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PubMed1994

[Effect of deliberate hypotension on renal functions during epidural block plus inhalation anesthesia: a comparison of prostaglandin E1 and trimethaphan].

To clarify the effect of prostaglandin E1 (PGE1) or trimethaphan (TMP) on the kidney during deliberate hypotension induced with epidural block plus inhalation anesthesia, we compared renal functions and renal tubular injury between the patient with PGE1-induced hypotension (n = 22) and those with TMP-induced hypotension (n = 18) undergoing spherical acetabular osteotomy. Hypotension was maintained at 75-80 mmHg of the systolic radial artery pressure for two hours. The urine volume, creatinine clearance, fractional sodium excretion and free water clearance were maintained within normal limits and they were not different between the two groups. The mean NAG index increased significantly to normal upper limits during hypotension in the PGE1 group but did not increase in the TMP group. However, there was no difference in the NAG index between the two groups. The changes in serum ADH level were not different between the two groups perioperatively. These results suggest that renal functions are not influenced by controlled hypotension induced with PGE1 or TMP during epidural plus general anesthesia.

Adult↗
PubMed1992

[A case of intractable status asthmaticus treated by isoflurane inhalational anesthesia and bronchial lavage].

A case of severe asthmatic attack treated by isoflurane inhalational anesthesia and bronchial lavage is reported. A 24-year-old woman was admitted to our hospital with severe asthmatic attack. Although she was treated by intravenous administration of aminophylline and corticosteroids, pulmonary function and consciousness deteriorated. Therefore, she was intubated nasally and mechanically ventilated by IPPV with administration of aminophylline, corticosteroids and epinephrine. Despite this treatment, she remained in status asthmaticus with high airway pressure and barotrauma causing pneumomediastinum and subcutaneous emphysema. On the 3rd hospital day, a system was arranged so that isoflurane could be given in an air and oxygen mixture, and administration was started with a concentration of isoflurane of 1.5%. In addition, bronchial lavage via bronchoscopy was performed in order to clear any mucous plugs. After 24 hours, there was marked improvement of wheezing, airway pressure and arterial blood gas level. Eventually, she was weaned from the ventilator on the 6th hospital day without significant side effects. The use of halothane inhalational anesthetic treatment for status asthmaticus is widely known, but it has serious side effects such as arrhythmia and liver injury. Isoflurane may be the inhalational anesthetic agent of choice in the treatment of status asthmaticus.

Adult↗
PubMed1983

Respiratory management after cardiac surgery with inhalation anesthesia.

Improvements in cardiac surgery techniques and anesthetic management have given us cause to re-evaluate the necessity for postoperative mechanical ventilation and delayed extubation after open-heart surgery with inhalational anesthesia. One hundred consecutive patients undergoing various types of cardiac surgery were entered into this study; 94 patients met the requirements for spontaneous ventilation in the immediate postoperative time period and mechanical ventilation was not utilized. Of these 94 patients, 40 (45%) met extubation requirements within 90 min and were subsequently extubated. No patient required reintubation. Six (6%) patients failed to meet the requirements for spontaneous ventilation and, therefore, required mechanical ventilatory assistance postoperatively. In the majority of cardiac patients, the anesthetic technique determines postoperative ventilatory needs. Very poor preoperative physical status and unusually long procedures, however, will probably preclude early extubation or spontaneous ventilation and dictate the need for mechanical ventilation regardless of the anesthetic technique.

Adult↗
PubMed1986

Physiologic and electrocardiographic responses of American river otters (Lutra canadensis) during chemical immobilization and inhalation anesthesia.

Rectal temperatures and heart rates of American river otters (Lutra canadensis) decreased significantly (P less than 0.05) during chemical immobilization with i.m. ketamine hydrochloride in combination with xylazine hydrochloride and acepromazine and during inhalation anesthesia with isoflurane. Anesthetized otters showed a tendency for apnea during induction and while dorsally recumbent, which was reflected by a respiratory acidosis on arterial blood gases. Declines in rectal temperatures and heart rates were not found to be a function of dosage (mg/kg) of the ketamine combination used except for rectal temperatures of otters in relatively poor body condition (inanition). The electrocardiograms of isoflurane-anesthetized otters were similar to those recorded on immobilized otters with the exception of an r' deflection in the ventricular depolarization complex (RSr'). Electrocardiographic criteria were not found which predicted the degree of right ventricular or generalized cardiac enlargement seen radiographically.

Anesthesia, Inhalation↗
PubMedDate not supplied

[Right-to-left shunt determination in dog lungs under inhalation anesthesia with rebreathing and non-rebreathing system].

PURPOSE: To investigatge right-to-left shunt determination in dog lungs under inhalantion anesthesia with non-rebreathing and rebreathing systems and fraction of inspired oxygen (F I O2) of 0.9 and 0.4, respectively. METHODS: Two groups of 10 dogs each under inhalation anesthesia with sevoflurane: GI in which it was utilized non-rebreathing semiclosed system and F I O2 = 0.9, and GII in which it was utilized rebreathing semiclosed system and F I O2 = 0.4. The study parameters were: heart rate, medium arterial pressure, right-to-left intrapulmonary shunt, hematocrit, hemoglobin, arterial partial pressure of oxygen, mixed venous partial pressure of oxygen, mixed venous oxygen saturation, arterial partial pressure of carbon dioxide, partial pressure of water in the alveoli. RESULTS: Shunt results were significantly different between the two groups - GI data were higher than GII in all the evaluated moments. Hence, the group with nonrebreathing (GI) developed a superior grade of intrapulmonary shunt when compared with the rebreathing group (GII). The partial pressure of water in the alveoli was significantly higher in GII. CONCLUSION: The inhalation anesthesia with non-rebreathing system and F I O2 = 0.9 developed a higher grade of intrapulmonary right-to-left shunt when compared with the rebreathing system and F I O2 = 0.4. The higher humidity in GII contributed to the result.

Anesthesia, Closed-Circuit↗
PubMed1987

Narcotics decrease heart rate during inhalational anesthesia.

We determined the heart rate (HR) response to enflurane, halothane, and isoflurane and the effects of narcotics on this response in 81 healthy patients scheduled for elective surgery. Patients were randomly assigned to one of six treatment groups: one of the three anesthetics (approximately 0.9 MAC) in 60% nitrous oxide, and either 0.15 mg/kg of intramuscular morphine 30-60 min before induction or 1 microgram/kg of IV fentanyl 10 min after skin incision. All patients received diazepam, 10 mg orally, 60-90 min before anesthesia, a rapid sequence intravenous induction, and mechanically controlled ventilation. During inhalational anesthesia and the first 10 min of surgery, no significant change in HR occurred in any group (compared to the preinduction HR), although patients given morphine premedication tended to have a decreased HR and those not given morphine premedication tended to have an increased HR. These trends partially account for significant differences that emerged between groups after induction of anesthesia. Patients given morphine premedication and halothane had lower HR (64 +/- 3 SEM) than patients given isoflurane (80 +/- 3) or enflurane (84 +/- 3) and no morphine premedication. Patients anesthetized with enflurane and morphine premedication had lower HR (71 +/- 3) than patients given enflurane without morphine premedication. Administration of fentanyl 10 min after incision (these patients had received no morphine) significantly decreased HR in the presence of any of the vapors. We conclude that inhalational anesthetics used in the clinical setting we employed do not significantly increase heart rate, and that prior administration of morphine or concurrent administration of fentanyl may significantly decrease HR.

Adult↗
PubMed2002

Severe status asthmaticus: management with permissive hypercapnia and inhalation anesthesia.

OBJECTIVE: To describe the difficulties that can be encountered during mechanical ventilation of severe status asthmaticus and to discuss the safety of permissive hypercapnia as a ventilatory strategy and the role and limitations of inhalation anesthesia in the treatment of refractory cases. DESIGN: Case series and review of literature. SETTING: Intensive care unit of a tertiary care hospital. PATIENTS: Two patients with severe status asthmaticus. INTERVENTIONS: Administration of inhalational anesthetics. MEASUREMENTS AND MAIN RESULTS: Both patients had respiratory failure secondary to status asthmaticus requiring mechanical ventilation and permissive hypercapnia. They also received inhalational anesthetics because of refractory bronchoconstriction. Levels of PaCO(2) in each case were among the highest and most prolonged elevations (>150 mm Hg for several hours) reported to date. In one case, life-threatening difficulties with ventilation were encountered related to the use of an anesthesia ventilator. Although they had complications related to the severity of their illnesses, both were treated to recovery. CONCLUSIONS: Mechanical ventilation in severe status asthmaticus can be challenging. Permissive hypercapnia is a relatively safe strategy in the ventilatory management of asthma. High levels of hypercapnia and associated severe acidosis are well tolerated in the absence of contraindications (i.e., preexisting intracranial hypertension). Inhalation anesthesia may be useful in the treatment of refractory cases of asthma but should be used carefully because it may be hazardous owing to poor flow capabilities of most anesthesia ventilators.

Adult↗
PubMedDate not supplied

[Inhalation anesthesia in porphyria variegata].

We report the anesthetic technique performed in a 38 year old woman with variegate porphyria who underwent a partial right mastectomy. The patient was diagnosed in 1984 on the basis of the biochemical profile and enzymatic deficit. She presented marked photosensitivity without neurological or systemic symptoms. Among their personal antecedents an uneventful general anesthesia in 1982 was recorded. The patient was premedicated one hour before surgery with 0.25 mg of scopolamine, 5 mg of dihydrobenzperidol (DHB), and 100 micrograms of fentanyl, all of them given by the intramuscular route. At the operating theater the patient received 5 mg of diazepam, 2.5 mg of DHB, and 200 micrograms of fentanyl. Anesthetic induction was done with a bolus of 20 mg of etomidate, 1 mg of atropine, and 60 mg of suxamethonium. Maintenance of the anesthetic level was achieved with 0(2), N2(0) with 0.5 of 1% isoflurane, and 40 mg of atracurium in two doses. Surgery lasted 50 min and pharmacologic reversion of the anesthesia was not required. Urine was collected in a dark recipient 24 hours after surgery in order to measure the following parameters: porphobilinogen, aminolevulinic acid, coproporphyrins and uroporphyrins. We found a significant increase of uroporphyrins at the three sampling times, although this increase was less marked during surgery, probably due to hemodilution. We stress the advantages of inhalation anesthesia in these patients.

5-Aminolevulinate Synthetase↗
PubMedDate not supplied

Secretion of neutral and acid DNases in cultivated human lymphocytes after incubation with DNA; possible consequences for inhalation anesthesia.

After incubation with DNA human lymphocytes release neutral and acid DNase activities into the culture medium; the release depends on DNA concentration and time of cultivation. The electrophoretic mobility of the released neutral DNase activity is in accordance with DNase I and the electrophoretic mobility of the released acid DNase activity with DNase II. The released DNase activities do not originate from dead cells and are not influenced by blast cell formation. The anesthetic halothane can inhibit the released neutral and acid DNase activities. Inhalation anesthesia can possibly disturb the correlation between DNA and DNases in human blood.

Anesthesia, Inhalation↗
PubMedDate not supplied

Understanding spontaneous output fluctuations of an amperometric glucose sensor: effect of inhalation anesthesia and use of a nonenzyme containing electrode.

Implantable glucose sensors are often unstable in vivo. Possible causes include local oscillations of glucose or oxygen levels, fluctuation of interferants, and external electromagnetic interference. To better understand glucose versus nonglucose mediated fluctuations, we compared sensors fabricated with glucose oxidase versus blank electrodes without enzyme in rabbits. We also investigated the effect of general anesthesia. We used power spectral analysis to investigate transmitted signals from amperometric peroxide sensing devices 2-3 weeks after subcutaneous implantation. Fasted animals were studied for 90 minutes in the conscious state and for 90 minutes during halothane anesthesia. Animals exhibited almost no body movement during the studies. In the conscious state, enzyme active sensors demonstrated more oscillations than blank electrodes at almost all frequencies from 2 to > 8 cycles per hour. This finding suggested that the spontaneous fluctuations were secondary to local changes in glucose or oxygen. Because fluctuations were not seen in the blank electrode, periodic changes in interferant concentrations, electromyographic activity, or in external electromagnetic interference are unlikely. General inhalation anesthesia was associated with markedly reduced sensor output fluctuation at almost all frequencies in enzyme active sensors. We conclude that fluctuation of electrochemical glucose sensor output, unrelated to fluctuations in blood glucose, is likely secondary to spontaneous changes in the local concentration or vascular delivery of glucose or oxygen. Anesthesia may have stabilized blood flow, preventing normal spontaneous autoregulatory variation.

Anesthesia, Inhalation↗
PubMed1984

Laryngoscopic endotracheal intubation of rats for inhalation anesthesia.

Endotracheal intubation of the rat under direct vision is described together with the details of procedures and apparatus for conducting inhalation anesthesia in this species. Our intubation method requires no special manufacture of equipment, because it employs the human laryngoscope equipped with an infant blade (size 0). Using inhalation anesthetics such as enflurane or halothane for induction, clear laryngoscopic visualization of the glottis is reliably obtained, allowing rapid and routine intubation of the rat in a highly predictable amount of time. In contrast, the injected anesthetics such as ketamine or pentobarbital sodium seem unsuited to laryngoscopic intubation as a result of problems of variable induction times, copious oral secretions, and strong pharyngeal-laryngeal reflexes.

Anesthesia, Inhalation↗
PubMed1994

Respiratory mechanics in status asthmaticus. Effects of inhalational anesthesia.

The incidence and severity of bronchial asthma has increased considerably in recent years. As a result, the number of patients requiring mechanical ventilation and more intensive medical therapy for treatment of refractory asthma has also increased. Despite this, available information concerning the quantitative changes in respiratory mechanics and the response to treatment that occur in such patients is limited. The present study describes the abnormalities in respiratory mechanics and the response to isoflurane anesthesia observed in three adults mechanically ventilated for treatment of status asthmaticus. Airway pressure, flow, and volume were measured during controlled mechanical ventilation in which the airway was periodically occluded in order to determine respiratory system mechanics. In two patients, the volume of hyperinflation and expiratory volume-flow relationship were also obtained. Inspiratory and expiratory indices of respiratory resistance were markedly abnormal. These abnormalities were associated with significant dynamic hyperinflation and high levels of intrinsic PEEP. Expiratory flow limitation was also identified in two patients by failure of low levels of applied positive end-expiratory pressure (PEEP) to alter the expiratory volume-flow relationship. Indices of respiratory resistance as well as the magnitude of dynamic hyperinflation and intrinsic PEEP improved considerably with isoflurane administration, after having been refractory to intensive conventional bronchodilator therapy. In summary, these results demonstrate the severity of abnormalities in respiratory mechanics present in ventilated patients with status asthmaticus and the potential therapeutic efficacy of inhalational anesthesia in this setting.

Adult↗
PubMed1984

[Electrostimulation anesthesia in comparison with enflurane-nitrous-oxide inhalation anesthesia during gynecologic operations. 2. Hormonal reactions in the pre-, intra- and postoperative course].

This study describes the secretion of cortisol, growth hormone, prolactin and catecholamines before, under, and following gynaecological surgery in electrostimulation anaesthesia combined with nitrous oxide (ESA). The hormonal stress reactions of ESA were compared to inhalation anaesthesia with enflurane-nitrous oxide ( EFL ). Twenty-two patients undergoing laparotomy were allocated evenly to one of these procedures. In both groups serum levels for cortisol, growth hormone, and prolactin increased during surgery. Growth hormone showed a considerably higher increase during ESA at the end of the operation, whereas prolactin was higher at all periods of surgery during EFL . Cortisol, however, was identical for both groups. Renal excretion rates of adrenaline and noradrenaline were not significantly different. During surgery more metanephrine and normetanephrine were excreted in the urine under ESA than under EFL . There is no advantage with ESA intra- or postoperatively as compared to other routine procedures of anaesthesia for abdominal gynaecological surgery with regard to the so-called stress hormones or sympathetic activity.

Anesthesia, Inhalation↗
PubMed1998

[Comparative investigations on inhalation anesthesia with isoflurane (Forene) and sevoflurane (SEVOrane) in racing pigeons (Columba livia Gmel., 1789, var. domestica) and presentation of a reference anesthesia protocol for birds].

A conventional inhalation anaesthesia using an isoflurane and sevoflurane-oxygen-nitrous oxide-mixture was performed in each six domestic pigeons (Columbia livia Gmel., 1789, var. domestica). Over a period of 60 minutes routine anaesthetic monitoring including reflex score (12 reflexes, cloacal body temperature and pulse oximetry) was performed. For anaesthesia maintainance 4.0 +/- 0.3 Vol. % sevoflurane compared to 2.0 +/- 0.2 Vol. % isoflurane were used. The induction period using sevoflurane was shorter (95 +/- 9 sec) than by using isoflurane (154 +/- 12 sec). The recovery period was significantly shortened using sevoflurane (162 +/- 12 sec) compared to isoflurane with 186 +/- 12 sec. Results show, that the use of sevoflurane is indicated especially in patients bearing anaesthesia risks, but has a number of advantages, though anaesthetic potency is approximately 50% lower than in isoflurane, causing higher costs. Furthermore low toxicity of sevoflurane leads to a lower burden for the surgical staff through so-called "waste gases", which play an important role in avian anaesthesia using a head chamber for application. Beside a review on current techniques in avian anaesthesia this paper includes a standardised detailed anaesthesia protocol description of avian inhalation anaesthesia regarding the technical equipment as well as its practice, which allows an exact documentation of the anaesthetic, meeting legal requirements, too. The results show that inhalation anaesthesia with isoflurane or sevoflurane has to be preferred even in birds when compared to ketamine anaesthesia, the future use of which has to be restricted to sedation and immobilisation partly due to animal welfare grounds.

Anesthesia, Inhalation↗
PubMed1998

[Remifentanil-propofol anesthesia in vertebral disc operations: a comparison with desflurane-N2O inhalation anesthesia. Effect on hemodynamics and recovery].

OBJECTIVE: To ascertain whether there is a difference between total intravenous anaesthesia with propofol (P) and remifentanil (R) and inhalational anaesthesia with desflurane (D) and nitrous oxide (N) with regard to haemodynamic reactions, recovery profile and postoperative analgesic demand in patients scheduled for elective microsurgical vertebral disc resection. METHODS: 50 patients (ASA I-II, 18-65 years) were randomly assigned to receive total intravenous anaesthesia with propofol and remifentanil or inhalational anaesthesia with desflurane and nitrous oxide. After standardised induction of anaesthesia in both groups (1 microgram.kg-1 remifentanil, 1.5 mg.kg-1 propofol 0.1 mg.kg-1 cisatracurium), anaesthesia was maintained in the D/N group with desflurane in 50% N2O. The patients of the P/R group received a constant infusion of 2 mg.kg-1.h-1 propofol and a constant infusion of 0.5 microgram.kg-1.min-1 remifentanil, which was reduced after 15 min by 50%. The administration of desflurane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anaesthesia. At the end of surgery the anaesthetics were discontinued and early emergence from anaesthesia was assessed by measuring time to spontaneous ventilation (VT > 4 ml/kg), tracheal extubation, opening of the eyes and stating correct name and data of birth. The frequency of analgesics and total demand for analgesics were determined using patient-controlled analgesia and recorded for 2 h postoperatively. In addition the pain level of the patients was measured on a visual analogue scale and the incidence of postoperative shivering, nausea and vomiting was noted. RESULTS: Patients anaesthetised with desflurane responded to tracheal intubation and skin incision with increasing blood pressure and showed higher heart rates than patients anaesthetised with propofol and remifentanil, but there were no other haemodynamic differences between the groups in response to surgical stimuli. There were significantly shorter times to spontaneous ventilation (3.2 vs. 6.3 min), extubation (3.8 vs. 9.5 min), eye opening (3.0 vs. 11.5 min) and giving name and date of birth (4.8 vs. 14.3 min) in patients anaesthetised with remifentanil and propofol than in those receiving desflurane and nitrous oxide. In addition, patients anaesthetised with remifentanil and propofol had a greater incidence of postoperative shivering. There were no significant differences between the two groups in the patients' pain scores, analgesic demand and incidence of nausea and vomiting. CONCLUSION: Patients anaesthetised with propofol and remifentanil have significantly shorter emergence times than patients anaesthetised with desflurane and nitrous oxide. The low incidence of postoperative pain after microsurgical vertebral disc resections requires no large-scale analgesic therapy, even after total intravenous anaesthesia including remifentanil.

Adult↗
PubMedDate not supplied

[Comparative study in pediatric inhalation anesthesia. Clinical characteristics and anesthetic complications with halothane and isoflurane].

OBJECTIVES: Comparative study of clinical characteristics and complications during induction, maintenance, and recovery in pediatric inhalational anesthesia between two commonly used fluoride agents (halothane and isoflurane). MATERIAL AND METHODS: We studied 66 children aged 1 month to 13 years undergoing general anesthesia for short lasting surgery who were divided into two groups of 33 patients each one: Isoflurane group and halothane group. Induction and maintenance anesthesia was performed with the corresponding inhalant agent. Parameters measured were duration of unconsciousness, time elapsed for intubation and recovery, heart rate, arterial blood pressure, and incidence of complications. RESULTS: Children anesthetized with isoflurane showed a shorter period of unconsciousness (1.55 +/- 0.11 min) than those anesthetized with halothane (1.91 +/- 0.12 min); whereas that the time required for intubation was significantly more prolonged (8.94 +/- 0.51 and 6.57 +/- 0.32 min, respectively). The incidence of complications was higher in the isoflurane group, mainly expressed as laryngeal spasm during the induction period. Both groups of patients showed a similar hemodynamic behaviour, although diastolic arterial pressure during maintenance anesthesia was significantly lower with isoflurane. Anesthesia recovery was faster and more predictable with isoflurane than with halothane. CONCLUSIONS: Anesthetic agent isoflurane is less appropriate than halothane for induction in pediatric anesthesia due to a high incidence of complications, specially laryngeal spasm.

Administration, Inhalation↗