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PubMedDate not supplied

[Characteristics of anesthesia in trauma surgery in children with severe burn injuries].

The authors analyze total anesthesia in 347 children with thermal injuries, subjected to traumatic operations involving massive blood loss. A characteristic feature of total anesthesia in children subjected to early necrectomies was a lower dose or refusal from cholinolytics for premedication, endotracheal multicomponent narcosis with ketamine, fentanyl (promedole) in the minimal doses in parallel with inhalation anesthesia by fluothane traces and a nitrous oxide-oxygen mixture with at least 50% oxygen. The optimal initial dose of nondepolarized myorelaxants in burnt children is 30-50% higher than the recommended dose and is determined by the size and depth of injury. For controlled myoplegia, the doses of nondepolarized myorelaxants for subsequent injections should be 1.5-2.5 times lower than the initial dose. The duration of pancuronium and arduan effects depended on hepatorenal function. Tracrium provided regulated myorelaxation in children with burns even in cases with hepatorenal dysfunction. A high rate of massive blood loss and early development of multiple organ failure in children with thermal injuries prompted us to develop infusion-transfusion therapy for traumatic operations involving massive blood loss. The volume of blood loss is estimated from the area of necrotic tissues removed and the type of necrectomy. Qualitative composition of transfusion mixture and the rate of transfusion is determined by the rate and volume of blood loss, level of hemoglobin and hematocrit, and metabolic disorders during the operation. Prolonged ventilation of the lungs is recommended for children with thermal injuries after operations involving blood loss of 1 circulating blood volume or more. These measures decreased the incidence and severity of complications involving the hemodynamics, oxygen status and metabolism in tissues, and improved the reparation.

Adolescent↗
PubMed1988

The effects of anesthesia on middle-ear effusions.

Surgeons occasionally note a discrepancy between preoperative assessment of middle-ear effusion and operative observation during the placement of ventilating tubes in children's ears. This study was designed to determine whether this variance is secondary to the effects of inhalation anesthesia or misinterpretation of the preoperative exam. Observations were recorded by three distinctly different methods of measurement: the surgeon, the MD-2 Impedance Analyzer, and the Acoustic Otoscope immediately before and after induction of anesthesia. These results were then analyzed and compared with the operative findings. Anesthetic induction was shown to cause alteration in the presence of middle-ear fluid in less than 10% of cases.

Acoustic Impedance Tests↗
PubMed2002

Operative technique for safe pulmonary lobectomy in Sprague-Dawley rats.

To perform safe and effective animal surgery, it is essential to follow a well- disciplined approach. We recently have embarked on a variety of wound-healing studies that involve multiple operative techniques including thoracotomy with lobectomy. Such procedures require specific attention to effective anesthesia and ventilation as well as a structured and safe approach to the actual procedure. We have developed operative techniques for thoracotomy and pulmonary lobectomy that limit animal morbidity and mortality. Using general anesthesia, we safely and effectively completed right thoracotomy and pulmonary lobectomy in 51 of the 54 (>94%) of the Sprague-Dawley rats that were our subjects. We effectively ventilated the animals with inhalation anesthesia, avoiding the need for endotracheal intubation. The three mortalities occurred during early experiments and were attributable to easily identified technical errors. Our animals did not experience postoperative respiratory complications. Postoperative recovery was excellent, and no appreciable postoperative morbidity was encountered.

Anesthesia, Inhalation↗
PubMed1991

Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants.

Airway obstruction plays an important role in the pathogenesis of apnea in premature infants who have not previously undergone anesthesia. To determine the role of airway obstruction in postoperative apnea, we studied 74 former premature infants by integrated recordings of nasal airflow, pneumocardiography, and pulse oximetry during the initial 2 h of recovery from inhalational anesthesia. Apnea (greater than 6 s) was classified as central, obstructive, or mixed, wherein mixed apnea consisted of central and obstructive apnea within the same apneic episode. Postoperative apnea was observed in 23 infants, ranging in age from 31-48 weeks postconception: 12 had inguinal herniorrhaphy (hernia group) and 11 had other procedures (other group). Of the 268 apneic episodes in the hernia group, 73% were central, 6% obstructive, and 21% mixed. Infants in the other group had 505 apneic episodes, with a distribution nearly identical to that in the hernia group. Central and mixed apnea occurred in all infants experiencing apnea, except in 1 infant, who had only central apnea, whereas obstructive apnea occurred in only one third of the apneic infants. Arterial hemoglobin desaturation was significantly more frequent at the end of mixed and obstructive apnea than after central apnea (P less than 0.01). In both groups, arterial hemoglobin O2 saturation (SpO2) decreased to less than 80% in approximately 35% of mixed and obstructive apneic episodes, compared to approximately 5% of central apneic episodes. SpO2 remained greater than or equal to 90% in over 80% of central apneic episodes, compared to 40% of mixed and obstructive apneic episodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗
PubMed2003

Hemodynamic stability, myocardial ischemia, and perioperative outcome after carotid surgery with remifentanil/propofol or isoflurane/fentanyl anesthesia.

This study compares remifentanil/propofol (remi/prop) with isoflurane/fentanyl (iso/fen) anesthesia to determine which provides the greater hemodynamic stability, lesser myocardial ischemia, and morbidity with better postoperative outcomes after carotid endarterectomy. Sixty patients undergoing unilateral carotid endarterectomy were randomized to receive either a remi/prop or iso/fen anesthetic. Hemodynamic variables were recorded during the surgical procedure. In addition, transesophageal echocardiography was used to assess evidence of intraoperative regional wall motion abnormalities suggestive of cardiac ischemia. Emergence and extubation times, recovery from anesthesia, hemodynamic instability, nausea, vomiting, and pain in post anesthesia recovery, discharge delays, ICU admittance, hospital discharge, and preoperative and postoperative troponin levels were compared using appropriate statistical methods with P < 0.05 considered significant. The groups were demographically alike. Hemodynamic variables were similar during intubation and throughout surgery. Twenty-two percent of patients receiving iso/fen developed intraoperative regional wall motion abnormalities suggestive of ischemia, whereas no remi/prop patients had changes (P < 0.05). There was no difference in ST-T wave changes after surgery, and no patient had an elevation in troponin I levels. Postoperative variables were similar except that patients who received iso/fen had lower Stewart recovery scores during the first 15 minutes after post anesthesia care unit admission and a higher incidence of nausea and vomiting the day after surgery, whereas patients receiving remi/prop had discharge delays secondary to hypertension. ICU admittance, time to first void, oral intake, and time to hospital discharge were similar between the groups. At 9 times the cost of an iso/fen anesthesia technique, remi/prop offers little advantage over inhalational anesthesia for carotid endarterectomy.

Aged↗
PubMed1990

Transient neuromuscular impairment resulting from prolonged inhalation of halothane and enflurane.

Inhalation anesthesia first with halothane followed by enflurane relieved a patient with status asthmaticus who was refractory to conventional therapy including mechanical ventilation. After 13 days of anesthesia while on mechanical ventilation and employing nondepolarizing muscle relaxants, significant neuromuscular impairment, manifested by tetraplegia and sensory disturbance, developed. Anesthesia was discontinued on day 14, and the patient was weaned from mechanical ventilation on day 16. Over the next two months, the neuromuscular impairment markedly improved. Halothane was associated with cardiac arrhythmias and hepatitis necessitating replacement by enflurane. Enflurane appeared to be as effective a treatment for refractory asthma as halothane. The most probable cause of the neuromuscular impairment in our patient was the long-term use of inhalation anesthetics or nondepolarizing muscle relaxants.

Adult↗
PubMed2000

Influence of volatile and intravenous anesthetics on the threshold of the acoustically evoked stapedius reflex.

The influence of volatile and intravenous anesthetics on the threshold of the acoustically evoked stapedius reflex (SR) was studied prospectively in 45 patients undergoing elective ENT surgical procedures. After premedication with flunitrazepam the patients were randomly assigned to one of nine groups. Group I: 70% nitrous oxide (N2O) in oxygen (O2); Groups II-VII: induction of anesthesia with intravenous thiopental, followed by mask inhalation with 100% O2 and 1.13% halothane (Group II), 2.52% enflurane (Group III) or 1.73% isoflurane (Group IV); or 70% N2O in oxygen, and 0.44% halothane (Group V), 0.86% enflurane (Group VI) or 0.75% isoflurane (Group VII): Group VIII: intravenous midazolam and ketamine; and Group IX: intravenous midazolam and alfentanil. Tympanometry and ipsilateral and contralateral SR measurements were performed when the effects of the anesthetics had achieved a steady state. Flunitrazepam raised the SR threshold only slightly. Substances applied during inhalation anesthesia either markedly increased the threshold contralaterally more than ipsilaterally (thiopental, N2O), or suppressed the reflex completely (thiopental, all volatile anesthetics with or without N2O). Under intravenous anesthesia the reflex was always present. The midazolam-ketamine combination influenced the threshold bilaterally only slightly, while the midazolam-alfentanil combination led to a pronounced, contralaterally significant elevation of the threshold. Based on its minimal influence on the SR threshold, flunitrazepam is especially suitable for sedation and the midazolam-ketamine combination for anesthesia in audiological diagnostic procedures.

Acoustic Impedance Tests↗
PubMed1995

[Air pollution by sevoflurane in operating room and serum and urine inorganic fluoride of anesthetists].

Since lower blood-gas partition coefficient of sevoflurane provides rapid induction and emergence from anesthesia, sevoflurane has been used widely for inhalational anesthesia. However, because higher minimum alveolar concentration of sevoflurane requires a large dosage of anesthetic than other volatile anesthetics, air pollution with sevoflurane in the operating room might be of great concern. Anesthetists may keep inhaling the low concentration of anesthetics every day, even though scavenging system is equipped in the operating room. The purpose of this study is to evaluate the effects on anesthetists of the low concentration of anesthetics by measuring the inorganic fluoride concentration in the urine and serum of anesthetists and operating room nurses. Healthy 29 anesthesiologists and two operating room nurses were studied. Informed consent was obtained. Inorganic fluoride ions in the serum and urine were measured. Simultaneously sevoflurane concentration in operating room was measured in three operating rooms, at two places in the corridor and in the recovery room. Sevoflurane concentrations in three operating rooms were 1.22 ppm, 2.13 ppm and 6.05 ppm respectively. Concentration in the recovery room was 0.544 ppm. Serum and urine concentrations of inorganic fluoride were 1.1 +/- 0.1 mumol.l-1 and 36.2 +/- 17.1 mumol.l-1, respectively (mean +/- SD). Serum concentration of inorganic fluoride was within normal ranges. Although it is possible that fluoride concentration in urine is influenced by urine volume and a half of fluoride deposits in bone, no abnormal values in urine were found in this study. These results suggest that long term exposure to low concentration of sevoflurane and isoflurane causes no significant increase in their metabolites in operating room staffs.

Adult↗
PubMed1999

Sevoflurane causes more postoperative agitation in children than does halothane.

BACKGROUND: An agitated recovery may occur after inhalation anesthesia. The aim of the present study was to assess the recovery quality after mask anesthesia with either halothane or sevoflurane in children. METHODS: Sixty-two children, 8 months to 18 years of age, scheduled for minor surgery, were randomly assigned to receive either halothane or sevoflurane. The patients were premedicated with midazolam and anesthesia was induced i.v. with propofol or by inhalation and maintained with halothane or sevoflurane in N2O/O2 via face mask. Recovery was assessed by a "blinded" observer using a postanesthetic recovery score. Agitation and pain were judged using a visual analog scale. The incidence of vomiting was noted. The day after anesthesia older children and parents of younger children were interviewed about their experience of the anesthesia and recovery period. RESULTS: There were no differences between groups in respect of age, weight, length, or duration of surgery or inhalational gas exposure. Median time from end of administration of inhalational agent to spontaneous eye opening was less after sevoflurane (25 min) than after halothane (48 min), (P < 0.01). Likewise, recovery was faster after sevoflurane anesthesia (P < 0.05). Agitation, but not pain, occurred more frequently after sevoflurane than after halothane (P < 0.05) and agitation was significantly more common in younger children. There was no difference in duration of hospital stay between day-care patients in the two groups. CONCLUSION: Early postanesthetic agitation and recovery was faster after mask anesthesia with sevoflurane than after halothane. There was a higher incidence of agitation in younger children, without correlation to pain.

Adolescent↗
PubMed1998

Evaluation of simethicone for the treatment of postoperative abdominal discomfort in infants.

STUDY OBJECTIVE: To determine whether abdominal discomfort is a cause for distress symptoms in infants following administration of inhalational anesthesia, and to evaluate the effectiveness of simethicone in treating this discomfort. DESIGN: Randomized, double-blinded study. SETTING: Large tertiary care, university-based medical center. PATIENTS: 175 ASA physical status I and II infants under 28 months of age who underwent an inhalational anesthetic for a variety of procedures that were expected to cause relatively little pain. INTERVENTIONS: Children were assessed for the presence of postoperative abdominal discomfort, and, if evident, were randomly given either simethicone or placebo in a double-blinded fashion. MEASUREMENTS AND MAIN RESULTS: Abdominal discomfort was measured using the Faces Legs Activity Cry and Consolability (FLACC) Behavioral Pain Scale. Scores were recorded pre-drug; at 10, 20, and 30 minutes following drug administration; and at discharge. If discomfort had not resolved within 15 minutes after the drug was given, routine analgesics or other medications were administered. Abdominal girth was measured preoperatively, on admission into the postanesthesia care unit (PACU), and at discharge. 21% of infants exhibited symptoms of abdominal discomfort postoperatively. Younger infants were at greater risk for this condition. 36 infants were given either placebo or simethicone, and of these, infants who received simethicone were comfortable earlier and required fewer rescue medications compared with placebo. There were no differences in ability to tolerate oral fluids prior to discharge or in the length of stay in the PACU. CONCLUSIONS: Simethicone is a safe and inexpensive medication that may provide anesthesiologists with an effective treatment choice for suspected postoperative abdominal discomfort in infants.

Abdominal Pain↗
PubMed1989

[Difficult intubation and anesthesia in Pfaundler-Hurler disease].

Because of increasing dyspnea, adenoidectomy and tonsillectomy were indicated in a 6-year-old girl with Pfaundler-Hurler disease. The main symptoms were cardiac insufficiency and chronic bronchitis. Because of the large skull with hypoplastic cervical spine, anomalies of facial bones, larynx and jawbone normal intubation was impossible. We therefore performed intubation during spontaneous breathing under inhalation anesthesia and topical anesthesia of the larynx. After exploratory laryngoscopy a preformed Woodbridge tube was inserted into the trachea blind and by ear during of inspiration. The patient's cardiac insufficiency and chronic bronchitis made a balanced anesthesia with reduced dosage of rapifen and halothane necessary. In spite of the poor general prognosis, after the operation a considerable relief of the patient's suffering was noted, because she was able to breathe freely.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Anesthesia for laryngoscopy.

The requirements of anesthesia for laryngoscopy and microlaryngeal surgery must be compatible with maximum safety and minimum patient discomfort. Some techniques require the use of an endotracheal tube while some do not. Others use a modified tube or a jetting system. In general, for pediatric endoscopy we prefer spontaneous respiration with inhalational anesthesia supplemented by topical lignocaine (lidocaine), and in adults, a relaxant technique with controlled jet ventilation supplemented by topical lignocaine. A new pediatric microlaryngoscope and a new tube for jet ventilation in older children and adults are described.

Age Factors↗
PubMed2004

Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review.

UNLABELLED: In this systematic review we focused on postoperative recovery and complications using four different anesthetic techniques. The database MEDLINE was searched via PubMed (1966 to June 2002) using the search words "anesthesia" and with ambulatory surgical procedures limited to randomized controlled trials in adults (>19 yr), in the English language, and in humans. A second search strategy was used combining two of the words "propofol," "isoflurane," "sevoflurane," or "desflurane". Screening and data extraction produced 58 articles that were included in the final meta-analysis. No differences were found between propofol and isoflurane in early recovery. However, early recovery was faster with desflurane compared with propofol and isoflurane and with sevoflurane compared with isoflurane. A minor difference was found in home readiness between sevoflurane and isoflurane (5 min) but not among the other anesthetics. Nausea, vomiting, headache, and postdischarge nausea and vomiting incidence were in favor of propofol compared with isoflurane (P < 0.05). A larger number of patients in the inhaled anesthesia groups required antiemetics compared with the propofol group. We conclude that the differences in early recovery times among the different anesthetics were small and in favor of the inhaled anesthetics. The incidence of side effects, specifically postoperative nausea and vomiting, was less frequent with propofol. IMPLICATIONS: A systematic analysis of the literature comparing postoperative recovery after propofol, isoflurane, desflurane, and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups. The incidence of nausea and vomiting were less frequent with propofol.

Ambulatory Surgical Procedures↗
PubMed1995

Clinical application of rapid inhalation induction of anesthesia using isoflurane and sevoflurane with nitrous oxide in dogs.

Clinical usefulness of rapid inhalation induction of anesthesia (RII) using 5.0 vol.% isoflurane (GOI) and sevoflurane (GOS) with N2O was evaluated in 124 canine patients. Induction times, loss of various reflexes and movement times were significantly faster in GOI group than in GOS group. Scores for the easiness of intubation and the degree of movements were also significantly less in GOI group than in GOS group. Positive correlation between body weight and degree of movements was observed in both induction groups. Thus, RII using GOI is a practically useful and safe induction modality in small- to medium-sized dogs.

Age Factors↗
PubMedDate not supplied

[High epidural anesthesia in the correction of congenital heart defects with artificial circulation in children].

Effects of high thoracic epidural anesthesia (TEA) on hemodynamics were studied in patients undergoing cardiopulmonary bypass (CPB) surgery. In 7 patients aged 3-7 years, TEA was used as an adjunct to standard oxygen-air-isoflurane anesthesia. We prefer using a combination of lidocaine with fentanyl for epidural anesthesia. Usually we take a loading dose of 4.5 mg/kg of lidocaine and 1 microgram/kg of fentanyl, which is followed after 40-50 min by 3.5 mg/kg lidocaine and 1 microgram/kg fentanyl. TEA ensures good pain relief and hemodynamic stability and can be accepted as a safe and effective anesthetic technique in combination with inhalation anesthesia in children subjected to CPB.

Anesthesia, Epidural↗