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PubMed1982

Hepatic Injury following halothane, enflurane, and isoflurane anesthesia in rats.

Halothane anesthesia administered to enzyme-induced animals in a hypoxic atmosphere consistently produced hepatic necrosis. Rats pretreated with phenobarbital were exposed to hypoxia at varying intervals after administration of halothane, enflurane, or isoflurane anesthesia. Anesthetics were administered at 1 MAC for 2 h. For each agent, hypoxia consisting of 8 per cent oxygen-balance nitrogen for 1 h was imposed at the end of anesthesia. In other groups of rats, we also used a 15-, 30-, 60-, and 120-min interval of 100 per cent oxygen between 2 h of halothane anesthesia and the imposition of hypoxia. Controls included enzyme-induced animals with and without hypoxia, hypoxia alone, and cage controls. Hepatic injury was graded by histologic examination of the livers. Injury was greater when hypoxia followed halothane anesthesia than when it followed enflurane, isoflurane, or enzyme-induction alone. A difference in injury score existed between control animals and those anesthetized with halothane who received a 15-min interval of oxygen before hypoxia. Combined results from the 15- and 30-min delay groups also were different from control. There was no difference between control and halothane groups when the oxygen interval was 60 or 120 min. The injury score of the enflurane and isoflurane groups were comparable to that of controls. We conclude that the potential for hypoxia-induced liver injury during recovery exists after halothane anesthesia. Neither enflurane nor isoflurane anesthesia produced significant hepatic injury in this model.

Anesthetics↗
PubMed1998

Is cerebral control of plasma [Na] a major determinant for systemic sodium balance?

To evaluate the role of volume expansion for prandial/postprandial natriuresis, we first determined spontaneous daily NaCl, H2O, and diet turnover and Evans blue and inulin spaces in male Wistar rats on various high-salt diets. Second, we measured the time course of Na and water clearance in chloralose/ketamine anesthetized rats over 270 minutes after a single intragastric Na load (0, 290.4, or 581 micromol/100 g body weight). Finally, similar measurements were made during and after a local [NaCl] increase in the left carotid artery supplying the brain for 60 minutes. Daily NaCl, H2O, and diet intake per rat was 2 to 74 mmol, 13 to 223 ml, and 1.5 to 33 g, respectively. Only inulin space and plasma [Na] correlated with daily Na uptake (X; regressions Y = 0.02X + 15.13, N = 99, r2 = 0.0716, P = 0.02; and Y = 141.7 + 0.1005X, N = 179, r2 = 0.104, P < 0.0001, respectively). Under chloralose/ketamine anesthesia, 86% to 102% of the total (i.v. plus i.g.) Na load and some 50% of the unilaterally administered intracarotid Na were excreted. Chloralose/ketamine anesthesia is thus suitable for studies on Na balance mechanisms. Plasma [Na] is under cerebral control. Because of its immediate onset, this mechanism might be the principal determinant of prandial and postprandial natriuresis and hence for the systemic Na balance.

Animals↗
PubMed1999

Propofol anesthesia.

Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided cardiopulmonary and neurological evidence of the efficacy and safety of propofol when used as an anesthetic under normal and selected impaired conditions in the dog. 1. Propofol can be safely and effectively used for the induction and maintenance of anesthesia in normal healthy dogs. Propofol is also a reliable and safe anesthetic agent when used during induced cardiovascular and pulmonary-impaired conditions without surgery. The propofol requirements to induce the safe and prompt induction of anesthesia prior to inhalant anesthesia with and without surgery have been determined. 2. The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Also, propofol compatibility with a large variety of preanesthetics may increase its use as a safe and reliable i.v. anesthetic for the induction and maintenance of general anesthesia and sedation in small animal veterinary practice. Although propofol has proven to be a valuable adjuvant during short ambulatory procedures, its use for the maintenance of general anesthesia has been questioned for surgery lasting more than 1 hour because of increased cost and marginal differences in recovery times compared with those of standard inhalant or balanced anesthetic techniques. When propofol is used for the maintenance of anesthesia in combination with a sedative/analgesic, the quality of anesthesia is improved as well as the ease with which the practitioner can titrate propofol; therefore, practitioners are able to use i.v. anesthetic techniques more effectively in their clinical practices. 3. Propofol can induce significant depression of respiratory function, characterized by a reduction in the rate of respiration. Potent alpha 2 sedative/analgesics (e.g., xylazine, medetomidine) or opioids (e.g., oxymorphone, butorphanol) increase the probability of respiratory depression during anesthesia. Appropriate consideration of dose reduction and speed of administration of propofol reduces the degree of depression. Cardiovascular changes induced by propofol administration consist of a slight decrease in arterial blood pressures (systolic, mean, diastolic) without a compensatory increase in heart rate. Selective premedicants markedly modify this characteristic response. 4. When coupled with subjective responses to painful stimuli, EEG responses during propofol anesthesia provide clear evidence that satisfactory anesthesia has been achieved in experimental dogs. When propofol is used as the only anesthetic agent, a higher dose is required to induce an equipotent level of CNS depression compared with the situation when dogs are premedicated. 5. The propofol induction dose requirement should be appropriately decreased by 20% to 80% when propofol is administered in combination with sedative or analgesic agents as part of a balanced technique as well as in elderly and debilitated patients. As a general recommendation, the dose of propofol should always be carefully titrated against the needs and responses of the individual patient, as there is considerable variability in anesthetic requirements among patients. Because propofol does not have marked analgesic effects and its metabolism is rapid, the use of local anesthetics, nonsteroidal anti-inflammatory agents, and opioids to provide postoperative analgesia improves the quality of recovery after propofol anesthesia. 6. The cardiovascular depressant effects of propofol are well tolerated in healthy animals, but these effects may be more problematic in high-risk patients with intrinsic cardiac disease as well as in those with systemic disease. In hypovolemic patients and those with limited cardiac reserve, even small induction doses of propofol (0.75-1.5 mg/kg i.v.) can produce profound hypotens

Anesthesia, General↗
PubMed1993

Results of venous thrombectomy in the treatment of deep vein thrombosis.

Despite the infrequent use in the United States, venous thrombectomy seems to have a beneficial effect in carefully selected patients with acute iliofemoral thrombosis. The final decision to proceed with venous thrombectomy should be based on a balanced analysis of two factors--the characteristics of the thrombus and the characteristics of the patient. First, the diagnosis of acute deep vein thrombosis must be unequivocally established preoperatively. Accurate anatomic localization is usually achieved with venography, but duplex Doppler examination may be sufficient in selected instances. Second, the distribution of thromboses should be determined. Venous thrombectomy should be considered only in instances of deep vein thrombosis involving the iliofemoral venous segment. Thrombectomy for venous thrombosis below the inguinal ligament has not been consistently beneficial. Third, the age of the thrombus should be estimated. This can usually be accomplished though a careful analysis of the clinical history, but may be corroborated by duplex Doppler or venographic features of the thrombus. Venous thrombectomy should rarely be attempted if the age of the thrombus is thought to be greater than 72 hours. Unfortunately, in many instances the clinical history substantially underestimates the actual age of the underlying thrombus. Fourth, patient characteristics must be assessed preoperatively. While venous thrombectomy can usually be accomplished using local anesthesia, substantial shifts in fluid and acid base balance may be poorly tolerated by elderly, frail patients. In the setting of widespread metastatic disease, rethrombosis rates may be too high to justify thrombectomy in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Femoral Vein↗
PubMed1993

Surface-induced hypothermia in dogs: 19 cases (1987-1989).

Surface-induced hypothermia is used to protect tissues from ischemic events during surgery. In a review of 19 clinical cases in dogs, the technique was used to enable intracardiac surgery (4 dogs) and to facilitate removal of extensive thoracic or abdominal masses (15 dogs). For 16 dogs (84%), anesthesia was induced with an opioid/benzodiazepine combination and maintained with a balanced technique by use of an opioid, a neuromuscular blocking agent, and isoflurane in oxygen. Dogs were cooled in an ice bath to a mean esophageal temperature of 27.8 +/- 1.4 C. Mean anesthesia time was 4.04 +/- 1.37 hours. Hypothermic-induced adverse effects, such as increased blood viscosity, increased myocardial irritability, and shivering, were managed by hemodilution, manipulation of acid-base balance, and administration of opioid and neuromuscular blocking agents. Complications requiring treatment included severe hypotension (74%), arrhythmias (47%), hypoxemia (42%), and acidemia (58%). Six dogs (32%) went into cardiac arrest and all were successfully resuscitated once the surgical procedure was completed. One dog was euthanatized during surgery, another died after surgery, and the 17 remaining dogs (90%) were discharged from the hospital to their owners. The technique appears beneficial in selected cases to decrease the morbidity and mortality associated with the risk of prolonged ischemia and life-threatening hemorrhage.

Animals↗
PubMed2001

[Stability of myocardial perfusion during revascularization under propofol anesthesia].

During coronary artery bypass grafting surgery (CABGS) there are many factors which may disturb myocardial oxygen balance with consequent irreversible myocardial damage. Anesthesiologists are expected to use drugs with tendency to optimize hemodynamics and myocardial oxygen balance, making in that way conditions for preserving myocardial perfusion. In this study, performed on 19 patients undergoing CABGS under dominant propofol anesthesia, there were no signs of intraoperative ischemia manifested by statistically significant dislocation of ST segment in EKG leads D11, V5 and aVL.

Anesthesia, Intravenous↗
PubMed1991

[Anesthesiologic management of surgery of the aorta and the major vessels in patients with diabetes mellitus].

In 23 patients with diabetes mellitus, the effectiveness of anesthesiologic support of the operations on the aorta and major vessels, which was based on combined epidural anesthesia performed using the conventional technique, was analysed. Sugar concentration in the blood was maintained at a level of no more than 11 mmol/l. Use of the method permitted to provide an adequate anesthesia, stable concentration of glucose in the blood, constant aqueous-electrolyte balance and acid-base state.

Anesthesia, Epidural↗
PubMed1991

Retrobulbar bupivacaine irrigation for postoperative pain after scleral buckling surgery. A prospective study.

The authors conducted a prospective, randomized, double-masked clinical trial to determine if retrobulbar irrigation with bupivacaine hydrochloride 0.75% (Marcaine) has an effect on postoperative pain after scleral buckling surgery. Fifty consecutive patients undergoing scleral buckling under general anesthesia were randomized to receive either bupivacaine or balanced salt solution as a retrobulbar irrigation at the end of their retinal detachment procedure. Of the 25 patients who received bupivacaine, only three (12%) required parenteral pain relief in the first 24 hours after surgery. This was statistically significant when compared with the 18 (72%) of 25 patients requiring parenteral pain relief in the placebo group (P less than 0.0001). In addition, when questioned about their perception of the degree of postoperative pain, patients in the control group rated their level of pain as significantly more severe than did patients in the bupivacaine group. The authors conclude that retrobulbar irrigation with bupivacaine is a safe and effective way to achieve postoperative pain relief after surgery for scleral buckling.

Adolescent↗
PubMed1993

Diagnosis and treatment of fractures of the facial bones in children 1943-1993.

It is clear that the foundations for diagnosis and the basic principles of management have changed little since 1943 and probably since the work of Kazanjian in World War I. Major advances have occurred, with modern techniques of airway management (particularly fiberoptic laryngoscopy), anesthesia, and an understanding of fluid and electrolyte balance and behavioral issues in children. In addition, the advent of antibiotics; new imaging techniques (particularly CT), and availability of new instrumentation and rigid internal fixation have all revolutionized the specific treatment of pediatric facial fractures. Craniofacial techniques, pioneered by Dr Paul Tessler, have significantly altered and improved treatment of pediatric midface fractures. Progress in the biology of bone healing will surely mark the next 50 years.

Accidents, Traffic↗
PubMed2001

Effects of lidocaine-HCl salt and benzocaine on the expansion of lipid monolayers employed as bio-mimicking cell membrane.

Effects of lidocaine-HCl salt and benzocaine on the expansion of lipid monolayers employed as bio-mimicking cell membrane were investigated using Langmuir-Blodgett film balance to figure out the molecular mechanism for anesthesia by these local anesthetics. Lidocaine-HCl salt in subphase expanded the monolayer of phosphatidyl choline (PC) and phosphatidyl ethanolamine (PE). Benzocaine was not mixed with lipids in the monolayer, but the monolayer of lipids on the surface of water saturated with benzocaine was expanded same as the case of lidocaine-HCl salt. Even though this study can not explain the whole molecular mechanism for anesthesia by lidocaine-HCl salt and benzocaine, it can be asserted from the results of this study that the expansion of cell membrane by lidocaine-HCl salt and benzocaine contribute, at least partially, to the generation of anesthesia.

Journal Article↗
PubMed1993

Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children.

Perioperative blood glucose and insulin levels were measured in children (1-9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n = 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n = 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P < 0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P < 0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P < 0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.

Anesthesia, Conduction↗