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At least 433 records · Page 24Linked to original sources
PubMed1998

[Perioperative management for nephrectomy in a long-term hemodialysis patient with anticoagulants for coronary stent].

A 53-year old man on long-term hemodialysis (HD) with anticoagulant therapy was scheduled for nephrectomy due to renal cell carcinoma. Two months before surgery, a coronary stent had been placed due to right coronary artery disease. One week before surgery, percutaneous transmural coronary angioplasty (PTCA) was performed for unstable angina. Aggressive oral antiplatelet therapy (aspirin and ticlopidine) was absolutely required to maintain patency. Following withdrawal of the antiplatelets, unfractionated heparin (UFH) was titrated to an activated partial thromboplastin time (APTT) of 1.5 times greater than the control value. Maintenance UFH (800 U.h-1) was continued until the time of arrival in the operation room (activated clotting time (ACT) was 166 seconds). One hour after arrival, reduced dose of UFH (200 U.h-1) was reinfused, and ACT was 121 140 seconds. Hemodynamic change was minimized using balanced general anesthesia (nitrous oxide-isoflurane, fentanyl, midazolam and vecuronium) accompanied by nitroglycerin and diltiazem. There was no ischemic change on ECG or transesophageal echocardiography. Following surgery, the UFH dose was augmented (400 U.h-1), and the maintenance dose was attained 11 hours after surgery. HD on the second postoperative day was performed uneventfully. This hemodynamic stability might be come from the no water removal. Fourteen days after surgery, the patient was discharged without hemorrhagic complications or clinical ischemic events. We conclude that perioperative UFH infusion is not contraindicated for dialysis patient if strict ACT control is maintained.

Anticoagulants↗
PubMed1994

Cardiac sympathovagal balance and peripheral sympathetic vasoconstriction: epidural versus general anesthesia.

Both epidural and general anesthetics alter autonomic balance. However, the relative differences between epidural (EA) and general anesthetics (GA) with regard to cardiac and peripheral sympathovagal balance have not been described. Twenty consecutive patients scheduled for radical retropubic prostatectomy were randomized to receive EA (n = 10) or GA (n = 10). Power spectral analysis was performed on the electrocardiographic recordings, with the ratio of low (0.05-0.125 Hz)/high (0.125-0.5 Hz) frequency power used an index of cardiac sympathovagal balance. The forearm minus fingertip skin-surface temperature gradient (> 4 degrees C) was used as an indicator of sympathetically mediated peripheral vasoconstriction. Patients in the EA group demonstrated a significantly greater low/high frequency power ratio and a more frequent incidence of peripheral vasoconstriction than the GA group during the intraoperative period. During the postoperative period, the GA group demonstrated an increase in the low/high ratio and the incidence of vasoconstriction relative to the intraoperative period. Intraoperatively, upper body vasoconstriction appears to be accompanied by a significant shift in cardiac sympathovagal balance toward sympathetic predominance with EA relative to GA. Postoperatively, GA is associated with a shift in the sympathovagal balance toward sympathetic predominance. Further research is required to determine whether this results in cardiovascular compromise in the high-risk patient.

Anesthesia, Epidural↗
PubMed1990

Anesthesia for angioembolization of brain arteriovenous malformations: a retrospective assessment.

We reviewed the anesthetic management of 55 patients under 18 years of age during angioembolization of arteriovenous malformations. Patients were grouped according to age: less than 1 month (A), 1-11 months (B), 1-5 years (C) and 7-13 years (D). All had general endotracheal anesthesia. In groups A and B, approximately 43% received pure narcotic and 43% balanced while only 14% had pure inhalational anesthesia. In groups C and D, 41 and 52% received pure inhalation and balanced anesthesia, respectively, while only 7% had pure narcotics. Hypotension was induced in 50% (C and D) and in 20% (A and B) of the patients. Intraoperative lasix or phlebotomy was used in 28, 16, 13 and 0% of groups A, B, C and D, respectively. Two arrests occurred immediately after the injection of the embolizing material. From our review, no single type of anesthesia can be advocated over all others. The use of invasive monitoring (arterial and central venous lines), precise fluid management and the avoidance of nitrous oxide will help to decrease the incidence of intraoperative complications during anesthesia.

Anesthesia, General↗
PubMedDate not supplied

Balanced anestesia versus total intravenous anestesia for kidney transplantation.

AIM: An ideal anesthetic regimen for kidney transplantation should be able to assure haemodynamic stability to obtain an optimal graft reperfusion. The aim of this study was to compare 2 regimens of anesthesia for patients submitted to kidney transplantation. METHODS: We studied 40 patients: 20 subjects (Group A) received balanced anesthesia with thiopental, fentanyl and isoflurane, to the others 20 (Group B), a total intravenous anesthesia (TIVA) with propofol and remifentanyl was given. In both groups muscle relaxation was obtained with a bolus of cisatracurium followed by a continuous infusion. We performed standard clinical, invasive blood pressure and central venous pressure monitoring. Hemodyna-mic data have been collected at standard times. During the postoperative period we evaluated the recovery (Aldrete Score) in the recovery room and the analgesia (VAS) at 1, 6, 24 h after the end of surgery. RESULTS: The trend of hemodynamic parameters did not show statistically significant differences between the 2 groups. We observed statistically significant differences concerning the quality of the recovery and the postoperative analgesia. The recovery in group B was faster than in group A, but in group A the pain control was better than in group B at least during the first postoperative hour. CONCLUSIONS: For their pharmacokinetic properties, propofol, remifentanyl and cisatracurium allow to obtain a good control of the hemodynamic parameters and a fast and safe recovery of consciousness. Total intravenous anesthesia regimen seems to be an alternative to the balanced anesthesia for patients undergoing kidney transplantation.

Adult↗
PubMed2003

Relationship between adrenomedullin and vasopressin-aquaporin system under general anesthesia.

AIM: The roles of adrenomedullin (AM) in body fluid balance under general anesthesia were investigated. METHODS: Time course changes in plasma osmolality, AM, arginine vasopressin (AVP), and urinary aquaporin 2 (AQP2) in 17 patients undergoing abdominal surgery under general anesthesia were examined. RESULTS: Increases in plasma AM levels were observed in parallel with increases in the levels of urinary AQP2/creatinine (Cr) before induction and 90 and 180 min after initiation of anesthesia. Significant correlations between plasma AM and urinary AQP2/Cr (r = 0.62, p < 0.0001) as well as urinary AVP/Cr and AQP2/Cr (r = 0.60, p < 0.0001) were uncovered. Multivariate stepwise analysis identified plasma AM as the critical independent factor affecting urinary AQP2/Cr level. CONCLUSION: A novel correlation of AM and AQP2 which overlays an AVP-AQP2 system may play a key role in fluid homeostasis during general anesthesia.

Adrenomedullin↗
PubMedDate not supplied

[Water balance and pharmacokinetics of ketamine during anesthesia in roentgen-endovascular procedures in children].

Forty-seven children, aged 2 to 12, with different pathologies, who underwent the abdominal aortography with the bolus introduction of 60% verografin, i.e. a radiopaque contrast agent (RCA), 2-3 ml/kg for 2-3 sec. The osmolar index of blood went up sharply, diuresis increased 7-fold and the aldosterone content topped 2-fold the original level. Simultaneously, the plasma concentration of ketamine was reducing by 2 times faster than in children who were not administered RCA. An additional introduction of an anesthetic made on minute 3 after RCA injection was suggested to modify the anesthesia management scheme.

Anesthesia, General↗
PubMed1993

Perianesthetic thermoregulation and heat balance in humans.

General anesthesia markedly impairs normal control of body temperature, reducing the threshold (triggering core temperature) for thermoregulatory vasoconstriction from approximately 37 to approximately 34.5 degrees C. Sweating and active vasodilation thresholds similarly are increased, widening the range of temperatures not triggering regulatory compensations from approximately 0.2 to approximately 4 degrees C. However, once initiated, the gains (slopes of response intensity vs. core temperature curves) and maximum intensities of thermoregulatory responses are nearly normal. Intraoperative core temperature initially decreases rapidly because anesthetic-induced inhibition of tonic thermoregulatory vasoconstriction causes a core-to-peripheral redistribution of body heat. The subsequent slower, linear decrease in body temperature results from heat loss exceeding metabolic heat production. And finally, after 3-4 h of anesthesia, core temperature stabilizes at an abnormally low value. In patients experiencing minimal heat loss, and therefore not becoming sufficiently hypothermic to trigger vasoconstriction, this plateau can be passive steady state in which heat loss equals production. Conversely, patients becoming sufficiently hypothermic will trigger thermoregulatory vasoconstriction that both decreases cutaneous heat loss and sequesters some metabolic heat in the core. Epidural and spinal anesthesia also cause core hypothermia by inhibiting tonic thermoregulatory vasoconstriction, producing an internal redistribution of heat from the warm core to cooler peripheral tissues. Core hypothermia provokes thermoregulatory responses including vasoconstriction (above the block level) and shivering. Nonetheless, many patients feel warmer after induction of regional anesthesia, apparently because perceived skin temperature is elevated. The following review will focus on anesthetic-induced impairment of normal thermoregulatory control and the resulting alterations in heat balance.

Anesthesia↗
PubMed2004

Time-frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia.

BACKGROUND: Time-frequency balanced spectral entropy of electroencephalogram (EEG) and frontal electromyogram (FEMG) is a novel measure of hypnosis during anesthesia. Two Entropy parameters are described: Response entropy (RE) is calculated from EEG and FEMG; and State Entropy (SE) is calculated mainly from EEG. This study was performed to validate their performance during transition from consciousness to unconsciousness under different anesthetic agents. METHODS: Response entropy, SE [S/5 Entropy Module, M-ENTROPY (later in text: Entropy), Datex-Ohmeda Division, Instrumentarium Corp., Helsinki, Finland] and BIS (BIS XP, A-2000, Aspect Medical Systems, Newton, MA) data were collected from 70 patients; 30 anesthetized with propofol 2 mg kg-1, 20 with sevoflurane inhalation, and 20 with thiopental 5 mg kg-1. Loss and regaining of consciousness (LOC, ROC) was tested every 10 s, and sensitivity, specificity, and prediction probability (Pk) were calculated. Behavior of the indices was studied. RESULTS: Sensitivity, specificity, and Pk values for consciousness were high and similar for all indices. During regaining of consciousness after propofol bolus, RE, SE, and BIS values recovered by 81 +/- 22%, 75 +/- 26%, and 59 +/- 18% (mean +/- SD), respectively, from the minimum relative to their baseline. After thiopental bolus, RE, SE, and BIS values recovered by 86+/-21%, 88 +/- 13%, and 63 +/- 14%, respectively. The relative rise was higher in RE and SE compared with BIS (P < 0.01). During deep levels of hypnosis, RE and SE decreased monotonously as a function of burst suppression ratio, while BIS showed biphasic behavior. On average, RE indicated emergence from anesthesia 11 s earlier than SE, and 12.4 s earlier than BIS. CONCLUSIONS: All indices, RE, SE, and BIS, distinguished excellently between conscious and unconscious states during propofol, sevoflurane, and thiopental anesthesia. During burst suppression, Entropy parameters RE and SE, but not BIS, behave monotonously. During regaining of consciousness after a thiopental or propofol bolus, RE and SE values recovered significantly closer to their baseline values than did BIS. Response entropy indicates emergence from anesthesia earlier than SE or BIS.

Adolescent↗
PubMed1997

Sympathovagal effects of spinal anesthesia assessed by the spontaneous cardiac baroreflex.

BACKGROUND: The changes in sympathovagal balance induced by spinal anesthesia remain controversial. The spontaneous baroreflex method allows the continuous assessment of the spontaneous engagement of the cardiac baroreflex, giving an index of sympathovagal balance. The purpose of this study was to follow the effects of spinal anesthesia on spontaneous baroreflex sensitivity. METHODS: Continuous electrocardiogram and noninvasive blood pressure were recorded in 24 patients scheduled for elective inguinal hernia repair and randomly assigned to three groups: (1) no volume loading, (2) volume loading of 15 ml/kg lactated Ringer's solution, and (3) continuous infusion of etilefrine (an ephedrine-like drug). Each patient was studied before, during, and after bupivacaine-induced spinal anesthesia (mean sensory block: T4). Spontaneous baroreflex sensitivity and parameters of time-domain analysis of heart rate variability were calculated from 30 min of recording of each period. RESULTS: No significant change in spontaneous baroreflex slope or parameters of time-domain analysis were observed after regional anesthesia in any group. However, three patients experienced episodes of bradycardia and hypotension in the absence of a high block; these three patients showed an increase in spontaneous baroreflex sensitivity and time-domain parameters. CONCLUSIONS: Using a noninvasive, continuous technique to estimate cardiac sympathovagal balance, no significant variation in autonomic balance induced by spinal anesthesia was observed. However, untoward episodes of bradycardia and hypotension occurred in three patients, who could not be prospectively identified by the parameters studied.

Adjuvants, Anesthesia↗
PubMed1994

Intraoperative anesthetic management of patients undergoing glomus tumor resection using a low-dose isoflurane-fentanyl technique.

Glomus jugulare and vagale tumors present unique problems to both anesthesiologists and surgeons. The anesthetic plant must be tailored to each patient and provide hemodynamic stability, a consistent intraoperative environment, and rapid awakening after prolonged administration. In this report, we describe our anesthetic method used for paraganglioma resection, which utilizes a combination technique of low-dose isoflurane with a narcotic infusion initiated after bolus administration. Results from the last three patients anesthetized by this "balanced" technique were compared to a similar patient who received isoflurane anesthesia exclusively for a major portion of the surgical procedure. The patients receiving the balanced anesthesia required no hemodynamic support during the procedure and were awakened within 15 to 25 minutes of surgical completion. The patient receiving high-dose isoflurane, however, had a prolonged anesthetic wake-up time and did not follow verbal commands for approximately 12 hours after surgical completion. This patient also required hemodynamic support with a phenylephrine infusion during tumor resection. The balanced technique seems to be superior to a straight inhalational technique. Neurological assessment and intubation times after prolonged surgery were reduced with superb hemodynamic stability throughout. This anesthetic method produces a stable intraoperative environment and provides deep surgical anesthesia during periods when muscle relaxants cannot be utilized.

Journal Article↗
PubMedDate not supplied

[The effect of anesthesia on the neurohumoral regulation system and water-electrolyte balance during aortocoronary bypass].

Two methods of multicomponent general anesthesia distinct in the analgetic agent used to ensure analgesia have been compared. In group I (6 patients) analgesia was ensured by fentanyl at a dose of 10 micrograms/(kg/min), in group II (7 patients) it was ensured by pyritramide (dipidolor) at a dose of 2 mg/kg for the whole operative period. The study has shown that during aortocoronary bypass surgery in patients with ischemic heart disease analgesia is better ensured by pyritramide than by fentanyl administration. The latter technique of analgesia should be improved, as the current modification causes almost twice as great stress-reaction as the one employing pyritramide.

Adult↗
PubMed1991

Thermal balance and tremor patterns during epidural anesthesia.

Five healthy, nonpregnant volunteers were studied before and after induction of lumbar epidural anesthesia to determine the cause of central hypothermia during epidural anesthesia. Cutaneous heat loss was measured from 10 area-weighted sites using thermal flux transducers. Oxygen consumption was measured and converted to heat production in watts (W). After a 2-h control period at approximately 20 degrees C, epidural anesthesia was induced by injection of 30-50 ml 3% chloroprocaine. Additional boluses were given to extend the sensory blockade to at least the T5 dermatome. Tremor during epidural anesthesia was compared with normal shivering induced by rapid central venous infusion of approximately 4 l iced saline in six unanesthetized volunteers. Average skin temperature and cutaneous heat loss decreased during the control period, while tympanic membrane temperature remained stable. During the 1st h of epidural blockade, tympanic membrane temperature decreased 1.1 +/- 0.3 degrees C, and average skin temperature increased 0.9 +/- 0.5 degrees C. Cutaneous heat loss increased 16 +/- 6% (15 +/- 5 W), but metabolic heat production increased even more (and was associated with a shivering-like tremor). Tremor during epidural anesthesia and shivering induced by iced saline infusion had similar synchronous waxing-and-waning patterns. No abnormal EMG patterns were detected during epidural anesthesia. We conclude that central hypothermia during the 1st h of epidural anesthesia does not result from heat loss to the environment in excess of metabolic heat production, but results primarily from redistribution of body heat from central to peripheral tissues. Analysis of the tremor patterns suggests that oscillations recorded during epidural anesthesia in nonpregnant individuals is normal thermoregulatory shivering. Shivering occurred sooner and was more intense during iced saline infusion than during epidural anesthesia, despite comparable central hypothermia. The low intensity of shivering during epidural anesthesia, and in some individuals the delay in onset, may result from blockade of afferent cutaneous cold signals.

Adult↗