PubMed · 5983560
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H Brückner. 1966-01-15. [Problems related to halothane anesthesia].. https://pubmed.ncbi.nlm.nih.gov/5983560/
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Noradrenaline (NA) kinetics represent an effective tool for evaluating the activity of the sympathetic system: thus plasma NA concentration, spillover rate (SOR) and metabolic clearance rate (MC) were measured in the rat. The dilution technique was adapted and validated: pithing that caused mechanical destruction of the spinal cord was shown to reduce drastically NA-SOR and plasma NA concentration with no effect on NA-MC. NA-SOR and plasma NA concentration were restored within their normal limits when 2.5 Hz electrical stimulation of the sympathetic roots was superimposed. Normal values of NA kinetics in non-anaesthetised normotensive 12-week-old rats are reported: NA-SOR=196.1+/-26.4 ng/kg/min, NA-MC=413.9+/-38.8 ml/kg/min and plasma NA=486+/-52 pg/ml. NA kinetic was investigated in response to anaesthesia, known to depress excitable tissues of the central nervous system and expected to depress the activity of the sympathetic system. When NA-SOR was significantly reduced during anaesthesia with either sodium pentobarbital or chloralose, plasma NA concentration was not changed because NA-MC was also reduced. Thus, plasma NA concentration can be a misleading marker of the sympathetic activity. The response of the sympathetic activity to four different anaesthetic agents is shown to be heterogeneous, ranging from inhibition to stimulation. Sodium pentobarbital anaesthesia was associated with a statistically significant reduction of both NA-SOR (105.6+/-14.1 ng/kg/min, P<0. 01) and NA-MC (239.3+/-18.7 ml/kg/min, P<0.001) while plasma NA was not changed (438+/-47 pg/ml). Chloralose reduced NA-SOR (101.6+/-20. 1 ng/kg/min, P<0.05) while ketamine did not (150.6+/-35.5 ng/kg/min, n.s.): both compounds reduced NA-MC (257.9+/-27.8 ml/kg/min, P<0.01 and 265.8+/-34.3 ml/kg/min, P<0.05, respectively). Diethyl ether was shown to increase both NA-SOR (472.2+/-111 ng/kg/min, P<0.05) and plasma NA concentration (1589+/-436 pg/ml, P<0.01), while NA-MC remained unchanged. Thus, any investigation of the activity of the sympathetic system in the anaesthetised rat has to take into account the specific effects related to the anaesthetic agent used.
OBJECTIVE: Patients who present an accident during general anesthesia must be tested 4 to 8 weeks later in order to determine the exact cause and prevent any further acute accidents. We report the results of a prospective study based on a 1-year period of allergology consultations after peroperative accidents in the Poitiers University Hospital. PATIENTS AND METHODS: Previous history, surgical procedure, the nature and gravity, of the reaction, risk factors and tests results were recorded. All observations were transmitted to the Regional Pharmacovigilance Center. The level of causality of the administered drug was determined from these data which were integrated into the national computer bank of side effects. RESULTS: After 2,500 general anesthesia procedures, a total of 21 patients had been referred to the allergology consultation. Eighteen were positive for at least 1 test (skin tests or laboratory tests). Among the substances administered, causality was probable for 16, possible for 4 and doubtful for 1. CONCLUSION: Our findings demonstrate the importance of allergy tests and the need for close collaboration between anesthetists, allergologists and pharmacologists.
STUDY OBJECTIVE: Despite widespread use of adjunctive benzodiazepines during ketamine sedation, their efficacy in reducing recovery agitation in children has never been studied. We wished to characterize the nature and severity of recovery agitation after ketamine sedation in children treated in the emergency department and to determine whether the addition of adjunctive midazolam reduces the magnitude of such recovery agitation. METHODS: The study was a randomized, double-blind, clinical trial of adjunctive midazolam versus placebo during ketamine sedation. We enrolled 104 children aged 12 months to 15 years (median age, 6 years) at a combined university medical center and children's hospital. Subjects received either intravenous midazolam (0.05 mg/kg up to 2 mg) or placebo after intravenous administration of a ketamine loading dose (1.5 mg/kg). Treating physicians and nurses independently noted the presence of crying, hallucinations, and nightmares during recovery and graded recovery agitation by using a 100-mm visual analog scale. Preprocedure agitation and external stimulation during recovery were also graded. The time from ketamine injection until each subject met the recovery criteria was recorded. RESULTS: Fifty-three subjects received midazolam, and 51 received placebo. Potentially confounding variables were similar between the groups. Sedation efficacy, adverse effects, and recovery time were also similar between groups. Interobserver agreement between physician and nurse assessments was substantial. Median physician assessment of recovery agitation was 4 mm (interquartile range, 2 to 19) in the midazolam group and 5 mm (interquartile range, 3 to 14) in the placebo group (difference -1; 95% confidence interval -3 to 2; P =.705). Recovery agitation was moderately correlated with preprocedure agitation (rho=0.486) but not with external stimulation during recovery (rho=0.147). CONCLUSION: Recovery agitation is common but generally of very low magnitude after ketamine sedation in children in the ED. We observed a median physician rating of 5 mm on a 100-mm visual analog scale, a score that we believe to be clinically insignificant. The degree of recovery agitation after ketamine sedation is significantly related to the degree of preprocedure agitation. In this study, concurrent midazolam did not diminish such agitation and had no measurably beneficial effect. Use of adjunctive benzodiazepines in pediatric ketamine sedation appears unnecessary.