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At least 793 records · Page 44Linked to original sources
PubMed1979

Effect of induction of general anesthesia for cesarean section on intervillous blood flow.

Intervillous blood flow was measured by a new intravenous 133Xe method before and during induction of general anesthesia for cesarean section in 10 healthy mothers. The flow values showed a highly significant decrease (p less than 0.001) (35 per cent on an average) at the time of anesthesia compared with the control values. The impairment was observed in all the cases. The role of the maternal changes in hemodynamic parameters and acid-base balance as a background of this decrease is discussed.

Acid-Base Equilibrium↗
PubMed1999

Anesthetic considerations in patients undergoing percutaneous radiofrequency interstitial tissue ablation.

Radiofrequency (RF) interstitial tissue ablation is a new, minimally invasive procedure for patients with liver cancer who are not candidates for conventional therapy. The percutaneous RF ablation therapy involves placing a needle electrode under ultrasound guidance into a selected portion of the tumor and heating the tissue between 90 degrees C and 100 degrees C. The ablation procedure can be done under monitored anesthesia care on an outpatient basis. The patient's ability to cooperate with regard to breathing is critical for accurate needle placement. Intravenous sedation must be meticulously titrated to maintain a delicate balance of patient cooperation and optimal comfort.

Anesthesia↗
PubMed2003

[Anesthetic management for cerebral aneurysm surgery in a patient with aortitis syndrome accompanied by lung edema].

A 48-year-old woman with aortitis syndrome underwent clipping of dissecting aneurysm of the left posterior inferior cerebellar artery following subarachnoid hemorrhage. Preoperative echocardiography demonstrated moderate aortic regurgitation and pulmonary hypertension. Intravenous infusion (1900 ml.day-1) was performed to avoid cerebral vasospasm, but the patient developed lung edema. She received delayed surgical treatment after the improvement of lung symptoms. Anesthesia was induced with fentanyl (0.1 mg), propofol (90 mg) and vecuronium (6 mg). Radial arterial flow was judged to be insufficient for cannulation, and a cannulation was therefore performed on the dorsal pedis artery. During induction of anesthesia, there was a significant decrease in the arterial pressure, that required a total of 32 mg of intravenous ephedrine. Following tracheal intubation, a central venous catheter was inserted and dopamine was continuously administered. The patient was positioned in the park bench position. We thought that the placement of the introducer for Swan-Ganz catheter was difficult under the position and Swan-Ganz catheter was not inserted. Anesthesia was maintained with sevoflurane, air, and oxygen. We continuously monitored the central venous pressure as an indicator of fluid balance. In this case, we monitored dorsal pedis arterial pressure directly, which might not be sufficiently reliable to predict the decrease in cerebral blood flow.

Anesthesia↗
PubMed1993

Postural control reduced by subanesthetic nitrous oxide narcosis.

The effects of subanesthetic (21%) nitrous oxide (N2O) narcosis on postural control, as measured by posturography were studied in 12 subjects. Vibration induced body sway, with open and closed eyes, and body sway induced by a visual stimulus were evaluated. Adaptation was measured as the quotient of body sway variance between the second and first halves of each trial. Change in postural strategy was evaluated as change in the variance of shear forces relative to change in body sway. Subjective evaluation of narcosis was recorded. Body sway variance increased significantly during exposure to N2O, and equally for all body sway inducing stimuli. With the eyes open, adaptation to vibratory perturbation was significantly reduced by N2O. Postural strategy was unaffected by N2O, but differed significantly between stimuli, with relatively less involvement of shear forces during vibratory perturbation in the eyes open condition than during the other body sway inducing stimuli. Subjective evaluation of narcosis correlated with body sway variance during the visual stimulus. The present findings indicate that subanesthetic N2O narcosis reduces postural control. Adaptation to a balance disturbing stimulus, with undisturbed vision, is decreased by N2O. Visual clues are shown to be crucial to the postural strategy adopted to maintain balance. The effects of N2O are assumed to be due to impairment of sensorimotor integration in the CNS.

Adaptation, Physiological↗
PubMed1978

Cardiac output and peripheral resistance of swim-trained rats under urethan anesthesia.

Several circulatory variables were determined in control and swim-trained white rats under urethan anesthesia. Trained animals exhibited significantly lower heart rate and cardiac index and significantly higher peripheral resistance than control animals. Blood pressure, systolic index and left ventricular work output were not statistically different in the two groups. These results suggest an alteration of resting cardiovascular regulation in trained animals. Beta adrenergic mechanisms are suppressed by increased parasympathetic tone, and the resting circulatory balance is maintained mainly by increased alfa adrenergic mechanisms.

Anesthesia, General↗
PubMed2006

Influence of infusion volume on the ocular hemodynamic effects of peribulbar anesthesia.

PURPOSE: To test the hypothesis that ocular blood-flow response to peribulbar anesthesia can be reduced by using a smaller volume of anesthetic mixture. SETTING: Departments of Ophthalmology and Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. METHODS: Twenty patients scheduled for bilateral age-related cataract surgery were enrolled in a prospective randomized balanced observer-masked crossover study. Two study days with a 2 mL injection volume or 5 mL injection volume used for peribulbar anesthesia were scheduled. On 1 study day, patients received the 1-dose regimen and on the other study day, when the contralateral eye had surgery, patients received the other injection volume. On both study days, the anesthetic mixture consisted of an equal amount of lidocaine, bupivacaine, and hyaluronidase independently of the injection volume. Intraocular pressure (IOP), blood pressure, and pulse rate were measured noninvasively. Ocular fundus pulsation amplitude (FPA) and peak systolic and end diastolic flow velocities in the central retinal artery were measured with laser interferometry and color Doppler imaging, respectively. The results were recorded as means +/- SD. RESULTS: Peribulbar anesthesia increased IOP and reduced FPA and flow velocities in the central retinal artery. The effects on IOP (5 mL, 35.1% +/- 16.0%; 2 mL, 14.1% +/- 14.1%; P<.001) and ocular hemodynamic parameters (FPA: 5 mL, -17.5% +/- 7.8%/2 mL, -7.3% +/- 7.2%, P<.001; peak systolic velocity: 5 mL, -19.5% +/- 10.7%/2 mL, -10.6% +/- 9.8%, P = .013; end diastolic velocity: 5 mL, -16.7% +/- 6.2%/2 mL, -8.4% +/- 7.3%, P = .005) were more pronounced with the 5 mL injection volume than with the 2 mL injection volume. CONCLUSIONS: An injection volume of 2 mL instead of 5 mL reduced the ocular blood-flow response to peribulbar anesthesia. This procedure may be used in patients with ocular vascular disease to reduce the incidence of anesthesia-induced ischemia and loss of vision.

Aged↗
PubMed1996

Balanced analgesia improves recovery and outcome after outpatient tubal ligation.

Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission. Ninety patients were randomised to this double-blind study, the aim being to evaluate the effect of balanced analgesia on postoperative pain and recovery after sterilization. The balanced analgesia group received 5 ml of 2% lidocaine gel on the sterilization clips and perioperatively 200 mg of ketoprofen i.v. The lidocaine group received 5 ml of 2% lidocaine gel on the clips and placebo i.v. perioperatively. The placebo group received 5 ml of placebo gel on the clips and placebo i.v. perioperatively. Infusion of propofol and 67% nitrous oxide in oxygen were used for maintenance of anesthesia. Succinylcholine and vecuronium were used for muscle relaxation and 0.1 mg of fentanyl i.v. was given to all patients at induction of anesthesia. Postoperative pain and analgesic requirements, incidence of PONV and need for antiemetic medication were all significantly lower in the balanced analgesia group. Home readiness was consistently achieved 70-90 min sooner in the balanced analgesia group compared to the other groups (P < 0.01 between the balanced analgesia and the placebo group), and the patients were able to return to normal activity sooner (cumulatively 93% of the patients in the balanced analgesia group vs. 60% in the other two groups (P < 0.01 between the balanced analgesia and the other groups) had returned to normal activity on the 2nd postoperative day). It is concluded that in patients undergoing laparoscopic TL the combination of analgesic regimens with different mechanisms of action offer a simple and efficient way of postoperative pain relief, as well as an improvement of quality (i.e. less PONV) and speed of recovery.

Adult↗
PubMed1983

Management of the acid-base balance by the red blood cell carbonic anhydrase (RCA). I. Correlation of the RCA activity and acid-base balance in the in vitro and in vivo experiments.

Changes in RCA activity are known to affect the acid-base balance, but a clear relationship between RCA activity and acid-base balance has not yet been established. The relationship between RCA activity and acid-base balance was studied in tonometry with 4 mixed gases for 6-9 hr, in healthy adults at rest, in halothane anesthesia and in hypothermia. RCA activity increases when pH and HCO3-/PCO2 ratio increase and PCO2 decreases in vitro. It also increases when pH and HCO3-/PCO2 ratio decrease and the range of PCO2 broadens in vivo. The relationship between RCA activity and the HCO3-/PCO2 ratio is a fan shape, because a change of the HCO3-/PCO2 ratio precedes the change of RCA activity. Some factor which increases the RCA activity may be produced secondarily in the body under the influence of high PCO2. Probably the acid-base balance is corrected by reduction of the RCA activity in the case of alkalosis, and the acid-base balance may be corrected by an increase in RCA activity in the case of acidosis.

Acid-Base Equilibrium↗
PubMed1992

Effect of pentobarbital on cerebral regional venous O2 saturation heterogeneity.

Observed venous O2 saturation inhomogeneity in the brain implies a microregional imbalance in O2 supply/consumption. We hypothesized that this heterogeneity should be decreased by pentobarbital anesthesia through a reduction in regional metabolic heterogeneity. Male, Long-Evans, approximately 350 g rats were either anesthetized with 50 mg/kg pentobarbital (n = 10) or used as a conscious control group (n = 10, catheters inserted two hours earlier under ether anesthesia). In each rat, regional cerebral blood flow was determined by [14C]iodoantipyrine and regional arterial and venous O2 saturation were determined by microspectrophotometry. In the PB group, the mean blood pressure (107 +/- 7 Torr), heart rate (362 +/- 29/min), average cerebral blood flow (63 +/- 19 ml/min/100 g), and average cerebral O2 consumption (3.7 +/- 1.2 ml O2/min/100 g) were lower than those values in the conscious group (128 +/- 15, 474 +/- 44, 112 +/- 40, and 7 +/- 3), respectively. O2 extraction did not change after pentobarbital anesthesia. However, the dispersion of venous O2 saturation narrowed. The distribution of O2 saturations in 373 cerebral veins of anesthetized rats had a significantly reduced coefficient of variation [C.V. = 100 x (S.D./mean) = 13] as compared to a C.V. of 18 in 320 veins in conscious rats. Thus, pentobarbital anesthesia reduced the microregional venous O2 saturation inhomogeneity in the brain, creating a more uniform balance of oxygen supply and consumption.

Animals↗
PubMed2005

Enhancement of indomethacin-induced gastric damage by mouth breathing in rabbits.

Previous studies have reported that mouth breathing is associated with respiratory acidosis. Regarding to the reports that renal elimination of weak acids such as indomethacin is pH dependent, this study was carried out to evaluate the role of mouth breathing on plasma level of indomethacin and indomethacin-induced gastric damage in rabbits. Mouth breathing was induced by surgical ligation of nostrils under general anesthesia. One day after the operation, arterial blood samples were collected for acid-base balance analysis and indomethacin was administered intraperitoneally in a single dose of 40mg/kg. The animals were killed 4h after indomethacin administration and blood samples were collected for spectrofluorometric determination of indomethacin in plasma. The results showed that indomethacin induces more severe gastric damage in nose obstructed rabbits compared with sham and unoperated (UNOP) animals. Acid-base analysis revealed a respiratory acidosis in nose obstructed rabbits and indomethacin level of plasma was significantly higher in nose obstructed animals in comparison with control rabbits. The study shows that mouth breathing can increase the potentiation of indomethacin-induced gastric mucosal damage that may be due to higher level of indomethacin in plasma of nose obstructed animals.

Journal Article↗
PubMed1987

Granulocyte microbicidal function in patients undergoing major abdominal surgery under balanced anaesthesia.

Granulocyte microbicidal functions were studied in 11 major abdominal surgery patients with the luminol-enhanced chemiluminescence method. The responses of granulocytes in phagocytosis of zymosan, S. aureus and E. coli and responses to N-formylmethionyl-leucylphenylalanine (FMLP) were unaffected by surgery. The percentage of high-peroxidase-activity cells among neutrophils was increased on postoperative days 1 (P less than 0.01) and 3-4 (P less than 0.05). We propose that microbicidal-related oxidative phagocytic functions of granulocytes are well maintained after major abdominal surgery under balanced anaesthesia.

Abdomen↗
PubMed1994

Effects of strontium on calcium metabolism in rats. I. A distinction between the pharmacological and toxic doses.

Strontium at low doses has been used to treat osteoporosis. However, excessive doses can disturb calcium metabolism. The aim of the present study was to determine a dose that does not have any significant toxic effects on calcium contents in bone and calcium metabolism, and, consequently, to distinguish between pharmacological and toxic doses in rats. The rats were divided into a control, 0.05%-Sr, 0.10%-Sr and 0.50%-Sr groups (strontium intake approx. 0, 87.5, 175 and 875 mumol/day, respectively). All of the rats were pair-fed their respective diets containing various doses of strontium in single metabolic cages from when they were 36 to 63 days old. When the rats were 60 days old, bone formation, bone resorption, calcium balance and intestinal calcium absorption were calculated as calcium metabolic parameters over a 3-day period using calcium balance and kinetic studies. At the age of 64 days, the rats were sacrificed under anesthesia, and the femur and blood were collected. Calcium and strontium levels in the bone and serum were then measured. In the strontium groups that received less than 175 mumol/day, none of the calcium metabolic parameters were significantly affected. However, the calcium contents in the bone were significantly increased in the group that received 87.5 mumol/day group. On the other hand, in the group that received the highest dose of strontium (875 mumol/day), all of the calcium metabolic parameters measured were markedly suppressed. A decrease in calcium level in both the bone and serum was also observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Hemodynamic effects of perioperative stressor events during rhinoplasty.

The hemodynamic effects of perioperative stressors, including preoperative patient anxiety, intraoperative local anesthetic/adrenaline infiltrations, and some painful interventions, have not been fully elucidated in plastic surgery procedures. The present study was designed to determine the hemodynamic effects of perioperative stressor events in American Society of Anesthesiologists class I patients undergoing rhinoplasty procedures under general anesthesia. The study included 50 healthy patients, 18 to 51 years of age (mean age, 27 +/- 7 years), who underwent a rhinoplasty procedure in the authors' department. All patients were connected to a digital ambulatory Holter recorder for 24 hours starting on the day before the operation and continuing throughout the procedure. All of the patients received 10 ml of 2% lidocaine with 1:80,000 adrenaline 15 minutes after intubation. Observations consisted of heart rate, noninvasive blood pressure, and power spectral heart rate variability analyses, the latter of which is indicative of the sympathovagal balance of the patients. The majority of patients developed a persistent, moderate sinus tachycardia before the induction of anesthesia. After the infiltration of lidocaine/adrenaline, a mild to moderate and short-lasting tachycardia was detected. A similar increase in pulse rate was also noticed during lateral osteotomies. No significant blood pressure changes attributable to perioperative stressors (with the exclusion of general anesthesia induction, intubation, and extubation) were observed. Sympathetic activity was found to be responsible from marked tachycardia before the induction, which was attributable to preoperative anxiety. The authors' study has demonstrated that there are three hemodynamically unstable periods causing tachycardia for rhinoplasty patients that directly concern the plastic surgeon: immediate preoperative anxiety, local anesthetic/adrenaline injection, and lateral osteotomies. The authors conclude that these patients would benefit from routine use of premedications and that a lidocaine/adrenaline combination is a safe adjunct to general anesthesia in young rhinoplasty patients. In addition, a deeper anesthesia during local infiltration and osteotomies would be appropriate.

Adult↗
PubMed2006

Recovery of intentional dynamic balance function after intravenous sedation with midazolam in young and elderly subjects.

BACKGROUND AND OBJECTIVE: Computerized dynamic posturography using an intentional postural-sway task can be used to assess body-leaning ability and postural-control ability to prevent falls. Falls are the leading cause of morbidity and mortality for the elderly. The purpose of the present study was to evaluate the recovery of intentional dynamic balance function after intravenous sedation with midazolam in elderly subjects in comparison with that in young subjects. METHODS: Midazolam was administered in small, divided doses over 4-5 min until the Wilson sedation score reached three in 20 young and 18 elderly male volunteers. The dynamic limits of the stability test, in which subjects leaned their body intentionally as indicated by a cursor moving on a computer screen, was determined before (baseline) and 50, 70, 90, 110, and 130 min after administration of midazolam. RESULTS: The changes from baseline values of path sway and movement time 50 min after the administration of midazolam in elderly subjects (106.8 +/- 101.0%, 4.6 +/- 3.0 s; mean +/- SD) were significantly greater than those (32.9 +/- 87.2%, 1.9 +/- 2.8 s) in young subjects (P = 0.024, P = 0.008), respectively. CONCLUSIONS: The elderly show slower recovery of the intentional dynamic balance function than do young adults after intravenous sedation with midazolam.

Adult↗
PubMed1982

Morphine increases myocardial infarction size in rats.

Morphine anesthesia is often recommended in patients with reduced cardiac reserve. As the effect of morphine on the balance between myocardial oxygen supply and demand is not well understood, the effect of large doses of morphine (3 mg/kg, subcutaneously) on experimental myocardial infarction size in the rat was evaluated. Morphine was administered 10 minutes before thoracotomy and coronary artery ligation. Myocardial infarction size was assessed by histologic techniques 48 hours later. Rats given morphine developed significantly larger infarctions than did rats receiving an injection of saline (45.8% of left ventricular area versus 35.3%, p less than 0.05). The data indicate that morphine increase the area of myocardial ischemia when administered before coronary artery occlusion in rats.

Anesthesia↗
PubMed1994

Postoperative pain management.

Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. Hence the availability of more sophisticated and effective treatment modalities, such as ambulatory PCA and continuous local and regional anesthetic blocks, with minimal side effects, are necessary to optimize the benefits of ambulatory surgery for both patient and health care provider. However, outcome studies are needed to evaluate the effect of these newer therapeutic approaches with respect to postoperative side effects and other important recovery parameters. Recent studies suggest that factors other than pain per se must be controlled to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anesthetic technique can influence analgesic requirement in the early postoperative period. Although oral analgesic agents will continue to play an important role, the adjunctive use of local anesthetic agents is likely to assume an even greater role in the future. Use of drug combinations (e.g., opiates and local anesthetics, opiates and NSAIDs) may provide improved analgesia with fewer side effects. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after ambulatory surgery. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress-free" anesthesia with minimal postoperative discomfort is now possible for most patients undergoing elective surgical procedures. The aim of an analgesic technique should be not only to lower the pain scores but also to facilitate earlier mobilization and reduce perioperative complications. If future clinical investigations clarify the issues that have been raised by laboratory studies, clinicians may be able to effectively treat postoperative pain using combinations of "balanced," "preemptive," and "peripheral" analgesia. More important, improved analgesic techniques will increase patient satisfaction and enhance their perception of ambulatory anesthesia and surgery.

Ambulatory Surgical Procedures↗
PubMed1998

Anesthesia for carotid endarterectomy.

Patients presenting for carotid endarterectomy provide anesthesiologists with many challenges. These include optimization of cerebrovascular hemodynamics and oxygen balance, as well as minimizing myocardial risk. Fiscal pressures have encouraged the development of clinical pathways in many centers, with a remarkable trend towards decreased intensive care unit utilization and length of hospital stay. Anesthetic and surgical practices vary widely, but outcomes in these high-risk patients are usually excellent despite these differences. The potential for expanded indications for carotid endarterectomy and development of percutaneous treatment for carotid stenosis will provide neurovascular anesthesiologists with additional incentives to refine the anesthetic management of these patients.

Journal Article↗