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PubMed1997

Does propofol reduce vomiting after strabismus surgery in children?

BACKGROUND: Previous studies have indicated that propofol anaesthesia may reduce the incidence of postoperative nausea and vomiting after strabismus surgery in children. This study was designed to investigate the incidence of vomiting after strabismus surgery at two different levels of propofol anaesthesia compared to thiopental/isoflurane anaesthesia. METHODS: Ninety ASA class I or II children, aged 5-14 yrs were randomly assigned to one of three groups: Group T/I (n = 30) induction with 5 mg kg-1 of thiopental and maintenance with isoflurane, group P5 (n = 31) induction with propofol 2 mg kg-1, maintenance with propofol infusion 5 mg kg-1 h-1 or group P10 (n = 29) induction with propofol 2 mg kg-1, maintenance with propofol 10 mg kg-1 h-1. All received glycopyrrolate, vecuronium, fentanyl and controlled ventilation with O2/N2O 30/70. Ketorolac i.v. was given to prevent postoperative pain. If additional analgesia was needed, ibuprofen/acetaminophen or buprenorphine was given according to clinical need. RESULTS: There were no differences between study groups with respect to age, weight, history of previous anaesthesia or emesis after previous anaesthesia, duration of anaesthesia, surgery or sleep after anaesthesia, or number of muscles operated. The incidence of vomiting was 37%, 29% and 28% in groups T/I, P5 and P10, respectively. There were no statistically significant differences between the three groups in the incidence of vomiting. The median age of patients who vomited was 7.5 (range 5.0-13.7) yrs while the median age of the patients who did not vomit was 9.1 (range 5.0-14.0) yrs (P < 0.01). CONCLUSION: In the present study, propofol anaesthesia compared to thiopental/isoflurane anaesthesia did not reduce the incidence of vomiting following strabismus surgery in children.

Adolescent↗

PubMed2005

Dobutamine-induced bradycardia in a dog.

An otherwise healthy 8-year-old neutered male, mixed breed dog was anesthetized for surgical removal of multiple uroliths. Pre-anesthetic medication was midazolam, glycopyrrolate, and morphine. Anesthesia was induced with propofol and maintained with isoflurane in oxygen. One hour after induction, the patient moved and propofol was administered. Subsequently, the patient developed hypotension. Dobutamine administered at this time produced a rapid and profound decrease in heart rate that was treated successfully with atropine. The bradycardia in this case may be the result of the Bezold-Jarisch reflex, an intracardiac parasympathetic nervous reflex. Discontinuation of dobutamine and/or administration of a parasympatholytic drug should be performed if bradycardia occurs during dobutamine infusion.

Anesthesia↗

PubMed2006

Laryngeal mask airway insertion requires less propofol than endotracheal intubation in dogs.

OBJECTIVE: To compare the doses of propofol required for insertion of the laryngeal mask airway (LMA) with those for endotracheal intubation in sedated dogs. STUDY DESIGN: Randomized prospective clinical study. Animals Sixty healthy dogs aged 0.33-8.5 (3.0 +/- 2.3, mean +/- SD) years, weighing 2.2-59.0 (23.4 +/- 13.6, mean +/- SD) kg, presented for elective surgery requiring inhalation anaesthesia. METHODS: Animals were randomly assigned to receive either a LMA or an endotracheal tube. Pre-anaesthetic medication was intravenous (IV) glycopyrrolate (0.01 mg kg(-1)) medetomidine (10 microg kg(-1)) and butorphanol (0.2 mg kg(-1)). Repeated IV propofol injections (1 mg kg(-1) in 30 seconds) were given until LMA insertion or endotracheal intubation was achieved, when the presence or absence of laryngospasm, the respiratory rate (fr) and the total dose of propofol used were recorded. RESULTS: The total propofol dose (mean +/- SD) required for LMA insertion (0.53 +/- 0.51 mg kg(-1)) was significantly lower than for endotracheal intubation (1.43 +/- 0.57 mg kg(-1)). The LMA could be inserted without propofol in 47% of dogs; the remainder needed a single 1 mg kg(-1) bolus (n = 30). Endotracheal intubation was possible without propofol in 3.3% of the dogs, 47% needed one bolus and 50% required two injections (n = 30). The f(r) (mean +/- SD) was 18 +/- 6 and 15 +/- 7 minute(-1) after LMA insertion and intubation, respectively. CONCLUSION AND CLINICAL RELEVANCE: Laryngeal mask airway insertion requires less propofol than endotracheal intubation in sedated dogs therefore propofol-induced cardiorespiratory depression is likely to be less severe. The LMA is well tolerated and offers a less invasive means of securing the upper airway.

Anesthesia, General↗

PubMed2006

A synthetic fraction of feline facial pheromones calms but does not reduce struggling in cats before venous catheterization.

OBJECTIVE: To evaluate whether a synthetic analogue of feline facial pheromone (FFP) calms cats before, and reduces struggling during intravenous catheterization. DESIGN: Block-randomized, 'blinded' clinical trial. ANIMALS: Seventy-seven healthy cats presented for elective surgery. PROCEDURE: Cats given glycopyrrolate and oxymorphone were assigned to one of four treatments: acepromazine and exposure to FFP (aceFFP); acepromazine and exposure to a placebo (acePlac); exposure to FFP only (FFP) and exposure to placebo only (Plac). The behaviour of cats was recorded on videotape for evaluation by assessors unaware of treatment group. Cats' veins were then catheterized by veterinary students unaware of the study protocol. Based on each cat's response to catheterization, the student independently decided whether intramuscular ketamine was required. RESULTS: Cats in the aceFFP group appeared to be calmer than acePlac cats on the basis of head position and their location in the cage (suggesting benefit from FFP among cats receiving acepromazine) but appeared to be less sedated. Cats in the aceFFP group also appeared to be calmer than FFP cats on the basis of head position and location in the cage. Feline facial pheromone cats were also calmer than Plac cats when compared using body and leg position. Exposure to FFP did not significantly reduce struggling at catheterization, nevertheless, the students were able to catheterize the veins in all cats. CONCLUSION AND CLINICAL RELEVANCE: There were no detrimental behavioural effects associated with either FFP or acepromazine. The FFP had additional calming effects in cats given acepromazine and, to a lesser degree, helped to calm cats that were not given acepromazine. Feline facial pheromone helps to calm cats in unfamiliar surroundings.

Acepromazine↗

PubMed2006

The effect of nitrous oxide on halothane, isoflurane and sevoflurane requirements in ventilated dogs undergoing ovariohysterectomy.

OBJECTIVE: To examine the effect of 64% nitrous oxide (N2O) on halothane (HAL), isoflurane (ISO) or sevoflurane (SEV) requirements in dogs undergoing ovariohysterectomy. STUDY DESIGN: Prospective, randomized, clinical trial. ANIMALS: Ninety, healthy dogs of (mean +/- SD) body weight 21.2 +/- 10.0 kg and age 17.8 +/- 22.8 months. MATERIALS AND METHODS: After premedication with acepromazine, hydromorphone and glycopyrrolate, anesthesia was induced with thiopental administered to effect. Dogs received one of six inhalant protocols (n = 15 group): HAL; HAL/N2O; ISO; ISO/N2O; SEV; or SEV/N2O. End-tidal CO2 was maintained at 40 +/- 2 mmHg with intermittent positive pressure ventilation (IPPV). Body temperature, heart rate, indirect systemic arterial blood pressures, inspired and end-tidal CO2, volatile agent, N2O and O2 were recorded every 5 minutes. The vaporizer setting was decreased in 0.25-0.5% decrements to elicit a palpebral reflex, and this level maintained. Statistical analysis included two-way anova for repeated measures with Bonferroni's correction factor and statistical significance assumed when p < 0.05. Percentage reduction in end-tidal volatile agent was calculated at 60 minutes after starting study. RESULTS: End-tidal HAL, ISO and SEV decreased when N2O was administered. Percentage reduction: HAL (12.4%); ISO (37.1%) and SEV (21.4%). Diastolic, mean and systolic blood pressures increased in ISO/N2O compared with ISO. Heart rate increased in ISO/N2O and SEV/N2O compared with ISO and SEV, respectively. Systolic, mean and diastolic blood pressures increased in SEV compared with HAL and ISO. Systolic, mean, diastolic blood pressures and heart rate increased in SEV/N2O and ISO/N2O compared with HAL/N2O. CONCLUSIONS: N2O reduces HAL, ISO and SEV requirements in dogs undergoing ovariohysterectomy. Cardiovascular stimulation occurred when N2O was used with ISO, less so with SEV and not with HAL

Anesthesia, Inhalation↗

PubMed1990

Inhibition of nicotine-induced relaxation of the bovine retractor penis muscle by compounds known to have ganglion-blocking properties.

1. The relative potency in blocking the nicotine-induced relaxation of the bovine retractor penis muscle (BRP) was estimated for 12 drugs known to have ganglion-blocking properties. 2. The order of potency of the drugs studied was mecamylamine greater than chlorisondamine greater than pentolinium greater than propantheline greater than (+)-tubocurarine greater than hexamethonium greater than emepronium greater than tetraethylammonium greater than glycopyrrolate greater than decamethonium greater than butylscopolamine greater than scopolamine. 3. The results conform well to those obtained with other pharmacological methods used for the estimation of ganglion-blocking activity. 4. It is concluded that blockade of the nicotinic relaxation of the BRP can be used as an alternative method for quantitative assessment of ganglion-blocking activity. 5. Advantages of this technique are that it discriminates well between antinicotinic and antimuscarinic activity and that it satisfies most or all ethical and economical demands. 6. It is also possible that this method has certain value in predicting whether a drug has enough ganglion-blocking activity to be likely to cause impotence.

Animals↗

PubMedDate not supplied

Suspected malignant hyperthermia after halothane anesthesia in a cat.

A 6 month old domestic shorthaired cat died of suspected malignant hyperthermia. Anesthesia was induced and maintained with halothane vaporized in oxygen and nitrous oxide, after acepromazine premedication. Before an incision was made, the cat's heart rate dropped from 140 to 90 beats/min concomitant with a drop in blood pressure. Glycopyrrolate administration resulted in severe ventricular tachycardia (340 beats/min). Halothane and nitrous oxide were discontinued and the surgery was abandoned. Lidocaine administration resulted in a normal sinus rhythm. In recovery, the cat was tachypneic and struggling, with a rectal temperature of 40.1 degrees C that quickly increased to 41.4 degrees C. While the cat was being cooled, cardiac dysrhythmias progressed to ventricular fibrillation that was not responsive to cardiorespiratory resuscitation. Blood specimens obtained while the cat was being cooled showed hyperkalemia (10.0 mEq/L) and increased serum creatine kinase activity (780 IU/L). There was extreme extensor rigidity (rigor mortis) within 5 min of cardiac arrest. Results of microscopic and electron microscopic examination of muscle showed occasional perivascular infiltrates of lymphocytes with infrequent perimysial and epimysial neutrophils and a few sarcomeres with streaming of Z-bands (suggesting a contracted state). Histochemical evaluation of skeletal muscle showed no significant difference between type I and type II fibers.

Anesthesia, General↗

PubMedDate not supplied

Evaluation of three midazolam-xylazine mixtures. Preliminary trials in dogs.

The depressant effects of midazolam and xylazine on the central nervous system (CNS) were evaluated in 12 dogs. Xylazine was administered to six dogs (1.1 mg/kg intravenously [IV]) followed in 5 minutes by midazolam (1.0 mg/kg intramuscularly [IM]). In a second group of six dogs, xylazine (2.2 mg/kg IM) was followed in 5 minutes by midazolam (1.0 mg/kg IV). Both drug regimens induced rapid and profound sedation or anesthesia. Duration of action varied with the doses and routes of administration. Dogs given the high dose of xylazine IM had an arousal time of 95.4 +/- 8.9 minutes and a walking time of 155.4 +/- 8.8 minutes. These values exceeded the IV xylazine values threefold. Partial reversal of CNS depression was accomplished with either a benzodiazepine antagonist (flumazenil) or an alpha-2 antagonist (yohimbine). In a separate trial, a mixture of xylazine (0.55 mg/kg), midazolam (1.0 mg/kg), and butorphanol (0.1 mg/kg) with and without glycopyrrolate was evaluated in eight dogs. As with the xylazine-midazolam combinations, the CNS depressant effect of this mixture was clinically indistinguishable from anesthesia achieved with other rapid-acting injectable agents. Clinical signs of CNS depression were readily and completely antagonized by the simultaneous injection of flumazenil and yohimbine.

Anesthesia↗

PubMed2003

Diazepam inhibits organophosphate-induced central respiratory depression.

OBJECTIVES: Current evidence suggests that mortality from acute organophosphate (OP) poisoning is partially mediated through central nervous system (CNS) respiratory center depression (CRD). However, the exact mechanism of OP-induced CRD is unknown. In these studies, the authors investigated the hypothesis that OP-induced CRD is the result of overstimulation of CNS respiratory centers. METHODS: Wistar rats received prophylaxis with either normal saline (controls), atropine, the peripherally acting anticholinergics glycopyrrolate (GLYC), ipratropium bromide (IB), or the CNS respiratory center attenuator diazepam. To determine if a dual CNS/peripheral cholinergic mechanism is responsible for animal death, two additional groups received combination treatment with diazepam plus either IB or GLYC. All treatments were completed 5 minutes before OP with subcutaneous dichlorvos. Differences in 10-minute and 24-hour mortality were assessed by the Fisher exact test. RESULTS: Dichlorvos poisoning resulted in profound fasciculations without obvious seizure in all cohorts. In controls and animals treated with peripherally acting anticholinergics, fasciculations were followed by sedation and respiratory arrest (0% 10-minute survival in all cohorts). In contrast, pretreatment with either atropine or diazepam significantly improved 10-minute survival (100% and 44%, respectively). Although GLYC or IB afforded no protection when given alone, when delivered in conjunction with diazepam, the combination significantly improved survival (both groups 88% at 24 hours), suggesting a dual CNS/pulmonary muscarinic mechanism of lethality. CONCLUSIONS: The central respiratory depressant diazepam paradoxically attenuates organophosphate-induced respiratory depression, and when combined with peripherally acting anticholinergic agents, reduces mortality in a rat model of severe acute OP poisoning.

Animals↗

PubMed2003

A systematic review for evidence of efficacy of anticholinergic drugs to treat drooling.

Drooling frequently occurs in children with multiple handicaps; application of anticholinergic drugs is a potential strategy to treat drooling. A computer aided search of original studies concerning the treatment of drooling was carried out. The methodological and statistical integrity of the identified studies were assessed with previously defined criteria. The articles were weighed for their separate contribution to the evidence. The search resulted in 64 reports, of which seven studies passed the screening and were subjected to further assessment and discussion by three referees. Because of the small number of reports and the methodological restriction within the studies, no meta-analysis could be performed. No general conclusion could be made about the efficacy of anticholinergic drugs in treatment of drooling in children with multiple handicaps. There was some evidence that three anticholinergic drugs (benztropine, glycopyrrolate, and benzhexol hydrochloride) are effective in the treatment of drooling, but it could not be concluded that one drug is preferable.

Child↗

PubMed1991

Effect of different bronchodilators on airway smooth muscle responsiveness to contractile agents.

"Functional antagonism" is often used to describe the general relaxant effect of beta 2 agonists and xanthines and their ability to protect the airways against bronchoconstrictor stimuli. This study in guinea pig isolated trachea addresses the question of whether the capacity of these drugs to protect against constrictor stimuli is related to smooth muscle relaxation. Three antimuscarinic drugs were also examined to determine whether antagonism of mediators other than muscarinic agonists might contribute to bronchodilatation by these antimuscarinic drugs. Terbutaline (1.1 x 10(-7), 2.2 x 10(-7) M), theophylline (2.2 x 10(-4), 4.4 x 10(-4) M), and enprofylline (5.2 x 10(-5), 1.0 x 10(-4) M) relaxed the tracheal tension that remained after indomethacin treatment. They did not, however, alter the carbachol concentration-response curve significantly. In addition, neither theophylline (2.2 x 10(-4) M) nor terbutaline (1.1 x 10(-7) M) altered histamine induced contraction. Atropine sulphate, glycopyrrolate, and ipratropium bromide had EC50 values of 10(-9) - 10(-8) M for relaxation of carbachol induced contractions, whereas concentrations of 10(-6) - 10(-3) M or greater were required to relax contractions induced by allergen and nine other non-muscarinic mediators. It is suggested that bronchodilatation by antimuscarinic drugs in vivo is due to inhibition of acetylcholine induced bronchoconstriction alone and that beta 2 agonists and xanthines have poor ability to protect airway smooth muscle against constrictor stimuli. Hence mechanisms other than bronchodilatation and "functional antagonism" should be considered to explain the protection against constrictor stimuli in asthma seen with beta 2 agonists and xanthines.

Animals↗

PubMed2002

Increased baroreceptor response in mice deficient in monoamine oxidase A and B.

The recent development of mice doubly deficient for monoamine oxidase A and B (MAO-A/B, respectively) has raised questions about the impact of these mutations on cardiovascular function, in so far as these animals demonstrate increased tissue levels of the vasoactive amines serotonin, norepinephrine, dopamine, and phenylethylamine. We recorded femoral arterial pressures and electrocardiograms in adult MAO-A/B-deficient mice during halothane-nitrous oxide anesthesia as well as 30 min postoperatively. During both anesthesia and recovery, systolic, diastolic, and mean arterial pressures were 10-15 mmHg lower in MAO-A/B-deficient mice compared with normal controls (P < 0.01). Mutants also showed a greater baroreceptor-mediated reduction in heart rate in response to hypertension after intravenous pulses of phenylephrine or angiotensin II. Tachycardia elicited in response to hypotension after nitroprusside was greater in mutants than in controls. Heart rate responsiveness to changes in arterial pressure was abolished after administration of glycopyrrolate, with no differences in this phenomenon noted between genotypes. These data suggest that prevention of hypertension may occur in chronic states of catecholaminergic/indoleaminergic excess by increased gain of the baroreflex.

Adrenergic beta-Antagonists↗

PubMed2000

Effect of timing of ondansetron administration on incidence of postoperative vomiting in paediatric strabismus surgery.

This prospective, randomized, double-blinded study evaluated the effect of the timing of ondansetron administration on its antiemetic efficacy in children undergoing elective strabismus surgery. One hundred and twenty children aged one to 15 years, ASA physical status 1 or 2, were randomly allocated to receive intravenous ondansetron 100 micrograms/kg either at induction (Group 1) or at the end of the surgery (Group 2). All patients had general anaesthesia induced and maintained with nitrous oxide and halothane, muscle relaxation with vecuronium, endotracheal intubation, reversal with neostigmine and glycopyrrolate, and pethidine 0.5 mg/kg analgesia. Episodes of nausea and vomiting were evaluated at 0 to 2, 2 to 6 and 6 to 24 hour intervals by a blinded observer. Demographic data, duration of anaesthesia, type of surgery, incidence of previous postoperative nausea or vomiting and motion sickness and number of patients who developed oculocardiac reflex requiring atropine treatment were similar in both groups. The incidence of emesis in the first 24 hours following surgery was similar in both groups (35% Group 1, 33.3% Group 2, P = 1.00). Severity of emesis (median number of emetic episodes, rescue antiemetic requirement and mean time to the onset of first episode of emesis) and mean time to discharge from the post anaesthesia care unit were also similar in the two groups. We conclude that the timing of ondansetron administration either before or after the surgical manipulation of extraocular muscles had similar antiemetic efficacy following strabismus surgery in children.

Adolescent↗

PubMed2004

Early and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children.

This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch, rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1+/-0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1+/-8.8 min and the recovery index (time between T25 and T75) 19.9+/-9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.

Analysis of Variance↗

PubMed1984

Cimetidine in anesthesia: does it minimize the complications of acid aspiration?

The use of cimetidine, an H2-receptor antagonist, to minimize the complications of acid aspiration pneumonia is reviewed. Since Mendelson's early description of acid aspiration in 66 obstetrical patients, attempts have been made to decrease gastric acidity by administering perioperative antacids and/or antihistamine drugs such as atropine and glycopyrrolate. In this review of the literature, strict attention is given to study design and subject selection, methods of collecting gastric samples and reporting both pH and volume measurements, and medications taken on admission, given preoperatively, and as anesthetics. Clinical trials evaluating cimetidine alone and compared with other prophylactic regimens were reviewed, detailing the timing, route, and frequency of drug administration. Cimetidine appears to be effective in minimizing complications of acid aspiration since gastric acidity (pH less than 2.5) is a contributing factor in both the morbidity and mortality of this disease state. In general terms, cimetidine 300 mg po 1.5-2.0 h prior to intubation or 45-60 minutes iv before surgery will decrease gastric acidity below the critical level. This effect may be maintained for up to three hours. Perioperative cimetidine administration, to minimize the complications of acid aspiration, appears to be safe in terms of drug-drug interactions and effects on labor, the fetus, and the newborn child.

Biological Availability↗

PubMed1983

Effect of cholinergic agents in Huntington's disease: a reappraisal.

The effects of centrally and peripherally active anti-cholinergic agents were investigated in four patients with Huntington's disease. Scopolamine reduced chorea, increased incoordination, induced sedation, and produced confusion. Benztropine produced similar but milder effects. A peripheral anticholinergic, glycopyrrolate, had no effect. These results, combined with previous studies, indicate that cholinergic agonists and antagonists that produce sedation may reduce chorea without improving coordination, and suggest that this antichoreic action is independent of their cholinergic actions.

Arecoline↗

PubMed1989

Failure of cholinergic agonist RS-86 to improve cognition and movement in PSP despite effects on sleep.

Postmortem studies of patients with progressive supranuclear palsy (PSP) have demonstrated loss of cholinergic neurons in the striatum, nucleus basalis of Meynert, and the pedunculopontine nucleus. These findings suggest that cholinergic drugs might be an effective treatment for this disease. We studied the efficacy of RS-86, a direct cholinergic agonist, upon motor abilities, eye movements, and psychometric performance in 10 patients with PSP during a 9-week placebo-controlled, double-blinded, crossover trial. Glycopyrrolate, a peripheral anticholinergic drug, was given throughout the trial to minimize cholinergic side effects. We used changes in rapid eye movement (REM) sleep to assess the degree of cholinergic activation achieved by treatment. Despite the enhancement of cholinergic activity in the CNS as indicated by increases in REM sleep latency and REM sleep time, RS-86 did not improve motor signs, eye movements, or cognition. Pharmacologic replacement of the cholinergic deficits in PSP does not result in significant clinical benefit.

Aged↗

PubMed2001

Basal forebrain malformation with hyperhidrosis and hypothermia: variant of Shapiro's syndrome.

A 62-year-old woman presented with episodic sweating and shivering with reduced core temperature. Brain MRI demonstrated a basal forebrain malformation. Physiologic testing included EEG, SPECT, heat challenge, and autonomic testing. Glycopyrrolate aborted spells and raised core temperature. Hypothalamic dysregulation is likely the primary pathophysiology in the setting of other forebrain anomalies. These findings expand the structural abnormalities and treatment options within the temperature dysregulating conditions of Shapiro's syndrome and "diencephalic epilepsy."

Female↗