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At least 559 records · Page 31Linked to original sources
PubMed1987

[Endocrine stress response in halothane, enflurane and isoflurane anesthesia in surgical interventions].

The endocrine stress response under inhalation anesthesia with halothane, enflurane, and isoflurane was investigated in 30 patients during and after orthopedic surgery (Table 2). Plasma levels of adrenaline and noradrenaline (by HPLC/ECD), ADH, ACTH, and cortisol (by RIA), glucose, lactate, and free glycerol were determined before induction of anesthesia, 10 min after intubation, 10 min before the end of the operation, and 5 and 30 min after extubation. Statistical evaluation was undertaken by analysis of variance with repeated measures on one factor. P values of less than 0.05 were considered significant. There were no significant differences in the concentrations of plasma catecholamines (Table 4, Figs. 1 and 2), ADH, ACTH (Table 5, Figs. 3 and 4), or cortisol before and during surgery between the groups. ADH was lower in the halothane group 5 and 30 min after extubation (P = 0.05), which might be due to the prolonged elimination of halothane after anesthesia. Blood pressure, heart rate (Table 3), and plasma concentrations of glucose, lactate, and free glycerol (Table 6) were comparable in all groups. It is concluded that for clinical practice halothane, enflurane, and isoflurane are comparable in their influence on the surgical stress response.

Adrenocorticotropic Hormone↗
PubMed1980

Relationship of impaired insulin secretion during surgical stress to anesthesia and catecholamine release.

Impaired insulin secretion has been observed during surgical stress in man. To determine the relationship between insulin secretion during anesthesia and surgical stress and plasma levels of norepinephrine (NE) and epinephrine (Epi), studies were performed in 16 patients before and during elective minor surgical procedures. In 8 patients studied during halothane inhalation anesthesia before operation, the acute insulin response (AIR) to glucose (5 g, IV) fell to 51 +/- 3% of the preanesthesia AIR (mean +/- SEM; P < 0.001). This inhibition of AIR appeared unrelated to increased adrenergic activity, since during anesthesia alone, plasma NE did not change significantly and plasma Epi fell from 94 +/- 11 to 34 +/- 10 pg/ml (P < 0.01). During the postoperative recovery period in these patients, after discontinuation of the anesthesia, the AIR to glucose was 50 +/- 5% of the preanesthesia baseline response (P < 0.001). At this time, both plasma NE and Epi were increased compared to preanesthesia levels [NE: 240 +/- 40 (preanesthesia) vs. 340 +/- 43 (postoperative); Epi: 219 +/- 43 (preanesthesia) vs. 94 +/- 11 (postoperative); both P < 0.05]. In eight patients undergoing similar operations during low spinal anesthesia, no inhibition of the AIR to glucose occurred, and plasma NE and Epi did not increase significantly during or after the operation. During the recovery period, there was a relationship between plasma Epi and the degree of inhibition of the AIR to glucose (r = 0.70; n = 11; P < 0.05). Thus, inhibition of insulin secretion during surgical stress may be mediated both by direct effect of the anesthesia used and by activation of the sympathetic nervous system.

Anesthesia, Inhalation↗
PubMed2001

[Anesthesia for electroconvulsive therapy during pregnancy--a case report].

We experienced anesthetic management for ECT in a patient with psychiatric disease during the third trimester of pregnancy. The 24 year-old patient had been on oral antipsychotics prescribed to treat schizophrenia for ten years. Her signs and symptoms deteiorated during pregnancy in spite of increased doses of antipsychotics. With tocolytic agent administered intravenously, anesthesia was induced by intravenous thiamylal immediately followed by intravenous suxamethonium for muscle relaxation. Alternative current was applied on both side of the head after the sufficient anesthesia had been obtained. The patient received intermittent mandatory ventilation by breathing mask with 100% oxygen during the procedure. Along with monitoring of maternal hemodynamic variables and arterial oxygen saturation (Spo2), fetal heart rate and uterine contraction were recorded by cardiotocogram throughout the procedure. At the first two treatments, the patient showed neither significant uterine contraction nor fetal heart rate changes. At the third treatment, continuous uterine contraction refractory to tocolysis was recorded for six minutes, resulting in fetal bradycardia. At the sixth treatment, general anesthesia was induced and maintained by sevoflurane in oxygen followed by suxamethonium for muscle relaxation. The uterine contraction was remarkably diminished and fetal heart rate remained unchanged during the procedure. In conclusion, inhalation anesthesia is beneficial for ECT in the last stage of pregnancy to reduce uterine contraction by potential uterine relaxation effect of anesthetics.

Adult↗
PubMed1977

Choice of analgesia or anesthesia for pain relief in suction curettage.

One hundred and fifteen patients admitted to Duke University Medical Center from January 1, 1973, to December 31, 1974 inclusive, with the diagnosis of uncomplicated spontaneous incomplete or inevitable abortion were included in a randomized prospective study. All patients underwent suction curettage under either analgesia or general inhalation anesthesia. Patient response was adjudged regarding comfort and cooperativeness in the group receiving analgesia and postprocedure rehabilitation and discharge times in both groups. Fifteen of 59 patients receiving analgesia only were recorded unanimously as failures. Post-operative ambulation was no more rapid in patients receiving analgesia. Procedure-to-discharge intervals were unrelated to medication modality. There appears to be no advantage to analgesia as far as rehabilitation time, procedure-to-discharge time, and medical complications are concerned.

Abortion, Spontaneous↗
PubMed2001

Clinical characteristics of perioperative coronary spasm: reviews of 115 case reports in Japan.

PURPOSE: Factors affecting perioperative development of coronary spasm have not been elucidated. A number of case reports describing perioperative coronary spasm have appeared in Japanese anesthesia journals, mostly published in Japanese. The purpose of this study was to investigate the contributing factors affecting perioperative coronary artery spasm by reviewing the published articles. METHODS: Reports were identified by using Medline database (1968-1998) or by manually searching nonindexed Japanese journals. The clinical characteristics of perioperative coronary spasm were analyzed in 115 patients who developed coronary artery spasm during the perioperative period. RESULTS: The mean age of the patients was 64 +/- 9 years (range, 36 to 87 years). There were 97 men (84%) and 18 women (16%). Preoperative risk factors included hypertension (27%), angina pectoris (27%), cigarette smoking (13%), and diabetes mellitus (11%). The attack was related to inadequate depth of general anesthesia (23%), use of vasopressors (22%), vagal reflex (19%), administration of drugs other than vasopressors (17%), and epidural block (15%). About 85% of patients showed no ischemic abnormality on the preoperative electrocardiogram, whereas 56% had significant coronary stenosis on postoperative coronary arteriography. Coronary spasm tended to occur in patients under inhalation anesthesia combined with epidural block. Nitrates alleviated the episode in the majority of cases, whereas defibrillation and cardiac massage were required in 19% of patients. No deaths were reported. CONCLUSION: Perioperative coronary spasm is prevalent in elderly male patients with coronary risk factors who undergo abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity may be the underlying pathogenic mechanisms of perioperative coronary spasm.

Journal Article↗
PubMed1999

Comparison of clinical signs and hemodynamic variables used to monitor rabbits during halothane- and isoflurane-induced anesthesia.

OBJECTIVE: To characterize variables used to monitor rabbits during inhalation anesthesia. ANIMALS: 8 male New Zealand White rabbits. PROCEDURE: Rabbits were similarly anesthetized with halothane (HAL) or isoflurane (ISO) in a crossover study; half received HAL followed by ISO, and the protocol was reversed for the remaining rabbits. After induction, minimum alveolar concentration (MAC) was determined for each agent, using the tail-clamp method, and variables were recorded at 0.8, 1.0, 1.5, and 2.0 MAC (order randomized). RESULTS: Mean +/- SEM MAC was 1.42 +/- 0.05 and 2.07 +/- 0.09% for HAL and ISO, respectively. Directly measured auricular mean arterial blood pressure was 52.8 +/- 5.6 and 54.8 +/- 6.1 mm Hg at 0.8 MAC for HAL and ISO, respectively, and decreased from these values in a parallel dose-dependent manner. Respiratory frequency remained constant (range, 69 to 78 breaths/min) over the range of HAL doses but incrementally decreased from a mean of 53 (at 0.8 MAC) to 32 breaths/min (at 2.0 MAC) for ISO. The PaCO2 was similar at 0.8 MAC for HAL and ISO and progressively increased with increasing doses of both agents; PaCO2 at 2.0 MAC for ISO was significantly greater than that at 2.0 MAC for HAL (79.8 +/- 13.7 vs 54.9 +/- 4.0 mm Hg, respectively). Eyelid aperture consistently increased in a dose-dependent manner for both anesthetics. CONCLUSIONS: Arterial blood pressure, PaCO2, and eyelid aperture consistently and predictably changed in rabbits in response to changes in anesthetic doses. The magnitude of respiratory depression was greater for ISO than for HAL.

Anesthesia, Inhalation↗
PubMedDate not supplied

Anesthesia for laryngeal laser surgery in the infant and child.

Currently available anesthetic techniques for laryngoscopy and bronchoscopy are briefly evaluated. Recently reported complications from the literature are reviewed. Satisfactory anesthetic techniques are shown to be limited by the physical dimensions of the instruments as well as the extreme limitations of the flow capacity of the small airway itself. The technique used at the Hospital for Sick Children for the past ten years is described. It is based upon spontaneous respiration with inhalation anesthesia, supplemented by topical lidocaine (Xylocaine). Size and age of the patient are not limiting factors. The safety and effectiveness of this technique are supported by representative blood gas studies as well as the clinical records of over 400 cases.

Adolescent↗
PubMed1997

[Postoperative nausea and vomiting after gynecologic abdominal surgery--a comparison of propofol versus inhalational technique].

Propofol has been reported to reduce emesis. This study was performed to evaluate the incidence of postoperative nausea and vomiting (PONV) in gynecologic abdominal surgery patients after propofol anesthesia and inhalational anesthesia. Sixty patients were evaluated for the incidence of PONV. Thirty patients received oxygen-propofol-epidural anesthesia (propofol group) and the others were maintained with nitrous oxide-oxygen-isoflurane/sevoflurane--epidural anesthesia (inhalational group). The incidence of PONV was 33.3% in propofol group and 60% in inhalational group (P < 0.05). The means of frequency of postoperative nausea were 0.63 and 1.97 in propofol-group and inhalational group, respectively (P < 0.05). Those of postoperative vomiting were 0.17 after propofol and 1.00 following inhalational anesthesia (P < 0.01). For the gynecologic abdominal surgery patients, PONV was significantly less following intravenous anesthesia with propofol than after isoflurane or sevoflurane inhalational anesthesia. This study indicated that propofol anesthesia was useful in reducing PONV after gynecologic abdominal surgery.

Anesthesia, Epidural↗
PubMed1994

Epidural lidocaine delays arousal from isoflurane anesthesia.

To clarify the effect of epidural lidocaine on arousal from inhaled anesthesia, we investigated the minimum alveolar anesthetic concentration at awakening (MAC-Awake) of isoflurane and the duration between discontinuance of isoflurane inhalation and arousal from anesthesia in 60 female abdominal hysterectomy patients. All patients received epidural catheterization and were randomly assigned to one of five groups. The control group, A, was given normal saline intravenously (IV) and epidurally. Group B was given 1 mg/kg of 2% lidocaine IV as a bolus. Groups C and D were given 0.5 and 1 mg/kg, respectively, of 2% lidocaine IV for 5 min, followed by 30 micrograms.kg-1.min-1. Group E was given 3 mg/kg of 1.5% lidocaine epidurally as a bolus. These doses of lidocaine or control saline were administered 15 min before the end of the surgical procedure. MAC-Awake values in Groups A, B, C, D, and E were 0.30% +/- 0.05%, 0.28% +/- 0.04%, 0.29% +/- 0.04%, 0.31% +/- 0.04%, and 0.18% +/- 0.05% (mean +/- SD), respectively. MAC-Awake in Group E was lower than in the other groups (P < 0.001). The duration until arousal in Group E (21.0 +/- 2.0 min) was longer than in Groups A, B, C, and D (12.6 +/- 1.8 min, 12 +/- 2.3 min, 13.3 +/- 2.5 min, and 14.3 +/- 2.7 min, respectively) (P < 0.001). Plasma lidocaine levels in Groups B, C, D, and E were 0.95 +/- 0.17 microgram/mL, 1.07 +/- 0.16 microgram/mL, 2.09 +/- 0.31 micrograms/mL, and 1.02 +/- 0.16 micrograms/mL, respectively. We conclude that analgesia produced by epidural lidocaine delays arousal from isoflurane anesthesia. Furthermore, lidocaine plasma levels are shown to be too low to cause any sedative effect, thus suggesting that postoperative pain may cause significantly faster arousal from anesthesia.

Adult↗
PubMed1991

Use of desflurane for outpatient anesthesia. A comparison with propofol and nitrous oxide.

Desflurane's induction and recovery characteristics were compared to those of propofol-nitrous oxide in outpatients undergoing laparoscopic procedures. Ninety-two healthy patients were randomized to receive either: 1) propofol induction and propofol-nitrous oxide maintenance (control), 2) propofol induction and desflurane-nitrous oxide maintenance, 3) desflurane-nitrous oxide, or 4) desflurane alone for induction and maintenance of anesthesia. Inhalation induction with desflurane-nitrous oxide was faster than with desflurane alone (100 +/- 35 vs. 124 +/- 43 s). Inhalation inductions were associated with a high incidence of apnea (17 and 26%), breath-holding (26 and 39%), and coughing (30 and 22%) in groups 3 and 4, respectively. The emergence time after discontinuation of desflurane in oxygen (4.5 +/- 2.1 min.) was significantly less than that after propofol-nitrous oxide (7.3 +/- 3.9 min.). However, times from arrival in the recovery room until the patients were judged fit for discharge were similar for all four treatment groups. Digit-symbol substitution test results and sedation visual analogue scores also were similar during the first 2 h in the recovery room. A lower incidence of moderate-to-severe nausea was reported in group 1 (15% vs. 52, 52, and 59% in groups 2, 3, and 4, respectively). In conclusion, induction of anesthesia with desflurane was rapid but is associated with a high incidence of airway irritation. Emergence and recovery profiles after maintenance of anesthesia with desflurane compared favorably to a propofol-nitrous oxide combination. However, propofol was associated with a lower incidence of nausea than was desflurane after outpatient anesthesia for laparoscopic surgery.

Adult↗
PubMed1994

Systemic opioids do not suppress spinal sensitization after subcutaneous formalin in rats.

BACKGROUND: Preemptive treatment with a combination of inhalation anesthesia plus intrathecal morphine has been shown to inhibit development of hyperalgesia that follows subcutaneous (SC) formalin injection in rats. Using a similar paradigm, this study sought to determine whether moderate doses of opioids, administered systemically, could inhibit development of a hyperalgesic state. METHODS: Flinches per minute were observed 1 and 5 min after formalin injection (phase 1) and at 5-min intervals for the remainder of 1 h (phase 2) for five groups of rats. All animals received isoflurane 1% during and for 6 min after formalin injection. Groups 1 and 2 received SC alfentanil 200 micrograms/kg or normal saline, respectively, before formalin and 0.5 mg/kg naloxone SC 6 min after formalin. Groups 3 and 4 received SC morphine 20 mg/kg or SC normal saline, respectively, before formalin and SC naloxone 0.5 mg/kg plus naltrexone 0.5 mg/kg after formalin. Group 5 received normal saline at both injection times. RESULTS: Phase 2 activity was nearly identical for the three control groups. Total phase 2 activity for group 1 (alfentanil) was 16% less than control (not significant, P > 0.05). Total phase 2 activity for group 3 (morphine) was almost identical to control. CONCLUSIONS: Administration of 1% isoflurane plus systemic opioids, administered in doses that produce profound analgesia in standard analgesic testing paradigms, do not produce the significant suppression of subsequent hyperalgesia that has been reported with inhalation anesthesia plus intrathecal opioids.

Alfentanil↗
PubMed1999

A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers.

BACKGROUND: Recently, two centers have independently developed a risk score for predicting postoperative nausea and vomiting (PONV). This study investigated (1) whether risk scores are valid across centers and (2) whether risk scores based on logistic regression coefficients can be simplified without loss of discriminating power. METHODS: Adult patients from two centers (Oulu, Finland: n = 520, and Wuerzburg, Germany: n = 2202) received inhalational anesthesia (without antiemetic prophylaxis) for various types of surgery. PONV was defined as nausea or vomiting within 24 h of surgery. Risk scores to estimate the probability of PONV were obtained by fitting logistic regression models. Simplified risk scores were constructed based on the number of risk factors that were found significant in the logistic regression analyses. Original and simplified scores were cross-validated. A combined data set was created to estimate a potential center effect and to construct a final risk score. The discriminating power of each score was assessed using the area under the receiver operating characteristic curves. RESULTS: Risk scores derived from one center were able to predict PONV from the other center (area under the curve = 0.65-0.75). Simplification did not essentially weaken the discriminating power (area under the curve = 0.63-0.73). No center effect could be detected in a combined data set (odds ratio = 1.06, 95% confidence interval = 0.71-1.59). The final score consisted of four predictors: female gender, history of motion sickness (MS) or PONV, nonsmoking, and the use of postoperative opioids. If none, one, two, three, or four of these risk factors were present, the incidences of PONV were 10%, 21%, 39%, 61% and 79%. CONCLUSIONS: The risk scores derived from one center proved valid in the other and could be simplified without significant loss of discriminating power. Therefore, it appears that this risk score has broad applicability in predicting PONV in adult patients undergoing inhalational anesthesia for various types of surgery. For patients with at least two out of these four identified predictors a prophylactic antiemetic strategy should be considered.

Adult↗