followed in the nearest period after surgical correction by lung hypertension which considerably aggravates the postoperative period. The observation of 74 patients has shown that infusions of 1% solution of phosphobion (0.05 mg/kg/min) in the pulmonary artery decrease the pressure in the pulmonary artery, pulmonary-vascular resistance, make the incidence of disturbed heart rate less frequent, reduce the concentration of noradrenaline and prostaglandins.

Adenosine Triphosphate↗
PubMed2001

[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].

This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. Anaesthesia was induced with 5 mg/kg thiopentone and 1 vol.-% halothane. Subsequently, 0.4 mg/kg rocuronium or 0.075 mg/kg vecuronium were administered, respectively. Anaesthesia and post-operative care were conducted by independent anaesthetists, who were unaware of the drug used and of the relaxometric data obtained. All children were monitored in the recovery room by pulse oximetry until they reached a Steward Score of 6. Demographic data did not differ between the groups. No differences were recorded between the non-depolarizing relaxants regarding intubation time (R: 24.1 +/- 4.2 min, V: 25.8 +/- 6.8 min) and the time interval from end extubation to leaving the operating theatre (R: 2.3 +/- 0.8 min, V: 2.6 +/- 1.2 min), respectively. Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.

Adenoidectomy↗
PubMed1989

Admissions to the intensive care unit after complications of anaesthetic techniques over 10 years. 1. The first 5 years.

Fifty-three patients were admitted in a 5-year period to the intensive care unit as a result of a complication of an anaesthetic technique. These patients represented 1 in 1543 anaesthetics carried out in the District in the period and 2.0% of all admissions to the intensive care unit. The mortality rate was 17%. The complication was considered to be wholly or partially avoidable in 14 instances (26%). Five of these subjects died and two had a residual neurological deficit.

Adolescent↗
PubMed1991

Neuromuscular and clinical effects of mivacurium chloride in healthy adult patients during nitrous oxide-enflurane anaesthesia.

We have studied the effects of mivacurium after induction of anaesthesia with alfentanil-propofol in healthy adult oral surgical patients. Anaesthesia was maintained with nitrous oxide and 0.75% (end-tidal) enflurane in oxygen after nasotracheal intubation. Recordings were made of the rectified compound adductor pollicis electromyogram in response to train-of-four (TOF) ulnar nerve stimulation. First and fourth TOF responses were defined as T1 and T4, with T1 suppression referenced to pre-mivacurium T1 height (Tc). Onset times (mean (SEM] to 90% T1 suppression were 2.5 (0.2), 2.1 (0.3) and 1.6 (0.1) min, respectively, after mivacurium 0.15 mg kg-1 (n = 18) and 0.2 mg kg-1 (n = 18) as 5-s boluses and 0.2 mg kg-1 over 30 s (n = 9). Intubating conditions 2 min after 0.15 mg kg-1 were good to excellent and not improved by a further 30-s delay or by use of a 0.2-mg kg-1 dose. Recovery to T1/Tc of 5% occurred on average in 12-13 min irrespective of dose. Thereafter, mivacurium infusions commenced at 8-10 micrograms kg-1 min-1 were adjusted at intervals of at least 3 min to achieve T1/Tc in the range 1-10%. Mean duration of infusion was 58 (3.4) min and mean infusion rate after a 15-min stabilization period was 6.6 (range 2.3-12.9) micrograms kg-1 min-1. On cessation of infusions, spontaneous recovery from T1/Tc 8% (1.0%) to T4:T1 = 0.7 took 17 (1.2) min. Neostigmine 0.04 mg kg-1 or edrophonium 0.75 mg kg-1 evoked recovery from T1/Tc 9% (SEM 1.2% and 1.0%, respectively) to T4:T1 = 0.7 in 11 (0.6) and 8 (0.9) min (both P less than 0.001 vs spontaneous recovery).

Adult↗
PubMed1993

Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures.

Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care, and who could not be satisfactorily examined or treated, were administered one of three medications--ketamine (Ketalar), 3 mg/kg; midazolam (Versed), 0.4 mg/kg; or sufentanil (Sufenta), 1.5 or 1.0 micrograms/kg--intranasally in a randomized, double-blinded protocol. The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse's arms. Cardiorespiratory monitors were applied when tolerated, and the child was placed on the operating room table. Each child was injected locally with up to one dental cartridge of 2% lidocaine with 1:100,000 epinephrine before dental extractions. A sedation score was recorded using a scale where 1 = hysterical/untreatable, 5 = ideal sedation, and 10 = obtunded and desaturated, requiring airway management assistance. Midazolam administration resulted in acceptable sedation (mean score: 4) with no desaturations below 90% as measured by pulse oximetry and a mean recovery room observation time of only 3 +/- 2 min (+/- SD). Ketamine also had a mean sedation score of 4 and a short recovery period (7 +/- 7 min); however, two children experienced brief desaturations. Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily sedated children (mean score 7), with a high incidence of significant oximetry desaturation (80%) and prolonged recovery room duration (58 +/- 40 min). Use of 1.0 microgram/kg sufentanil resulted in no desaturations, less sedation (mean score 4), and a brief recovery time (7 +/- 13 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1994

Comparison of propofol and methohexital for deep sedation.

The purpose of this investigation was to compare two sedation techniques for use in outpatient third molar surgery. Forty ASA class I or II volunteers were randomly allocated to two groups. All subjects received supplemental oxygen via a nasal hood, sublimaze (.0007 mg/kg [corrected] intravenous bolus), and midazolam (.5 mg/min) titrated to effect. Using an incremental bolus technique, group A then received methohexital, while group B received propofol. Both groups maintained stable mean arterial pressure, oxygen saturation, and end-tidal CO2 throughout the perioperative period. However, group A had a dramatic increase in heart rate (26.7% versus 13.9% for group B [P < .05]). Better postoperative psychomotor performance (P < .05) as measured by the Trieger Dot analysis was demonstrated by patients who received propofol. It was concluded that propofol is superior to methohexital for intravenous sedation.

Adult↗
PubMed1998

Patient selection and anesthetic management for early extubation and hospital discharge: CABG.

Three model systems have been described that may facilitate an increase in the numbers of patients passing through the hospital within the resource allocation available: (1) early fast-track extubation, < 3 hours after surgery, (2) planned intensive care unit discharge < 18 hours, and (3) early hospital discharge < 5 days. Thus far, studies have not clearly identified patient group or risk demonstrating a need for prolonged intubation or delayed intensive care unit and hospital length of stay. It thus appears appropriate to suggest that all patients be considered suitable for early extubation, mobilization, and hospital discharge. An increase in the proportion of patients eligible for a more rapid, but safe, progression through their operative procedures may be facilitated by pharmacologic intervention or alteration in anesthetic technique. Prevention of adverse perioperative myocardial outcome by inhibition of stress responses and careful control of intraoperative cardiovascular variables is most easily achieved by high thoracic (C7-T1) epidural conduction block or by a high-dose opioid anesthetic technique using remifentanil. The ultrashort action of remifentanil facilitates the ability to plan and control the period of recovery of spontaneous ventilation and extubation while providing profound reduction of intraoperative stress responses and hemodynamic stability. Safe extubation requires that the patient be alert and cooperative, be hemodynamically stable and warm, is not bleeding, and has adequate respiratory function. Interventions with anti-inflammatory and hemostatic agents such as the serine protease inhibitor aprotinin or with corticosteroids can have a major impact on achieving the criteria needed to ensure rapid discharge from the intensive care unit.

Analgesics, Opioid↗
PubMed2003

LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy.

PURPOSE: To compare the laryngeal mask airways (LMA), LMA-Classic(TM) (LMA-C) and LMA-ProSeal(TM) (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy. METHODS: We stratified 209 women, aged > or = 18 yr, ASA physical status I-III, by body mass index as non-obese (< or = 30 kg x m(-2)) or obese (> 30 kg x m(-2)) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30-50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL x kg(-1)). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0-10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure. RESULTS: There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO(2,) P(ET)CO(2) or airway pressure before or during peritoneal insufflation in short (< or = 15 min) or long (> 15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant. CONCLUSION: A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.

Adult↗
PubMed2003

Wound infiltration with ropivacaine and fentanyl: effects on postoperative pain and PONV after breast surgery.

STUDY OBJECTIVE: To determine whether postoperative wound infiltration with local anesthetics combined with fentanyl improves analgesia following breast surgery; and to investigate awakening and postoperative nausea/vomiting. DESIGN: Prospectively randomized clinical study. SETTING: University hospital. PATIENTS: 45 ASA physical status I and II patients scheduled for breast surgery. INTERVENTIONS: Patients were prospectively randomized and assigned to one of three treatments during general anesthesia: postsurgical wound infiltration with ropivacaine 0.375%; wound infiltration with ropivacaine 0.375% combined with fentanyl 0.5 microg/kg; and intravenous (i.v.) fentanyl 0.5 microg/kg before skin incision and no wound infiltration. Time to first verbal response, pain at rest, postoperative nausea and vomiting, and ketobemidone and dixyrazine utilization were compared. MEASUREMENTS AND MAIN RESULTS: Time to first verbal response was significantly shorter in the i.v. fentanyl group compared to both infiltration groups (8.1 +/- 4.5 min vs. 15.3 +/- 4.3, and 12.0 +/- 5.0 min; p < 0.05, respectively). Postoperative pain at rest, and nausea and vomiting occurred with similar frequencies in the groups. Ketobemidone utilization in both infiltration groups, (2.4 +/- 1.8 mg and 3.1 +/- 1.8 mg, respectively) was not different compared to the i.v. fentanyl group (2.9 +/- 2.0 mg; NS). There were no differences in postoperative antiemetic requirements during the first, second and third two-hour periods postoperatively. The dixyrazine consumption was similar in the three groups, (0.9 +/- 1.5 mg, 0.8 +/- 1.3 mg, and 1.4 +/- 1.8 mg, respectively; NS). CONCLUSION: Postsurgical ropivacaine wound infiltration, with or without adding fentanyl, demonstrates no differences in postoperative pain relief and nausea/vomiting compared to a balanced general anesthetic including i.v. fentanyl.

Amides↗
PubMed1987

[Locoregional anesthesia by peri-dural route in neck surgery].

Principal anatomical "targets" and physiological consequences of cervical epidural anesthesia are outlined, technic and aims of the method discussed and 53 patients (class ASA I and II) receiving major cervical surgery, mainly for cancer, reviewed. Effectiveness of cervical epidural anesthesia was rated as excellent for total pharyngo-laryngectomy, with or without flaps, total laryngectomy, lymph node curettage and thyroidectomy, moderate for reconstructive laryngectomy and only fair for transmaxillary buccopharyngectomy. Advantages of the method concern principally the postoperative period: immediate awakening (92% of cases) in the operating room whatever the duration of surgery, avoiding intensive care, and pain relief for at least 48 hours (85% of cases) by maintenance of catheter. Contraindications include hypocoagulability, local or general infection and impossibility of adjusting heart rate, and the method is not applicable for all patients in whom general anesthesia with assisted ventilation is contraindicated.

Adult↗
PubMed1992

Chest wall motion during halothane anaesthesia in infants and young children.

Chest wall motion during anaesthesia may differ from the awake state because of the effect of anaesthetic agents on the muscles of respiration. The purpose of this study was twofold (1) to describe the pattern of chest wall motion in infants and children during halothane anaesthesia (HA) using respiratory inductive plethysmography (RIP) and (2) to calibrate the voltage output of RIP in units of volume. Seven infants (2.3 +/- 1.7 mo, 5.9 +/- 0.7 kg) and five children (2.9 +/- 1.1 yr, 15.5 +/- 1.5 kg) were studied. Since results in both age groups were qualitatively similar they are presented as a single group. Respiratory excursions of the rib cage (RC) and abdomen (ABD) were measured using RIP. Airflow was measured with a pneumotachograph. During spontaneous breathing the analogue signals of airflow, pressure, RC and ABD were recorded. Measurements were taken during (1) halothane anaesthesia and (2) during emergence from anaesthesia. The XY plots of the RC and ABD signals were plotted for each period. In addition the voltage output of the respiratory excursions of the RC and ABD signals was converted to units of volume using the simultaneous solution of equation method. The accuracy of conversion factors was validated by regression analysis of the predicted and measured tidal volume using breaths sampled at random throughout the entire period of study. Regression analysis of this relationship gave a slope between 0.85 and 1.15 (r2 value greater than 0.7) in five of the twelve patients. The pattern of chest wall motion in the XY plots showed synchronous motion between RC and ABD signals during HA in nine of the twelve patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗