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At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Three balanced anesthetic techniques for neuroanesthesia: infusion of thiopental sodium with sufentanil or fentanyl compared with inhalation of isoflurane.

STUDY OBJECTIVE: To compare emergence from anesthesia and the hemodynamic and respiratory depressant effects of thiopental sodium infusion plus sufentanil or fentanyl with those of isoflurane as the primary component of a balanced technique for neuroanesthesia. DESIGN: Randomized, double-blind, prospective study. SETTING: University hospital and its affiliated Veterans Affairs Medical Center. PATIENTS: Thirty patients undergoing elective craniotomy for aneurysm or tumor. INTERVENTIONS: Thiopental with infusion of sufentanil 0.1 microgram/kg/hr, thiopental with infusion of fentanyl 1 microgram/kg/hr, or inhalation of 0.25% to 2% isoflurane as the major component of a balanced anesthesia technique that included nitrous oxide (N2O) and vecuronium (potency ratio of sufentanil to fentanyl, 10:1). MEASUREMENTS AND MAIN RESULTS: Intraoperative stress response (as indicated by intraoperative hypertension) was said to be the percentage of time the patient required administration of an antihypertensive drug, measuring from the first dose of thiopental to discontinuation of N2O at the end of the procedure, excluding any period of induced hypotension. Rapidity of emergence was measured by the number of minutes from discontinuation of N2O to first opening of the eyes on command. Adequacy of spontaneous ventilation was evaluated by determining partial pressure of arterial carbon dioxide 1, 2, and 3 hours after discontinuation of N2O. Extent of vasoactive drug administration for control of intraoperative hypertension (as determined by the clinicians caring for the patients) was described by minutes of vasodilator infusion and milligrams of propranolol or labetalol administered. The frequency of postoperative hypertension was defined as the number of patients in each group who required medication for postoperative hypertension. No significant differences in variables were found for thiopental/sufentanil, thiopental/fentanyl, or isoflurane when these drugs were used with N2O and vecuronium. CONCLUSIONS: Any one of these balanced anesthetic techniques appears appropriate for craniotomy.

Adult↗
PubMed2004

Perioperative use of selective alpha-2 agonists and antagonists in small animals.

Alpha-2 agonists are the only single class of anesthetic drugs that induce reliable, dose-dependent sedation, analgesia, and muscle relaxation in dogs and cats. Used at low doses, as adjuncts to injectable and inhalational anesthetics, selective alpha-2 agonists dramatically reduce the amount of anesthetic drug required to induce and maintain anesthesia. This reduction in anesthetic requirements is achieved without significant depression of pulmonary function and with limited effects on cardiovascular function. Selective alpha-2 agonists can also be used postoperatively to potentiate the analgesic effects of opioids and other drugs. Given the nearly ideal pharmacodynamic profile and reversibility of alpha-2 agonists, these drugs will play a central role in balanced approaches to anesthesia and the management of perioperative pain in healthy dogs and cats.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1975

[Sodium and water balance in the dog under halothane and methoxyflurane anesthesia (author's transl)].

In our model of volume expanded dogs with an equilibrium between input and renal output of sodium and water halothane anesthesia (1,5 Vol.-% insp.) was performed. In deepening halothane anesthesia we found a progressive decrease of mean aortic pressure, GFR and renal sodium and water excretion. There was a strong correlation between GFR and sodium excretion. With a high GFR significantly more sodium was excreted under halothane, whilst reduction of GFR led to an overproportional decrease of sodium excretion. Urine osmolality, too, depended on GFR under halothane. The results of methoxyflurane anesthesia were quite similansion. Concentrations of inorganic fluoride in serum and urine, which we measured in these experiments, did not result in visible changes of sodium or water balance, compared with the conscious state.

Animals↗
PubMed1992

A review of anesthesia for the open globe.

There are many factors, both physiological and pharmacological, that influence IOP during anesthesia. The choice of anesthetic technique must consider factors other than IOP such as the patient's general condition, concomitant injuries, and the nature of the operation. At this time, there is no ultrarapidly acting neuromuscular blocking agent to allow succinylcholine to be completely abandoned and no method of succinylcholine pretreatment is completely effective in blocking the increase of IOP. The anesthesia provider must balance the overall risk to the patient with the risk to the injured eye when deciding if succinylcholine is to be used. The controversy regarding the actual risk that succinylcholine presents to the open eye has gone on for years and can be expected to continue.

Anesthesia, General↗
PubMedDate not supplied

Capnographic monitoring during anesthesia with controlled ventilation in the horse.

Forty-five horses were maintained on halothane or isoflurane anesthesia for at least 90 minutes and received positive pressure ventilation after the first 30 minutes of anesthesia. Parameters monitored included end-tidal partial pressure of carbon dioxide (ETPCO2), arterial blood pressure, and arterial blood gases and pH. There was a statistically significant correlation between end-tidal carbon dioxide and arterial partial pressure of carbon dioxide (PaCO2) for both halothane and isoflurane anesthesia. There was no significant correlation between end-tidal carbon dioxide and either body weight or systolic blood pressure. No statistically significant difference was found in arterial to end-tidal carbon dioxide difference nor in alveolar dead space because of time or positioning over anesthetic periods of up to 3 hours. It is concluded that end-tidal carbon dioxide monitoring is a satisfactory measure of changes in respiratory acid-base balance with inhalation anesthesia in horses when ventilation is controlled.

Anesthesia, Inhalation↗
PubMed2002

Modeling for neuromonitoring depth of anesthesia.

This article reviews the various modeling techniques for neuromonitoring depth of anesthesia (DOA). Traditional techniques such as parametric, predictive, optimal, and adaptive modeling, proportional, integral, derivative (PID) modeling, together with modern techniques such as bispectral-based, artificial neural-network-based, fuzzy logic, and neuro-fuzzy modeling, bring us to the current state of the art in DOA neuromonitoring. This article reviews historical information about each of the modern techniques and provides an example demonstrating its implementation; reviews drug pharmacokinetic/pharmacodynamic (PK/PD) and drug interaction PK/PD modeling techniques for a balanced total intravenous anesthesia (TIVA) administration; and discusses the existing technical problems and clinical challenges, suggesting new techniques necessary for the future development of a DOA monitoring and control system.

Anesthesia↗
PubMed2004

The pharmacodynamic effects of a lower-lipid emulsion of propofol: a comparison with the standard propofol emulsion.

UNLABELLED: Using a randomized, double-blind protocol design, we compared a new lower-lipid emulsion of propofol (Ampofol) containing propofol 1%, soybean oil 5%, and egg lecithin 0.6% with the most commonly used formulation of propofol (Diprivan) with respect to onset of action and recovery profiles, as well as intraoperative efficacy, when administered for induction and maintenance of general anesthesia as part of a "balanced" anesthetic technique in 63 healthy outpatients. Anesthesia was induced with sufentanil 0.1 microg/kg (or fentanyl 1 microg/kg) and propofol 2 mg/kg IV and maintained with a variable-rate propofol infusion, 120-200 microg x kg(-1) x min(-1). Onset times to loss of the eyelash reflex and dropping a syringe were recorded. Severity of pain on injection, speed of induction, intraoperative hemodynamic variables, and electroencephalographic bispectral index values were assessed. Recovery times to opening eyes and orientation were noted. The results demonstrated that there were no significant differences between Ampofol and Diprivan with respect to onset times, speed of induction, anesthetic dose requirements, bispectral index values, hemodynamic variables, recovery variables, or patient satisfaction. However, the incidence of pain on injection was more frequent in the Ampofol group (26% versus 6%, P < 0.05). We conclude that Ampofol is equipotent to Diprivan with respect to its anesthetic properties but was associated with a more frequent incidence of mild pain on injection. IMPLICATIONS: The pharmacodynamic profile of a lower-lipid containing emulsion of propofol (Ampofol) was compared with Diprivan when administered for induction and maintenance of general anesthesia. This preliminary study demonstrated that the two formulations of propofol were equivalent with respect to their induction and maintenance properties. However, Ampofol was associated with a more frequent incidence of pain on injection.

Adult↗
PubMedDate not supplied

[Anesthesiology in orthotopic liver transplantation: first experience].

The authors present the first clinical experience gained in anesthesia and intensive care during 8 orthotopic transplantations of the liver in 4 male and 4 female patients aged 24-50 years. Veno-venous bypass for general anesthesia is described. hemodynamic, oxygen balance, metabolic and blood clotting parameters during anesthesia and surgery are analyzed. Drastic changes were noted during the liver-free phase: oxygen delivery and consumption decreased almost twofold, a metabolic acidosis was observed before and, more so, during this phase.

Acidosis↗
PubMed1999

Intravenous regional anesthesia (Bier block) in a dog.

Intravenous regional anesthesia was used in an adult dog as part of a balanced approach to general anesthesia for amputation of the 4th digit of its right hind limb. It allowed the concentration of isoflurane to be reduced to 0.5%.

Amputation, Surgical↗
PubMed1998

Pharmacokinetics and pharmacodynamics of cisatracurium after a short infusion in patients under propofol anesthesia.

UNLABELLED: Fourteen patients, ASA physical status I or II, were recruited to assess the pharmacokinetic-pharmacodynamic relationship of cisatracurium under nitrous oxide/sufentanil/propofol anesthesia. The electromyographic response of the abductor digiti minimi muscle was recorded on train-of-four stimulation of the ulnar nerve. A 0.1-mg/kg dose of cisatracurium was given as an infusion over 5 min. Arterial plasma concentrations of cisatracurium and its major metabolites were measured by using high-performance liquid chromatography. A nontraditional two-compartment pharmacokinetic model with elimination from central and peripheral compartments was used. The elimination rate constant from the peripheral compartment was fixed to the in vitro rate of degradation of cisatracurium in human plasma (0.0237 min(-1)). The mean terminal half-life of cisatracurium was 23.9+/-3.3 min, and its total clearance averaged 3.7+/-0.8 mL x min(-1) x kg(-1). Using this model, the volume of distribution at steady state was significantly increased compared with that obtained when central elimination only was assumed (0.118+/-0.027 vs 0.089+/-0.017 L/kg). The effect-plasma equilibration rate constant was 0.054+/-0.013 min(-1). The 50% effective concentration (153+/-33 ng/mL) was 56% higher than that reported in patients anesthetized with volatile anesthetics, which suggests that, compared with inhaled anesthetics, a cisatracurium neuromuscular block is less enhanced by propofol. IMPLICATIONS: The drug concentration-effect relationship of the muscle relaxant cisatracurium has been characterized under balanced and isoflurane anesthesia. Because propofol is now widely used as an IV anesthetic, it is important to characterize the biological fate and the concentration-effect relationship of cisatracurium under propofol anesthesia as well.

Adolescent↗
PubMed1997

Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery.

The regulation of the hypothalamo-pituitary-adrenal (HPA) axis in the operative and perioperative period of major surgical procedures is necessary for successful adaption to surgical stress. We report evidence on an altered response of HPA axis regulation in patients who underwent coronary artery bypass grafting (CABG) surgery. Plasma levels of adrenocorticotropin (ACTH), beta-endorphin, and cortisol were determined with radio-immune assay in 50 males for elective CABG surgery. The patients received general anesthesia using a balanced technique with sufentanil, isoflurane, and midazolam. Pre- and intraoperatively, there was no significant increase in plasma cortisol, ACTH, and beta-endorphin levels. On the evening of surgery, all plasma hormone levels were increased. On the evening of the first and second postoperative day, plasma ACTH and beta-endorphin levels returned to the preoperative baseline values. During the same time interval, plasma cortisol levels were significantly elevated and remained high until the end of the study period (p < 0.001). Our results indicate an altered regulation of the HPA axis in the postoperative period of patients after CABG surgery, as they are compatible with similar results in patients after major abdominal surgery, burned patients, and critically ill patients. Therefore, it is assumed that the finding of a postoperative dissociation between ACTH and cortisol is a result of the severity of perioperative adaptive mechanisms rather than of the specific conditions related to cardiac surgery.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Reorganizing the system of care surrounding laparoscopic surgery: a cost-effectiveness analysis using discrete-event simulation.

PURPOSE: To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety. METHODS: Discrete-event simulation methods were used to compare current surgical practice with a new modular system in which patient care is handed off between 2 anesthesiologists. A health care system's perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume. RESULTS: The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/ patient/d = 5327 dollars v. 5289 dollars) to the current strategy with an incremental cost-effectiveness of 318 dollars/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15 min before the new strategy is no longer more effective. CONCLUSION: The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.

Academic Medical Centers↗
PubMed1990

Avoiding unintentional hypothermia: anesthesia implications.

Maintaining normal thermal balance in the anesthetized patient remains a primary physiological consideration for the anesthetist. Because hypothermia occurs frequently during surgery and anesthesia, it is imperative that the anesthetist fully appreciate the variety of factors associated with unintentional hypothermia. This knowledged, coupled with an understanding of physiological ramifications and meaningful therapeutic interventions will enable the anesthetist to provide optimal care for patients, particularly those at risk for developing hypothermia intraoperatively. This survey article will trace current research as it applies to the principles underlying proper management of the hypothermic patient.

Anesthesia↗
PubMed2003

The effect of the interval between blood pressure determinations on the delay in the detection of changes: a computer simulation.

UNLABELLED: The frequency of automated noninvasive blood pressure (NIBP) measurements during routine anesthesia is a balance between potentially deleterious effects of frequent cycling and a delay in detecting changes caused by a long cycle time. A computer model generated systolic blood pressures that changed to a new, random value after a period of stability. We sampled these data at intervals between 1 and 10 min to simulate NIBP measurements. A separate algorithm, based on Trigg's Tracking Variable, indicated when a change had been detected. For each set of variables, the simulation was repeated 1000 times, and the average time to detect a change was recorded. The mean time to detect a change was 8.0 min with a 1-min cycle, 8.9 min with a 2-min cycle, 10.8 min with a 5-min cycle, and 13.0 min with a 10-min cycle. As the cycle time increased, the delay in detecting changes increased but only by approximately half the increase in the cycle time. The optimum variables for the trend detection algorithm also changed as the NIBP interval increased. Provided that abrupt changes in blood pressure are not anticipated, a 1- or 2-min cycle time for NIBP offers little advantage over a longer period. IMPLICATIONS: We used a computer model to study the effect of increasing noninvasive blood pressure (NIBP) sampling interval on the detection of blood pressure changes. The detection time increased only 50% of the increase in the sampling interval. This information may help optimize NIBP intervals in different circumstances.

Algorithms↗
PubMed1994

Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis.

We reviewed the records of 128 patients who had a total of 128 consecutive posterior operations on the cervical spine for problems related to rheumatoid arthritis. Our purpose was to examine perioperative complications related to the airway. The patients were divided into two groups for analysis on the basis of the technique of intubation that had been used. An upper-airway obstruction developed after extubation in eight (14 per cent) of the fifty-eight patients who had been intubated without fiberoptic assistance compared with one (1 per cent) of the seventy patients who had been intubated fiberoptically (p = 0.02). The two groups had similar characteristics with regard to age, sex, severity of the myelopathy, American Rheumatology Association classification, American Society of Anesthesiologists physical status classification, cigarette use, duration of the arthritis, use of preoperative traction, use of steroids (both preoperatively and intraoperatively), size of the endotracheal tube, duration of the operation, total duration of the anesthesia, intraoperative fluid balance, and type of immediate immobilization of the neck. The only significant difference between the groups was the time to extubation, which averaged 17.9 hours in the fiberoptic group and 10.6 hours in the non-fiberoptic group (p = 0.02). Logistic regression analysis showed that non-fiberoptic intubation was the significant risk factor, even when allowance was made for the difference in the lengths of time to extubation. We concluded that this life-threatening complication can be minimized with fiberoptic management of the airway.

Adult↗
PubMed1993

[Comparative studies on complications occurring during and after surgery in elderly patients with and without cardiovascular disorders].

Comparative studies of the differences in elderly patients with and without cardiovascular disorders were made in regard to complications occurring during and after operation. The subjects included 38 patients (6 men and 32 women) aged 70 to 99 years (mean: 84 years) at Nagoya City Kouseiin Geriatric Hospital who had orthopedic surgery under general anesthesia, between March 1990 and October 1992. Diseases identified in these subjects were sequelae of cerebrovascular disease (38 subjects), heart disease (22 subjects), hypertension (9 subjects), senile dementia (6 subjects), Parkinson's disease (5 subjects), malignant disease (3 subjects) and diabetes mellitus (2 subjects). They were initially divided into 2 groups according to ultrasonic cardiography: a normal group comprising 20 patients without cardiovascular abnormalities, and a disorder group comprising 18 patients with reduction of left ventricule function, left ventricular hypertrophy and/or valvular disease (more than moderate). All subjects were examined with regard to age, weight, the nutrition index proposed by Onodera, activity of daily living (ADL), cardiac output, left ventricular ejection fraction, serum level of BUN and albumin etc. Moreover, the disorder group subjects were divided into 2 groups according to the presence or absence of heart failure occurring after surgery. In addition to the above-mentioned, we also studied the duration of surgery and anesthesia, and water balance during and after surgery. Results showed that the ADL and nutrition index in the disorder group were lower compared to the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗