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PubMed1999

[Application of intravenous and inhalational combined anesthesia with midazolam, fentanyl 1 and enflurane in cleft palate repair operation].

OBJECTIVE: To observe the effects of intravenous and inhalational combined anesthesia with midazolam, fetanyl l and enflurane in the cleft palate repair operation. METHODS: 128 patients prepared for cleft palate repair operation were selected randomly. Anesthesia was induced with 0.2-0.3 mg/kg midazolam, 3-5 micrograms/kg fentanyl 1, and intubation was facilitated with 1-2 mg/kg succinylcholine. Anesthesia was maintained with fentanyl 1 and enflurane, and changes of hemodynamics and incident rates of hiccup, cough and vomit were observed during and after operation. RESULTS: 1. After inducing, systolic pressure (SP) was decreased by 5%-8%, diastolic pressure (DP) decreased by 8%-10%(P < 0.05), and there were no significant changes in heart rates (HR) (P > 0.05). After intubation, there were no significant changes in SP, DP and HR. 2. After induction, the incident rates of hiccup and cough were 3.1% and 7.8% respectively. After operation, the incident rate of vomit was 7.0%. 3. The volume of lost blood was 5% less than the patient's whole blood volume. CONCLUSION: The anesthetic way is easy to be controlled with few side effects, and patients can revive easily, so it is a safe, efficient and perfect way in cleft palate repair operation.

Anesthesia, General↗

PubMed1989

Llama anesthetic programs.

Llamas are anesthetized conveniently with guaifenesin thiamylal mixes, or, for short periods of time, with xylazine/ketamine. Small individuals must be accurately weighed. Estimating weight without experience is dangerous in this species. The greatest levels of safety and control, especially for critical patients, is afforded by inhalation anesthesia techniques using small animal equipment. All neonates and juveniles can be masked readily but in adults intravenous induction is most satisfactory. Intubation is aided by a long blade laryngoscope. Blood pressure monitoring is best accomplished with an arterial line in the ear artery. However, doppler equipment on the tail or distal leg usually works well.

Age Factors↗

PubMed2005

Concealed mothball abuse prior to anesthesia: mothballs, inhalants, and their management.

Mothballs are one of a number of volatile compounds including model airplane glue, spray paint, nail polish remover, room fresheners, and gasoline that are intentionally inhaled for the purpose of recreational self-intoxication. Their inhalation produces a rapid 'high' characterized by euphoria and generalized intoxication. Chronic abuse can be associated with significant organ impairment, and, in rare cases, cardiac dysrhythmias and deranged end-tidal gas monitoring. Mothballs contain the aromatic compound naphthalene and/or paradichlorobenzene. Prolonged exposure can cause hepatic failure and severe hemolytic anemia. We present a case of a young adult who initially concealed her chronic mothball inhalation. The literature regarding mothball abuse as well as inhalant abuse relevant to anesthesia is reviewed, and suggestions for the diagnosis and peri-operative management are offered.

Alkanes↗

PubMed1993

Vital organ blood flow during deliberate hypotension in dogs.

Increasing the inspiratory concentration of isoflurane is a commonly used technique for producing deliberate hypotension (DH) when isoflurane is used as the principal anesthetic. When an intravenous anesthetic technique is used, DH can be produced by the administration of a peripheral vasodilator, eventually in association with low concentrations of isoflurane. The aim of this investigation was to compare the effects of these two different approaches on vital organ blood flow. DH was induced in 12 mongrel dogs with two different anesthetic techniques: inhaled anesthesia with isoflurane (ISO) or an intravenous anesthetic technique combining propofol and alfentanil in combination with the alpha-adrenoreceptor antagonist, urapidil, and isoflurane at low end-expiratory concentrations. Mean arterial pressure (MAP) was initially decreased by 20% of its baseline and then to 50 mm Hg. Vital organ blood flows and the cerebral metabolic rate for oxygen were determined at each decrement in MAP, and after discontinuation of DH. A decrease in cardiac output was observed in the ISO group when MAP was decreased to 50 mm Hg. Cerebral blood flow was constantly and significantly higher in the ISO group. The cerebral metabolic rate for oxygen did not change compared to baseline values in both groups. At a MAP of 50 mm Hg, a decrease in renal blood flow was observed in both groups. Splanchnic blood flow remained stable in the intravenous anesthetic group in contrast to the ISO group where splanchnic blood flow decreased significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗

PubMed1996

[Hemodynamic changes during laparoscopic cholecystectomy under different anesthesia methods].

We measured cardiovascular changes associated with insufflation of carbon dioxide and the reverse Trendelenburg position during laparoscopic cholecystectomy. Twenty eight ASA I and II patients were assigned to three groups depending on the anesthesia method. Inhalation anesthesia (I) group (n = 10) was maintained with nitrous oxide-oxygen-isoflurane (GOI), fentanyl (F) group (n = 10) was maintained with GOI and fentanyl (4.8 +/- 0.9 micrograms . kg-1), and epidural (E) group (n = 8) was maintained with GOI and continuous epidural infusion (1.5% lidocaine, 5 ml . h-1). Swan-Gantz catheters were inserted to the patients in groups F and E. Heart rate and arterial blood pressure increased significantly in group I and this elevated pressure was difficult to control using even high concentrations in isoflurane. Heart rate, arterial blood pressure, right atrial pressure, pulmonary arterial pressure cardiac output, and systemic and pulmonary vascular resistance were not significantly changed in groups E and E. Stroke volume decreased significantly in group F after pneumoperitoneum. Our result showed that hemodynamics during laparoscopic cholecystectomy were the most stable in group E.

Adult↗

PubMed2002

Propofol compared with general anesthesia for pediatric GI endoscopy: is propofol better?

BACKGROUND: The objective of this study was to compare the efficacy and safety of propofol and general anesthesia in children undergoing elective GI endoscopy. METHODS: The study design was prospective, randomized, and open label. Pediatric patients aged 2 to 21 years in whom elective GI endoscopy under general anesthesia was required were randomized to receive propofol or standard inhalational anesthesia. The parameters monitored in the 2 groups were (1) time until wake-up after completion of the procedure, and (2) total time for anesthesia and recovery. Adverse events during the procedures were noted with each agent. RESULTS: Fifty pediatric patients were recruited, 25 in each group. The mean (SD) time until wake-up in the propofol group was 29.92 (16.01) minutes and 18.52 (10.03) minutes in the anesthesia group, (p = 0.002). With stratification into 4 age groups, it was noted that the youngest children, those 2 to 5 years of age, took the longest to awaken with propofol compared with inhalational anesthesia, whereas in the other age groups the differences were not statistically significant. In contrast, the mean total time for anesthesia and recovery in the propofol group was 107.4 (30.14) minutes and 139 (7.61) minutes in the inhalational anesthesia group (p < 0.004). The total time for anesthesia and recovery was longest in the group 5 to 8 years of age who had inhalational anesthesia (p < 0.01). Changes in systolic and diastolic blood pressure occurred with equal frequency in both groups. Transient apnea was noted in 20% of patients receiving propofol. Restlessness and agitation occurred in 52% of patients receiving inhalational anesthesia compared with 8% in the propofol group (p = 0.001). CONCLUSIONS: Propofol, administered by an anesthesiologist, is an excellent and safe intravenous anesthetic agent for pediatric GI endoscopy.

Adolescent↗

PubMed1989

Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia.

Recovery from inhalation anesthesia is often marked by the occurrence of postoperative tremor that resembles shivering, which is known to be associated with an increase in oxygen uptake (VO2), CO2 output (VCO2), and minute ventilation (VE). This study determined the time course of the ventilatory changes observed during the first hour of recovery from isoflurane anesthesia. Ten patients (ASA PS 1) scheduled for minor orthopedic surgery (knee arthroscopy) were included in this study. Anesthesia was induced with thiopental (5 mg/kg) and maintained with 70% N2O and isoflurane (1-2%) in oxygen, allowing spontaneous ventilation. In the recovery room, after N2O had been discontinued, patients were connected to a Beckman Metabolic measurement cart, which allowed a continuous monitoring of VE, VO2, VCO2, and PETCO2. Postoperative tremor was observed in all patients within 7.1 +/- 1.2 min (mean +/- SEM) after isoflurane discontinuation and was associated with a marked increase in the following: VO2, from 173 +/- 26 ml/min at the end of anesthesia to 457 +/- 88 ml/min; VCO2, from 149 +/- 18 ml/min at the end of anesthesia to 573 +/- 98 ml/min; and VE, from 6.8 +/- 0.7 l/min at the end of anesthesia to 16.6 +/- 2.8 l/min (values obtained 20 min after isoflurane discontinuation). In three patients during intense shivering, VO2, VCO2, and VE reached peak values higher than 800 ml/min, 1,300 ml/min and 30 l/min, respectively. This study shows that postoperative tremor following isoflurane anesthesia may be associated with prolonged and large increases in oxygen uptake, CO2 output, and minute ventilation.

Adolescent↗

PubMed2005

Effect of 2 anesthetic techniques on the postoperative proinflammatory and anti-inflammatory cytokine response and cellular immune function to minor surgery.

STUDY OBJECTIVE: The aim of this study was to investigate the influence of 2 established anesthetic techniques: total intravenous anesthesia and balanced inhalation anesthesia (BAL) on the perioperative-induced changes of peripheral blood mononuclear cells (PBMCs), changes in lymphocyte subsets, and the balance of proinflammatory and anti-inflammatory cytokines. DESIGN: This is a prospective, randomized, clinical comparison study. SETTINGS: This study was set at a university hospital. PATIENTS: This study involved 50 patients with American Society of Anesthesiologists physical status I who were scheduled for elective minimal invasive partial diskectomy. INTERVENTIONS: There was no intervention involved in this study. MEASUREMENTS: Changes in differential counts, lymphocyte subsets, and proliferation rates were determined before surgery and in the early postoperative period. Plasma concentrations of proinflammatory cytokines (IL-2, IL-6, IL-12, interferon gamma) and anti-inflammatory cytokines (IL-10, IL-1RA, transforming growth factor beta), and plasma concentrations of cortisol, epinephrine, and norepinephrine were measured before, during, and after surgery. MAIN RESULTS: Absolute number of CD3+, CD4+, and CD8+, and expression of HLA-DR and activation marker CD25+, CD26+, and CD69+ decreased more in response to surgery after BAL. Changes in distribution of T-lymphocyte cells seem to be in part related to severe postoperative pain. Plasma concentration of IL-6 significantly increased during and after surgery with BAL without relation to pain. CONCLUSION: Anesthetic management may have varying influences on the postoperative immune response. Surgery-induced inflammatory response and alteration in cell-mediated immunity seem to be more pronounced after BAL. These effects were attributed to the enhanced stress response after BAL.

Adult↗

PubMed2001

Understanding the mechanisms by which isoflurane modifies the hyperglycemic response to surgery.

UNLABELLED: We studied the effect of anesthesia on the kinetics of perioperative glucose metabolism by using stable isotope tracers. Twenty-three patients undergoing cystoprostatectomy were randomly assigned to receive epidural analgesia combined with general anesthesia (n = 8), fentanyl and midazolam anesthesia (n = 8), or inhaled anesthesia with isoflurane (n = 7). Whole-body glucose production and glucose clearance were measured before and during surgery. Glucose clearance significantly decreased during surgery independent of the type of anesthesia. Epidural analgesia caused a significant decrease in glucose production from 10.2 +/- 0.4 to 9.0 +/- 0.4 micromol. kg(-1). min(-1) (P < 0.05), whereas the plasma glucose concentration was not altered (before surgery, 5.0 +/- 0.2 mmol/L; during surgery, 5.2 +/- 0.1 mmol/L). Glucose production did not significantly change during fentanyl/midazolam anesthesia (before surgery, 10.5 +/- 0.5 micromol. kg(-1). min(-1); during surgery, 10.1 +/- 0.5 micromol. kg(-1). min(-1)), but plasma glucose concentration significantly increased from 4.8 +/- 0.1 mmol/L to 5.3 +/- 0.2 mmol/L during surgery (P < 0.05). Isoflurane anesthesia caused a significant increase in plasma glucose concentration (from 5.2 +/- 0.1 mmol/L to 7.2 +/- 0.5 mmol/L) and glucose production (from 10.8 +/- 0.5 micromol. kg(-1). min(-1) to 12.4 +/- 1.0 micromol. kg(-1). min(-1)) (P < 0.05). Epidural analgesia prevented the hyperglycemic response to surgery by a decrease in glucose production. The increased glucose plasma concentration during fentanyl/midazolam anesthesia was caused by a decrease in whole-body glucose clearance. The hyperglycemic response observed during isoflurane anesthesia was a consequence of both impaired glucose clearance and increased glucose production. IMPLICATIONS: Epidural analgesia combined with general anesthesia prevented the hyperglycemic response to surgery by decreasing endogenous glucose production. The increased glucose plasma concentration in patients receiving fentanyl/midazolam anesthesia was caused by a decrease in whole-body glucose clearance. The hyperglycemic response observed during inhaled anesthesia with isoflurane was a consequence of both impaired glucose clearance and increased glucose production.

Aged↗

PubMedDate not supplied

[Combined inhalation-epidural anesthesia during highly traumatic abdominal operations].

Sixty-nine patients from 2 groups were examined to optimize anesthesiological support of highly traumatic abdominal interventions. Whether graded prolonged epidural infusion of 0.3% naropine solution could be combined with low-flow anesthesia with isoflurane and oxide-oxygen mixture, which could ensure adequate actinociception and completely refuse narcotic analgesics, was studied. The proposed type of combined inhalation-epidural anesthesia creates favorable conditions for the cardiovascular system to function, by increasing cardiac output by 25-30%, by lowering postload by 16% and heart rate by 11-17% with the stability of the remaining central hemodynamic parameters, provides a significant depth of anesthesia and a sufficient stability of regulatory systems and homeostasis during highly traumatic abdominal operations.

Abdomen↗

PubMed2000

Probing for nasolacrimal duct obstruction with intravenous propofol sedation.

BACKGROUND: Nasolacrimal duct obstruction occurs in 5% to 6% of neonates. Many studies advocate the probing of nasolacrimal duct obstruction under general inhalational anesthesia in patients at a late age (12 to 13 months) because a high percentage will resolve spontaneously. Others support early surgical intervention in patients aged younger than 6 to 9 months without anesthesia. We present late nasolacrimal duct probing under intravenous propofol sedation as an alternative approach to the treatment of nasolacrimal duct obstruction with a decrease in cost and time compared with probing under general inhalational anesthesia. METHODS: We made a retrospective review of patient charts of children who underwent nasolacrimal duct probing with intravenous propofol sedation from April 1996 to September 1997. Procedure time and cost of procedure were compared for patients who had probings under propofol sedation to patients who had probings under general anesthesia. RESULTS: A total of 22 patients (31 eyes) underwent nasolacrimal duct probing with propofol sedation; the patients' ages ranged from 11.5 to 39 months (average age, 17.8 months). Twenty-six (84%) of 31 eyes had resolution of the symptoms. The average total time for procedure under propofol sedation was 10.5 minutes, compared with 43.6 minutes under general inhalational anesthesia. The average total recovery time under propofol sedation was 13.6 minutes, compared with 121.1 minutes with general inhalational anesthesia. The cost of probing under propofol sedation was one third less than the cost of probing under general inhalational anesthesia. DISCUSSION: Late probing for nasolacrimal duct obstruction under intravenous propofol sedation is comparable in efficacy to late probing under general inhalational anesthesia with a shorter time for the procedure and decreased expense.

Anesthesia, Intravenous↗

PubMed1995

Anesthesia for magnetic resonance imaging in children: a low incidence of protracted post-procedure vomiting.

STUDY OBJECTIVE: To determine the incidence and severity of vomiting in pediatric patients who have had inhalation anesthesia for magnetic resonance imaging (MRI). DESIGN: A retrospective study of consecutive pediatric patients who had anesthesia for MRI. SETTING: A large university hospital with an integrated clinic facility. PATIENTS: 234 children who required an MRI under general anesthesia over a 30 month period (July 1989 to February 1992). MEASUREMENTS AND MAIN RESULTS: The duration of inhalation anesthesia was 105 +/- 33 minutes. Following anesthesia, the time to oral intake was 92 +/- 69 minutes. Eighteen patients (9%) experienced one or more episodes or emesis. In 14 of the 18 patients, vomiting occurred once and did not delay the intake of oral fluids or the discharge time from clinic when compared with the rest of the patients. Only one patient had frequent vomiting (more than three episodes), and all vomiting resolved spontaneously without anti-emetic therapy in less than eight hours following anesthesia. CONCLUSIONS: Protracted post-procedure vomiting is an infrequent complication of inhalation anesthesia for MRI. Inhalation anesthesia may be a less important cause of postoperative vomiting than factors such as the type of operative procedure, use of opioids, or presence of postoperative pain.

Anesthesia, Inhalation↗

PubMed1995

Hemodynamic and oxygenation variables during radical cystectomy. Does the anesthetic technique really matter?

The effect of anesthetics on hemodynamic variables (HV) has been clarified, but ambiguity existed concerning their effect on oxygenation variables (OV). Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjected to radical cystectomy (n = 33) were assigned through balanced randomization to receive one of four anesthetic modalities, namely; group I: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine (n = 11); group II: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine, and supplemented with epidural analgesia (EA) (n = 11); group III: total intravenous anesthesia (TIVA) using ketamine 10-30 ug.kg-1.min-1, propofol 2 mg.kg-1.h-1, d-tubocurarine, and supplemented with continuous EA (n = 6): and group IV:TIVA using ketamine 20-50 ug.kg-1.min-1, midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA (n = 5). Monitoring entailed continuous ECG, pulse oximerty, invasive arterial pressure, and pulmonary artery catheter for HV (HR, MAP, PAP, PAOP, CO, SVR, and PVR) and OV. (PaO2, SaO2, PvO2, SvO2, a-vDO2, O2ext, Qs/Qt, DO2, and VO2). The heart rate was lower in TIVA while other HV did not show striking differences, Group I showed higher arterial oxygen tension than group II and IV. Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences.

Adult↗

PubMed2000

Less adrenergic activation during cataract surgery with total intravenous than with local anesthesia.

BACKGROUND: Previous studies reported that, contrary to local anesthesia, cataract surgery under inhalational anesthesia is associated with substantial adrenergic activation. We tested the hypothesis that total intravenous anesthesia (TIVA) with propofol and alfentanil produces less or comparable adrenergic activation during cataract surgery than local anesthesia. METHODS: Patients were randomly assigned to peribulbar local block (n=10) or TIVA (n=10). The heart rate, blood pressure, plasma concentrations of catecholamines, cortisol, and glucose were assessed at seven pre-, intra-, and post-operative time points. RESULTS: In the patients given local anesthesia, plasma concentrations of epinephrine, norepinephrine and cortisol did not change significantly. In contrast, plasma epinephrine decreased by roughly 66% during TIVA: from 45+/-16 to 15+/-8 pg/ml. Plasma norepinephrine concentration decreased by roughly 50%, from 462+/-265 to a minimum value of 219+/-6 pg/ml and plasma cortisol concentrations decreased by roughly 61%, from 16.4 ng/ml to 6.4 ng/ml. Blood pressure and heart rates remained near baseline values during local anesthesia. In contrast, systolic blood pressure decreased by 30% and heart rate by 12 beats/min during TIVA. CONCLUSION: The presented study and available data clearly suggest that local anesthesia produces the best adrenergic and hemodynamic stability during cataract surgery. Contrary to previously reported results on inhalational anesthesia (thiopentone/enflurane), the TIVA regimen used effectively prevents the adrenergic and metabolic response during cataract surgery.

Adult↗

PubMedDate not supplied

[Modern approaches to choice of anesthesia in children].

The advantages and disadvantages of intravenous and inhalation anesthesias in pediatric anesthesiology are analyzed. Causes of complications induced by myorelaxants and measures for preventing these complications are discussed. Basic protocols of intravenous or inhalation anesthesias with the minimum fresh gas flow for pediatric anesthesiology are presented.

Anesthesia, Inhalation↗

PubMedDate not supplied

[Blood oxygen-transporting function during different anesthesiological provision procedures in the surgery of the hepatopancreatoduodenal area].

A comparative analysis of blood oxygen-transportingfunction (BOTF) under 6 types of combined general anesthesia (low-flow inhalational anesthesia in combination with a narcotic analgesic or with continuous graded epidural infusion (CGEI) of local anesthetics) during high-traumatic and prolonged operations on the hepatopancreaoduodenal area has revealed no significant abnormalities of tissue oxygen transport and metabolism. At the same time when a procedure of anesthesia is chosen for this category of patients, preference should be given to a combination of CGEI and low-flow inhalational anesthesia with isoflurane in nitrous-oxide mixture, which provides a minimum drug load, optimal conditionsfor cardiovascular performance, and stability of BOTF parameters even in baseline endotoxicosis.

Adolescent↗

PubMed1979

Pure memory loss with hippocampal lesions: a pneumoencephalographic study.

A case of pure memory loss occurred suddenly following inhalation anesthesia. Examination seven years after the onset of amnesia disclosed a profound and selective impairment of recent memory without concomitant deterioration of other higher functions or evidence of other neurologic abnormalities. Pneumoencephalotomography focused on the temporal horns showed severe atrophic changes confined to both hippocampi. This finding provides a radiologic counterpart of previously reported surgical and pathological observations of bilateral hippocampal lesions in cases with relatively pure loss of memory.

Amnesia↗

PubMed1995

Gasless laparoscopy in infants: the rabbit model.

Laparoscopic operations can be performed in neonates and infants, but carbon dioxide pneumoperitoneum may be more dangerous than in adults. Therefore the concept of gasless laparoscopy is especially attractive for small children. The authors have developed an animal training model of gasless infant laparoscopy using the rabbit. Eleven New Zealand white rabbits (mean weight, 2.2 kg) were premedicated with fentanyl (10 micrograms intramuscularly) and maintained under inhalation anesthesia by mask, with halothane (1.0 to 2.5%) in oxygen and nitrous oxide (1:1). The animals were neither intubated nor mechanically ventilated. Heart rate and oxygen saturation were monitored by pulse oximetry. A supraumbilical incision was made through the peritoneum, and an abdominal wall elevator was inserted. A 4-mm-diameter 30 degrees endoscope was introduced at the same site, allowing excellent visualization of the abdominal cavity. Three additional 5-mm cannulas were placed, and a standard Nissen fundoplication was performed in all 11 animals. In seven of these, a left nephrectomy was also performed. Five-millimeter pediatric instruments and 1.7- and 2.7-mm laryngoscopic instruments were used. The rabbit can serve as a training model for laparoscopy in the infant. Gasless laparoscopy, using abdominal wall elevation, may be particularly useful in very small patients.

Abdominal Muscles↗