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At least 145 records · Page 8Linked to original sources
PubMed1986

Changes in skin thermal clearance during anaesthesia.

Thermal and vascular side effects occurring during general anaesthesia are related to skin blood flow. A new, noninvasive probe which measures skin thermal clearance, a variable closely related to skin blood flow, was used in nine patients under phenoperidine, droperidol, propanidid anaesthesia. Statistically significant increases in skin thermal clearance clearly preceded the drop in mean arterial blood pressure and the rise in skin temperature. It is concluded that general anaesthesia induced an early increase in skin blood flow and that thermal clearance is a better technique than skin thermometry to monitor skin blood flow.

Adult↗
PubMed1986

Work practices relating to intubation and associated procedures in intensive care units in Sweden.

A survey into the current usage of tracheal tubes and associated procedures, such as various sedation regimes and antacid therapy, in intensive care units was carried out in Sweden by sending a questionnaire to physicians in charge of intensive care units in 70 acute hospitals which included seven main teaching hospitals. The purpose of the survey was to see how far the recent advances in tube and cuff design and awareness of the problems caused by prolonged therapeutic paralysis in intensive care units have influenced the attitudes and work practices of physicians in Sweden. Forty-nine replies were received (a 70% response rate). All hospitals used polyvinyl chloride tubes of Magill design, with high residual volume, low pressure cuffs. Intensive care units in 85.7% of teaching hospitals and 47.6% of non-teaching hospitals preferred the nasal route for intubation. Most non-teaching hospitals used a size 7 tube in both adult male and female patients for nasal intubation. The majority of units changed from tracheal tubes to tracheostomy after a period of 1-2 weeks. 85% of all hospitals monitored intracuff pressure as a routine, and in most intensive care units the cuff was inflated to no-leak ventilation. The majority of units rarely used muscle relaxants. Phenoperidine and diazepam were the most popular drugs used for the sedation technique. 71.4% of teaching hospitals and 40.9% of non-teaching hospitals used antacids routinely in patients on intermittent positive pressure respiration. The results are discussed.

Anesthesia↗
PubMed1989

Effects of adenosine-induced hypotension on cerebral blood flow and metabolism in the pig.

The cerebral and systemic effects of hypotension induced by adenosine (0.61 +/- 0.07 mg.kg-1.min-1) were studied in eight pigs anesthetized with droperidol, phenoperidine and nitrous oxide. Mean arterial blood pressure (MABP) was reduced by 58%, from 17.2 kPa (128 mmHg) to 6.9 kPa (53 mmHg) during a 30-min period. The hypotension was caused by a decrease in systemic vascular resistance (58%) while the cardiac output was unaffected. Cerebral blood flow (CBF), as determined by microsphere distribution, and the cerebral metabolic rate for oxygen (CMRO2) remained unchanged. Cerebral vascular resistance decreased by 61%. There were no signs of cerebral lactate release. After discontinuation of adenosine infusion, the MABP returned to control levels within 5 min. Thirty minutes later the CBF was increased by approximately 60% in comparison to the control, while the CMRO2 was unchanged. It is concluded that adenosine-induced hypotension in pigs is associated with preserved CBF and CMRO2, whereas cerebral hyperperfusion is present in the early post-hypotensive period.

Adenosine↗
PubMed1990

Midazolam and flumazenil in ophthalmology.

Midazolam's pharmacodynamic properties are used in ophthalmology in several indications: 1. to relieve anxiety and unwanted reactions during radial keratotomy in ambulatory patients; 2. to provide sedation and amnesia during cataract surgery using local anaesthesia, in combination with low doses of phenoperidine; 3. to induce general anaesthesia, combined with fentanyl and vecuronium, for intraocular surgery in the elderly; and 4. to decrease intraocular pressure. Flumazenil is not in routine use but is usually administered to antagonise the deleterious effects of midazolam on upper airway resistances and the respiration system and may be used to reverse "paradoxical", i.e. anxiogenic reactions to benzodiazepines in the elderly.

Aged↗
PubMed1978

Morphine analgesia and cerebral opiate receptors: a developmental study.

1 Development of the analgesic response to morphine and ontogenesis of central opiate receptors were analyzed in rats 5 to 120 days old. 2 The analgesic effect of morphine increased until day 15, after which it decreased to reach a plateau at about day 30. With phenoperidine, on the other hand, the analgesic effect increased until day 15, remained constant between day 15 and day 30 after which it decreased slowly. 3 The ratio of the amounts of morphine in blood over those in brain increased about 3 fold between day 15 and day 30. 4 Opiate receptors were detected in the brain of newborn rats: stereospecific binding of [3H]-naloxone at 10 and 50 nM indicated the presence of low and high affinity binding sites. 5 The number of [3H]-naloxone binding sites increased rapidly during the second and third week after birth. Their affinity for several opiates remained constant throughout development. 6 These results indicate that the analgesic activity of opiates varies with age: until day 15, the analgesic effect of opiates increases in parallel with the number of opiate brain receptors. Then, the formation of the blood brain barrier introduces an additional step in the regulation of opiate activity.

Aging↗
PubMed1983

Anaesthesia for the patient with impaired renal function.

Patients with renal disease are at risk of further deterioration of renal function and acute tubular necrosis when subjected to anaesthesia and surgery. Optimal fluid loading and careful selection of anaesthetic techniques and agents, appropriate monitoring and the use of mannitol and dopamine assist in the maintenance of renal blood flow and help preserve renal function in these patients. In association with renal failure, physiological changes in other systems result in reduced oxygen supply to the tissues, metabolic disturbances, impairment of the coagulation and immune defence mechanisms and an increased risk of cardiac and cerebrovascular catastrophe. Although many anaesthetic techniques including regional analgesia may be used successfully in these patients caution with most drugs, especially pethidine, phenoperidine, suxamethonium and all non-depolarising neuromuscular relaxants is recommended. Of the volatile anaesthetics currently available, halothane is the agent of choice. Oxygen therapy and close monitoring of cardiorespiratory function are necessary postoperatively.

Anesthesia↗
PubMed1976

[Significance of Alfatesine in anesthesia for multiple dental extractions before major cardiac surgery].

This technique of anaesthesia used for oral surgical operations such as, multiple dental extractions, apical resection, carried out in cardiac patients before major cardiac surgery under extra-corporeal circulation, for insertion of valvular prostheses or aorto-coronary by-pass operations, has passed by various stages. The present technique associating phenoperidine-alfatesine-suxame-thonium-N2o-o2, was used in the last 58 cases. It presents a certain number of advantages compared with previous techniques: -very stable level of anaesthesia whatever the duration of the operation, -satisfactory cardio-vascular stability, -almost constant absence of hypo-excitability of the myocardium even in patients in poor cardiac condition before the operation with uninterrupted treatment with digitalis and diuretics, -good quality of awakening.

Adolescent↗
PubMedDate not supplied

[Evaluation of the activities and value of allergo-anesthetic consultation at the University Hospital Center of Nice 1985-1991].

Life-threatening accident during anesthesia scarcely happen but the consequences may be dramatic. We report our experience of an allergo-anesthesia consultation created since 1985 in Nice hospital. 452 patients have been investigated: 1) 109 for life-threatening anaphylactic and anaphylactoid drug reactions. They have been investigated by: skin tests intradermal reactions (IDR) and prick tests with substances used during anesthesia (drugs and latex) and for all the muscle relaxants; the radioabsorbent test (RAST) for the muscles relaxants, propofol and latex; the human basophilic degranulation test (HBDT) for all the other drugs. We used the imputability decision table to classify the reactions. When anaphylaxis diagnosis was established (14) an "allergy card" was given to patients which identified the drugs to which they had a positive reaction. 62 patients have presented an anaphylaxis: 57 due to muscle relaxants (37 due to suxamethonium), 4 to latex and 1 to a gelatin. Patients were subsequently contacted and 50 of the 58 have responded. 18 of these patients have received 22 new anesthesias. Without exception, the advises to avoid a drug have been followed, 17 patients have a positive reaction to a muscle relaxant. In four of these, another muscle relaxant (skin test negative) was used without any trouble. For the other 13 who had shown a cross reactivity, all the muscle relaxants had been rejected and another anesthetic technique have been used: local anesthesia (3 cases), epidural (2 cases) associated or not with narcotics (propofol, midazolam), general anesthesia (propofol, midazolam, droperidol, phenoperidine). These drugs were all skin test negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis↗
PubMed1990

Simultaneous screening and quantification of several nonopiate narcotic analgesics and phencyclidine in human plasma using capillary gas chromatography.

This paper describes a procedure for the quantitative determination of alfentanil, dextromoramide, fentanyl, methadone, pentazocine, pethidine, phenoperidine and phencyclidine in human plasma. Some drug metabolites were included in the study. The procedure involves a simple alkaline extraction technique and capillary gas chromatography separation followed by a nitrogen-selective detection. Concentrations as low as 10 micrograms/l can be routinely evaluated, making this method suitable for use in overdose drug screening, therapeutic drug monitoring and pharmacokinetic studies.

Analgesics, Opioid↗
PubMed1980

[Continuous monitoring of temperature in anesthesia and intensive care].

Continuous surveillance of both regional and general temperatures is of great interest in anaesthesia and intensive care. After a brief review of temperature regulation and the value of temperature control, the authors suggest a simple and reliable method of surveillance. This uses Chromel/Alumel thermocouples connected to a central device used to store the information. An experimental clinical study involved the assessment of 3 different anaesthetic protocols: Taractan-Palfium; Droleptan-Phenoperidine, Fentanyl only. These measurements were made in 30 young subjects undergoing a maxillofacial surgical procedure under identical conditions. The parameters studied were central temperature (rectal) and skin temperature of the index finger. With regard to peripheral temperature curves the results showed a first phase consisting of fall followed by a second phase characterised by a sudden increase up to a plateau. This plateau (3rd phase) persisted as long as the subject slept. The 4th phase, when peripheral temperature fell suddenly to a level sometimes lower than the initial temperature represented one of the first signs of awakening. As far as central temperature was concerned it fell in a linear fashion for all curves. Comparing the different curves obtained, the authors conclude by noting that the more vasoplegic the anaesthetic protocol, the higher the induction peak of the second phase of peripheral temperature pattern, but also that the fall in central temperature was marked. The authors feel that an anaesthetic which is biologically satisfactory and at the same time produces an overall fall in the production of heat without causing chills avoids the development of vasoconstrictor reactions between the care and the surface which are reflected by a decrease in the gradient between central and peripheral temperatures.

Anesthesia↗
PubMed1982

[Pharmacology of narcotics administered by the epidural or intrathecal route (author's transl)].

Owing to the presence of specific opiate receptors in the spinal cord, analgesia can be obtained with epidural or intrathecal injections of morphine derivatives. The duration of analgesia depends upon the degree of water solubility of the compound. Compounds with low coefficient of distribution in lipids (e.g. morphine) do not readily cross the blood-brain barrier and have a prolonged action, whereas the duration of analgesia induced by highly lipid-soluble compounds, such as dextromoramide and phenoperidine, is not very different from that obtained with more conventional routes of administration. The fact that large amounts of narcotics are taken up by the spinal cord explains that central effects are relatively rare. However, side-effects may be observed, and their frequency mainly depends upon the quantity of narcotic injected. These side-effects reduce the number of indications, which cannot yet be precisely determined. Epidural and intrathecal analgesia appears to be particularly useful during the post-operative period in patients liable to respiratory complications.

Analgesia↗
PubMed1980

[Perioperative cardiac arrhythmias in digitalized patients with ischemic heart disease (author's transl)].

The purpose of this study was to establish the incidence of pre-operative digitalization by intravenous digoxin on cardiac arrhythmias in 24 patients with ischemic heart disease who underwent abdominal surgery. Ambulatory electrocardiographic monitoring was performed for 12 hours before digitalization, for 12 hours during digitalization (before surgery), for the whole period of anesthesia. General anesthesia used thiopentone, phenoperidine, pancuronium and suxamethonium for endotracheal intubation. No more premature ventricular (PVC) and auricular contractions were detected after digitalization and during anesthesia and surgery. But PVC with begeminism or severe bradycardia were recorded in two patients and episodes of "torsades de pointes" occurred in two other patients during endotracheal intubation. "Torsades de pointes" have never been reported after suxamethonium and endotracheal intubation in digitalized patients. Digitalization, ischemic heart disease, cardiac effects of suxamethonium might be factors of the onset of these first reported "torsades de pointes". In conclusion, after a pre-operative digitalization in the coronary patients the frequency of arrhythmias is not exaggerated during the pre- or per-operative period except during induction and intubation. As the role of suxamethonium seems to be important as a trigger for severe arrhythmias endotracheal intubation in digitalized coronary patients should be performed without suxamethonium.

Acid-Base Equilibrium↗
PubMed1995

[Cerebrovascular reactivity to CO2 during general anesthesia maintained with either isoflurane-N2O or propofol-N2O. A comparative study by transcranial Doppler velocimetry].

OBJECTIVES: To compare, using transcranial doppler velocimetry (TDV), the cerebral blood flow velocity and CO2 reactivity during general anaesthesia maintained with either isoflurane-N2O-O2(IF) or propofol-N2O-O2 (PF) in adults with a normal brain. STUDY DESIGN: Nonrandomized controlled trial. PATIENTS: Forty ASA I patients (mean age 41 +/- 13 yrs, 15 F/35 M) undergoing surgery of the lumbar spine in prone position. The first 20 were allocated into the IF group and the subsequent 20 into the PF group. METHODS: General anaesthesia was induced with midazolam (0.05 mg.kg-1), phenoperidine (0.03 mg.kg-1), thiopentone (5 mg.kg-1), vecuronium (0.1 mg.kg-1) and maintained with N2O (50 vol %) and O2 (50 vol %) and either isoflurane (0.8 < Fet < 1 vol %) in IF group or propofol (6 mg.kg-1.h-1) in PF group. The vascular reactivity was assessed with velocimetry measurements (Angiodine DMS, with a probe transmitting a 2-MHz pulsed wave) of flow in the middle cerebral artery at a given PetCO2 (obtained by adjustments of VT) during systole (SV) and diastole (DV). Three measurements were made: at T1 (PetCO2 = 30 +/- 2 mmHg), at T2 (PetCO2 = 40 +/- 2) and at T3 (PetCO2 = 30 +/- 2 mmHg). RESULTS: In the IF group, VS increased by +32% at T2 (P = 0.006) with an increase of + 3.4 %/1 mmHg of PetCO2. Similarly, in the PF group VS increased by + 31 % at T2 (P < 0.0001) with an increase of 2.9 %/1 mmHg of PetCO2. In both groups the VS returned to baseline values at T3. In the IF group, VD increased by + 66% at T2 (P < 0.0001), with an increase of + 7%/1 mmHg of PetCO2. Similarly in the PF group, VD increased by + 61% (P < 0.0001) with an increase of + 5.7%/1 mmHg of PetCO2. In both groups the VD returned to baseline values at T3. CONCLUSIONS: During anaesthesia maintained with either isoflurane-N2O-O2 or propofol-N2O-O2, a change in PetCO2 results in similar changes in VS and VD. These anaesthetic agents preserve the cerebrovascular reactivity of the normal brain. The results of this study are in accordance with those obtained with other reference techniques in healthy volunteers. Transcranial doppler velocimetry can be a useful noninvasive tool of clinical research in neuroanaesthesia.

Adult↗
PubMed1994

[Indications of planned sedation following intracranial neurosurgery. Prospective study of decisional criteria].

General Anaesthesia (GA) is usually stopped early after intracranial surgery. An impaired neurological status or surgical difficulties may lead to sedate some patients (pts) in the intensive care unit (ICU). The aims of the study were to establish and to evaluate predictive criteria for post- operative sedation. In one group (G1), GA and mechanical ventilation (MV) were discontinued early after surgery and pts stayed at least 12 h. in the ICU. In the other group (G2), sedation and MV were prolonged 24 h., until a clinical and scannographic evaluation. Thereafter, sedation was discontinued or prolonged according to both surgical and anesthetic considerations. These criteria were established according to the literature and to local practices. Before surgery, they depended on clinical status, radiological data and etiology; during surgery, on surgical and medical semiology and difficulties or incidents during the procedure. Adult pts undergoing intracranial surgery under GA were consecutively included in a 6 months prospective study. Patients suffering acute head trauma, pre operative coma (Glasgow CS < 8) or extraneurologic disease (responsible for delayed MV weaning) were not included. Sedation was performed with midazolamR (.05-.15 mg.kg-1.h-1) + phenoperidineR without myorelaxation. The ideal level of sedation was established as defined by Boeke. One hundred and ninety five pts (80 f; 49 +/- 15y-o) were included (G1 = 130, G2 = 65). Surgical indications were: malignant tumor = 61, meningioma = 50, vascular disease = 53, other = 31. ICU stay lasted 5.6 +/- 8 d and MV 3.7 +/- 7 d.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Effects of preoxygenation methods on the course of PaO2 and PaCO2 in anesthetic post-induction apnea].

This study compares two preoxygenation techniques by blood gases measurements during induction of anaesthesia. After hospital ethics committee approval, 17 adult surgical patients, ASA I, all free of cardiac or lung disease were randomly assigned to two groups. Before preoxygenation, venous and radial artery canulations were performed. The patients were not premedicated and rested supine. Oxygen was given using a Mapleson A system with a 10 l.min-1 flow. In group I, 9 patients breathed 100 per cent O2 with a normal pattern. In group II, 8 patients took four deep breaths of 100 per cent O2 within 30 seconds. After this, the mask was removed and anaesthesia was induced with thiopental (5 mg.kg-1), phenoperidine (0.04 mg.kg-1) and vecuronium (0.1 mg.kg-1). After intubation, patients remained apnoeic until SpO2 decreased to 90%. Samples for arterial blood gas measurements were obtained before preoxygenation and then every minute. The two groups were similar in age (26.8 +/- 8.1 vs 29.2 +/- 9.0 years) and weight. The group I had significantly higher PaO2 immediately after preoxygenation (397 +/- 49 vs 293 +/- 86 mmHg) and the time for SaO2 to decrease to 95% was significantly shorter in group II (3 +/- 1 vs 1.87 +/- 0.99 min). PaCO2 was not different after preoxygenation in group II. In summary, healthy and young patients receive better protection against hypoxia with normal breathing of 100% for 4 minutes.

Adult↗
PubMed1998

Diagnosis and pathogenesis of the anaphylactic and anaphylactoid reactions to anaesthetics.

Immediate adverse reactions to anaesthetics have an immune mechanism in more than 50% of the cases. They are mainly due to muscle relaxant drugs. A prospective evaluation of tryptase, histamine and serotonin for diagnosing anaphylaxis to anaesthetics was performed over 2 years. The sensitivity of each marker was at 60-70% and it reached 80% when combining tryptase and histamine. Specific IgE have been already observed in serum from patients allergic to muscle relaxant, thiopentone, morphine, phenoperidine, propofol and radio-contrast media. However, the recent progress in the identification of drug epitopes by Sepharose-solid drug phase IgE radioimmunoassay has to be reconsidered as non-specific binding of hydrophobic drugs such as propofol to hydrophobic serum IgE has been observed recently in patients with drug allergy. In addition, association of drugs such as propofol and muscle relaxant may potentiate the mediator release by a non-elucidated mechanism.

Anaphylaxis↗