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PubMed1986

Alfentanil v. isoflurane for outpatient arthroscopy.

Alfentanil by continuous intravenous infusion and isoflurane have been compared as anaesthetic agents for outpatient arthroscopy. In 42 patients, divided at random into two groups, anaesthesia was induced with methohexitone and vecuronium bromide, and, after intubation, maintained with nitrous oxide 66% in oxygen combined with alfentanil or isoflurane. Alfentanil was given before intubation (1 mg), as a loading dose before starting surgery (50 micrograms kg-1) and by a continuous infusion at a rate of 1 microgram kg-1 min-1. Isoflurane was given in a concentration of 0.9% as a maintenance dose. Awakening from anaesthesia was more rapid with alfentanil than with isoflurane. Recovery tests were applied in the recovery room. Both anaesthetic techniques provided satisfactory anaesthesia and rapid recovery. All patients but one were content with the anaesthesia. The patients who received isoflurane scored better in the recovery tests in the first 3 h, but after 3 h there was no difference between the groups. The alfentanil group showed a higher incidence of nausea and/or vomiting: 45% compared to 14% in the isoflurane group.

Adult↗

PubMed1987

Recovery from sufentanil anaesthesia for outpatient arthroscopy: a comparison with isoflurane.

This study compares the recovery from sufentanil and isoflurane anaesthesia in patients undergoing outpatient arthroscopy of the knee under general anaesthesia. In 40 unpremedicated patients, divided at random into two groups, anaesthesia was induced with methohexitone and vecuronium bromide and, after intubation, maintained with nitrous oxide 66% in oxygen supplemented with sufentanil or isoflurane. Patients in Group A received sufentanil (1 microgram/kg) at induction and if necessary an incremental dose of 10 micrograms. Patients in Group B received 3% isoflurane prior to intubation and 0.9% during maintenance. Awakening from anaesthesia was more rapid with sufentanil than isoflurane. Recovery was assessed from the time patients took to open their eyes, to give correct answers to five questions and to recover from ocular imbalance. (Maddox wing test), and by comparing pre- and postoperative performance of a paper and pencil test (the p-deletion test). After 2 h, there was no difference between the two groups. Both anaesthetic techniques provided satisfactory operating conditions, but the sufentanil group showed a higher incidence of nausea and vomiting (45%) than the isoflurane group (15%).

Adolescent↗

PubMed1987

Effect of clonidine on haemodynamic responses to endotracheal intubation and on gastric acidity.

Sixty-three patients (ASA 1-2), scheduled for elective surgery under general anaesthesia, were randomly given either oral clonidine (225-375 micrograms) + diazepam (5 15 mg), cimetidine (300 mg the night before and 300 mg in the morning) + diazepam or only diazepam for premedication. Anaesthesia was induced with thiopentone and maintained with N2O + O2 (70:30), enflurane and fentanyl. Vecuronium bromide was used as a muscle relaxant. The sleep dose of thiopentone was significantly smaller in the patients pretreated with clonidine than in the other groups. The mean maximal increase in heart rate was lowest in the clonidine-pretreated patients, but there were no significant differences in the mean arterial pressure changes associated with intubation. Before and just after intubation and in the recovery room, the arterial pressures were lowest in the patients pretreated with clonidine. During anaesthesia, marked bradycardia (less than or equal to 45 beats min-1) did not occur more often when clonidine was used, but in the recovery room there were statistically significantly more patients with bradycardia in the clonidine group than in the other groups. On the electrocardiogram (ECG) during the endotracheal intubation, the incidence of bigeminy was higher in the diazepam patients (5/20) than in the cimetidine patients (2/20) and the clonidine patients (0/23). There were significantly more gastric content samples with a pH above 2.5 in the cimetidine group than in the other groups, and clonidine patients did not differ from diazepam patients in this respect. The high incidence of bradycardia with the concomitant hypotension may limit use of this drug to highly selected patients.

Administration, Oral↗

PubMed1989

Recovery from fixed-dose midazolam-induced anaesthesia and antagonism with flumazenil for outpatient arthroscopy.

This study evaluated recovery after a fixed dose of midazolam as induction agent and the influence of flumazenil on recovery parameters in patients undergoing day-case surgery (arthroscopy of the knee). In 40 unpremedicated patients, anaesthesia was induced with midazolam 0.2 mg/kg, vecuronium bromide 0.1 mg/kg intravenously and 3 vol.% isoflurane in oxygen prior to intubation. Anaesthesia was maintained with nitrous oxide 66% in oxygen and 0.9 vol.% isoflurane. Ten minutes after the end of anaesthesia 20 patients received 0.2 mg flumazenil intravenously, followed by increments of 0.1 mg at 60 s intervals until eye opening. Recovery was assessed by the time to eye-opening, to answering five set questions correctly, and to recovering ocular balance (Maddox Wing test), and by comparing pre- and postoperative performance in a pencil and paper test (the p-deletion test). With the exception of ocular balance, all parameters showed a quicker improvement without side-effects in the flumazenil group. After 4 h all patients were fit for discharge. One month after the procedure, all patients were satisfied with the anaesthesia. Full recovery took on average 1.5 days (range between 0 h-10 days). Whilst the technique employing a fixed dose of midazolam as induction agent gives satisfactory intraoperative anaesthesia for day-case arthroscopy, further improvement can be made with the use of flumazenil which hastens recovery.

Adolescent↗

PubMed2005

Effect of low-dose N-acetyl-cysteine infusion on tourniquet-induced ischaemia-reperfusion injury in arthroscopic knee surgery.

BACKGROUND: Temporary occlusion of blood flow is used during arthroscopic knee surgery in order to provide a bloodless surgical field. The resulting ischaemia-reperfusion causes lipid peroxidation, which contributes to tissue injury. The aim of the study was to investigate the effect of low-dose n-acetyl cysteine (NAC) infusion on oxidative stress by determining malondialdehyde (MDA) levels during arthroscopic knee surgery. METHODS: Thirty patients, ASA I - II, undergoing arthroscopic knee debridement under a tourniquet were divided into NAC and control groups. Anaesthesia was induced with propofol, fentanyl and vecuronium bromide and maintained with desflurane in an equal parts O(2)-N(2)O mixture. In the NAC group, an infusion of NAC, 5 mg kg(-1).h(-1), was started after intubation, and continued until extubation. An equal volume of saline was infused to the control group. Duration of ischaemia, anaesthesia time, total dose of NAC infused were also recorded. Venous blood and synovial membrane tissue samples were obtained 10 min after the onset of NAC infusion but before tourniquet inflation (t1), after 30 min of ischaemia (t2), and after 5 min of reperfusion following tourniquet release (t3). RESULTS: Plasma MDA levels were significantly lower in the NAC group on reperfusion. There were no differences between the groups in tissue MDA levels at ischaemia and reperfusion times. CONCLUSION: Low-dose n-acetyl cysteine infusion attenuates lipid peroxidation and ischaemia-reperfusion injury in arthroscopic knee surgery requiring tourniquet application.

Acetylcysteine↗

PubMed1998

Central command, but not muscle reflex, stimulates cutaneous sympathetic efferents of cats.

We determined the effects of stimulation of the mesencephalic locomotor region (MLR) and the muscle reflex, each evoked separately, on the discharge of cutaneous sympathetic fibers innervating the hairy skin of decerebrate cats. Electrical stimulation of the MLR was performed while the cats were paralyzed with vecuronium bromide. The muscle reflex was evoked while the cats were not paralyzed by electrical stimulation of the tibial nerve at current intensities that did not activate directly group III and IV muscle afferents. MLR stimulation increased, on average, the discharge of the 23 cutaneous sympathetic fibers tested (P < 0.05). The muscle reflex, in contrast, had no overall effect on the discharge of 21 sympathetic fibers tested (P > 0.05). Both maneuvers markedly increased mean arterial pressure and heart rate (P < 0.05). Prevention of the baroreceptor reflex with the alpha-adrenergic blocking agent phentolamine did not reveal a stimulatory effect of the muscle reflex on cutaneous sympathetic discharge. We conclude that the MLR is a more important mechanism than is the muscle reflex in controlling sympathetic discharge to hairy skin during dynamic exercise.

Afferent Pathways↗

PubMed1997

Static muscular contraction elicits a pressor reflex in the chicken.

Static muscular contraction has been shown to increase arterial blood pressure and heart rate in humans and other mammals. It is not clear, however, whether birds exhibit a similar response to this maneuver. Therefore, we designed these experiments to determine if the chicken exhibits a cardiovascular response to static muscular contraction and if the observed responses are evoked through a reflex involving muscle afferents. Static contraction of the gastrocnemius muscle was evoked by electrically stimulating the sciatic nerve at 1.5-3.0 times motor threshold (30-40 Hz; 0.025 ms) in 13 chloralose-anesthetized cockerels. We measured arterial blood pressure and muscle tension before and during static contraction and calculated mean arterial pressure and heart rate from the arterial pressure trace. We found that static contraction of the gastrocnemius muscle increased mean arterial pressure from 71 +/- 4 to 95 +/- 4 mmHg (P < 0.05) and increased heart rate from 304 +/- 8 to 345 +/- 10 beats/min (P < 0.05). Furthermore, we found that stimulation of the sciatic nerve after paralysis of the birds with vecuronium bromide or stimulation of the cut peripheral end of the sciatic nerve (using the same stimulation parameters described above) evoked no change in mean arterial pressure or heart rate. We conclude that static muscular contraction of the gastrocnemius muscle in the chicken elicits a pressor response and that this response is due to a reflex arising from the contracting muscles.

Animals↗

PubMedDate not supplied

Effects of diazoxide on the cardiovascular response to tracheal intubation.

The efficacy of 2 or 3 mg/kg diazoxide given 2.5 min before laryngoscopy in attenuating the cardiovascular responses to laryngoscopy and intubation was studied in 30 patients undergoing elective surgery. Data were compared with those from 10 control patients receiving saline. Anaesthesia was induced using 5 mg/kg thiopentone given intravenously and tracheal intubation was facilitated with 0.2 mg/kg vecuronium bromide. Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. The increases following tracheal intubation were significantly reduced (P less than 0.05) in diazoxide-treated patients compared with those in the control group, but there were no significant differences in heart rate following tracheal intubation among the three groups. Data suggest that diazoxide can be used as a supplement during induction of anaesthesia to attenuate the hypertensive response associated with laryngoscopy and tracheal intubation.

Adult↗

PubMed1997

Do intensive care drug infusions support microbial growth?

The potential for commonly infused drug solutions to support or inhibit microbial growth was explored in this study. Drugs examined were midazolam HCl, morphine sulphate, fentanyl citrate, pethidine HCl, bupivacaine HCl, atracurium besylate, vecuronium bromide, adrenaline, dopamine, dobutamine, noradrenaline, isoprenaline, glyceryl trinitrate, sodium nitroprusside and propofol. All drugs were studied in both diluted and undiluted forms. Of the 15 medications investigated, all except propofol were found to be bactericidal and to reduce fungal growth.

Anesthetics, Intravenous↗

PubMedDate not supplied

Interstitial densities following radiotherapy.

After admission on June 30, R.D. remained intubated, and he continued on i.v. steroids, heparin, and warfarin. Nutritional needs were met with a nasointestinal feeding tube and nutritional preparations. He was alert and oriented and communicated appropriately with family and staff via written notes. The patient and his wife wanted to try a ventilator for a period of time before considering a "No CPR" order. His chest wound continued to be open but was healing slowly. Over the next few days, R.D. became more hypoxic with increased respiratory effort and required sedation and assist-control ventilator settings. On July 1, he required more sedation to keep him comfortable, but remained alert and oriented and continued to communicate with his family. On July 3, he sat in a chair for 1.5 hours. On July 4, he developed a large right pneumothorax and a chest tube was placed. He continued to indicate that he was short of breath. The patient remained very anxious and was started on a propofol drip. Later that day, his wife had a discussion with the healthcare team; the decision was made not to resuscitate the patient. On July 5, R.D.'s agitation increased and he was started on additional propofol for sedation, vecuronium bromide to facilitate breathing, and lorazepam i.v. push for relaxation. R.D.'s oxygenation-ventilation status declined through the night. After a discussion between the family and the physician on July 6, life support was withdrawn, and R.D. died later that day. Some of the factors that may have led to R.D.'s radiation-induced pneumonitis include his prior history of smoking as well as his former occupation as a coal miner. He received 15 radiation treatments to his chest area. He also received chemotherapy, including the drug paclitaxel; this combination may have contributed to his radiation-induced pneumonitis. The pneumonitis led to his immunosuppressed condition. R.D.'s superior vena cava syndrome led to the formation of clots for which he received heparin and coumadin. He received steroids to reduce the inflammation from the mediastinoscopy site and in his lung tissues. All of these factors contributed to R.D.'s outcome.

Carcinoma, Non-Small-Cell Lung↗

PubMed1999

[Anesthetic management of a patient with Coffin-Lowry syndrome].

Coffin-Lowry syndrome (CLS) is characterized by mental retardation, a peculiar face and deformities of the thorax and spine. A 33-year-old female with Coffin-Lowry syndrome (CLS), further complicated with atrial septal defect and ventricular tachycardia, underwent elective surgery for anterior cervical cyst. As difficult intubation had been anticipated, anesthesia was induced with continuous administration of propofol. After confirming that she could be ventilated by mask, vecuronium bromide, midazolam and fentanyl were given. The operation and anesthesia were conducted uneventfully. No complications occurred postoperatively. The use of propofol for slow induction of anesthesia was advantageous for hemodynamic stability in this case.

Abnormalities, Multiple↗

PubMed1999

[General anesthesia with remifentanil in a case of "sleep apnea syndrome"].

The authors report the case of a patient suffering from central sleep apnea (CSA) who underwent neurosurgery for ventriculo-peritoneal derivation under general anesthesia. Given the risk of postoperative hypoventilation in CSA, intraoperative anesthesia was induced using remifentanyl, an opiate with a plasma half-life of less than 5 minutes. Propofol (2 mg/kg) and remifentanyl at a dose of 0.5 microgram/kg was used during induction. The patient was curarised with vecuronium bromide, intubated and ventilated with a mixture of O2/N2O. During the operation, remifentanyl was administered as a continuous infusion at a starting dose of 0.2 microgram/kg/min, subsequently modified according to changes in arterial pressure and heart rate. At the end of surgery, which lasted approximately 120", decurarisation was carried out using prostigmin, and the infusion of remifentanyl was suspended, together with N2O. Reawakening times were recorded. Extubation took place 8' and 30" after the suspension of remifentanyl. Postoperative monitoring of SpO2 continued for 1 h and blood-gas analysis was satisfactory. No hypoventilation episodes were reported throughout the postoperative period and the patient was discharged from hospital after 7 days. The authors consider that remifentanyl should be the drug of choice to guarantee intraoperative analgesia in patients suffering from CSA requiring general anesthesia.

Aged↗

PubMed1999

Prolonged mivacurium-induced neuromuscular block. Case report.

A 38-year-old white male patient was admitted to the hospital for elective surgery. General anesthesia was performed with propofol, alfentanil, nitrous oxide and mivacurium as neuromuscular blocker. Seven months before he had the same surgery without anesthetic problems (he received: propofol, vecuronium bromide, fentanil, nitrous oxide). Neuromuscular monitoring was carried out because the patient was included in a study assessing the clinical effect of mivacurium in microlaryngoscopy surgery. After mivacurium administration the first signs of recovery from neuromuscular block were observed after 255 min. The tracheal tube was withdrawn after 410 min from mivacurium administration, at this time the T1 was 80% of the control values and 7 min later the T1 reached 98%.

Adult↗

PubMed2000

[Perioperative stress response in elderly patients for elective gastrectomy--the comparison between isoflurane anesthesia and sevoflurane anesthesia both combined with epidural anesthesia].

The difference in stress responses between isoflurane anesthesia (I group) and sevoflurane anesthesia (S group) was studied. Twelve patients for elective gastrectomy were divided into two groups: S group, 7 patients, 78 +/- 4.3 years of age, and I group, 5 patients, 77.4 +/- 6.9 years of age. Anesthesia was induced by fentanyl, midazolam and sevoflurane or isoflurane with 100% oxygen. After laryngeal mask air way was inserted under spontaneous ventilation, anesthesia was maintained with air (3 l.min-1), oxygen (2 l.min-1), sevoflurane or isoflurane and epidural block. Vecuronium bromide was given during surgery when needed. The demographic data were not different between the two groups. During operation, it was confirmed that the responses of sympathetic nervous system (epinephrine, norepinephrine) and pituitary-adrenocortical system (ACTH, cortisol) were maintained in both groups. After operation plasma norepinephrine levels increased in both groups. Although the responses of I group tended to be stronger than that of S group, there was no significant difference between the two groups.

Aged↗

PubMed2000

[Anesthesia in single and bilateral sequential lung transplantation. Lung Transplantation Group].

BACKGROUND: Anesthesia for lung transplantation: intraoperative complications and long term results. METHODS: 52 patients were scheduled for 16 single lung transplantations (SLT) (9 fibrosis and 7 emphysema) and 36 bilateral sequential lung transplantations (DLT) (4 bronchiectasis, 6 emphysema, 3 fibrosis, 22 cystic fibrosis and 1 pulmonary hypertension). Anesthesia was induced with propofol or midazolam, and fentanyl or alfentanil. As muscle relaxant vecuronium bromide was used. Anesthesia was maintained with isoflurane, fentanyl in boluses or sufentanil continuous infusion in O2 100%. Prostaglandin E1 (20-300 ng/kg/min), inhaled nitric oxide (10-40 ppm), dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-3 mcg/kg/min) and ephedrine (5-10 mg per bolus) were used for hemodynamic management. In 2 patients inhaled areosolized prostacyclin were administered. RESULTS: Mean pulmonary arterial pressure (mPA) and pulmonary vascular resistance (PVRI) increased after pulmonary artery clamping during first lung (mPA: 3347 nel DLT, 3643 nel SLT; PVRI; 375488 nel DLT, 377420 nel SLT) and second lung implantation (mPA: 3746; PVRI: 263553) and decreased after reperfusion of the first (mPA: 4737 nel DLT, 4329 nel SLT; PVRI: 488263 nel DLT, 420233 nel SLT) and the second lung (mPA: 4629; PVRI: 553260). Only in 9 cases (7 DLT and 2 SLT) C-P bypass was used. CONCLUSIONS: With a strong drug support with pulmonary vasodilators, positive inotropic and systemic vasoconstrictor drugs, in most patients we transplanted C-P bypass can be avoided. Intraoperative deaths were not observed. Two years actuarial survival is 65% for DLT and 60% for SLT.

Adolescent↗

PubMed2000

[Anesthetic management for MIDCAB using the target controlled infusion and the bispectral index].

We report our experience in using the target controlled infusion (TCI) of propofol combined with the bispectral index (BIS) monitoring for anesthetic management of minimally invasive direct coronary artery bypass (MIDCAB) in a 43-year-old-male patient with angina pectoris. After premedication, the patient was connected to the monitor with electrodes for BIS monitor. Then, anesthesia was induced with fentanyl and propofol using TCI technique. When blood concentration of propofol reached 4 micrograms.ml-1, the trachea was intubated. Before starting the operation, we evaluated the relationship between blood concentration of propofol and the value of BIS, and the standard maintenance concentration of propofol was set at 3 micrograms.ml-1. When the concentration of propofol was 3 micrograms.ml-1, the value of BIS was about 60. Anesthesia was maintained with nitrous oxide and oxygen and continuous infusion of propofol using TCI technique. When necessary, we gave additional injection of fentanyl and vecuronium bromide. Furthermore, diltiazem was infused continuously for cardiac rate control, as well as infusion of nicorandil, nitroglycerine for prevention of coronary artery spasms, and prostaglandin. After the operation, the patient was alert in 8 minutes and we could extubate in 12 minutes. The use of TCI combined with BIS monitoring for maintenance of anesthesia for MIDCAB is useful and safe.

Adult↗

PubMed2000

[A case of rectal excision in a patient with cervical spinal cord injury of chronic stage].

A 63-year-old man, scheduled for a Hartmann's procedure, sustained a cervical injury with resultant complete motor and sensory loss below the fourth cervical segment 39 years prior to admission. Anesthesia was induced with propofol 70 mg, vecuronium bromide 5 mg and an endotracheal tube was placed in the trachea. Anesthesia was maintained with nitrous oxide/oxygen and fentanyl. Ventilation was controlled to maintain normocapnea. We did not employ epidual anesthesia due to inability to flex the spine. We administered fentanyl to control hypertension, but it led to hypotension. And about 500 ml of bleeding also caused hypotension. These episodes of hypotension are associated with hypovolemia and instability of vascular tone. To control hypotension, we finally selected continuous intravenous administration of norepinephrine. The manifestations of cardiovascular instability during surgery in chronic stage of cervical spinal cord injury is not only hypertension associated with autonomic hyperreflexia, but also hypotension associated with instability of vascular tone and hypovolemia.

Anesthesia, General↗

PubMed2001

[Anesthesia using propofol for a patient with arthrogryposis multiplex congenita].

Arthrogryposis multiplex congenita (AMC) is a syndrome with multiple persistent limb contractures, often accompanied by associated anomalies. Pediatric patients with AMC frequently require operations, necessitating general endotracheal anesthesia. We report on the anesthesia used for a 14-year-old male with AMC, who required the surgical removal of soft tissue from both hip joints. We used propofol and vecuronium bromide to induce anesthesia, and maintained anesthesia with 40% nitrous oxide, oxygen, and propofol at 6 mg.kg-1.1 hr-1. Both induction and maintenance were smooth, and no hyperthermia occurred perioperatively. Propofol can be safely used for anesthesia in AMC patients.

Adolescent↗