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PubMed1991

Epidural versus general anesthesia for infrainguinal arterial reconstruction.

A prospective evaluation of 213 consecutive infrainguinal bypass procedures was performed to determine the effect of anesthesia technique on the postoperative complication rate. Limb salvage was the indication for surgery in 92% of cases. No significant differences were observed in age, sex, indication for surgery, presence of cardiovascular and pulmonary risk factors, American Society of Anesthesiologists classification, or Goldman scores between patients receiving epidural anesthesia and those receiving general endotracheal anesthesia. Epidural anesthesia was used for 96 procedures and general endotracheal anesthesia was used in 117 cases. Cardiac complications for the epidural anesthesia and general endotracheal anesthesia groups, respectively, included a mortality rate of 5% versus 3%, nonfatal infarctions in 6% versus 7%, and reversible cardiac events in 14% versus 16%. A high-risk subgroup of 69 patients (American Surgical Association classes IV and V or Goldman score greater than 10 points) also had no significant difference in outcome between epidural anesthesia and general endotracheal anesthesia. Major noncardiac complications occurred in an additional 8% of each group. Regional and general anesthesia therefore produce equivalent cardiovascular risk for infrainguinal arterial reconstruction. These results suggest that indicated operations should not be postponed or avoided for patients either requiring or requesting general anesthesia. Furthermore, other investigations of cardiac risk in vascular surgery do not require a uniform anesthetic technique for valid interpretation of results.

Aged↗
PubMed1987

Modulation of oxygen-free radicals from human leukocytes during halothane- and enflurane- induced general anesthesia.

Oxidative metabolism correlates with the release of microbiocidal oxygen-free radicals, measured as luminol-dependent chemiluminescence. The effect of general anesthesia on the oxidative metabolism of human leukocytes was investigated. Sixteen patients undergoing a halothane-induced general anesthesia and 14 patients receiving an enflurane-induced general anesthesia participated in the study. Halothane-induced anesthesia was accompanied both by a suppression of basic chemiluminescence and by a decrease in chemiluminescence during the phagocytosis of zymosan A. This was monitored 15 min, 30 min and 60 min after starting general anesthesia and compared to the level of chemiluminescence before starting general anesthesia. Ninety minutes after finishing general anesthesia, a significant recovery of chemiluminescence was seen to exceed the level before general anesthesia. Comparable findings were observed with enflurane-induced general anesthesia, suggesting a decreased release of oxygen-free radicals during general anesthesia, and afterwards an increase exceeding the initial level.

Adolescent↗
PubMed1993

[Anesthesia with epidural spinal cord stimulation--I). Its application to general anesthesia].

Epidural spinal cord stimulation (SCS) has been used for the relief of pain. We tried to apply SCS for general anesthesia. The subjects were 76 patients, undergoing thoracotomy (3 cases), thoraco-laparotomy (4), laparotomy (57) and others (12). A monopolar electrode was introduced to the epidural space via a Touhy needle. The conditions of the electrical stimulation were 12.5-50 Hz, 1.0 ms and 2-8 V. The voltage was adjusted to give comfortable sensation to the patients. After the electrode had been introduced, induction of anesthesia and tracheal intubation were performed with thiopental, diazepam and pancuronium or vecuronium. Anesthesia was maintained with nitrous oxide (70%-50%) and SCS. Nine patients inhaled low concentrations of enflurane in addition to nitrous oxide, and 39 patients received injection of vasodilators because of hypertension. All the patients were not awake during operation, and recovered their consciousness soon after the end of operations. SCS was continued for 17 hrs after operation. During 24 hrs after operation, 16 patients required no analgesics, 32 patients once and others twice or more. We conclude that SCS added to general anesthesia is useful to control pain, not only intraoperatively, but also postoperatively.

Adult↗
PubMed2001

Lumbar puncture in pediatric oncology: conscious sedation vs. general anesthesia.

BACKGROUND: Lumbar punctures (LP) generally have been performed with conscious sedation (CS) but are increasingly performed using general anesthesia (GA) owing to the belief that this is less distressing. The aim of this study was to compare these two methods concerning distress, discomfort, pain, well-being and security after the LP, and problems with the LP. PROCEDURE: Twenty-five children with cancer participated in this prospective, randomized, crossover study. Children, parents, and nurses completed a visual analogue scale questionnaire to evaluate the efficacy of CS and GA. In addition, sedation and anesthesia protocols were reviewed. RESULTS: The two methods seemed to be equivalent concerning distress, discomfort, pain, well-being and security after the procedure, and procedure problems. Most children (80%), parents (66%), and nurses (58%) preferred LP in CS. However, the LP was not performed in CS in five cases because the child did not cooperate. Younger children less often preferred CS. CONCLUSIONS: Outcomes for CS and GA in LP were similar. Although there were failures with the CS model, most preferred it to GA. LP in CS also saved time and medical resources. An alternative approach would be to have a pediatric anesthesiologist available at the oncology ward for these elective LPs to provide the sedation or anesthesia required by each individual.

Adolescent↗
PubMed1994

Postoperative morbidity is similar in patients anesthetized with epidural and general anesthesia for radical prostatectomy.

OBJECTIVES: To compare the effect of epidural and general anesthesia on the postoperative course and complication rate in patients undergoing radical prostatectomy. METHODS: Ninety-eight men scheduled for radical retropubic prostatectomy (RRP) were randomly assigned to receive epidural anesthesia only (EA, n = 34), combined epidural and general anesthesia (EG, n = 33) or general anesthesia only (GA, n = 31). In the EA group, epidural anesthesia was induced and maintained with bupivacaine. In the EG group, patients received epidural bupivacaine after the induction of general anesthesia. In the GA group, anesthesia was induced with morphine and maintained with isoflurane. In the postoperative period, epidural patient-controlled analgesia (PCA) was maintained in all patients for 3 to 5 days. Patients were evaluated throughout the hospitalization period and at 3, 6, and 12 weeks following surgery. RESULTS: The three groups did not differ with regard to postoperative pain, bleeding, urine output, fever, length of paralytic ileus, or length of hospitalization. No major cardiovascular, pulmonary, or neurologic complications occurred in any of the patients either perioperatively or in the first 3 months postoperatively. CONCLUSIONS: Intraoperative anesthetic technique was not associated with a different postoperative complication rate in patients undergoing RRP. The very low incidence of complications and the uniform postoperative analgesic regimen may have contributed to the similarity between groups.

Analgesia, Patient-Controlled↗
PubMed1993

General anesthesia: what the perioperative nurse needs to know.

General anesthesia represents a critical experience for the surgical patient. The implications of general anesthesia for perioperative nursing care are extensive and complex. The surgical patient's needs require the perioperative nurse to possess knowledge of the basic principles of general anesthesia and its complications.

Anesthesia, General↗
PubMed1984

General anesthesia for whole-body hyperthermia.

General anesthesia was used to facilitate 259 whole-body hyperthermia treatments in 90 patients. These patients fell into American Society of Anesthesiologists Classifications 3 (moderate to severe systemic disease) and 4 (severe systemic disease with life-threatening potential). Whole-body hyperthermia imposes severe stress on cardiopulmonary and renal function. In this series, elevation of temperature from 38 degrees to 41.5 degrees raised cardiac output to approximately 200% of control, while oxygen consumption rose 35%. General anesthesia provides conditions which allow for more precise control and support of vital signs, fluid requirements, and blood gases.

Anesthesia, General↗
PubMed2003

[The effects of general anesthesia combined with epidural anesthesia on the stress response in thoracic surgery].

OBJECTIVE: To study the effects of general anesthesia combined with epidural anesthesia (GEA) and pure general anesthesia (GA) on the surgical stress response and cytokines in pulmonary surgery. METHODS: Twenty patients submitted to elective pulmonary surgery were randomly divided into 2 groups of 10 patients: GEA group receiving general anesthesia combined with thoracic epidural analgesia and GA group receiving only general anesthesia. Blood samples were taken before induction, at incision, 2 h, 4 h, 6 h following the incision, and in the 1st and 3rd postoperative day. IL-6, ACTH and cortisol were detected with radioimmunoassay. RESULTS: (1). The concentration of ACTH was similar in the 2 groups before operation, was remarkably increased 2 hours postoperatively (P < 0.05), reached the peak values 2 approximately 4 hours after the incision in most patients (P < 0.01), and returned to the preoperative levels one day after operation without a significant difference at every time point between the two groups. (2). The concentration of cortisol decreased transiently during incision in the GEA group (P < 0.05), then increased gradually, was significantly higher than the preoperative level (P < 0.01), and remained at the high level till the morning of the 1st day after operation (P < 0.01). In the GA group the cortisol concentration was higher than that before operation 2 hours after incision (P < 0.01), and remained at the level higher than that before operation 4 h and 6 h after incision (P < 0.01), and returned to the normal level by the morning of the 3rd day. The cortisol concentration 2 hours after incision in GEA group was significantly lower than that in GA group (P < 0.05), however, the peak concentrations of these 2 groups were not significantly different (P > 0.05). In the GA group the IL-6 concentration began to increase after operation, became significantly different from that before operation 4 hours after operation (P < 0.01), reached the peak level in the morning of the first postoperative day (P < 0.05), and returned to the preoperative level in the third day. In the GEA group the IL-6 concentration began to increase 2 hours after operation (P < 0.05), and returned to the preoperative level in the morning of the first postoperative day. The concentration of IL-6 was positively correlated with that of cortisol (r = 0.231). CONCLUSION: Pulmonary surgery performed with two different anesthetic techniques causes inflammatory cytokine responses. The additional epidural anesthesia doesn't influence cytokine production. It incompletely inhibits the stress response in the early phase. IL-6 and cortisol may have some effects on each other.

Adrenocorticotropic Hormone↗
PubMed1995

Propofol infusion technique for outpatient general anesthesia.

PURPOSE: The purpose was to evaluate the suitability of a continuous propofol infusion in combination with alfentanil for outpatient general anesthesia in an oral and maxillofacial surgery practice. MATERIALS AND METHODS: Twenty-seven ASA 1 patients were selected to undergo oral and maxillofacial surgery outpatient procedures of short duration. Induction of anesthesia was accomplished with 1 mg/kg intravenous (i.v.) propofol and 10 micrograms/kg i.v. alfentanil. Local anesthesia was administered. General anesthesia was maintained with a continuous infusion of 150 micrograms/kg/min of propofol. Various physical and psychomotor responses were recorded during induction, maintenance, emergence, and recovery. RESULTS: Anesthesia was successfully induced in all patients with single, slowly titrated, bolus doses of 1 mg/kg of propofol and 10 micrograms/kg of alfentanil. Induction of general anesthesia occurred in less than 1 minute in all cases and no excitatory phenomena, tremor, or hypertonus were observed. Maintenance of anesthesia was adequately accomplished and cardiovascular parameters remained within acceptable limits throughout the procedure. The average length of surgery was 22 minutes. Movement to surgical stimulus was minimal and easily managed with additional local anesthetic and/or a 10-mg bolus of propofol. Time to eye opening was approximately 5 minutes from the discontinuation of the propofol infusion. No emergence phenomena were observed. All patients were ready for discharge with baseline psychomotor activity within 30 minutes following the end of the procedure. The average total dose of propofol was 350 mg and the average dose of alfentanil was 750 micrograms. CONCLUSION: This anesthetic technique has numerous advantages with minimal side effects, and should be considered for routine use for outpatient general anesthesia in oral and maxillofacial surgery.

Adolescent↗
PubMed1989

Fetal surgery and general anesthesia: a case report and review.

Fetal surgery, in utero, is now a viable option for some congenital conditions due to recent advances in ultrasound and microsurgical technology. Previous reports of anesthesia for such procedures have focused on spinal or epidural conduction techniques. General endotracheal anesthesia may have several advantages in this setting. In addition to maternal anesthesia, general anesthesia can provide fetal neuromuscular block (without direct fetal injection of blocking agents) and uterine relaxation. It may also blunt fetal response to surgical stimulation.

Adult↗