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At least 649 records · Page 36Linked to original sources
PubMed2001

[Effects of combined transdermal acupoint electric stimulation and isoflurane anesthesia on isoflurane-induced hypotension and tissue oxygen metabolism in patients undergoing craniotomy].

OBJECTIVE: To observe the effects of combined transdermal acupoint electric stimulation and isoflurane anesthesia on isoflurane-induced hypotension and tissue oxygen metabolism in patients undergoing craniotomy. METHODS: Forty-two patients with brain tumor of ASA physical status I or II and scheduled for elective surgery were randomly divided into two groups. The craniotomy was undergoing in Group A with isoflurane anesthesia, while in Group B, with combined transdermal acupoint electric stimulation (TAES) and isoflurane anesthesia. Isoflurane induced hypotension was performed in both groups by augmenting the concentration of isoflurane to lower the mean arterial pressure than before anesthesia for 30%-40% and maintain for 30-45 mins. The tissue oxygen metabolism, blood gas and arterial lactic acid level before, during and after hypotension were monitored by Swan-Ganz floating catheterization. RESULTS: As compared with before hypotension, the pulmonary arterial and mixed with venous blood oxygen saturation lowered and oxygen supply lowered, and oxygen uptake increased significantly in both groups (P < 0.05), but the extent of changes in oxygen metabolic criteria in Group B were all lesser than those in Group A (P < 0.05). CONCLUSION: Combined acupoint electric stimulation and general anesthesia could maintain the tissue oxygen supply and demand balance better in the isofluraneinduced hypotension process.

Acupuncture Points↗
PubMed1990

Temperature problems in the postoperative period.

Postoperative patients have difficulty maintaining thermal balance for several reasons. Normal thermoregulation is suppressed by anesthesia, neuromuscular blocking agents, and other drugs, and cool environmental conditions and exposure contribute to heat loss. Specific patient groups at high risk for hypothermia include infants, the elderly, and the neurologically impaired. Temperature drift, afterfall, shivering, malignant hyperthermia, and fever are among the temperature-related conditions requiring vigilant assessment and nursing action during the postoperative period.

Body Temperature Regulation↗
PubMed1993

[The effect of isoflurane on plasma concentration-response curve of vecuronium determined with continuous infusion method].

To investigate the interaction between vecuronium and isoflurane at the neuromuscular junction in man, I determined the plasma concentration-response curve of vecuronium both under balanced and isoflurane (0.7% and 1.2% end-tidal) anesthesia. In addition, I also determined clinically the infusion rate of vecuronium that made a suitable sustained relaxation possible. I used train-of-four (TOF) stimulation to monitor neuromuscular blockade by vecuronium. Plasma isoflurane concentration was kept constant throughout the observation period. Plasma clearances of vecuronium calculated from the infusion rate and resulting plasma concentration were also found not to be different among the three groups. A significant leftward shift of the concentration-response (T1 inhibition) curve was found both between 1.2% isoflurane group and NLA group, and between 1.2% isoflurane group and 0.7% isoflurane group. The relationship between T1 inhibition and TOF ratio reduction was found not to be different among the three groups. I conclude that 1.2% isoflurane potentiates vecuronium-induced T1 inhibition, but it does not affect the relationship between T1 inhibition and TOF ratio reduction in man. It is helpful for clinical determination of the infusion rate to measure the time period from bolus administration of vecuronium 0.1 mg.kg-1 to reappearance of T3.

Adult↗
PubMed2004

[Transient increase of bispectral index in a patient with bronchoconstriction after endotracheal intubation].

A 62-year-old woman (148 cm, 48.5 kg) with a history of bronchial asthma underwent an emergency appendectomy. Ten days before the operation she developed symptoms of wheezing while under asthma medication. An endotracheal tube (7 mm) was inserted after the induction of general anesthesia with intravenous injection of fentanyl 100 micrograms, propofol 100 mg and vecuronium 10 mg under Sellick's maneuver. Anesthesia was maintained with 1% sevoflurane with oxygen 6l-min-1 just after intubation, but bilateral lung sound soon became weaker and ventilation difficult. Based on a diagnosis of bronchoconstriction, we started hyperventilation with 3% sevoflurane. Ventilation returned to normal after about 5 minutes. Percutaneous O2 saturation was maintained at 100% during this episode, but the BIS transiently rose to 82. Anesthesia was maintained with 2% sevoflurane and 50% nitrous oxide balanced with oxygen, and 250 mg aminophylline was administered. Upon completion of the operation, the endotracheal tube was removed without any events. The patient gave no sign of awareness during the operation. When severe bronchoconstriction prevents the absorption of anesthetics from the lung alveoli, additional intravenous anesthetics should be administered to maintain stable amnesia.

Anesthesia, General↗
PubMed1980

[Use of althesin as a drug to induce and maintain anesthesia for cesarean section].

Results with CT 1341 as the main anaesthetic agent in balanced anaesthesia in 90 cases of caesarean section are presented. It was found that this form of steroid anaesthesia had no effect on the Apgar score uterine tone, maternofoetal metabolism, or cardiocirculatory and respiratory stability. Reference is made to the possible injury of theatre staff owing to chronic exposure to volatile anaesthetics, and it is asserted that the use of althesin is a positive step forward in the solution of this problem.

Adolescent↗
PubMed1987

Isoflurane-fentanyl anesthesia for coronary bypass surgery in patients with good left ventricular function.

The hemodynamic effects of a balanced anesthetic technique where a moderate dose of fentanyl (32 micrograms/kg) is supplemented with isoflurane were studied in 15 patients with good left ventricular function. Mean inspired isoflurane concentration was 0.63% during induction and 0.74% during maintenance. Induction of anesthesia was associated with a significant decrease (p less than 0.05) in systolic and diastolic pressure and left ventricular stroke work index (LVSWI). During maintenance systolic blood pressure and LVSWI remained significantly depressed. It is concluded that isoflurane-fentanyl anesthesia has myocardial depressant properties. There is a reduced incidence of break-through hypertension during noxious stimuli, when compared with high-dose fentanyl anesthesia. During maintenance, clinical signs that could reflect myocardial ischemia were not observed. Heart enzymes remained within normal range postoperatively in all patients and ECG morphology was unchanged.

Anesthesia, Inhalation↗
PubMedDate not supplied

Cardiac arrest caused by coronary spasm in two patients during recovery from epidural anesthesia.

BACKGROUND AND OBJECTIVES: In order to reduce the surgical stress on the heart, anesthesiologists frequently use regional anesthesia in patients with coronary artery disease. METHODS: Two patients underwent reconstructive peripheral vascular surgery under continuous epidural anesthesia with bupivacaine. During the surgery and later in the recovery room, they received continuous electrocardiographic (ECG), invasive arterial blood pressure, and oxyhemoglobin saturation monitoring. RESULTS: In both patients, the anesthetic course during surgery was uneventful, but while recovering from the anesthesia, they developed ECG changes consistent with myocardial ischemia, followed by malignant dysrhythmias and cardiac arrest. The clinical pictures, ECGs, coronary angiogram, and (in one patient) autopsy findings suggested coronary artery spasm as the cause of the malignant dysrhythmias and cardiac arrests. CONCLUSIONS: It is possible that the coronary spasms were caused by an altered balance between sympathetic and parasympathetic nervous activity during recovery from epidural anesthesia. Therefore, patients with coronary artery disease must be closely monitored for signs and symptoms of myocardial ischemia during the entire recovery period from epidural anesthesia.

Aged↗
PubMed1994

Thermogenesis in brown adipocytes is inhibited by volatile anesthetic agents. A factor contributing to hypothermia in infants?

BACKGROUND: In infants, nonshivering thermogenesis from brown adipose tissue provides an important source of heat for thermoregulation. Infants are known to have a high susceptibility to hypothermia during anesthesia. To investigate whether this could be due to an inhibition of nonshivering thermogenesis by anesthetics, the effect of preincubation with volatile anesthetics on the norepinephrine-induced heat production of brown adipocytes was investigated. METHODS: Brown adipocytes from hamsters were isolated with a collagenase digestion method and preincubated with volatile anesthetics. The cells were stimulated with norepinephrine, and heat production, measured as oxygen consumption, was monitored polarographically. RESULTS: Norepinephrine addition led to a 20-fold increase in the rate of oxygen consumption (thermogenesis). However, preincubation of cells with 3% halothane reduced the response to norepinephrine by more than 70%. The potency of norepinephrine (the median effective concentration) was not affected by halothane. Full effect of halothane was reached quickly, and after halothane withdrawal, the thermogenic response recovered, although rather slowly. Halothane, isoflurane, and enflurane were approximately equipotent inhibitors of thermogenesis, with concentrations of approximately 0.7% resulting in 50% inhibition. The inhibitory effect of 1% halothane was unaffected by the presence of 74% nitrous oxide, but nitrous oxide alone also reduced thermogenesis. CONCLUSIONS: Volatile anesthetics severely attenuated the thermogenic response to norepinephrine of isolated brown-fat cells. It is inferred that brown-adipose-tissue heat production is reduced during (and probably also some time after) anesthesia. Because infants are dependent on brown-fat-derived nonshivering thermogenesis for thermal balance, the inhibition by volatile anesthetic agents of brown-adipocyte heat production may at least partly explain the susceptibility of infants to hypothermia during and after anesthesia.

Adipocytes↗
PubMed2005

Collection and quantification of urine during anesthesia in small animals.

This note describes a simple method for collecting urine and quantification of urine production during anesthesia in small animals. It offers two advantages, especially important for procedures requiring lengthy anesthesia: 1) The animals are kept dry, and 2) fluid balance can be maintained more accurately. The method, which we have applied to rats, is to rest the animal on an absorbent pad of known weight and to weigh the pad after urine has been collected. The note describes the performance characteristics of a preferred pad type and contrasts them with those of other readily available types of absorbent pads. The preferred pad keeps the animal dry while facilitating quantification of urine production, a refinement of animal use.

Absorbent Pads↗
PubMed2001

A comprehensive review of epinephrine in the finger: to do or not to do.

The prohibition against the use of local anesthetics with epinephrine for digital blocks or infiltration is an established surgical tradition. The present article provides a comprehensive review of all reported digital necrotic and ischemic complications with epinephrine in the digits in an effort to understand whether the current prohibition is based on documented reports. A comprehensive review of articles showing the successful use of local anesthetic with epinephrine in the digits is presented.A review of Index Medicus from 1880 to 1966 and a computer review of the National Library of Medicine database from 1966 to 2000 were performed using multiple keywords. Selected major textbooks from 1900 to 2000 were also reviewed.A total of 48 cases of digital gangrene after anesthetic blocks (mostly using cocaine or procaine) have been reported in the world literature. Only 21 cases involved the use of epinephrine; 17 involved an unknown concentration based on manual dilution. Multiple other concurrent conditions (hot soaks, tight tourniquets, and infection) existed in these case reports, making it difficult to determine the exact cause of the tissue insult. There have been no case reports of digital gangrene using commercial lidocaine with epinephrine (introduced in 1948). Multiple studies involving thousands of patients support the premise that the use of lidocaine with epinephrine is safe in the digits. An extensive literature review failed to provide consistent evidence that our current preparations of local anesthesia with epinephrine cause digital necrosis, although not all complications are necessarily reported. However, as with all techniques, caution is necessary to balance the risks of this technique with the dangers of mechanical tourniquets and upper extremity block anesthesia.

Anesthesia, Local↗
PubMed1991

Adenotonsillectomy in children with sickle cell disease.

The pediatric patient with sickle cell disease risks having a vasoocclusive episode during adenotonsillectomy under general anesthesia. With proper patient selection and appropriate perioperative management, adenotonsillectomy can be accomplished safely in children with sickle cell disease. We review the management of 10 children with sickle hemoglobinopathies who had adenotonsillectomy. Indications for surgery were recurrent streptococcal infections in four and obstructive sleep apnea in six of these children. No complications resulted from any of these procedures, and the mean length of postoperative hospitalization was 2.4 days. The principal feature of preoperative management was the transfusion of red blood cells to suppress the patient's endogenous erythropoiesis and to reduce the concentration of sickle cell hemoglobin to less than 30%. Though a prospective, multi-institutional clinical trial will ultimately be required to settle the issue of the safest preoperative management of children with sickle cell disease, balancing the risks of transfusion-related complications against anesthesia-related complications, our experience supports the operative safety of hypertransfusion therapy in children with sickle cell disease.

Adenoidectomy↗
PubMed1989

Hemodynamic changes and oxygen consumption in burned patients during enflurane or isoflurane anesthesia.

The effects of enflurane or isoflurane anesthesia on the systemic circulation and whole-body oxygen (O2) uptake (VO2) of 15 burn patients undergoing wound excision and skin grafting procedures were studied. The possibility that burn wound excision might adversely affect pulmonary circulation was also investigated. The patients were preanesthetically in a hyperdynamic-hypermetabolic state, characterized by a resting cardiac index (CI) of 6.2 +/- 0.9 L.min-1.m-2 (mean +/- SD), a VO2 (calculated using the Fick principle) of 213 +/- 44 mL.min-1.m-2, a normal mean systemic arterial pressure (MAP) (92 +/- 15 mm Hg), and markedly decreased systemic vascular resistance (SVR) (570 +/- 162 dynes.sec.cm-5). Mean pulmonary arterial pressure (MPAP) preanesthetically was slightly increased (21 +/- 3 mm Hg), while pulmonary vascular resistance (PVR) was in the low-normal range (59 +/- 16 dynes.sec.cm-5). No difference among the effects of enflurane and isoflurane on systemic and pulmonary hemodynamics and metabolic rate was detected. Induction of anesthesia was associated with a decrease in VO2, CI, MAP, and MPAP (P less than 0.001), while SVR and PVR did not change. The decrease in CI paralleled the decrease in VO2, thereby maintaining whole-body O2 supply-demand balance. VO2 decreased most likely because of lessened tissue O2 requirements. When anesthesia was discontinued, all metabolic and hemodynamic variables promptly returned to preanesthetic values. No effect of burn wound excision on pulmonary circulation was detected.

Adult↗
PubMed1998

Influence of the reference gas of paramagnetic oxygen analyzers on nitrogen concentrations during closed-circuit anesthesia.

Nitrogen (N2) may accumulate to unacceptable levels during closed-circuit anesthesia (CCA) when the sampled gases are redirected to the anesthesia circuit, because many gas analyzers entrain air as a reference gas to calibrate for oxygen analysis. Using oxygen instead of air as the reference gas for paramagnetic oxygen analysis could attenuate N2 accumulation. Forty-three adult ASA physical status I-III patients undergoing a variety of peripheral and abdominal procedures were assigned to one of two groups, depending on the reference gas used by a paramagnetic oxygen analyzer, either air (group I, n = 23) or oxygen (group II, n = 20). Gases sampled by the multigas analyzer were redirected to the anesthesia circuit. End-expired N2 (N2Et) was calculated as "balance gas": (100 - %O2 - %anesthetic vapor - %CO2). N2Et after 55 min (N2Et55min) was correlated with the end-expired N2 concentration when the circuit was closed (N2Et0min) and 5 min (N2Et5min) thereafter. In group I, N2Et accumulated almost linearly over time (t, min): N2Et (%) = 2.47 + 0.61 * t (r2 = 0.999). N2Et0min, N2Et5min, and N2Et55min were 1.3+/-0.8, 5.3+/-1.7, and 35.3+/-5.3%, respectively (mean +/- SD). The correlation (r2) between N2Et55min and N2Et0min was 0.19, and between N2Et55min and N2Et5min it was 0.56. In group II, N2Et increased exponentially: N2Et (%) = 1.01 + 11.9 * (1 - e(-t/43.5)) (r2 = 0.99). N2Et0min, N2Et5min, and N2Et55min were 0.87+/-0.93, 2.6+/-1.5, and 10.1+/-2.9%, respectively. The correlation (r2) between N2Et55min and N2Et0min was 0.04, and between N2Et55min and N2Et5min it was 0.40. We conclude that paramagnetic oxygen analyzers that use oxygen as the reference gas significantly attenuate N2 accumulation during CCA, which may reduce the need for frequent flushing of the anesthesia system, may provide more constant oxygen and nitrous oxide concentrations, and may simplify pharmacokinetic studies of potent inhaled anesthetics.

Adult↗
PubMed2001

Upregulation of IFN-gamma and soluble interleukin-2 receptor release and altered serum cortisol and prolactin concentration during general anesthesia.

The effects of surgery, surgical stress, and anesthesia compromise the optimal function of the immune system. Recent studies demonstrate the influence of anesthesia on the immune response by modulation of neural-immune interactions. To evaluate the immunologic effects of general anesthesia with the hypnotic agent propofol and the opioid fentanyl, two drugs used frequently in anesthesia, we studied 30 patients undergoing elective orthopedic surgery before and during narcosis. We found a significant enhancement of interferon-gamma (IFN-gamma) and soluble interleukin-2 receptor (sIL-2R) release in lipopolysaccharide (LPS)-stimulated whole blood cultures after induction of anesthesia. Similar results were observed in cultures stimulated with polyclonal T cell activators, such as staphylococcal enterotoxin B (SEB) and phytohemagglutinin (PHA). IL-1beta and IL-8 release was not affected, but the anti-inflammatory cytokine IL-10 decreased after skin incision. Serum prolactin significantly increased immediately after induction of anesthesia, whereas serum cortisol levels declined. Our results point to enhanced proinflammatory T lymphocyte and natural killer (NK) cell activity, probably caused by prolactin and cortisol modulation in the serum. This may disturb the balance of human proinflammatory and anti-inflammatory pathways during surgery and general anesthesia.

Adolescent↗
PubMed2002

Inhaling nitrous oxide or xenon does not influence bowel wall energy balance during porcine bowel obstruction.

UNLABELLED: Xenon (Xe) is less soluble than nitrous oxide (N(2)O) and hence may be more suitable during bowel obstruction. Therefore, we compared the intestinal mechanical and biochemical effects of these two gases with those of total IV anesthesia in a porcine model of small-bowel obstruction. Intestinal obstruction was induced in 33 anesthetized pigs, in 18 of which segmental ileal perfusion was reduced by partial arterial occlusion. Pigs received total IV anesthesia, Xe, or N(2)O (in 30% oxygen) for 4 h, and we determined the intraluminal pressure and volume, the arterial-ileal PCO(2) gap, and the lactate and pyruvate levels in the segmental mesenteric vein. Under both experimental conditions, Xe or N(2)O ventilation caused the volume to significantly increase with a concomitant significant increase in the intraluminal pressure during N(2)O ventilation. Regardless of the anesthesia technique, none of the biochemical variables was influenced in the animals with maintained ileal blood supply. In contrast, reducing the segmental perfusion induced pronounced alterations of all variables of bowel wall energy metabolism. The type of anesthesia, however, had no further statistically significant effect. Short-term inhalation of Xe or N(2)O seems to have no deleterious effects on the metabolic balance of the gut wall during intestinal obstruction. IMPLICATIONS: In anesthetized pigs, short-term inhalation of xenon or nitrous oxide over 4 h when compared with total IV anesthesia had no additional deleterious effects on the metabolic balance of the gut wall during intestinal obstruction, no matter whether the arterial blood flow was reduced or not.

Anesthetics, Inhalation↗
PubMedDate not supplied

[The action of carbon dioxide gas in high concentrations on ixodid ticks].

The ticks Ixodes persulcatus, Dermacentor reticulatus, D. marginatus were affected by 50, 70, 80 and 90% CO2 at 18 to 26 degrees. The higher the gas concentration and the lower the temperature, the quicker and the deeper was anesthesia. Additional tests have shown that response to CO2 depends on the water balance level determining the position of atrial valves. The response of some individuals to CO2 can change depending on the tick state during the experiment.

Anesthesia↗