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PubMed1995

[Inhalation anesthesia and intravenous anesthesia from the medical and economic viewpoint].

The unique pharmacokinetic properties of propofol gave rise to a widespread use of the technique of total intravenous anaesthesia. These properties of propofol are reviewed and compared to those of barbiturates and benzodiazepines. Based on this comparison and with respect to their respective intra- and postoperative effects, a cost-benefit analysis of both inhalational- and intravenous anaesthesia is presented. The choice of an anaesthetic technique must not only be made with regard to medical implications; economical aspects have also to be taken into account without challenge to the quality of care. A consequent use of low-flow techniques and a market oriented purchase of drugs and disposables may allow cost savings in anesthesia.

Anesthesia, General↗

PubMed1997

[PhysioFlex: a target-controlled self-regulating closed-circuit inhalation anesthesia regulator].

Physi Flex is the first commercially available apparatus capable for quantitative, or self-regulating target controlled inhalational anaesthesia, with a totally closed circuit, in adults and children. The fresh gas supply to the circuit is intermittent, automatically regulated by continuous monitoring of the volume and composition of the gas mixture in the breathing circuit. The circle system includes, instead of the two conventional one way valves, a blower creating a continuous unidirectional flow at 70 L.min-1. In addition to the CO2-absorber it contains an absorber with carbon, absorbing the anaesthetic vapour when switched into the circuit. The ventilator consists of four ventilating chambers, each one with a membrane separating the patient and the motor compartments. The displacement of the membranes generates and measures the tidal volume. Automatic ventilation is achieved by electric valves and motor gas, and manual ventilation using a bag. Spontaneous ventilation is also possible. The machine is operated via a computer with selects the number of ventilating chambers (one, two or four), and the tidal volume between 50 and 2,000 mL, depending on age, gender and weight of the patient. The computer maintains the gas volume and the gas and vapour concentrations at their preset values. The O2-flow and consumption, the N2O flow and uptake, FICO2 and FETCO2, FI and FET of the volatile anaesthetic, all other important data are displayed in a numerical and graphical form on a color screen and registered for a delayed analysis. The end tidal concentration of the volatile anaesthetic drives a stepmotor with a syringe containing the selected volatile anaesthetic agent with is directly injected into the breathing circuit where it is vaporized. Therefore the concentration of the anaesthetic vapour can be instantaneously increased with this injector at induction and lowered at end of anaesthesia with the carbon absorber, and the fresh gas consumption is significantly decreased.

Adult↗

PubMedDate not supplied

The recovery of horses from inhalant anesthesia: a comparison of halothane and isoflurane.

OBJECTIVE: Recovery is one of the more precarious phases of equine general anesthesia. The quality and rate of recovery of horses from halothane and isoflurane anesthesia were compared to determine differences in the characteristics of emergence from these commonly used inhalant anesthetics. EXPERIMENTAL DESIGN: Prospective, randomized blinded clinical trial. SAMPLE POPULATION: A total of 96 Thoroughbred and 3 Standardbred racehorses admitted for elective distal forelimb arthroscopy. METHODS: All horses were premedicated with intravenous xylazine, induced with guaifenesin and ketamine, and maintained on a large animal circle system fitted with an out of the circle, agent specific vaporizer. Recoveries were managed by a blinded scorer with a standardized protocol. A 10 category scoring system was used to assess each horse's overall attitude, purposeful activity, muscle coordination, strength and balance from the time of arrival in recovery to standing. Times to extubation, sternal recumbency and standing were recorded. Median recovery scores and mean times to extubation, sternal and standing were compared using the Mann-Whitney U test and student's t test, respectively. RESULTS: The median score for horses recovering from halothane was lower (20.0; range, 10 to 57) than that for horses recovering from isoflurane (27.5; range, 10 to 55). Horses in the two groups were extubated at similar mean times (halothane, 11.3 +/- 5.5 and isoflurane, 9.5 +/- 5.2 minutes) but horses recovering from isoflurane achieved sternal recumbency (halothane, 37.7 +/- 12.1 and isoflurane, 24.7 +/- 8.8 minutes) and stood (halothane, 40.6 +/- 12.9 and isoflurane, 27.6 +/- 9.6 minutes) sooner than those recovering from halothane. CONCLUSIONS: The recovery of horses from isoflurane anesthesia was more rapid but less composed than that from halothane. CLINICAL RELEVANCE: The quality of recovery following isoflurane was worse than after halothane anesthesia using the criteria chosen for this study. However, the range of recovery scores was similar for both groups and all horses recovered without significant injury.

Anesthesia Recovery Period↗

PubMed1990

[Inhalation anesthesia with halogenated hydrocarbons: value of isoflurane].

The halogenated hydrocarbons halothane, enflurane and isoflurane are used extensively. Like every other anaesthetic, these inhaled agents are not devoid of side effects, most of which are undesirable. This review summarises the similarities and differences between the actions of these vapours. Although isoflurane appears to be more advantageous than enflurane and halothane in certain patients, isoflurane is no panacea and the question of which agent to choose still has to be answered for every patient. A note of caution is warranted against the further use of halothane in adults, as halothane offers no advantages when compared to enflurane and isoflurane but carries a higher risk of hepatotoxicity. However, in children halothane remains the halogenated agent of first choice, when anaesthesia is induced via face mask.

Anesthesia, General↗

PubMed1999

[Postoperative nausea and vomiting following stabismus surgery in children. Inhalation anesthesia with sevoflurane-nitrous oxide in comparison with intravenous anesthesia with propofol-remifentanil].

BACKGROUND: Postoperative nausea and vomiting (PONV) is still one of the major problems in strabismus surgery, especially in children. In recent years many studies have been published, suggesting that choosing propofol as the anaesthetic agent may help to reduce the high incidence of PONV in children undergoing strabismus surgery. Experience with remifentanil in children is still very limited and little is known, whether propofol in combination with this new short acting opioid is also superior regarding PONV in squint surgery compared to sevoflurane/N2O. Additionally, little is known, whether the type of operation or the muscle which is operated on has any influence with respect to PONV. METHODS: Following sample size estimation, ethics committee approval and parents informed consent in a prospective, randomised, observer-blind study 105 ASA I and II children aged 3-8 years scheduled for elective strabismus surgery were assigned into one of the following groups: Group TIVA (propofol/remifentanil, n = 53): anaesthesia was induced by remifentanil 0.5 microgram kg-1 min-1 over 2 min (loading phase), followed by 3 mg kg-1 propofol along with 30% O2 in air. After endotracheal intubation anaesthesia was maintained initially with remifentanil 0.25 microgram kg-1 min-1 and propofol 10 mg kg-1 h-1 by constant infusion. In the course of the operation the infusions of the anaesthetics were adjusted to the decreasing need for anaesthesia. Group VOLATIL (sevoflurane/N2O, n = 52): anaesthesia was induced by inhalation of sevoflurane along with 50% O2 in N2O. After endotracheal intubation anaesthesia was maintained with sevoflurane 1.0-1.5 MAC along with 30% O2 in N2O and in the course of the operation the administration of the inhaled anaesthetics was adjusted correspondingly. Preoperatively collected data included gender, age, weight and history of PONV. Intraoperatively collected data consisted of data belonging to routine monitoring (heart rate, blood pressure, peripheral oxygen saturation and temperature) as well as the duration of the operation and anaesthesia and specific data regarding the operation (including the number and type of muscles as well as the kind of operation). Data collected within the first 24 hours postoperatively in the recovery room and on the ward by blinded observers included any PONV events as well as the antiemetics and analgesics applied. RESULTS: Vomiting was observed less frequently in the TIVA-group than in the VOLATIL-group (21 of 53 vs. 32 of 52, p = 0.03) within the first 24 hours postoperatively. Posterior fixation suture ("faden-operation") compared to other operations was followed rather frequently by nausea and vomiting (30 of 44 and 33 of 44, respectively), whereas recessions were rarely associated with nausea and vomiting (12 of 35 and 9 of 35, respectively). CONCLUSIONS: TIVA with propofol/remifentanil proved to be a suitable form of anaesthesia for children in this setting. Propofol showed advantages over sevoflurane/N2O with respect to PONV after squint surgery in children also when applied in the combination with remifentanil. TIVA with propofol/remifentanil may therefore be one way to reduce the high incidence of PONV in this setting, bearing in mind, that PONV is not only influenced by the regimen of the general anaesthesia but rather by the combination of many other factors, in particular the type of operation.

Anesthesia, Inhalation↗

PubMed1987

Cardiovascular responses to acute loading with nifedipine alone and nifedipine plus propranolol during inhalation anesthesia in monkeys.

The cardiovascular effects of the administration of nifedipine and nifedipine combined with propranolol were examined in 15 monkeys during 0.75 and 1.25 MAC of anesthesia with isoflurane, enflurane, or halothane. Hemodynamic variables measured included heart rate (HR), mean arterial pressure (MAP), left ventricular end-diastolic pressure (LVEDP), maximum rate of increase of the Left ventricular pressure (max LV dP/dt), and thermodilution cardiac output (CO). The infusion of nifedipine at a rate adequate to produce therapeutic blood levels during 0.75 MAC with each anesthetic decreased MAP and SVR, but had no effect on cardiac index (CI), max LV dP/dt, or HR. Increasing the anesthetic concentration from 0.75 to 1.25 MAC during nifedipine administration decreased HR and MAP in all groups and decreased CI with halothane and enflurane, but not with isoflurane. Addition of propranolol by infusion in amounts adequate to produce 75% beta-adrenergic blockade caused a further depression of CI, max LV dP/dt, HR, and MAP. However, the hemodynamic depression was significantly greater with halothane and enflurane than with isoflurane. Intravenous administration of calcium chloride (10 mg/kg) after calcium channel and beta-adrenergic blockade only partially reversed the hemodynamic depression that occurred with all three anesthetics. It was concluded that acute loading with nifedipine with and without propranolol exerts a greater cardiovascular depressant effect during enflurane or halothane anesthesia than during isoflurane anesthesia. The myocardial depressant effects of nifedipine and propranolol myocardial depressant effects of nifedipine and propranolol may be synergistic with the depressant effects of potent inhalation anesthetics.

Anesthesia, Inhalation↗

PubMed2000

[Relation between oxygen consumption and cardiac output during inhalation anesthesia under the influence of catecholamines. A study in dogs].

OBJECTIVE: The metabolic regulation of tissue blood flow manifests itself in a linear relation between blood flow and oxygen consumption (VO2). It is unknown, however, if this fundamental physiological principle operates also during inhalation anaesthesia and catecholamine therapy, both known to be associated with changes of cardiac output (Q) and VO2 in opposite directions. METHODS: On different days, 17 trained, healthy dogs (26-33 kg) with chronically implanted flow probes around the pulmonary artery were either anaesthetized with halothane, enflurane, isoflurane, sevoflurane, and desflurane at increasing minimum alveolar concentrations (1-3 MAC) or treated with one of the endogenous catecholamines epinephrine and norepinephrine or the synthetic ones dobutamine and dopexamine (a total of 186 experiments). Cardiac Output (ultrasound transit-time flowmeter) and VO2 (indirect calorimetry) were measured continuously and the relations between both variables (Q/VO2 relations) analyzed. MAIN RESULTS: In awake dogs under basal metabolic conditions, VO2 was 4.6 +/- 0.1 ml x kg-1 x min-1 and Q 105 +/- 3 ml x kg-1 x min-1 (mean +/- SEM). During inhalation anaesthesia, VO2 and Q decreased in parallel, yielding a uniform Q/VO2 relation, which was nearly linear. Above 2 MAC, O2 extraction increased by 50%, indicating compromised oxygen delivery (DO2). Imposed increases in Q and thus DO2 during anaesthesia to rates comparable to that in the awake state did not restore VO2 to baseline. Catecholamines increased both VO2 and Q in a dose-dependent manner, albeit to a different extent. The resulting Q/VO2 relations were linear up to the maximum effects, but their slopes increased about threefold in the order norepinephrine (34), epinephrine (54), dobutamine (86), and dopexamine (105). Despite these differences, VO2 and Q correlated linearly over the whole range studied, which covered a doubling of VO2 and an up to fourfold increase in Q. CONCLUSIONS: The metabolic regulation of blood flow apparently also operates during inhalation anaesthesia, regardless of the anaesthetic. Catecholamines (except norepinephrine) preferentially stimulated Q rather than VO2 (excess perfusion), so that agents like dopexamine might be preferred in the treatment of low cardiac output states because of its low metabolic costs. Our observations imply that cardiac output alone provides little information on the function of the circulation during inhalation anaesthesia and catecholamine therapy unless related to metabolic demands, i.e. to VO2.

Adrenergic alpha-Agonists↗

PubMed1993

Direct in vivo visualization of bronchodilation induced by inhalational anesthesia using high-resolution computed tomography.

BACKGROUND: Volatile anesthetics are effective at preventing and reversing bronchospasm, but their effects on baseline airway tone are controversial. While tantalum bronchography has been used in the past to measure one-dimensional airway diameter changes, this method has inherent problems associated with the irritant effects of tantalum. Until recently, no other direct noninvasive in vivo method to assess airway caliber was available. The present investigation assesses the effects of the inhalation anesthetic halothane on individual unstimulated airways in vivo. METHODS: Ten studies were performed in seven dogs. All dogs were initially anesthetized with 15 mg/kg thiopental followed by a 10-mg.kg-1 x h-1 maintenance dose. Following tracheal intubation the lungs were mechanically ventilated (15 ml/kg, 15 beats/min). The dogs subsequently received increasing doses of halothane (range 0.5-1.5%). On a separate day, the dogs were pretreated with atropine (0.2 mg/kg) and the study was repeated. Fifty sequential high-resolution computed tomography scans were obtained using a 1-s scan time, 137 kVp, 220 mA, 2-mm slice thickness, and 1-mm table feed. Airway areas ranging in size from 3 to 22 mm in diameter were measured and analyzed by one way analysis of variance and Bonferroni pair-wise comparisons of means. RESULTS: Halothane in concentrations of 0.5%, 1.0%, and 1.5% showed significant dose-dependent dilation of the airways (percent increase from control) that averaged 90 +/- 19% (mean +/- SEM), 128 +/- 20%, and 182 +/- 27%, respectively (P = .017). Atropine pretreatment alone significantly dilated the airways to 151 +/- 25% (P = .002) of their baseline value. Halothane caused no further airway dilation in atropine pretreated dogs. CONCLUSIONS: Halothane dilates baseline airways by blocking baseline vagal tone. Since baseline airway tone, airway wall thickness, and initial airway diameter are major determinants of airway reactivity, the observed dilation by halothane may be one of the mechanisms by which inhalational anesthetics decrease airway reactivity.

Anesthesia, Inhalation↗

PubMed1995

[Effects of preoperatively administered flurbiprofen axetil on the action of inhaled anesthesia and postoperative pain].

Flurbiprofen axetil (FP) was evaluated in a randomized study relative to placebo in 26 patients undergoing endonasal ethmoidectomy. The FP group (n = 13) was administrated 1 mg.kg-1 FP 15 minutes before operation during a half hour. Likewise, the control group (n = 13) received intravenous NaCl 0.9%. Concentration and the quantity consumed of sevoflurane, perioperative body temperature, postoperative pain and on-demand dicrofenac sodium consumption were measured. No significant differences were observed concerning concentration and the quantity consumed of sevoflurane. Body temperature of the FP group fell significantly before infusion. The FP group showed lower pain scores and required less dicrofenac sodium than the control group (P < 0.05). This study suggests that preoperative FP infusion relieves postoperative pain, but does not affect the action of the inhalation anesthetic.

Adult↗

PubMed2002

Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children.

To assess effects of anesthesia and opioids, we studied 13 children with obstructive sleep apnea (OSA, age 4.0 +/- 2.2 yr, mean +/- SD) and 24 age-matched control subjects (5.8 +/- 4.0 yr). Apnea indexes of children with OSA were 29.4 +/- 18 h-1, median 30 h-1. Under inhalational anesthetic, closing pressure at the mask was 2.2 +/- 6.9 vs. -14.7 +/- 7.8 cmH2O, OSA vs. control (P < 0.001). After intubation, spontaneous ventilation was 115.5 +/- 56.9 vs. 158.7 +/- 81.6 ml x kg-1 small middle dot min-1, OSA vs. control (P = 0.02), despite elevated PCO2 (49.3 vs. 42.1 Torr, OSA vs. control, P < 0.001). Minute ventilation fell after fentanyl (0.5 microg/kg iv), with central apnea in 6 of 13 OSA cases vs. 1 of 23 control subjects (P < 0.001). Consistent with the finding of reduced spontaneous ventilation, apnea was most likely when end-tidal CO2 exceeded 50 Torr during spontaneous breathing under anesthetic. Thus children with OSA had depressed spontaneous ventilation under anesthesia, and opioids precipitated apnea in almost 50% of children with OSA who were intubated but breathing spontaneously under inhalational anesthesia.

Analgesics, Opioid↗

PubMed1987

[Halogenated inhalation anesthesia with a semiclosed circle system].

Thirty-six patients were anaesthetized for a maxillofacial surgical procedure. Ventilation was controlled by a ventilator (Kontron ABT 4100) with a semi-closed circle system. The flow of fresh gases was 1,200 ml.min-1. The vaporizer for the halogenated anaesthetic agent was placed out of the circle before the ventilator. Halothane was used for maintenance of anaesthesia and isoflurane for induced hypotension in orthognathic surgery. The inspired concentration of the halogenated agent was monitored by an analyser. A linear correlation between the delivered and the inhaled concentration of halogenated agent was established, the latter never reaching the delivered concentration. Monitoring the inspired oxygen concentration was required, so as to maintain a constant value. Carbon dioxide absorption by soda lime was also studied. The known advantages were: substantial economies in nitrous oxide and halogenated agents, prevention of contamination of the operating theatre, humidification and warning of the inspired gases. The use of such a system with the vaporizer out of the circle was safe, all the more so as the concentration of inhaled halogenated agents could be predicted.

Adult↗

PubMed1998

[Postoperative vomiting. A score for prediction of vomiting risk following inhalation anesthesia].

UNLABELLED: Despite numerous factors are thought to affect postoperative vomiting (PV) recent studies demonstrated that the risk of PV can be predicted by considering just the most important ones. Therefore, the aim of this study was to present the clinically most relevant factors, a risk score based upon those factors and its clinical applicability for other types of surgery. METHODS: In a prospective study 2220 adult inpatients scheduled for elective surgery were monitored for PV after inhalational anaesthesia over 24 hours. None of the patients received prophylactic antiemetic treatment. Multivariate analyses were performed with data of patients who underwent otolaryngological procedures to identify the major risk factors and to derive a risk score. The applicability of the score in surgical and ophthalmological procedures was tested by linear regression analysis of expected and observed incidences. RESULTS: In the multivariate model, clinically most important risk factors for PV were female gender, young age, a positive history of postoperative nausea and vomiting or motion sickness, non-smoking and a long duration of anaesthesia, whereas the relative impact of the "type of operation itself" was small. Expected and observed incidences in patients undergoing other types of surgery were strongly correlated (R2 = 0.99, P < 0.001). CONCLUSION: The risk for PV after inhalational anaesthesia in adults can be predicted using a score which is based on individual risk factors and the duration of anaesthesia only.

Adolescent↗

PubMed1993

Morphine, but not inhalation anesthesia, blocks post-injury facilitation. The role of preemptive suppression of afferent transmission.

BACKGROUND: The subcutaneous injection of formalin in the rat paw results in several minutes of flinching (phase 1) followed by cessation of activity then resumption of flinching (phase 2), which depends on facilitation of spinal transmission evoked by C-fiber activity generated immediately after the noxious stimulus. It was hypothesized that suppression of dorsal horn activity during and immediately after formalin injection by inhalation anesthetics or intrathecal opiates would block spinal facilitation and inhibit phase 2 flinching, even if the anesthetic or opiate were eliminated before phase 2. METHODS: Flinches/min were observed 1 and 5 min after formalin injection (phase 1) and at 5-min intervals thereafter for 60 min (phase 2) for five groups of rats: control (group 1); 1% isoflurane before and for 6 min after formalin (group 2); 2.5% isoflurane before and for 6 min after formalin (group 3); 1% isoflurane and 70% N2O before and for 6 min after the formalin (group 4); and 30 micrograms intrathecal morphine given 20 min before formalin and 30 micrograms intrathecal naloxone given 6 min after formalin, combined with 1% isoflurane as in group 2 (group 5). RESULTS: All groups, except control, exhibited essentially complete suppression of phase 1 flinching. The changes in phase 2 flinching, expressed as a percent of total phase 2 flinches for the control animals, were: control (100%) = group 4 (109 +/- 17%) > group 2 (66 +/- 13%) = group 3 (66 +/- 14%) > group 5 (19 +/- 12%). CONCLUSIONS: Isoflurane, even at high concentrations, administered during and shortly after a noxious stimulus produces only a modest reduction in facilitation of afferent processing. The addition of intrathecal morphine during the period of nociceptor activity results in marked attenuation of the facilitated state.

Anesthesia, Inhalation↗

PubMedDate not supplied

The influence of chronic administration of hypnotics and analgesics on rate of recovery from inhalation anesthesia in rats.

A series of groups of Sprague-Dawley rats were given either secobarbital, phenobarbital, morphine, pentazocine, diazepam, methotrimeprazine, or saline (control) intraperitoneally on 4 consecutive days and then, on day 5, anesthetized with chloroform, trichlorethylene, fluroxene, halothane, methoxyflurane, enflurane, isoflurane, bromotrifluorocyclobutane, or chlorotrifluorocyclobutane. One control group received neither pretreatment nor anesthetics and another was given pretreatment but no anesthetics. The factor of "enzyme induction" is also evaluated, as are SGPT elevation and liver and kidney lesions. If enzyme induction occurred with the drugs used for pretreatment, the anesthetics suppressed the expected response. SGPT levels were generally within normal range. The combinations of all pretreatments with enflurane, halothane, or methoxyflurane had the fastest recovery; recovery was slower with the other anesthetic agents, but none of the prior chemotherapeutic drugs accelerated recovery from the inhalation anesthetics.

Alanine Transaminase↗

PubMed1997

Inhalation anesthesia. What to learn from modelisation?

Models describing pharmacokinetics of inhalational anesthetic agents have been developed, usually on Mapleson's description of the body as a collection of tissues characterised by their volume, local blood flow and anesthetic solubility. Such models are very useful to understand the use of inhalation agents and circle circuit, to compare consumption of different agents in different anesthetic practices, and to prepare the anesthetist to administer new products safely.

Anesthetics, Inhalation↗

PubMed1992

[Continuous Fick cardiac output measurement during inhalation anesthesia].

A computer based system that continuously monitors cardiac output (CO) and the other hemodynamic variables has been developed. Fick CO was calculated every 10 sec on breath by breath basis. The arterio-venous oxygen content difference was measured by a combination of a pulse oximeter and a fiberoptic oximeter. Oxygen consumption was calculated by a direct measurement of respiratory gas exchange: airway flow was obtained from a Servo 900C ventilator and the instantaneous oxygen concentration was measured with a paramagnetic oxygen sensor. This system enabled us to use inhalation anesthetics which were avoided during Fick CO measurement with a zirconium oxygen sensor. Fick CO was compared to electromagnetic CO (EMCO) in 5 dogs anesthetized with enflurane. A total of 198 simultaneous data of CO measurements had a range from 0.5 to 2 l/min. Simultaneous measurements of Fick CO and EMCO showed a good correlation (r = 0.97), and a regression equation was: Y = X + 0.029. Fick CO was compared with cardiac output measured by a conventional thermodilution method (TDCO) in 12 patients anesthetized with either enflurane or isoflurane. A total of 207 simultaneous CO measurements ranged from 3 to 10.2 l/min. Regression analysis of 207 paired Fick CO and TDCO values showed a good correlation (r = 0.94), and a regression equation (Fick CO = TDCO-0.28). The "limits of agreement" (mean difference +/- 2 SD of bias) were within +/- 1.12 l/min, which could be acceptable for clinical settings. When hemodynamic states were abruptly changed by an intravenous administration of isoproterenol, Fick CO reached 90% of EMCO change within 30 sec. The author concludes that this system provides virtually continuous hemodynamic analyses and facilitates more sophisticated circulatory control of the patients within a limited fluctuation.

Anesthesia, Inhalation↗

PubMed1994

[A case of life-threatening acute asthma with marked elevation of serum theophylline level during inhalational anesthesia].

A 21-year-old man was admitted to our hospital because of life-threatening acute asthma. His condition deteriorated while he was receiving aminophylline and high-dose corticosterolids, and complicated by pneumomediaststinum. He was intubated and ventilated mechanically. Since peak inspiratory pressure was very high and arterial blood gases were not improving, he was treated with inhaled haltohane and enflurane, and bronchial lavage was done via a bronchoscope. Anesthesia continued for 114 hours before his condition improved. The serum theophylline levels were elevated during anesthesia. Since the dose of aminophylline was not very high, this elevation may have been related to the inhalation of halothane and enflurane.

Acute Disease↗

PubMed2005

The clinical utility of inhalational anesthesia with sevoflurane in electroconvulsive therapy.

Anesthesia in electroconvulsive therapy (ECT) almost always is induced with intravenous agents, typically barbiturates, etomidate, or propofol. There are, however, circumstances in which an inhalational agent would be preferable for induction of general anesthesia. These uncommon clinical scenarios include severe needle stick phobia, agitation preventing insertion of an intravenous catheter, and poor tolerance of intravenous induction agents. Among the inhalational agents available, sevoflurane has several properties that make it the most desirable. In this case series, we describe several patients in our ECT practice in whom inhalational induction of general anesthesia with sevoflurane was deemed appropriate. In all patients, this method was well tolerated and offered distinct advantages compared with an intravenous induction agent. We conclude that ECT practitioners should keep this option in mind for select patients.

Adult↗