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PubMed1990

[Hyperosmolar volume replacement in heart surgery].

The ideal solution for use in volume therapy is still a matter of debate. Hypertonic sodium (HS) solutions have been advocated for resuscitation from hemorrhagic shock (small volume resuscitation). As hypertonic fluids may also be of interest in cardiac surgery, the effects of a new HS solution were studied. METHODS. In 90 patients undergoing aorto-coronary bypass grafting studies were performed at three different periods: I (n = 30) after induction of anesthesia (before onset of the operation); II (n = 30) during cardiopulmonary bypass (CPB); III (n = 30) after termination of bypass. During these periods the patients were randomly allocated to one of three groups with 10 patients in each group: group 1 received a new hypertonic solution prepared in hydroxyethyl starch (HES) solution (72 g/l NaCl, 60 g/l HES, 2400 mosmol/l; HS-HES patients), group 2 received a 6% HES solution (200/0.5; HES patients), and group 3 received no volume infusion and served as controls. RESULTS. After the induction of anesthesia, significantly less HS-HES solution (4.5 +/- 0.5 ml/kg) than 6% HES solution (10.1 +/- 1.4 ml/kg) was necessary to double the baseline PCWP. The fluid balance during CPB was negative in the patients who had received HS-HES preoperatively (-0.03 +/- 0.01 ml/kg.min CPB), whereas 6% HES (+0.06 +/- 0.02 ml/kg.min CPB) and control patients (+0.13 +/- 0.03 ml/kg.min CPB) had a positive fluid balance. Both after the induction of anesthesia and after termination of bypass, CI increased more in the HS-HES group than in the HES patients, and it even decreased in the control group. SVR decreased in the HS-HES patients, whereas it increased in the control group. Rapid infusion of HS-HES during CPB was followed by a significant, but short-lasting decrease in MAP (-40 mmHg) and an increase in the oxygenator volume. Pulmonary gas exchange (= paO2) was least compromised in the HS-HES patients; the sodium concentration increased only in the HS-HES patients, but never exceeded 150 mmol/l. DISCUSSION. Cardiac surgery procedures offer a special situation for volume therapy as there is a possibility of deterioration in the macro- and microcirculation before, after, and during the period of CPB. Hemodynamic effects of the new HS-HES solution included an increase in CI and a decrease in SVR, which were not merely transient as has been reported which hypertonic saline solution used alone. It was also observed that HS-HES patients required significantly smaller volumes of fluids, both during CPB and during the early postoperative period. This effect seems to be due to a redistribution of interstitial fluid to the intravascular space, possibly decreasing tissue edema. CONCLUSION. The hypertonic saline HES solution adds a new dimension to volume therapy for cardiac surgery patients. The improvement in hemodynamics was effective and not only transient. Fluid requirements were significantly reduced during as well as after CPB, and pulmonary gas exchange was least compromised in these patients.

Aged↗
PubMed1997

Perioperative thermoregulation and heat balance.

In summary, both regional and general anesthesia markedly impair the normal precise regulation of core body temperature. Consequently, inadvertent perioperative hypothermia is common. Hypothermia develops because the typical operating room environment is cold; however, it is anesthetic-induced impairment of thermoregulatory responses that contributes most. Internal redistribution of body heat is a surprisingly important factor, contributing more to core hypothermia than net heat loss in most patients. There is now convincing evidence that a typical amount of intraoperative hypothermia, say 2 degrees C, predisposes numerous complications and alters patient outcome. Fortunately, effective methods are available for preventing hypothermia.

Anesthesia, General↗
PubMed1999

Timolol effects on aqueous humor dynamics in eyes of anesthetized rats.

Anterior chambers of the eyes of male rats were cannulated under pentobarbital anesthesia for intracameral infusions of balanced salt solution (BSS) and intraocular pressure (IOP) recording. Blood pressure was recorded from a femoral artery. IOP was recorded during a 2-h intracameral infusion composed of a constant component (0.05 microl/min) and a periodic component (0.25 microl/min), cycling at 4 min on and then 4 min off. After a 20-min baseline period, 1 drop of timolol (0.5%) or BSS was applied to the cornea and repeated 1 h later. Intracameral infusions of BSS and 0.05% timolol were also compared. Topical timolol slightly delayed the BSS-induced IOP rise (p <.05). Complex demodulation and the estimated gain parameter of a second-order transfer function fit to the periodic responses revealed that topical timolol also reduced (p <.05) passive outflow resistance. Intracameral timolol markedly delayed the BSS-induced rise in IOP. Initially, timolol decreased both outflow impedance and nonresistive components (p <.05) of IOP, but these effects dissipated by 2 h when IOPs were similar. In all experiments, within-group blood pressure was unchanged. Topical and intracameral timolol have different effects on IOP. The data support the opinion that, in vivo, timolol acts at beta-receptors that control both outflow impedance and nonresistive mechanisms, probably vascular, to lower IOP.

Administration, Topical↗
PubMedDate not supplied

[Combined general anesthesia using moradol in children].

The purpose of this study was to assess the efficacy of moradol (butorphanol tartrate) as an analgetic component of combined total anesthesia in children. The adequacy of anesthesia was assessed by echography, electrocardiography, and electroencephalography, measurements of stress hormones, electrolyte balance, and metabolic parameters at various stages of anesthesia and surgery. A total of 103 patients aged 1 to 4 years were examined, subjected to abdominal, thoracal, urological, orthopaedic, and ENT surgery. The stability of the basic hemodynamic parameters and some stress hormones in the blood during surgery indicated effective protection of the organism from surgical trauma, on the one hand, and evidenced the minimal effect of anesthesia on the adrenal and thyroid function, on the other. A single injection of moradol during induction narcosis was sufficient for 2.5 to 3 hours of surgery. No serious side effects of the drug were observed. Prolonged (10 hours on average) anesthesia persisted after the operation, this decreasing the postoperative use of analgesics.

Adolescent↗
PubMed1984

The effect of ether, pentobarbitone sodium and fentanyl on blood gases, acid-base balance and hematological parameters in the rat.

Blood gases, acid-base balance and hematological parameters (RBC, PCV and Hb) were measured in adult rats of both sexes. The use of ether and fentanyl had a very little effect on the blood gases and acid-base balance. The induction of pentobarbitone anesthesia, however, was followed by a significant increase in PCO2 and TCO2, while the pH value decreased.

Acid-Base Equilibrium↗
PubMed1984

Intraoperative evoked potential monitoring of the spinal cord: enhanced stability of cortical recordings.

Intraoperative EP monitoring of spinal cord function depends upon a quickly obtained, reproducible EP. The records must be obtained in a hostile environment where artifacts and other sources of electrical noise cannot easily be eliminated: records are obtained continuously without interrupting the surgery. We studied EP reproducibility by measuring cortical EP amplitude range and latency range within individual patients. Reproducibility was enhanced by several changes in the stimulus and recording parameters: (1) Bipolar recording near the vertex (Cz-Pz, E1-E2) eliminated a significant amount of the artifacts and random variations seen in referential recordings. Bipolar recordings sacrifice some amplitude but the improved reproducibility is worthwhile. (2) Restricted filters (especially 30-3000 Hz) improve reproducibility still further, compared to the traditional open filters (1-1000 Hz). (3) Fast stimulation rates improve monitoring up to rates of about 5 stimuli/sec. At even faster rates too much amplitude attenuation usually occurs. Using these techniques stable intraoperative EPs were recorded from all 115 patients except those in whom EPs were abnormal even before surgery. Advantages and disadvantages compared to epidural recording techniques were discussed. Several further observations were made, including (1) monitoring could be done equally as well with stimulation either at the peroneal or at the posterior tibial nerve; (2) balanced nitrous oxide and narcotic anesthesia did attenuate EPs by about 60%, although this is not so much as to interfere seriously with monitoring.

Adolescent↗
PubMed2007

Propofol versus sevoflurane: bleeding in endoscopic sinus surgery.

OBJECTIVE: Reduction of intraoperative bleeding is desirable to improve intraoperative visibility and to avoid complications. STUDY DESIGN: Prospective, controlled, randomized, double-blinded study. SETTING: Inclusion criteria were chronic rhinosinusitis with nasal polyps that involved all paranasal sinuses, Lund-CT score > or =12, and double-blind preoperative randomization of narcotics. Exclusion criteria included abnormal coagulation, perioperative blood pressure outside the range of 70 to 140 mmHg systolic and 50 to 90 mmHg diastolic and perioperative medication. Total blood loss (mL), blood loss per minute (mL/min), platelet function, and parameter for endoscopic vision were evaluated. RESULTS: Forty-six patients (22 sedated with sevoflurane/fentanyl, 24 sedated with propofol/fentanyl) completed the study. Total blood loss (300.1 +/- 168.5 mL/276.9 +/- 201.3 mL), blood loss per minute, and endoscopic vision showed no group difference. Platelet function was significantly impaired 45 minutes after onset of surgery in both groups, but more pronounced after propofol anesthesia. CONCLUSION: Under conditions of balanced circulatory parameter, equal blood loss and endoscopic vision can be achieved with both tested anesthetic regimens. During extended operations demonstrated thrombocyte impairment by propofol may become clinically relevant.

Adult↗
PubMed2002

Corneal-wetting property of lignocaine 2% jelly.

PURPOSE: To evaluate the corneal-wetting property of lignocaine 2% jelly. SETTING: A district general hospital. METHODS: Fifty patients having cataract surgery were divided into 3 groups. Group 1 comprised 20 patients who had topical eyedrop anesthesia and corneal irrigation with balanced salt solution (BSS(R)) during surgery as necessary. Group 2 comprised 15 patients who received lignocaine jelly on arrival and just before the corneal incision was made as well as corneal moisturizing by BSS during surgery. Group 3 comprised 15 patients who received lignocaine jelly on arrival and additional lignocaine jelly if necessary just before the corneal incision was made to maintain corneal clarity. The duration of efficacy and the frequency of the applications of the 2 agents were recorded. Corneal clarity and reflections were noted intraoperatively. Corneal status was assessed postoperatively in the ward. RESULTS: Preoperative lignocaine 2% jelly maintained corneal clarity longer than BSS (P <.001). A second application of lignocaine was needed when surgery was prolonged. CONCLUSIONS: The corneal-wetting property of lignocaine 2% jelly can be useful during cataract surgery by avoiding repeated corneal irrigation with BSS.

Acetates↗
PubMed1996

Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination, or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty.

This study was designed to examine postoperative analgesia with intrathecal neostigmine in a randomized, blinded trial with morphine as the active control in patients undergoing anterior and posterior vaginoplasty. A secondary aim was to provide preliminary data on the interaction between these two drugs. The incidence of adverse effects was also assessed. Forty-eight patients were divided into eight groups (50 micrograms, 100 micrograms, and 200 micrograms morphine [M]; saline; 50 micrograms, 100 micrograms, and 200 micrograms neostigmine [N]; and 50 micrograms morphine + 50 micrograms neostigmine). Anesthesia was provided with a balanced technique. All patients stayed 24 h in the recovery room where adequacy of postoperative analgesia and side effects were assessed. Increasing doses of intrathecal morphine (50 micrograms, 100 micrograms, and 200 micrograms) and intrathecal neostigmine (50 micrograms, 100 micrograms, and 200 micrograms) showed a dose-dependent pattern of analgesia (P < 0.001). The M50 + N50 combination resulted in a better analgesic effect with fewer side effects than M50, N50, and control groups. These preliminary data suggest that spinal neostigmine produces analgesia for vaginoplasty surgery similar in duration to spinal morphine and that the combination of morphine and neostigmine may allow a reduction in the dose of each component for postoperative analgesia.

Adult↗
PubMed2002

Treatment of morbid obesity with intragastric balloon in association with diet.

BACKGROUND: The BioEnterics Intragastric Balloon (BIB, BioEnterics, Santa Barbara, CA) in association with restricted diet has been used for the treatment of obesity and morbid obesity. METHODS: Since March 1998, 322 BIB were placed in 281 obese and morbidly obese patients; 73 patients were male and 208 female; mean age was 41.6 years (21-70); mean weight was 117.4 kg (67-229); mean BMI was 41.8 kg/m2 (29-81); % excess weight was 62% (10-216). The balloon was inserted and removed endoscopically under general anesthesia. Patients were given a balanced diet of 1000 kcal/day. Also, for 18 months we compared 42 obese patients treated only with 1000 kcal/day diet (group A) with 31 obese patients subjected to BIB for 4 months + 1000 kcal/day diet (group B). RESULTS: After 4 months of balloon treatment, the mean weight loss was 13.9 kg and the mean reduction in BMI was 4.8. Weight loss was greater in male patients. Weight loss was accompanied by an improvement of the diseases associated with obesity, in particular diabetes. In the diet vs BIB + diet study, BIB with diet produced a greater weight loss in a shorter time than diet alone. CONCLUSION: The best indications for BIB were: morbidly obese opatients (BMI > 40) and super-obese patients (BMI > 50) in preparation for bariatric operations; obese patients with BMI 35-40 with co-morbilities in preparation for bariatric surgery; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI < 30 only in a multidisciplinary approach.

Adult↗
PubMed1975

[Sodium- and water balance in the dog in the conscious state and under nitrous-oxide and barbiturate anesthesia (author's transl)].

By a suitable pattern of saline infusion we established an equilibrium between input and renal output of sodium and water in the conscious animal, which was maintained for six hours. During this period of equilibrium we found an increase in GFR, plasma volume and functional ECFV of about 30% each, the amount of intravascular protein and albumin being unchanged. Under nitrous-oxide and thiopentone anaesthesia renal sodium and water excretion was unchanged compared with values of conscious animals. However there was a striking decrease in plasma volume as well as in circulating protein and albumin by approximately 20%. Similarly functional ECFV (sulphate space) was found to be reduced under thiopentone anaesthesia. Retention of sodium about 12 hours after the end of anesthesia amounted to 7% of the quantities infused (about 50 mval per animal), whilst the applied water load had been completely excreted.

Anesthesia↗
PubMedDate not supplied

Intragastric balloon: another option for treatment of obesity and morbid obesity.

BACKGROUND/AIMS: The BioEnterics Intragrastric Balloon (BIB, BioEnterics, Santa Barbara, CA) in association with restricted diet has been used for the treatment of obesity and morbid obesity. METHODOLOGY: Since March 1998, 349 BIB were placed in 303 obese and morbidly obese patients; 95 patients were male and 208 female; mean age was 41.5 years (19-70); mean weight was 118.8 Kg (67-229); mean BMI was 42 Kg/m2, % excess weight was 62.3% (4.6-216.3). The balloon was inserted and removed endoscopically under general anesthesia. Patients were given a balanced diet of 1000 Kcal/day. RESULTS: After 4 months of balloon treatment, the mean weight loss was 13.9 Kg and the mean reduction in BMI was 4.8 Kg/m2. Weight loss was greater in male patients. Weight loss was accompanied by an improvement of the diseases associated with obesity, in particular diabetes. CONCLUSIONS: The best indications for BIB were: morbidly obese (BMI >40) and super-obese patients (BMI >50) in preparation for bariatric operations; obese patients with BMI 35-40 with co-morbidity in preparation for bariatric surgery; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI <30 only in a multidisciplinary approach.

Adult↗
PubMed1976

[Intensive care in ENT medicine, head and neck surgery (author's transl)].

In intensive medicine we distinguish between intensive care units which have mostly observatory and monitoring functions and intensive therapy units. For the surgical patients of the ear, nose, and throat department the intensive care units are probably of greater significance. The following play an important role: Preoperative work-up including laboratory fluoroscopy and x-rays, pulmonary function tests and blood gas analysis; induction of anesthesia, access to good veins, gastric intubation, urinary bladder catheterization; maintenance of anesthesia and postoperative observation, fluid balance, oral and parenteral feeding, tracheostomy care, bronchial toilet; inhalation therapy. The last receives an extensive discussion.

Acid-Base Equilibrium↗
PubMed2006

Does isoflurane anesthesia alter immuno-modulatory response in schistosomal patients? Assessment of serum pro- and anti-inflammatory cytokine balance.

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immuno-suppressive effects, can influence long term disease progression, morbidity, and mortality. Literature on postoperative immune response in schistosomiasis patients is scarce. The aim of this study was to assess the impact of isoflurane anesthesia on pro- and anti-inflammatory cytokine balance in schistosomal patients undergoing minor procedures. The study was conducted on 24 patients (ASA class I-II) scheduled for elective urologic endoscopic procedures. Patients were divided into two groups 12 patients each: control group (n=12) and patient group (n=12). Anaesthesia was induced by a bolus dose of sufentanil 0.2 microg x kg(-1), thiopentone sodium 5 mg x kg(-1), vecuronium 0.1 mg x kg(-1) and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 microg x kg(-1) when indicated. Venous blood samples were obtained from each patient: before induction, fifteen minutes, one hr after induction and 24 hrs after surgery. Plasma levels of IL-1beta, TNF-alpha, IL-8, IFN-gamma, IL-1ra and TNF-BP1, as well as stress hormones (cortisol and prolactin) were measured. As for pro- and anti-inflammatory cytokine balance, the overall end-result was a rise at 24 hr postoperatively, in the level of TNF-alpha (a key pro-inflammatory cytokine) and IFN-gamma, as well as both anti-inflammatory cytokines (IL-Ira & sTNF-R1). The anti-inflammatory response was more conspicuous in the patients than controls.

Adult↗
PubMed1994

Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia.

BACKGROUND: The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after vasoconstriction, core cooling rates during combined epidural/general anesthesia are greater than those during general anesthesia alone. Vasoconstriction thresholds and heat balance were evaluated under controlled circumstances in volunteers, whereas the clinical importance of intraoperative thermoregulatory vasoconstriction was evaluated in patients. METHODS: Five volunteers were each evaluated twice. On one of the randomly ordered days, epidural anesthesia (approximately T9 dermatomal level) was induced and maintained with 2-chloroprocaine. On both study days, general anesthesia was induced and maintained with isoflurane (0.7% end-tidal concentration), and core hypothermia was induced by surface cooling and continued for at least 1 h after fingertip vasoconstriction was observed. Patients undergoing colorectal surgery were randomly assigned to combined epidural/enflurane anesthesia (n = 13) or enflurane alone (n = 13). In appropriate patients, epidural anesthesia was maintained by an infusion of bupivacaine. The core temperature that triggered fingertip vasoconstriction identified the threshold. RESULTS: In the volunteers, the vasoconstriction threshold was 36.0 +/- 0.2 degrees C during isoflurane anesthesia alone, but significantly less, 35.1 +/- 0.7 degrees C, during combined epidural/isoflurane anesthesia. Cutaneous heat loss and the rates of core cooling were similar 30 min before vasoconstriction with and without epidural anesthesia. In the 30 min after vasoconstriction, heat loss decreased 33 +/- 13 W when the volunteers were given isoflurane alone, but only 8 +/- 16 W during combined epidural/isoflurane anesthesia. Similarly, the core cooling rates in the 30 min after vasoconstriction were significantly greater during combined epidural/isoflurane anesthesia (0.8 +/- 0.2 degrees C/h) than during isoflurane alone (0.2 +/- 0.1 degrees C/h). In the patients, end-tidal enflurane concentrations were slightly, but significantly, less in the patients given combined epidural/enflurane anesthesia (0.6 +/- 0.2% vs. 0.8 +/- 0.2%). Nonetheless, the vasoconstriction threshold was 34.5 +/- 0.6 degrees C in the epidural/enflurane group, which was significantly less than that in the other patients, 35.6 +/- 0.8 degrees C. When the study ended after 3 h of anesthesia, patients given combined epidural/enflurane anesthesia were 1.2 degrees C more hypothermic than those given general anesthesia alone. The rate of core cooling during the last hour of the study was 0.4 +/- 0.2 degrees C/h during combined epidural/enflurane anesthesia, but only 0.1 +/- 0.3 degrees C/h during enflurane alone. CONCLUSIONS: These data indicate that epidural anesthesia reduces the vasoconstriction threshold during general anesthesia. Furthermore, the markedly reduced rate of core cooling during general anesthesia alone illustrates the importance of leg vasoconstriction in maintaining core temperature.

Adolescent↗