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Results for “Balanced Anesthesia”

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At least 559 records · Page 31Linked to original sources
PubMed1991

[Water-electrolyte balance in patients during operation on the aorto-femoral segment using various types of anesthesia].

The indices of aqueous-electrolyte metabolism in patients, who underwent the reconstructive operations on the aorta, were studied. In patients with concomitant diabetes mellitus, a method of choice for anesthesia is an epidural anesthesia, with ischemic heart disease--combined epidural anesthesia. The most severe changes in electrolyte metabolism were noted after restoration of blood flow in blood loss of more than 10 ml/kg, under conditions of epidural anesthesia these shifts are less pronounced.

Aged↗
PubMed1992

Physiology, pathophysiology and pharmacology of the coronary circulation with particular emphasis on anesthetics.

The normal control of coronary blood flow is through alterations in the resistance of the intramyocardial arterioles (R2). Myocardial cellular hypoxia causes increased breakdown of ATP (or decreases synthesis) resulting in increased concentrations of the purine metabolite, adenosine. This potent endogenous, vascular smooth muscle relaxant vasodilates the R2 arterioles increasing coronary blood flow and myocardial O2 delivery. This mechanism autoregulates coronary blood flow according to myocardial O2 needs. Myocardial hypertrophy (from chronic hypertension) or coronary atherosclerosis interfere with this process and result in myocardial ischemia which may cause symptoms (angina), signs (ECG changes, regional muscle dysfunction) or tissue death (myocardial infarction). In addition, coronary atheroma disrupt endothelial function in the large R1 coronary arteries predisposing to vasoconstriction, platelet aggregation and thrombosis. Therapeutic measures for controlling ischemia may include decreasing oxygen demand (especially heart rate) and maintaining supply (R1 vasodilators and anti-thrombotic drugs such as non-steroidal anti-inflammatories). Intravenous, most inhalational and regional anesthesia appear to interfere minimally in the control of both the normal and ischemic coronary circulation. Thus optimizing myocardial oxygen balance (maintaining supply and decreasing demand) during anesthesia protects the ischemic myocardium. High doses of isoflurane, sevoflurane or desflurane are potent R2 coronary vasodilators which may cause redistribution of collateral blood flow away from ischemic regions (coronary steal). However, if tachycardia and hypotension are avoided, such an effect has not been shown experimentally or clinically. Preliminary evidence suggests that halothane may preferentially dilate R1 arteries and/or interfere with platelet aggregation. If these effects are confirmed, then halothane may prove to be the anesthetic of choice in the non-failing ischemic heart.

Anesthetics↗
PubMed2001

Goal oriented general anesthesia for Cesarean section in a parturient with a large intracranial epidermoid cyst.

PURPOSE: To illustrate the anesthetic management of a term parturient with a large brain tumour scheduled for Cesarean section. CLINICAL FEATURES: A 26-yr-old woman presented at 33 weeks gestation with a generalized grand mal seizure. Magnetic resonance imaging demonstrated a 5-cm multi-lobulated extra axial mass compatible with an epidermoid cyst, arising from the left temporal lobe associated with shift of the midline structures and compression of the brainstem. She remained stable neurologically until elective Cesarean section at 38 weeks. Immediately prior to induction of general anesthesia, the proposed incision site was infiltrated with lidocaine and the supraglottic structures anesthetized with bilateral superior laryngeal nerve blocks. Remifentanil, thiopentone sodium and succinylcholine were administered in a rapid sequence fashion following voluntary hyperventilation to an endtidal CO2 of 28 mmHg. Anesthesia was maintained with desflurane in oxygen/air and an infusion of remifentanil. Postoperative pain control was achieved using a multi-modal approach which included intraperitoneal deposition of local anesthetic, im ketorolac and rectal acetaminophen prior to emergence followed by regular administration of naproxen and acetaminophen for 72 hr. CONCLUSION: In a parturient with a large intracranial tumour, general anesthesia combined with multi-modal balanced analgesia met the predefined anesthetic management goals and was associated with a favourable outcome.

Adult↗
PubMed1993

[Mean body temperature during anesthesia in children with burns--its information value and use].

In forty-four children with total body surface amounting to 0.4-0.6 sq. m., and burnt surface ranging from 6 to 60 per cent, measurements of the mean body temperature are done during anesthesia with halothane, methoxyflurane and ketamine. Group one is made of 14 children anesthesized with halothane, nitrous oxide and oxygen in conditions of controlled ventilation; group two--16 children anesthesized with methoxyflurane, nitrous oxide and oxygen under controlled ventilation, and group three--14 children subjected to intravenous ketamine anesthesia with spontaneous respiration. Rectal and skin temperatures are registered at 15-minute intervals in the course of two-hour-long anesthesia. The mean body temperatures are calculated. The study results point to a significant temperature reduction on the first and second hour, and after extubation, but there are no differences between the individual groups. The mean body temperature has low informative value, and is mainly applied in thermal balance assessment.

Anesthesia↗
PubMed1981

Computer-calculated pulmonary carbon dioxide and oxygen exchange in human subjects during general anesthesia with mechanical ventilation.

Computer calculation of minute-by-minute and breath-by-breath values for carbon dioxide excretion (VCO2) and oxygen consumption (VO2) in human subjects during general anesthesia and mechanical ventilation were obtained with position changes and after drug administration to demonstrate a method for monitoring pulmonary gas exchange. A modified response to the intravenous injection of doxapram hydrochloride was observed in 12 patients with pancuronium bromide neuromuscular relaxation when they were compared with 12 patients who had been tubocurarine. The data included representative values for VCO2 and VO2 measured simultaneously in normal women after 1-2 h of balanced nitrous oxide-oxygen-fentanyl anesthesia with muscular relaxation and mechanical ventilation.

Adolescent↗
PubMedDate not supplied

[Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis].

BACKGROUND: The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. METHODS: 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. RESULTS: Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). CONCLUSION: At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.

Adult↗
PubMedDate not supplied

Analysis of heart rate dynamics as a measure of autonomic tone in obstetrical patients undergoing epidural or spinal anesthesia.

BACKGROUND AND OBJECTIVES: The purpose of this study is to determine if spectral analysis of beat-to-beat heart rate variability will provide important data on autonomic nervous system function during either spinal or epidural anesthesia that is not apparent from the monitoring of mean heart rate and blood pressure. METHODS: Twelve ASA I patients presenting for elective cesarean delivery (7 epidural and 5 spinal anesthetics) were prospectively selected for study. Control and postblock 10-minute segments of instantaneous heart rates were analyzed for each patient. The total spectral power (Ps, 0.02-0.5 Hz), low frequency spectral power (PLF, 0.02-0.12 Hz), and high frequency spectral power (PHF, 0.12-0.5 Hz) were calculated for each data segment. The complexity of the heart rate time series was estimated by calculating the approximate entropy. RESULTS: Neither spinal or epidural anesthesia had any effect on heart rate or blood pressure. Both spinal and epidural anesthesia did produce a significant decrease in PS, PLF, and PHF. Although there were significant decreases in both the PLF and PHF, there was no change in the PLF/PHF ratio. There was a significant reduction in approximate entropy with spinal and epidural anesthesia, indicating a decrease in complexity of the heart rate dynamics. CONCLUSIONS: These data suggest that autonomic tone decreased with spinal and epidural anesthesia but the sympathetic-parasympathetic balance (expressed as PLF/PHF) did not change. Spectral measures, as well as approximate entropy, provide an independent evaluation of the integrity of the autonomic nervous system and cardiovascular control mechanisms that cannot be discerned from mean heart rate and blood pressure.

Adult↗
PubMed1996

Adenosine does not mediate renal sodium retention and peripheral vasodilation elicited by partial portal vein ligation in rats.

This study was conducted to assess the role of adenosine in the peripheral vasodilation and sodium retention that occurs after partial portal vein ligation (PVL) in the rat. The experiment was performed on day 1 after surgery when transient maximal sodium retention developed and day 7 when rats returned to sodium balance. Hemodynamic studies were conducted under anesthesia in portal hypertensive rats with sodium retention and in sham-operated controls. Measurements were obtained before and after administration of a nonselective A1 and A2 adenosine receptor antagonist 1,3-dipropyl-8-p-sulfophenylxanthine (DPSPX) (10 mg/kg intravenously followed by 150 micrograms/min). Under baseline conditions, portal hypertensive rats with sodium retention were hypotensive, with decreases in total peripheral resistance and filtration fraction on day 1 in comparison with the control group. Although hyperdynamic circulation was still maintained by day 7, there was a return to sodium balance. The adenosine receptor antagonist had a modest vasoconstrictor effect on systemic and renal vasculature in both groups, but less in portal hypertensive rats. However, no change in glomerular filtration rate was observed. DPSPX induced a natriuresis in control rats (from 0.40 +/- 0.11 to 5.97 +/- 0.61 mEq/min on day 1, from 0.48 +/- 0.20 to 6.34 +/- 0.45 mEq/min on day 7). This response was attenuated in portal hypertensive rats on day 1 (from 0.14 +/- 0.04 to 1.67 +/- 0.57 mEq/min). but not on day 7 (from 0.20 +/- 0.06 to 5.11 +/- 0.55 mEq/min). These results suggest that in portal hypertensive rats (1) adenosine is not responsible for vasodilation and sodium retention, (2) a sodium-retaining factor acting directly on the renal tubule is responsible for sodium retention.

Adenosine↗
PubMed1997

Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination.

BACKGROUND: It is widely presumed that the development of postoperative hyponatremia (which may be severe) results from administration of hypotonic fluids while antidiuretic hormone is acting. OBJECTIVE: To show that hyponatremia would occur in patients 24 hours after surgery if only near-isotonic solutions are given and to evaluate the mechanisms responsible for hyponatremia in this setting. DESIGN: Prospective cohort study. SETTING: University medical center. PATIENTS: 22 women who were having uncomplicated gynecologic surgery with infusion of near-isotonic solutions only (sodium chloride, 154 mmol/L, or Ringer lactate [sodium, 130 mmol/L, and potassium, 4 mmol/L]). MEASUREMENTS: Plasma electrolyte levels were measured at the time of induction of anesthesia and 24 hours later. Data on the balance of water and electrolytes were obtained for the same 24-hours period. RESULTS: At the time of induction of anesthesia, the plasma sodium concentration was 140 +/- 1 mmol/L; 24 hours later, it decreased in 21 of 22 patients (mean decrease, 4.2 +/- 0.4 mmol/L [P < 0.001]; lowest level, 131 mmol/L in 2 patients). The urine remained hypertonic (peak sodium plus potassium concentration in urine, 294 +/- 9 mmol/L) in all patients for the first 16 hours after induction of anesthesia. CONCLUSIONS: Postoperative hyponatremia occurred within 24 hours of induction of anesthesia when only near-isotonic fluids were infused. Hyponatremia was generally caused by generation of electrolyte-free water during excretion of hypertonic urine-a desalination process. This electrolyte-free water was retained in the body because of the actions of antidiuretic hormone. If the pathophysiology of this hyponatremic state is understood, recommendations for its prevention and treatment can be deduced.

Adult↗
PubMed2004

Reduced plantar sensitivity alters postural responses to lateral perturbations of balance.

There is considerable evidence that lower-limb somatosensation contributes to the control of upright balance. In this study, we investigated the specific role of foot sole cutaneous afferents in the generation of balance corrections following lateral accelerations of the support surface. Participants were subjected to balance perturbations before and after targeted anesthesia of the cutaneous soles induced by intradermal injections of local anesthetic. Subject responses were quantified in terms of net joint torques at the ankles, hips and trunk. Contrary to the conclusions drawn in earlier studies, response torque impulses at the ankles and hips were clearly scaled with the perturbation impulse under both control and anesthetized conditions. Reduced plantar sensitivity produced a relative shift in compensatory torque production from the ankles and trunk to the hips. These findings demonstrate that plantar cutaneous afferents play an important role in the shaping of dynamic postural responses. Furthermore, the results suggest that loss of plantar sensation may be an important contributor to the dynamic balance deficits and increased risk of falls associated with peripheral neuropathies.

Adult↗
PubMed2005

Spectral entropy monitoring is associated with reduced propofol use and faster emergence in propofol-nitrous oxide-alfentanil anesthesia.

BACKGROUND: This multicenter study evaluated the effect of a new depth of anesthesia-monitoring device based on time-frequency-balanced spectral entropy of electroencephalogram monitoring (GE Healthcare Finland, Helsinki, Finland) on consumption of anesthetic drugs and recovery times after anesthesia. METHODS: The study was a prospective, randomized, single-blind study performed in six hospitals in Finland, Sweden, and Norway. After institutional review board approval and written informed consent from each patient, the patients were randomly allocated to anesthesia with entropy values either shown (entropy group) or not shown (control group). Anesthesia was maintained with propofol, nitrous oxide, and alfentanil. In the entropy group, propofol was given to keep the state entropy value between 45 and 65, and alfentanil was given to keep the state entropy-response entropy difference below 10 units and heart rate and blood pressure within +/-20% of the baseline values. The control group patients were anesthetized to keep heart rate and blood pressure within +/-20% of the baseline values. Statistical methods included Mann-Whitney U test and unpaired t tests. RESULTS: A total of 368 patients were studied. In the entropy group, entropy values were higher during the whole operation and especially during the last 15 min (P < 0.001). Consequently, propofol consumption was smaller in the entropy group during the whole anesthesia period (P < 0.001) and especially during the last 15 min (P < 0.001). This shortened the time delay in the early recovery parameters in the entropy group. CONCLUSION: Entropy monitoring assisted titration of propofol, especially during the last part of the procedures, as indicated by higher entropy values, decreased consumption of propofol, and shorter recovery times in the entropy group.

Adult↗
PubMed1992

Effects of fentanyl-diazepam-pancuronium anesthesia on heart rate variability: a spectral analysis.

The effects of induction of anesthesia with fentanyl, 62.1 +/- 7.9 micrograms/kg, diazepam, 0.21 +/- 0.08 mg/kg, and pancuronium on beat-to-beat heart rate variations were studied in seven patients undergoing cardiac surgery. Spectral analysis was used to determine the intensity of the variations in each of the two main frequency bands in which variations are known to occur: (1) high-frequency band, mediated by the parasympathetic nervous system, at the frequency band of respiration, and (2) the low-frequency band, mediated by both sympathetic and parasympathetic nervous systems, at 0.04-0.12 Hz. Both the mean low- and high-frequency band areas were significantly decreased after induction of anesthesia. The ratio of high-to-low frequency band areas increased significantly after induction of anesthesia, from 45% to 62% (P less than 0.05). These results suggest that fentanyl-diazepam-pancuronium anesthesia decreases total autonomic nervous system activity and alters the balance between parasympathetic and sympathetic activities. Thus, spectral analysis of heart rate variations during anesthesia may provide a quantitative measure of assessing the activity of the autonomic nervous system.

Adult↗
PubMedDate not supplied

Anesthesia for intraocular surgery.

Surgeons must decide on the type of anesthesia to use when performing cataract surgery. These "viewpoints" articles provide a well-balanced discussion offering the pros and cons of both topical anesthesia and retrobulbar/peribulbar injection. Dr. Dutton gives an overview of both techniques, focusing on relevant orbital anatomy. Drs. Hassan, Edelhauser and Kim, review the various types of topical anesthesia currently in use, and Drs. Spriggs and Broocker examine retrobulbar and peribulbar injections. Both techniques are associated with advantages and risks, so each surgeon must decide which technique is best suited for his or her own practice.

Anesthesia, Local↗
PubMed1999

A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine.

OBJECTIVE: To determine whether intraocular lidocaine increases patient comfort during cataract surgery while under topical anesthesia. DESIGN: Prospective, randomized, double-masked, placebo-controlled clinical trial. PARTICIPANTS: Both men and women between 45 and 85 years of age who were scheduled for elective cataract surgery while under topical anesthesia participated. Sixty-eight patients were randomized to each group. INTERVENTION: Patients were randomized to receive either topical anesthesia plus intracameral 1% preservative-free lidocaine or intracameral balanced salt solution. MAIN OUTCOME MEASURES: Patient assessment of pain during delivery of the anesthesia, surgery, and after surgery using a visual analog pain scale was measured. Patients also recorded the degree to which they were bothered by tissue manipulation and the microscope light. Surgeon assessments of operative conditions, patient cooperation, and intraoperative complications were recorded. The attending anesthesiologist recorded any required supplemental intravenous sedation and any increase in pulse or increase in blood pressure. RESULTS: There was no significant difference in patient-reported pain scores for delivery of anesthesia (P = 0.902), surgery (P = 0.170), or after surgery (P = 0.680). Patients in the lidocaine group reported being less bothered by tissue manipulation (P = 0.021). The surgeon assessment showed more patient cooperation in the lidocaine group (P = 0.043). CONCLUSIONS: Both topical anesthesia alone and topical anesthesia plus intracameral lidocaine provide good operative conditions for the surgeon and comfortable surgical circumstances for the patient. Injection of intraocular lidocaine increases patient cooperation and decreases the degree to which patients are bothered by tissue manipulation, two outcomes that justify its use.

Administration, Topical↗
PubMed1981

Myocardial oxygen extraction rate under general anesthesia.

Myocardial oxygen extraction rates (R) were measured in dogs anesthetized with eight kinds of anesthetic agents to study the balance between myocardial oxygen consumption and its supply under general anesthesia. The R value for basal anesthesia (pentobarbital), original neuroleptanesthesia (Thalamonal), modified neuroleptanesthesia (droperidol and pentazocine), morphine anesthesia or halothane anesthesia was not significantly different from each other, and similar to those for conscious dogs reported by Merin or Spencer. On the other hand, the R values for ether anesthesia, methoxyflurane anesthesia and enflurane anesthesia were significantly lower than those for the above mentioned anesthesia.

Anesthesia, General↗