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Results for “Balanced Anesthesia”

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At least 595 records · Page 33Linked to original sources

PubMed2006

The decrease in erythrocyte sedimentation rate related to general anesthesia.

The aim of this study was to investigate whether general anesthetic agents change erythrocyte sedimentation rate (ESR) affecting erythrocytes' shape and membrane structure in routine clinical dose manner. Forty patients (23 female and 17 male) undergoing elective surgery were included to the study. Blood samples were obtained just before induction of the anesthesia and 10 minutes after endotracheal intubation. The ESR was measured using Test-1 ESR analyzer. ESR values of the second blood samples were significantly lower than the first values (p<0.001). At the beginning, the ESR was 18.1+/-11.5 mm/h, and then it decreased to 13.1+/-9.3 at 10th minutes. Our results indicated that anesthetic agents affected the ESR. No increase was observed in the second ESR values which were equal to, or less than the first values. General anesthesia may lead to this decrease changing electrolyte balance of erythrocyte, affecting ligands of agglomerins in membrane directly and indirectly, or changing discoid shape of erythrocyte.

Adult↗

PubMedDate not supplied

Postoperative myocardial ischemia: epidural versus intravenous patient-controlled analgesia. A pilot project.

BACKGROUND AND OBJECTIVES: Continuous postoperative epidural analgesia with bupivacaine (BUP) and morphine (MS) may be associated with a decreased incidence of postoperative myocardial ischemia (ISCH) and infarction (MI). This study evaluated the incidence of ISCH and MI in patients with two or more risk factors for coronary artery disease (CAD) who were admitted to the ICU after upper abdominal surgery for cancer. METHODS: During a 1-year period, 198 patients were studied for the incidence of ISCH and MI in a prospective, nonrandomized fashion. The epidural group (EPI, n = 110) received continuous epidural anesthesia by injection at the T7-9 interspaces with 0.5% BUP/0.013% MS and light general anesthesia followed by 0.1% BUP/0.01% MS epidural analgesia for 5-7 days. The general anesthesia group (GEN, n = 88) received a balanced technique followed by intravenous patient-controlled analgesia with 0.1% MS for 5-7 days. All patients had preoperative and postoperative 12 lead ECGs every 6 hours on the first 3 postoperative days. Patients with ECG changes consistent with myocardial ischemia had creatine kinase levels with isoenzymes drawn every 8 hours. RESULTS: There were no differences in age, sex, number of cardiac risk factors, number taking anti-anginal medication, preoperative heart rate (75 +/- 5 [EPI] vs. 73 +/- 4 [GEN]), and incidence of preoperative or intraoperative ischemia between the two groups. All patients had adequate analgesia. Postoperatively, patients in the EPI group had a lower incidence of tachycardia (15 [14%] vs. 58 [65%], P < .00001), ischemia (5 [5%] vs. 15 [17%], P < .004), and infarction (0 vs. 3 [20% of patients with ischemia]). All episodes of ischemia were silent and occurred more frequently during the first 36 hours postoperatively (14 episodes or 72%). Overall 60% of the ISCH episodes were associated with tachycardia (5/5 in the EPI group and 7/15 in the GEN group). There were no deaths in either group. CONCLUSIONS: These preliminary results suggest that epidural anesthesia and analgesia may decrease the incidence of postoperative tachycardia, ischemia, and possibly infarction in patients undergoing upper abdominal procedures.

Abdomen↗

PubMed1992

Anesthesia for patients with dehydration/hypovolemia.

Anesthetic drugs normally depress cardiovascular function and in a patient that is already dehydrated and hypovolemic can cause severe hypotension. Reestablishing intravascular volume with a balanced salt solution can return cardiovascular function to normal, and anesthesia must not be induced until the animal has been stabilized.

Anesthesia↗

PubMed1997

Effects of inhaled nonimmobilizer, proconvulsant compounds on desflurane minimum alveolar anesthetic concentration in rats.

UNLABELLED: Anesthetics depress the central nervous system, whereas nonimmobilizers (previously called nonanesthetics) and transitional compounds having the same physical properties (e.g., solubility in lipid) do not produce anesthesia (nonimmobilizers) or are less potent anesthetics than might be predicted from their lipophilicity (transitional compounds). Potential explanations for the absent or decreased anesthetic effect of nonimmobilizer and transitional compounds include the theories that the nonimmobilizers are devoid of anesthetic effect and that transitional compounds have a decreased capacity to produce anesthesia; that the effects of these compounds are not apparent because the concentrations examined are too low; or that anesthesia, or lack thereof, results from a balance between depression and excitation (all nonimmobilizer and transitional compounds produce convulsions). To examine these issues further, we tested the effect of various multiples of the convulsive 50% effective dose (ED50) of three nonimmobilizers and one transitional compound on the minimum alveolar anesthetic concentration (MAC) of desflurane in rats. The nonimmobilizer 2,3-dichlorooctafluorobutane (NI-1), from 0.7 to 1.1 times its convulsive ED50, increased the MAC of desflurane by 14%-27%, but at 1.6 times its convulsive ED50 caused no change in MAC; the nonimmobilizer 1,2-dichlorohexafluorocyclobutane (NI-2) did not change MAC at concentrations up to its convulsant ED50, but it increased MAC by 25% and 36% at 1.3 and 1.7 times its convulsant ED50, respectively. The nonimmobilizer flurothyl (NI-3) decreased the MAC of desflurane by 20% +/- 6% (mean +/- SD) at 0.5 times its convulsant ED50, but it caused no change at higher partial pressures (up to 7.8 times its convulsant ED50), and the transitional compound CF3CCl2-O-CF2Cl (T-1) significantly decreased MAC by 16% +/- 7% at 0.8 times its convulsant ED50, but the 6%-8% decreases in MAC at 0.4 and 1.6 times its convulsant ED50 were not significant. Thus, neither nonimmobilizer nor transitional compounds produced a consistent dose-related effect on the MAC of desflurane, and any changes were small. These results suggest that the excitation produced by transitional compounds or nonimmobilizers does not explain their limited ability or inability to produce anesthesia. The data are consistent with a decreased anesthetic efficacy of transitional compounds and the lack of efficacy of nonimmobilizers. IMPLICATIONS: Inhaled compounds that do not cause anesthesia (nonimmobilizers) are used to test theories of anesthetic action. Their use presumes that a trivial explanation, such as cancelling stimulatory and depressant effects, does not explain the absence of anesthesia. The present results argue against such an explanation.

Anesthetics↗

PubMedDate not supplied

The public's fears about and perceptions of regional anesthesia.

BACKGROUND AND OBJECTIVES: The public is not well informed about matters relating to regional anesthesia. Previous studies concerning regional anesthesia have involved patients, surgeons, and anesthesiologists. This study is the first in-depth survey of the attitudes of the general public toward a number of commonly perceived fears about regional anesthesia. METHODS: A province-wide telephone survey was conducted in Alberta, Canada. The sample surveyed was representative of the adult population of the province and included an equal balance of urban and rural participants. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents were then questioned so their attitudes toward commonly perceived fears associated with regional anesthesia could be assessed. RESULTS: A total of 1,216 people were surveyed. A preference for regional or general anesthesia was not expressed in this scenario. Approximately 27% of respondents were very concerned about permanent paralysis, back injury, perioperative pain, seeing the surgical procedure, and the prospect of a needle in the back. Only 6% of individuals were concerned about headaches. CONCLUSIONS: The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia.

Adult↗

PubMedDate not supplied

Endocrine-metabolic response to abdominal aortic surgery: a randomized trial of general anesthesia versus general plus epidural anesthesia.

The influence of epidural anesthesia on the endocrine-metabolic response following abdominal aortic reconstruction was studied in a prospective randomized trial. Cortisol and catecholamine responses and nitrogen balance were measured in two groups of five patients receiving general anesthesia only (group 1) or general anesthesia combined with epidural bupivacaine (group 2). The study lasted from preoperatively until the first postoperative day. At 2100 hours on the day of surgery serum cortisol concentrations were higher in group 1 than in group 2 (1.41 versus 0.82 mumol/L; p < 0.01). Likewise the total perioperative hypercortisolemia, expressed as the area under the curve, was significantly higher in group 1 (11.7 versus 5.7 mumol/L/hr, p < 0.01). Intraoperative urinary excretion of epinephrine and postoperative norepinephrine excretion were significantly higher in group 1 than in group 2. Urinary excretion of free cortisol and cumulative nitrogen balance were not different between the groups. Although the number of patients was limited and the sensory nerve block level was not measured perioperatively, this study suggests that epidural anesthesia attenuates the stress response to aortic surgery.

Aged↗

PubMed2001

Transition between anesthesia and post-operative analgesia: relevance of intra-operative administration of analgesics.

The rapid awakening without residual analgesic effect seen with the new "fast-in-fast-out" anesthetic agents forces us to anticipate post-operative pain management. More then ever, "balanced analgesia" appears the key for successful transition between anesthesia and post-operative analgesia. This review focuses on practical aspects seeking to answer the following questions: which analgesics should be used?; how should they be given?; at what stage of the anesthetic time should they be injected? In the absence of a loco-regional technique, analgesics must be given before the end of surgery to obtain a quiet awakening. The transition in this delicate period may be facilitated by the intra-operative use of various adjuvant therapies such as ketamine, lidocaine infusion, clonidine, and magnesium, that reduce the needs for opioid and/or post-operative pain severity. All non-opioid analgesics (propacetamol, NSAIDs, tramadol) must be given according to their pharmacokinetic characteristics, indications and contraindications to ensure the required analgesic effect is effective at the time of awakening. If tramadol is not used, an initial dose of a long-acting opioid should be given 20-30 minutes before the end of surgery. Insufficient analgesia must be corrected by titrating an opioid intravenously before allowing the patient to control his/her analgesia using a PCA pump.

Analgesics↗

PubMedDate not supplied

[Total intravenous anesthesia with ketamine and the condition of the higher psychic function in the early and remote postoperative periods].

Influence of total intravenous anesthesia with ketamine on the higher psychic function was studied, immediately after surgery and in the remote postoperative period, in 143 patients with different typological properties of the nervous system after a scheduled surgery--supravaginal uterectomy in fibromyoma of the uterine body. The authors defined 6 groups of patients with different typological properties of the nervous system. Persistent impairment of the higher nervous functions were established, immediately after surgery and in the remote postoperative period, in patients with a weak nervous system, biased nervous balance towards excitation, and with lability of nervous processes. Total intravenous anesthesia with ketamine, when used in patients with the robust nervous system, biased nervous balance towards excitation, and with lability of nervous processes, caused changes in the higher nervous functions and an intensified level of nervous-and-psychic loads, which were unstable and were arrested by the 30th postoperative day. The use of such anesthetic scheme was found to be inadvisable in the above groups of patients. The described impairments were not registered when total intravenous anesthesia was used in patients with a balanced nervous system irrespective of its type, a biased nervous balance towards inhibition and with inertness of nervous processes. The above anesthetic management is acceptable for such patients.

Adult↗

PubMed2001

Free tissue transfer in pregnancy: guidelines for perioperative management.

A successful free tissue transfer of serratus anterior muscle, to provide coverage for an open ankle defect in a pregnant patient, is described. Microvascular surgery in the presence of a viable pregnancy demands considerations unique to this situation. Although rarely possible, an attempt should be made to plan surgery to coincide with the second trimester, to lessen the risk of anesthesia to the fetus. Maternal positioning, fluid balance, and aspiration precautions need to be critically addressed. Close perioperative monitoring by an obstetrician is essential. The condition of pregnancy results in a hypercoagulable state that may lead to an increased risk of anastomotic failure. The use of anticoagulants results in increased risk of bleeding, not only for the patient but also for the fetus, as well as risk of teratogenic effects. Closely monitored heparin is considered safe in pregnancy as is low-molecular-weight dextran and low-dose aspirin. Additional considerations include the use of narcotics and sedatives for comfort postoperatively, as well as antibiotic choices, if indicated.

Accidents, Traffic↗

PubMed1998

Bleomycin associated pulmonary toxicity: is perioperative oxygen restriction necessary?

PURPOSE: We delineate predictive factors of pulmonary morbidity in patients who receive combination chemotherapy with bleomycin and undergo surgical resection of residual disease, and establish updated guidelines for perioperative management. MATERIALS AND METHODS: A total of 77 patients with high volume stage II to IV nonseminomatous germ cell tumors underwent 97 major surgical procedures a mean of 6.4 months following high dose combination chemotherapy, including bleomycin (mean 437.5 units per 8.2 courses), between 1988 and 1995 at the University of Texas M. D. Anderson Cancer Center. The importance of preoperative pulmonary status, anesthesia time, fraction of inspired oxygen, fluid balance, bleomycin dose, number of acute toxicity episodes, oxygen saturation problems and pulmonary symptoms was examined. Cases were divided into groups according to whether there were postoperative oxygen saturation problems (19) or not (58). RESULTS: There were no significant differences in age, weight, bleomycin dose, number of acute toxicity episodes, cardiac ejection fraction or preoperative pulmonary symptoms between the 2 groups. Restrictive spirometry patterns were seen in 26 of 74 patients (35%), only 9 of whom had postoperative oxygen saturation problems. Mean induction fractional inspired oxygen was 87% (median 100%) for an average of 56 minutes. Intraoperative fractional inspired oxygen averaged 40% for a mean duration of 8.1 hours. Postoperative oxygen saturation problems, consisting of prolonged intubation, pulmonary edema, dyspnea, tachypnea or desaturation requiring diuresis, occurred in 19 patients (25%). Surgery/anesthesia time, amount of blood transfused, estimated blood loss, fluid balance, type of fluid given (all p < 0.0001) and preoperative forced vital capacity (p = 0.012) were significant predictors of postoperative oxygen saturation problems on univariate analysis. On multivariate analysis only the amount of blood transfused, preoperative forced vital capacity and surgical time in descending order remained significant. Maintained intraoperative fractional inspired oxygen was not significant on either analysis. There were no deaths. CONCLUSIONS: Perioperative oxygen restriction in patients treated with bleomycin is not necessary. Intravenous fluid management, including transfusion, appears to be the most significant factor affecting postoperative pulmonary morbidity and overall clinical outcome. In addition, post-chemotherapy forced vital capacity and operative time are significant predictive factors of procedure related pulmonary morbidity.

Adolescent↗

PubMed2003

[Effect of general and epidural anesthesia on autonomic nervous system].

OBJECTIVE: To evaluate autonomic nervous tone during general and epidural anesthesia. METHODS: Thirty-two female patients(ASA grade I-II), scheduled for elective hysterectomy, were randomized to receive epidural anesthesia (group EA, n = 16) or general anesthesia (group GA, n = 16). The changes of HRV were observed with power spectral analysis of heart rate variability (HRV-PSA) at the following time intervals: immediately pre-anesthesia (T1), 15 min after induction (T2), 1 min after incision (T3), dragging uterus (T4), after removing uterus (T5) and end of surgery (T6). RESULTS: Patients in group EA demonstrated a significant advance in LF/HF at T4 and descending in LF and HF at T5, T6 to compare with T1, LF, HF and LF/HF remained unchanged at the rest time intervals. In group GA, compared with T1, LF, HF and LF/HF dropped remarkably except for an increase in LF/HF at T6. CONCLUSION: The autonomic nervous tone is inhibited by both epidural and general anesthesia. EA reveals a shift in the sympathovagal balance toward sympathetic predominance. GA is associated with a shift toward parasympathetic predominance intraoperatively, while postoperatively appears a dramatic increase in LF/HF. Relative to EA, there is a greater effect on autonomic nervous system with GA.

Anesthesia, Epidural↗

PubMed2001

Optimization of intraperitoneal injection anesthesia in mice: drugs, dosages, adverse effects, and anesthesia depth.

PURPOSE: The goals of the study were to find a safe intraperitoneal injection anesthesia protocol for medium-duration surgery in mice (e.g., embryo transfer/vasectomy) coupled with a simple method to assess anesthesia depth under routine laboratory conditions. METHODS: Eight anesthetic protocols consisting of combinations of dissociative anesthetics (ketamine, tiletamine), alpha2-agonists (xylazine, medetomidine), and/or sedatives (acepromazine, azaperone, zolazepam) were compared for their safety and efficacy (death rate, surgical tolerance), using observations and reflex tests. The four best protocols were further evaluated during vasectomy: physiologic measurements (respiratory rate, electrocardiogram, arterial blood pressure, body temperature, blood gas tensions, and acid-base balance) were used to characterize the quality of anesthesia. The reactions of physiologic parameters to surgical stimuli were used to determine anesthesia depth, and were correlated with reflex test results. RESULTS: The protocol with the highest safety margin and the longest time of surgical tolerance (54 min) was ketamine/ xylazine/acepromazine. Three further anesthetic combinations were associated with surgical tolerance: ketamine/ xylazine, ketamine/xylazinelazaperone, and tiletamine/xylazine/zolazepam (Telazol/xylazine). The protocols consisting of ketamine/medetomidine and ketamine/azaperone were not associated with clearly detectable surgical tolerance. The most reliable parameter of surgical tolerance under routine laboratory conditions was the pedal withdrawal reflex. CONCLUSIONS: The best intraperitoneal injection anesthesia regimen consisted of ketamine/xylazine/acepromazine. The dose must be adapted to the particulars of each experimental design (mouse strain, sex, age, mutation). This is best done by measuring surgical tolerance, using the pedal withdrawal reflex.

Acepromazine↗

PubMed1981