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PubMed1998

Effects of isoflurane on oxygenation during one-lung ventilation in pulmonary emphysema patients.

BACKGROUND: Hypoxic pulmonary vasoconstriction has an important role in human one-lung ventilation (OLV) in the lateral decubitus position under general anesthesia. During OLV, inhalational anesthesia may inhibit hypoxic pulmonary vasoconstriction and the decrease in arterial oxygenation. We studied the effect of isoflurane administration on arterial oxygen tension in chronic obstructive pulmonary disease patients. METHODS: Ten patients who had thoracoscopic laser ablation of bullous emphysema were studied. Patients received 2% isoflurane in oxygen from induction until the first 20 min of OLV in the lateral decubitus position, then were switched to 1% isoflurane lasting 20 min and next were switched to 0.5% isoflurane lasting 20 min. After each 20-min inhalation, pulmonary and hemodynamic parameters were measured. The given concentrations for isoflurane were merely vapor meter concentrations. RESULTS: PaO2/FIO2, Qs/Qt respiratory rate peak inspiratory pressure and PaCO2 showed no significant changes at each point of isoflurane. Expiratory tidal volume significantly decreased (P < 0.05) with 0.5% isoflurane compared to that with 2% isoflurane. Cardiac output, mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance and pulmonary vascular resistance showed no significant changes at each point of isoflurane. CONCLUSIONS: In patients with pulmonary emphysema, arterial oxygenation is not affected by low isoflurane concentration during OLV in the lateral decubitus position.

Aged↗
PubMed1994

[Effects of pressure support ventilation (PSV) or PSV+PEEP on the respiratory function during general anesthesia under spontaneous ventilation].

This study was performed to examine the hypothesis that PSV with PEEP compared to spontaneous breathing with a circle anesthesia system may have beneficial effects on gas exchange and work of breathing during inhalational anesthesia. Nine patients (age; 58 +/- 20 yr) scheduled to receive general anesthesia for orthopedic (n = 3) or ENT (n = 6) surgery were randomly assigned in a triple cross-over manner to breathe with a standard anesthesia circle system, 5 cmH2O PSV, and 5 cm H2O PSV above 5 cmH2O PEEP. General anesthesia was induced with thiamylal (5 mg.kg-1) and succinylcholine (1 mg.kg-1), followed by tracheal intubation. General inhalation anesthesia was maintained with 1% isoflurane and nitrous oxide in 40% oxygen. Patients were permitted to breathe spontaneously. A BiPAP-S Ventilatory Support System was connected to a standard anesthesia machine instead of a reservoir bag to deliver PSV or PSV with PEEP. Respiratory parameters were measured with a C-P 100 Pulmonary Monitor. After breathing for 20 minutes with the assigned mode, measurements and blood gas sampling were performed. Statistical analysis was performed with ANOVA. There were no statistical differences in PaO2 within the three groups (table). PaCO2 was lower during PSV+PEEP, but the difference was not significant. This level of PSV or PSV with PEEP may have little beneficial effects on gas exchange in our study condition. The mean WOBp was smaller in the PSV with PEEP group but the difference was not statistically significant.

Adult↗
PubMed1997

A new in vivo method for the direct measurement of nutrient artery blood flow.

A new method of directly measuring nutrient artery blood flow using ultrasonic probes is described. These probes have provided reproducible results in our experiments. Advantages of ultrasonic probes include the direct measurement of blood flow through small arteries, ease of use, accuracy of measurement, applicability to a wide range of vessel diameters, the capability of chronically monitoring blood flow over time using permanently implanted probes, and the ability to use the method in conjunction with previous methods of bone blood flow measurement. The method is limited to the extent that only the contribution of the nutrient artery can be measured and total bone blood flow cannot be assessed. Tibial nutrient arterial flow and cardiac output were measured in adult mongrel dogs. Two experiments were performed: 1) bilateral baseline tibial nutrient artery blood flow measurements over time and 2) tibial nutrient blood flow comparing inhaled anesthesia (halothane/nitrous oxide/oxygen) and intravenous anesthesia (pentobarbital [Nembutal]). In 15 mongrel dogs, tibial nutrient artery blood flow averaged 1.46 +/- 0.72 mL/min (0.09 +/- 0.05 percent of cardiac output and 2.75 +/- 1.95 mL/min/100 g of bone). No significant difference in tibial nutrient artery blood flow was observed between animals given intravenous and inhaled anesthesia (P > .05). As a basic research tool, transit-time ultrasonic blood flow technology may be useful. The method is relatively easy to use and may be applied to experimental models designed to investigate various physiologic and pathologic states frequently encountered in orthopedics (eg, shock, sepsis, fractures).

Adjuvants, Anesthesia↗
PubMed1992

Comparison of induction, maintenance, and recovery characteristics of sevoflurane-N2O and propofol-sevoflurane-N2O with propofol-isoflurane-N2O anesthesia.

Induction of, maintenance of, and recovery from sevoflurane anesthesia were compared with propofol and isoflurane anesthesia when administered with nitrous oxide to patients undergoing gynecologic surgery. Seventy-five healthy (ASA I or II), consenting patients were randomly assigned to receive either (I) propofol for induction of anesthesia and isoflurane-nitrous oxide for maintenance (control), (II) propofol for induction and sevoflurane-nitrous oxide for maintenance, or (III) sevoflurane-nitrous oxide for induction and maintenance of anesthesia. Inhaled induction of anesthesia with sevoflurane-nitrous oxide was rapid (109 +/- 25 s to loss of consciousness) and without any untoward hemodynamic changes or episodes of coughing and laryngospasm. Mean arterial blood pressure after induction of anesthesia with propofol (71 +/- 11, 73 +/- 12 mm Hg for groups I and II, respectively) was lower than when sevoflurane (80 +/- 14 mm Hg) was used. The emergence time after discontinuation of isoflurane-nitrous oxide (6.7 +/- 2.2 min) was significantly longer than after propofol-sevoflurane-nitrous oxide or sevoflurane-nitrous oxide alone (4.1 +/- 2.2 and 4.0 +/- 2.0 min for groups II and III, respectively). However, later recovery events did not differ between groups. Serum fluoride levels increased after administration of sevoflurane but not isoflurane. The levels of fluoride ions correlated with the degree of exposure to sevoflurane in MAC-hours. In conclusion, induction of anesthesia with either propofol or sevoflurane-nitrous oxide was rapid and without significant side effects. Emergence and early recovery after maintenance of anesthesia with sevoflurane-nitrous oxide was significantly faster than that after an isoflurane-nitrous oxide combination.

Adult↗
PubMed2004

[Retrospective analysis of postoperative nausea and vomiting after craniotomy].

BACKGROUND: Postoperative nausea and vomiting are important complications after craniotomy. METHODS: One hundred and seventy eight patients who had undergone brain tumor resection at Nara Medical University were retrospectively divided to one of two groups; with or without PONV within 24 hours postoperatively. Variables compared between the groups include gender, age, weight, height, site of surgery (supratentorial versus infratentorial craniotomy), size of brain tumor, type of anesthesia (inhalation versus intravenous anesthesia with nitrous oxide), intraoperative fentanyl dose, duration of surgery as well as anesthesia, and intraoperative posture. RESULTS: PONV occurred in 87 patients (49%). The incidence of PONV in patients undergoing infratentorial craniotomy was significantly higher than that in patients undergoing supratentorial craniotomy (75% vs 45%, P = 0.0011). There were no significant associations between PONV and other variables analyzed. CONCLUSIONS: These results indicate that the incidence of PONV after brain tumor resection is high and infratentorial surgery is a risk factor for PONV. Strategies for the prevention of PONV after craniotomy are required.

Anesthesia, General↗
PubMed2004

[Difficult airway in a child with multiple juvenile xanthogranulomas].

Juvenile xanthogranuloma (JXG) is a benign and self-healing histiocytosis on the skin. A 4-year-old boy with multiple JXG was scheduled for plastic surgery to correct the scar contraction of the neck. The patient was expected to have difficult airway caused by small mouth, limitation of neck movement and numerous nodular lesions located at the face. Initially he underwent resection of the neck scar under local anesthesia with added inhalation anesthesia via mask, and the restricted neck recurvation was improved. One week later, he underwent skin grafting under general anesthesia. We used a spiral tube of 3 mm diameter inserted to the nostril for manual ventilation, and bronchofiberscope-aided tracheal intubation was successfully performed through the laryngeal mask airway under general anesthesia without any problems.

Anesthesia, General↗
PubMedDate not supplied

[To the history of organisation and development of cardiac anesthesiology in the A. N. Bakulev Research Center of Cardiovascular Surgery of the Russian Academy of Medical Sciences: the start of activities (1956-1965)].

The authors present data on the development and introduction of anesthetic techniques during cardiac surgery at the Institute of Thoracic Surgery, USSR Academy of Medical Sciences, in 1956-1960 and after its reorganization to the Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences, in 1961-1965. It is shown that in the years of introduction of closed operations on the heart, the methods of one- and many component inhalational anesthesia were mastered, its techniques were developed, anesthesia apparatuses and an anesthesia schedule were designed, cardiac anesthesiological studies were conducted, training of physicians from the country's regions was initiated, and the first guidelines for general anesthesia were published. In these years, the firm foundation was laid for the development of cardiac anesthesia. Later on the Institute developed and introduces all basic types of inhalational anesthesia during operations on the open heart under both extracorporeal circulation and hypothermia. The gained experience allowed the laboratory staff to defend several dissertations, to issue two monographs, and to analyze errors and risks of general anesthesia in patients with cardiovascular diseases at surgery.

Academies and Institutes↗
PubMed1985

[Behavior of the hypophyseal-adrenal cortex system in inhalation and conduction anesthesia. A review with comparative study].

The effects of halothane anaesthesia or epidural analgesia on the per- and postoperative change in blood concentrations of ACTH, beta-lipotropin, cortisol, dehydroepiandrosterone, aldosterone, glucose, lactate and free fatty acids were investigated in connection with elective orthopaedic surgery. Anaesthesia in man with halothane and nitrous oxide was found to be associated with a significant increase in plasma ACTH levels and beta-LPH levels. Changes in plasma dehydroepiandrosterone were similar to those in plasma cortisol. The elevation of plasma aldosterone during major surgery could be explained as the effect of an increased renin secretion. However, simultaneous increase in plasma cortisol and plasma aldosterone during surgery reflect an additional effect of adrenocorticotropin upon aldosterone secretion.

Adrenal Cortex↗
PubMedDate not supplied

Effects of general anesthesia on the human blink reflex.

The blink reflex was studied in 10 patients undergoing elective procedures under general anesthesia. Anesthetic agents were isoflurane, halothane, nitrous oxide, methohexital, and thiopental in various combinations. At induction, blink reflexes were diminished by low-dose thiopental (1-1.5 mg/kg) and abolished by high-dose thiopental (4-8 mg/kg) and methohexital (1.5 mg/kg). Blink reflexes were absent during halogenated volitile inhalational anesthesia and did not return until patients were in the recovery room, well after end-tidal anesthetic levels were zero by mass spectroscopy. Recovery of consciousness and the ability to blink on command often preceded return of any blink reflex activity, indicating that the blink reflex is not useful as a postoperative test of facial nerve function in the operating room after anesthesia. In six patients, blink reflexes were still diminished 2-3 hours after cessation of anesthesia, at a time when patients were fully oriented and corneal and eyelid reflexes were clinically normal. This finding suggests that the blink reflex might be a sensitive test of subtle CNS dysfunction after inhalational anesthesia and potentially could serve as a useful objective indicator of recovery from anesthesia for outpatient surgery.

Adult↗
PubMed2005

Cardiopulmonary and acid-base effects of desflurane and sevoflurane in spontaneously breathing cats.

The cardiopulmonary effects of desflurane and sevoflurane anesthesia were compared in cats breathing spontaneously. Heart (HR) and respiratory (RR) rates; systolic (SAP), diastolic (DAP) and mean arterial (MAP) pressures; partial pressure of end tidal carbon dioxide (PETCO2), arterial blood pH (pH), arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2); base deficit (BD), arterial oxygen saturation (SaO2) and bicarbonate ion concentration (HCO3) were measured. Anesthesia was induced with propofol (8+/-2.3mg/kg IV) and maintained with desflurane (GD) or sevoflurane (GS), both at 1.3 MAC. Data were analyzed by analysis of variance (ANOVA), followed by the Tukey test (P<0.05). Both anesthetics showed similar effects. HR and RR decreased when compared to the basal values, but remained constant during inhalant anesthesia and PETCO2 increased with time. Both anesthetics caused acidemia and hypercapnia, but BD stayed within normal limits. Therefore, despite reducing HR and SAP (GD) when compared to the basal values, desflurane and sevoflurane provide good stability of the cardiovascular parameters during a short period of inhalant anesthesia (T20-T60). However, both volatile anesthetics cause acute respiratory acidosis in cats breathing spontaneously.

Acid-Base Equilibrium↗
PubMed1998

[Memory, awareness and learning in general anesthesia].

Enough information concerning memory and other cognitive functions in total anesthesia is available in the literature. Some basic theories about neuronal mechanisms of memory and consciousness are known. An attempt trying to bridge the gap between psychological and biologic levels is the usage of anesthetics in pharmacologic tests enabling the study of their influence on awareness and memory in humans. With the help of this approach it is possible to inquire into the psychological mechanisms and to demonstrate the influence of anesthetics on them. 44 patients were included in the study, operated on in inhalation anesthesia. The effects of anesthesia on awareness, consciousness, learning and memory in our study sample were following: 1. No episode of awareness was observed during the study; 2. There was an improvement of the memory quotient (MQ) following total inhalation anesthesia (p < 0.05); 3. The pain threshold significantly decreased after anesthesia (p < 0.001); 4. There exists a learning mechanism in total anesthesia more efficient in the group of patients auditively learning pain related words (p < 0.05) comparing to the control group of patients auditively learning pain nonrelated words; 5. Statistical analysis of the number of remembered pain related words and pain nonrelated words revealed significantly higher number of words in the first group of pain related words (p < 0.001). (Tab. 3, fig. 6, Ref. 22.)

Anesthesia, Inhalation↗
PubMed2001

Integrated analysis of protein and glucose metabolism during surgery: effects of anesthesia.

The aim of this study was to assess dynamic changes in protein and glucose metabolism during surgery. Twelve patients undergoing colorectal surgery received either intravenous propofol anesthesia (n = 6) or inhalational anesthesia with desflurane (n = 6). Pre- and intraoperative protein and glucose kinetics were analyzed by an isotope dilution technique using L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose. Plasma concentrations of glucose, lactate, free fatty acids, insulin, glucagon, and cortisol were measured before and after 2 h of surgery. The rates of appearance of leucine and glucose, leucine oxidation, protein synthesis, and glucose clearance decreased during surgery, independent of the type of anesthesia (P < 0.05). A correlation between the rate of appearance of leucine and glucose was observed (r = 0.755, P < 0.001). Intraoperative plasma cortisol and glucose concentrations increased (P < 0.05), whereas plasma concentrations of lactate, free fatty acids, insulin, and glucagon did not change. Surgery causes a depression of whole body protein and glucose metabolism, independent of the anesthetic technique. There is a correlation between perioperative glucose production and protein breakdown.

Adult↗
PubMed1977

[Aspects of the clinical use of methoxyflurane analgesia and of the determination of its concentration and distribution in the body].

As a supplement to local anesthesia in aortography, appendectomies and operations for hernia in 118 patients the authors employed through a mask an inhalation anesthetic methoxyflurane in subnorcotic concentrations. The patients were in the state of consciousness, analgesia was adequate, no complications relative to methoxyflurane inhalation were noted inhalation anesthesia with methoxyflurane proved to be safe and effective in combination with local anesthesia. The method is indicated in aortographies.

Analgesia↗
PubMed1990

[Changes in arterial oxygen tension during and after enflurane or halothane anesthesia as well as epidural analgesia].

Recovery from inhalation anesthesia is often marked by the occurrence of postoperative hypoxemia. In this study, we compared the effects of enflurane or halothane anesthesia and epidural analgesia on arterial oxygen tension during and after the operation in 60 ASA physical status 1-2 patients who underwent cholecystectomy. Anesthesia was induced with thiopental and maintained with 66% N2O and -enflurane (1.5%), -halothane (1%), or -epidural lidocaine (1% solution, 17.5 ml) in oxygen. Blood gas analysis was done before and 10, 30, 60 min after induction. PaO2 was measured on 1st and 3rd postoperative days in all patients breathing air spontaneously. PaO2 decreased during operation in all three groups of anesthesia. PaO2 values on first postoperative day were significantly lower than those before operation, and PaO2 value in enflurane group (PaO2 = 67 +/- 1 mmHg) was significantly lower than that in halothane group (PaO2 = 72 +/- 2 mmHg, P less than 0.05).

Adult↗
PubMed1995

[Intravenous anesthesia with inhalation anesthetics].

The authors describe intravenous anaesthesia with diethyl ether that has been in use for over 70 years as the only clinically useful form of anaesthesia with intravenously applied volatile anaesthetics. Intravenous ether anaesthesia, which had been introduced in 1909 by Burkhardt, was rarely but regularly used in Europe and the United States between 1910 and 1930. In the course of development of new intravenous anaesthetics such as hexobarbital and thiopental, which were easier to handle, intravenous ether narcosis was used only sporadically after 1930. The method, however, has certain "pros", such as: rapid and excitation-free introduction, good manageability, only mild postnarcotic disturbances and volume substitution by the carrier solution. The "cons" are a quite considerable incidence of venous irritations and thromboses, complicated and costly equipment and preparation of the solution as well as cardiovascular stress in case of cardiac insufficiency patients. Simulation confirmed the statements from literature in respect of the characteristic features concerning induction and manageability.

Anesthesia, Intravenous↗
PubMed1984

[Anesthesia procedures in the rabbit].

In a review common regimens of anesthesia in the rabbit are described. To carry out an anesthesia the following knowledge is requested: preanesthetic history and physical condition, preanesthetic feeding and handling, methods of drug application (aerogen, intravenously and intramuscularly). Special anesthetic risks in the rabbit are lined out. The methods of anesthesia are presented in four tables. Long term anesthesia: Ketamine (Ketanest) + Xylazine (Rompun) i.m. or Fluanison/Fentanyl (Hypnorm) i.m. Medium term anesthesia: Ketamine + Xylazine i.v. or Pentoparbitone (Narcoren) i.v. Short- and introductive anesthesia: Propanidid (Epontol) i.v.; Althesine (Saffan) or (Aurantex); Thiamylal (Surital) i.v.; Alfentanil (Rapifen) i.v. + Etomidat (Hypnomidat) i.v. + Azaperon (Stesnil) premedication Methods of inhalation anesthesia with volatile anesthetics like ether, halothan or methoxyfluran as admixture with normal air or with nitrousoxide/oxygen.

Anesthesia, General↗