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At least 487 records · Page 27Linked to original sources
PubMed1996

[Anesthetic management for AICD (automatic implantable cardioverter defibrillator) implant surgery].

We studied anesthetic management and monitoring during AICD (automatic implantable cardioverter defibrillator) implantation. For anesthetic management, complete sedation and amnesia are needed during implantation procedures with rapid awakening and extubation after the surgery. We chose inhalation anesthesia supplemented with small doses of fentanyl or thiamylal. Monitoring for AICD implantation should be less invasive, continuous and rapid in responsiveness. For brain and cardiac monitoring, a combination of near infrared spectroscopy and transesophageal echocardiography was quite useful.

Anesthesia, General↗
PubMed1997

[The effect of nicardipine hydrochloride upon the pulmonary arterial pressure].

This study examines the effects of induced hypotension with intravenous administration of nicardipine hydrochloride (NIC) upon pulmonary arterial pressure (PAP) undergoing modified radical mastectomy with neuroleptanesthesia (NLA-group; 3 cases) and inhalation anesthesia (N2O+ isoflurane; GOI-group; 3 cases). Systolic arterial pressure was reduced and maintained at 80 mmHg. During and after induced hypotension in NLA-group, heart rate (HR), cardiac index, pulmonary arterial pressure (PAP) increased remarkably. On the other hand, systemic vascular resistance index was reduced. In GOI group, no significant changes were seen in PAP. The acceleration of the autonomic baro-reflex induced by decreased blood pressure produced by NIC may be depressed under anesthesia to initiate this difference in response of HR to NIC. The data indicate that this depressive effect of NLA on this reflex is weak, and NIC is a potent systemic vasodilator with hyperdynamic hemodynamic effects in addition to an increase in right ventricular function, and PAP was increased.

Adult↗
PubMed1997

Evoked facial nerve EMG and brainstem auditory evoked potential monitoring in cerebellopontine angle tumor resection.

BACKGROUND: The preservation of normal nerve function or identification of nerve route is critical in some surgeries of cerebellopontine angle tumors. Over the last 5 years, intraoperative facial nerve electromyogram (EMG) and brainstem auditory evoked potential (BAEP) were applied for evaluation of facial nerve integrity and brainstem function in patients while undergoing resection of cerebellopontine angle (CPA) tumor. This report represents the retrospective analysis of our results. METHODS: The inhalational anesthesia with 1-1.5% isoflurane in pure O2 was used. Muscle relaxation was maintained with continuous infusion of atracurium. The degree of muscle relaxation was aimed at a T4/T1 ratio of train-of-four response more than 20% of the adductus pollicis upon ulnar nerve stimulation at the wrist. In 236 patients suffering from CPA tumor without facial palsy, the EMG of the mentalis muscle ipisilateral to the tumor was obtained through stimulation of the facial nerve. The stimulation was applied with a nerve finder, which delivered an electrical stimulation of a single 2 mamp direct current. The EMG finding was compared with the clinical result. In 198 patients, BAEP was used to monitor the brainstem function during tumor resection. In case of intact hearing the BAEP was taken ipsilateral to the operation side and in case with total hearing loss contralateral BAEP to operation side was used. For BAEP stimulation, 90 db click sound stimulation with frequency of 11.26 Hz was applied to both ears. BAEP signals were obtained and recorded at the mastoid region of either side in reference to the vertex. The EMG and BAEP signals were recorded and saved to an evoked potential monitor. RESULTS: In facial nerve EMG monitoring, there were two false positive and no false negative tests. Except for the two false positive tests, the postoperative clinical results in the other cases were compatible with the intraoperative facial nerve EMG findings. In BAEP monitoring, there were twenty-eight positive tests. CONCLUSIONS: The low incidence of false negative test suggests that facial nerve EMG is valuable in detection of facial nerve function in CPA tumor resection. Intraoperative BAEP abnormality is possibly useful in identifying postoperative brainstem dysfunction.

Adult↗
PubMed1976

[Damage of teeth by oral airways].

Oral Guedel airways do not necessarily protect the patient's teeth during inhalation anesthesia. This is contrary to the general opinion. Because of the anatomical structure of the human teeth and the dynamic forces on teeth occlusion during postanesthetic excitation the applied chewing-pressure is concentrated by a Guedel airway at a few front teeth only. Under this abnormally forceful, localized pressure especially capped teeth and teeth in gums with paradentosis may easily break. Therefore, the use of nasal airways should be preferred in these cases.

Anesthesia, Inhalation↗
PubMed1980

Effects of anesthesia and surgical stress on insulin secretion in man.

Surgical stress with inhalation anesthesia is associated with increased circulating catecholamines, hyperglycemia, and impaired insulin secretion. These changes do not occur during surgical stress with spinal anesthesia, suggesting that they are neurally mediated due to pain initiated afferents from the site of tissue trauma. Inhalation anesthesia alone was found to suppress basal insulin levels and the insulin response to intravenous glucose with no significant increase in plasma norepinephrine and a decrease in plasma epinephrine. Thus, these changes in insulin secretion are not attributable to adrenergic mechanisms. In the postoperative period, however, suppressed insulin secretion was found to be correlated with elevated plasma epinephrine concentrations and may, therefore, be mediated by adrenergic mechanisms. Thus, these findings indicate that impaired insulin secretion during surgical stress may have two etiologies--one related to the type of anesthesia used and the other due to adrenomedullary stimulation due to pain.

Anesthesia, Inhalation↗
PubMedDate not supplied

Does sympathetic blockade prevent the physiologic changes associated with tourniquet use in children?

This study investigated a means of controlling the altered physiologic effects that occur when tourniquet inflation time is > or = 50 min during orthopaedic surgery in children. Forty patients were assigned randomly, 20 in each group. Both groups received inhalational anesthesia for induction. The control group had nitrous/narcotic with inhalation anesthesia for maintenance. The other group received a sympathetic blockade with 0.5% epidural bupivacaine, which was confirmed with the use of thermography technique and supplemented with 0.5-1% isoflurane. Duration of surgery and length of tourniquet inflation time were equal in the two groups. There was a significant difference in physiologic changes related to the tourniquet inflation time. The group with sympathetic blockade had only minor changes in blood pressure, pulse rate, and temperature compared with the control group.

Anesthesia, Epidural↗
PubMed1981

Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans.

In order to quantitate the effect of spinal anesthesia on adrenergic tone, plasma levels of norepinephrine (NE) and epinephrine (EPI) were measured by radioenzymatic assay in 24 patients were then compared to those of 10 patients receiving inhalation anesthesia (halothane-nitrous oxide). High thoracic dermatome spinal anesthesia caused suppression of both arterial plasma NE and EPI and a fall of mean arterial pressure (MAP); in contrast, no changes of NE, EPI, or MAP were observed in patients receiving low spinal anesthesia. Overall, there was a relationship between the sensory dermatome anesthesia level and changes of both plasma NE (r = 0.71, P less than 0.001) and EPI (r = 0.52,P less than 0.02). In the inhalation anesthesia group, plasma NE increased during the operation and plasma levels of NE, EPI, growth hormone, and cortisol were elevated during the postoperative recovery period. These neuroendocrine responses to surgical stress were not observed in patients receiving either low or high spinal anesthesia. Thus, the effect of spinal anesthesia on adrenergic tone depends on the cord level of anesthesia and can be quantitated by measurement of plasma catecholamines. The neuroendocrine responses to surgical stress were prevented in patients who received low spinal anesthesia and who had no suppression of efferent adrenergic tone. These findings indicate that neural afferents from the site of tissue injury, which were blocked by low spinal anesthesia, mediated both the adrenergic and the hormonal responses to surgical stress in the inhalation anesthesia group.

Adrenergic Fibers↗
PubMed2002

Clinical comparison of xylazine and medetomidine for premedication of horses.

OBJECTIVE: To compare the analgesic and cardiopulmonary effects of medetomidine and xylazine when used for premedication of horses undergoing general anesthesia. DESIGN: Randomized clinical trial. ANIMALS: 40 horses. PROCEDURE: Twenty horses were premedicated with medetomidine (10 microg/kg [4.5 microg/lb], i.m.) and the other 20 were premedicated with xylazine (2 mg/kg [0.9 mg/kg], i.m.). Horses were then anesthetized with a combination of guaifenesin and ketamine; anesthesia was maintained with halothane. Additional doses of medetomidine or xylazine were given if horses were not sufficiently sedated at the time of anesthetic induction. After induction of anesthesia, sodium pentothal was administered as necessary to prevent limb movements. Hypotension was treated with dobutamine; hypoventilation and hypoxemia were treated with intermittent positive-pressure ventilation. The quality of anesthetic induction, maintenance, and recovery and the quality of the transition to inhalation anesthesia were scored. RESULTS: Scores for the quality of the transition to inhalation anesthesia were significantly higher for horses premedicated with medetomidine than for horses premedicated with xylazine. However, other scores, recovery times, and numbers of attempts needed to achieve sternal recumbency and to stand were not significantly different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that medetomidine is suitable for premedication of horses undergoing general anesthesia. Analgesic and cardiopulmonary effects of medetomidine were similar to those of xylazine, except that the transition to inhalation anesthesia was smoother when horses were premedicated with medetomidine, rather than xylazine.

Adrenergic alpha-Agonists↗
PubMed2006

Cerebrovascular reactivity to carbon dioxide in the normal and abnormal cerebral hemispheres under anesthesia in patients with frontotemporal gliomas.

Cerebral pathology may alter the cerebrovascular reactivity to carbon dioxide (CO2). In the present study, in patients with brain tumors, we examined the cerebral vascular reactivity to CO2 in the cerebral hemispheres with and without tumors under intravenous and inhalational anesthesia. Twenty-nine patients undergoing craniotomy for frontotemporal gliomas were randomized to receive intravenous anesthesia with propofol or inhalational anesthesia with isoflurane. Cerebral blood flow velocity in the middle cerebral artery (VMCA) and pulsatality index were measured under normocapnia and hypocapnia in the normal cerebral hemisphere and the hemisphere with tumor. Hypocapnia significantly decreased the VMCA in both the cerebral hemispheres under both the anesthetic techniques (P < 0.006). The percentage change in VMCA was similar between the hemispheres with and without tumor both under isoflurane (3.45 +/- 4.11% on the normal side and 2.91 +/- 2.40% on the tumor side; mean difference 0.54 +/- 1.31%; 95% CI -2.18 to +3.27) and propofol anesthesia (2.32 +/- 2.64% on the normal side and 1.69 +/- 4.04% on the tumor side; mean difference 0.63 +/- 1.2%; 95% CI -1.83 to +3.10). The changes in pulsatality index also were not significantly different between the hemispheres. In conclusion, cerebrovascular response to hypocapnia is similar between the normal and the abnormal cerebral hemispheres both under intravenous and inhalational anesthesia.

Adult↗
PubMedDate not supplied

[Anesthesia during liver transplantation].

Different methods and components of anesthesia during operations in donors and recipients were studied by using the experience in maintaining anesthesia during 39 relative and 7 cadaveric hepatic transplantations. The experience in using epidural anesthesia and total intravenous anesthesia at the donor stage of hepatic lobar transplantation was comparatively analyzed. Combined epidural anesthesia (CEA) may be used during long-term and traumatic operations dealing with hepatic lobectomy in a relative donor since it is noted for low hepatotoxicity and no drastic hemodynamic exposures. CEA can substantially reduce pharmacological loading with opioids or myorelaxants, which is particularly important in taking the lobe of the liver. This reduces the recovery period of adequate own respiration, activates a patient more rapidly, substantially reduces the risk for postoperative iatrogenic complications. Balanced general anesthesia whose major component is inhalational anesthesia with isoflurane is the method of choice in performing an operation in the recipient. The use of isoflurane in the minimal-flow mode is cost-effective and safe. When anesthesia is performed in the recipient, it is necessary to take in account drastic hemodynamic pattern changes at the liverless stage during vein-venous bypass surgery, including the liver into systemic circulation, and the likelihood of development of significant reperfusion and concomitant metabolic and coagulative disorders.

Adolescent↗
PubMed1988

[Intravenous combination anesthesia using alfentanil in infants].

Intravenous anesthesia is a method rarely used during infancy. Only neuroleptanalgesia has a number of indications, especially in major surgery and for seriously ill children. There are several advantages of inhalation anesthesia in infancy: good control of anesthesia because of low fat-muscle mass, low functional residual capacity, relatively increased alveolar ventilation, and increased cardiac output. Potential disadvantages of inhalation anesthesia in infancy are numerous: The necessity of high concentrations of inhalational agents may cause myocardial depression and blood pressure drops, the analgetic potency is very low, damage to surfactant is possible, there is a prolonged awakening period in many cases, and cerebral blood flow and intracranial pressure can be increased by inhalation anesthetics. Positive results with the short-acting opiate alfentanil in adult lead us to the idea of replacing routine inhalation anesthesia by a combination of low-dose halothane and intermittent injections of alfentanil. Fifty infants undergoing corrective orthopedic surgery of the hip and lower limb were anesthetized with the combination of alfentanil and halothane described in Fig. 1. Patient data are shown in Table 2. All children were premedicated orally with flunitrazepam 0.1 mg/kg body weight and Bellafolin 1 drop/kg and were primarily anesthetized via inhalation of oxygen/N2O/halothane. After relaxation with vecuronium, intubation and administration of alfentanil, halothane concentrations were reduced to low maintenance doses. Intraoperative und postoperative circulatory parameters showed remarkable stability. Postoperative blood gas analyses--in 8 cases done using capillary blood--gave no hint of any respiratory or metabolic disorder caused by the anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗