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Lipolysis in human fat cells obtained under local and general anesthesia.

OBJECTIVES: As adipose tissue is usually obtained during local or general anesthesia in clinical studies, these two forms of anesthesia were presently compared as regards lipolysis induced by catecholamines in isolated human fat cells. DESIGN: Fat samples from the abdominal subcutaneous region were obtained first during local anesthesia (lidocaine) given so that the anesthetic agent did not influence lipolysis and second, during gastric banding under general anesthesia (propofol) immediately after skin incision. SUBJECTS: Eleven obese patients, drug free and otherwise healthy. MEASUREMENTS: Isolated fat cells were incubated in the presence or absence of increasing concentrations of different lipolysis agents, acting at adrenoceptor or various post-receptor levels in the lipolytic cascade. Glycerol release to the incubation medium was measured as an index of lipolysis. RESULTS: All agonists caused a concentration dependent increase (terbutaline, dobutamine, CGP 12177, forskolin, dibutyryl cyclic AMP, isoprenaline and noradrenaline) or inhibition (clonidine) of glycerol release. The comparison of data from local and general anesthesia procedures showed no statistical difference in glycerol response for any of the drugs used. CONCLUSIONS: Adrenergic regulation of lipolysis is not influenced by the mode of sampling, at least not in subcutaneous fat cells of obese subjects obtained during local anesthesia with lidocaine as compared to general anesthesia with propofol.

Abdomen↗

Prevention of vomiting after general anesthesia for pediatric ophthalmic surgery.

We evaluated the effectiveness of a multifaceted general anesthesia protocol designed to minimize postoperative vomiting after pediatric eye surgery. A convenience sample of 150 consecutive children, aged 2 weeks to 18 years, who received general anesthesia for pediatric ophthalmic surgery was studied. General anesthesia was administered with induction by mask for 82.7% of the children and intravenously using propofol in 17.3% of the children. Anesthesia was maintained using halothane or isoflurane, oxygen, and air mixture for all patients. Morphine sulfate was used for additional pain relief, up to 0.1 mg/kg. Gastric aspiration was performed after intubation for each child. Metoclopramide, 0.15 mg/kg, and 0.1 mg/kg of ondansetron were administered before the end of each operation. Postoperatively, patients were monitored for vomiting for 24 hours. Postoperative vomiting occurred in 11 (7.3%) of 150 cases. Acute elevation of intraocular pressure was found in 5 of the 11 children who vomited. This vomiting was unresponsive to intravenous rescue ondansetron, but responded to lowering the intraocular pressure. The incidence of postoperative vomiting after general anesthesia for pediatric eye surgery can be substantially decreased by adopting a protocol designed to lessen the emetic effects of general anesthesia. Limited use of nitrous oxide for mask induction only, gastric emptying, and administration of metoclopramide and ondansetron intravenously in combination proved effective in reducing the incidence of postoperative vomiting.

Adolescent↗