PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Anesthesia, Inhalation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 829 records · Page 46Linked to original sources
PubMed2005

[Effect of esmolol on cardiovascular responses induced by scopolamine butylbromide].

BACKGROUND: Scopolamine butylbromide (hyoscine-N-butylbromide, HB) is an anticholinergic drug used as a smooth muscle relaxant, and is used even in some surgical procedures during general anesthesia. HB also causes an increase in heart rate as a side effect. The authors evaluated the efficacy of esmolol on hemodynamic changes induced by HB in major abdominal surgery under inhalation anesthesia. METHODS: Seventeen patients for major abdominal surgery were randomly assigned to control group (C group, n = 9) or to esmolol group (E group, n = 8). Anesthesia was induced with propofol and was maintained with isoflurane-nitrous oxide inhalation and intermittent administration of fentanyl and vecuronium. At the time of bowel anastomosis, 20 mg of HB was administrated as an antispasmodic. In E group, esmolol 0.6 mg x kg(-1) was administered immediately after HB administration. RESULTS: There were no differences in the patient background between the two groups. At 1 to 10 minutes after HB administration, heart rate increased significantly compared with that at pre-administration in C group, while there was no significant change in heart rate in E group. Heart rate in E group was significantly lower than that in C group at 2 and 3 minutes after HB administration. Blood pressure was not significantly changed in both groups during the observation period. CONCLUSIONS: The simultaneous administration of HB and esmolol was useful for heart rate control after HB administration.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Late postoperative apnea in a premature newborn infant].

We report the case of a premature newborn child (36 weeks) who was operated on a teratoma of the sacrum when he was 12 days old and weighed 2,950 g. The patient presented a late postoperative apnea 17 hours after anesthesia. The anesthetic technique consisted of lumbar epidural blockade with 0.33% bupivacaine at a dose of 2.25 ml and superficial inhalation anesthesia with 0.5% isoflurane. Relaxing muscular agents used in this case were succinylcholine (3 mg) for orotracheal intubation and pancuronium bromide (0.3 mg) for maintaining the anesthetic level. The immediate postoperative phase was uneventful but 17 hours after surgery the patient presented apnea, bradycardia (40 beats/min), and marked cyanosis requiring assisted ventilation with bag and mask during 3 min and initial cardiac massage. Recovery of heart rate was immediate and recovery of ventilation was progressive. The patient was treated with caffeine during one week and no relapses occurred. Pneumocardiographic recordings obtained later on revealed sporadic short lasting episodes of apnea (shorter than 15 s) sometimes associated with bradycardia (40 beats/min lower than baseline). There were no apparent intercurrent or precipitating factors for this apnea. We believe that the present clinical picture corresponds to a late postoperative apnea of unknown origin which required reanimation measures and that until present, there are no reported complications of the anesthetic technique that can explain this episode.

Anesthesia, Epidural↗
PubMed1993

[Practical methods of using propofol as a complement to loco-regional anesthesia in children].

Propofol fulfills most of the requirements for the ideal intravenous agent usable in conjunction with regional anesthesia in children, especially for outpatient surgery. Some limitations are easily overcome by simple means such as contact anesthesia of the skin prior to venous puncture or addition of lidocaine (1 ml 1% lidocaine in 20 ml of propofol). In clinical practice, it is mandatory that the sites of puncture (venous line as well as block technique) be anesthetized by skin application of EMLA cream and that anxious children be given premedication (0.3 mg.kg-1 of rectal midazolam). Recommended induction dose of propofol is 3 to 4 mg.kg-1. Maintenance of anesthesia can be achieved either by continuous infusion of 2 to 5 mg.kg-1.h-1 of propofol or by inhalation anesthesia with low concentrations of halogenated agents. Spontaneous ventilation through a face mask or a laryngeal mask is usually made possible. Satisfactory conditions for performing the regional block technique are especially obtained when the skin at the site of puncture is anesthetized. Adverse effects are unusual and mainly consist of undesirable movements, the occurrence of which is favored by the existence of a differential sensory block. Propofol allows easy and complete post-anesthesia awakening and it has anti emetic and anxiolytic effects: due to these properties, it is remarkably suitable for use in association with regional anesthesia in children.

Ambulatory Surgical Procedures↗
PubMed1982

[Oxygen transport in general anesthesia with ftorotan and sodium oxybutyrate].

The functional capacity of the oxygen transport system was studied in 51 patients subjected to the operative treatment for the complicated ulcerous disease. The general inhalation anesthesia by fluothane resulting in a decreased oxygen transport might limit the adequate metabolism. The general intravenous anesthesia by sodium hydroxybutyrate is followed by a true hypometabolic effect without any decrease in the efficiency of the cardio-vascular, system and disorders in the functional capacity of the oxygen transport system.

Anesthesia, General↗
PubMedDate not supplied

[Mediastinal tumors in children: apropos of 2 cases].

General anesthesia in patients with mediastinal tumors has specific problems that need careful evaluation before surgery. Sometimes, mediastinal masses may result in life threatening complications, such as upper airway obstruction, superior vena cava syndrome, cardiac or pulmonary artery compression and acute pulmonary edema. After a review of the literature related to death during general anesthesia in children with mediastinal tumors, we emphasize the importance of the agreement between oncologists, surgeons and anesthesiologists for a sound diagnosis of these patients. We report two patients which illustrate the possibility of airway obstruction during anesthesia. The first was a 13-year-old female with an anterior and mean mediastinal tumor who had severe respiratory complications during general anesthesia for biopsy of cervical lymphadenopathy . The second patient was a 2-year-old female with anterior mediastinal and paratracheal masses and severe respiratory compromise, who was operated under general inhalation anesthesia and spontaneous breathing for biopsy of supraclavicular lymphadenopathy, after a meticulous preanesthetic evaluation. In these patients, the anesthetic procedure is a challenge to the anesthesiologist. Inhalation induction in a half seated position is recommended, maintaining the patient with spontaneous ventilation with halogenated agents and avoiding muscle relaxants.

Adolescent↗
PubMedDate not supplied

Caudal epidural anesthesia in awake premature neonates for inguinal herniorrhaphy.

Postoperative apnea (PA) occurs between 12 and 40% in premature infants, varying inversely in postconceptual age (risk is greater if age is less than 44 weeks). It can appear as late as 12 hours after the end of the surgical anesthesia (7). In a recent article (1), the author related the occurrence of PA in an ex-premature infant submitted to inhalation anesthesia The use of regional blockings is pointed out as one of the solutions for the problem (9,5). This paper is about the use of caudal epidural anesthesia in a premature neonate, submitted to bilateral inguinal herniorraphy.

Anesthesia, Caudal↗
PubMedDate not supplied

[Comparison of the effects of isoflurane and alfentanyl on the mononuclear-phagocytic system].

BACKGROUND AIMS: The effects of two anesthetic agents, alfentanil and isoflurane, on the macrophage-monocytic system and the relation with the adrenocortical-hypophyseal axis were analyzed. MATERIAL AND METHODS: Thirty ASA I-II patients submitted to elective surgery were distributed into two groups: group I, analgesic anesthesia with alfentanil 100 micrograms/kg, a perfusion of 2-3 micrograms/kg/min and naloxone 0.2-0.4 mg upon termination of surgery; group II, inhalation anesthesia with isoflurane at 2-2.5% and O2/air = 1/1. HLA-DR membrane receptors and vimentin threads of the cytoskeleton were determined in basal conditions, at one hour and two hours of induction and upon termination of surgery by means of indirect immunofluorescence with the use of monoclonal antibodies. Phagocytosis of latex particles was also measured and ACTH and cortisol levels were obtained by radioimmunoassay. RESULTS: In group I (alfentanil) a decrease (p < 0.01) of all the monocyte parameters analyzed, which was more significant than that observed in group II (isoflurane), was observed. In group II only the expression of HLA-DR and the index of phagocytosis (p < 0.05) were statistically significant. Following the administration of naloxone a reversion of these parameters was observed. The maximum immune depression corresponded with the lowest values of ACTH and cortisol (group I) with surgical stress being discarded as the cause of this immunodepression. CONCLUSIONS: Alfentanil produces a monocytic depression which reverses following the administration of naloxone, thus discarding surgical stress as the cause of this immunodepression suggesting a mechanism mediated by opiate receptors. With regards to isoflurane, the functions of the mononuclear-phagocytic system were hardly altered in the patient studied.

Adrenocorticotropic Hormone↗
PubMed1994

[Respiratory exchange during laparoscopic and laparotomic cholecystectomy].

The utility of laparoscopic cholecystectomy in reducing postoperative pain and patient's hospital discharge is already known. Nevertheless peritoneal gas insufflation required by surgical procedure can modify respiratory homeostasis during general anesthesia. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy on pulmonary dead spaces and alveolar gas exchange during inhalation anesthesia compared with traditional laparotomic cholecystectomy. With the approval of Hospital Ethical Committee, thirty-one patients undergoing isoflurane general anesthesia for laparoscopic (CL-S, n = 16) and open (CL-T, n = 15) cholecystectomy were prospectively evaluated in order to asses modifications in physiological (VDphy/VT), anatomical (VDan/VT) and alveolar (VDalv/VT) dead space to tidal volume ratio, arterial to end-tidal carbon dioxide partial pressure difference [P(a-Et)CO2] and alveolar to arterial oxygen partial pressure difference (A-aDO2). Patients, 21-64 years-old, ASA I-II, had no cardiopulmonary diseases. The CL-S group required peritoneal insufflation of carbon dioxide with an intraabdominal pressure (IAP) of about 10-14 mmHg and antitrendelenburg positioning (15-20 degree). Expired gas measurements and arterial blood gas sample for pulmonary dead spaces and arterial to alveolar CO2 and O2 gradient calculation were performed 20 min after a steady state condition. VDphy/VT, VDalv/VT, P(a-Et)CO2 and A-aDO2 increased significantly in the CL-S compared to the CL-T group (p < 0.05). No differences were found in the VDan/VT. These results can be explained by analteration of the ventilation to perfusion ratio (VA/Q) with an increase of high VA/Q regions due to the antitrendelenburg positioning with a redistribution of blood flow towards basal zones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

The effects of sevoflurane and halothane anesthesia on cerebral blood flow velocity in children.

UNLABELLED: We compared cerebral blood flow velocity during anesthesia with sevoflurane and halothane in 23 children admitted for elective surgery (age, 0.4-9.7 yr; median age, 1.9 yr; ASA physical status I-II). Inhaled induction was performed in a randomized sequence with sevoflurane or halothane. Under steady-state conditions, cerebral blood flow velocity (systolic [V(s)], mean [V(mn)], and diastolic [VD]) were measured by a blinded investigator using transcranial pulsed Doppler ultrasonography. The anesthetic was then changed. CBFV measurements were repeated after washout of the first anesthetic and after steady-state of the second (equivalent minimal alveolar concentration to first anesthetic). The resistance index was calculated. VD and V(mn) were significantly lower during sevoflurane (V(mn) 1.35 m/s) than during halothane (V(mn) 1.50 m/s; P = 0.001), whereas V(s) was unchanged. The resistance index was lower during halothane (P < 0.001). Our results indicate lower vessel resistance and higher mean velocity during halothane than during sevoflurane. IMPLICATIONS: The mean cerebral blood flow velocity is significantly decreased in children during inhaled anesthesia with sevoflurane than during halothane. This might be relevant for the choice of anesthetic in children with risk of increased intracranial pressure, neurosurgery, or craniofacial osteotomies.

Anesthetics, Inhalation↗
PubMed2006

Sevoflurane modulates the activity of glyceraldehyde 3-phosphate dehydrogenase.

The mechanism of inhalation anesthesia remains to be fully elucidated. While certain neuronal membrane proteins are considered sites of action, cytosolic proteins may also be targets. We hypothesize that inhaled anesthetics may act via glyceraldehyde 3-phosphate dehydrogenase (GAPDH), which has recently been shown to participate in neuronal inhibition. We examined the effects of sevoflurane, a halogenated ether anesthetic, on the catalytic and fluorescence properties of GAPDH. Initial rates of oxidoreductase activity decreased approximately 30% at saturating levels of sevoflurane. NADH-stimulated oxidoreductase activity (25 microM NADH; 0.8mM NAD+) increased with sevoflurane. Sevoflurane quenched tryptophan fluorescence emission and increased polarization. Additionally, sevoflurane increased the susceptibility of GAPDH to thermal denaturation suggesting an effect on conformation. Our findings warrant further research on sevoflurane's effect on GAPDH and indicate that this approach may lead to delineation of a novel contribution to the mechanism of anesthesia.

Animals↗
PubMed1999

Effects of vaginal birth versus caesarean section birth with general anesthesia on blood gases and brain energy metabolism in neonatal rats.

Using a rat model, several laboratories have demonstrated long-term effects of Caesarean section (C-section) birth or of global hypoxia during C-section birth on a variety of central nervous system (CNS) parameters. These studies used C-section delivery from rapidly decapitated dams, to avoid confounding anesthetic effects, or from dams anesthetized with halothane or ether under unspecified conditions. Systemic oxygenation or cerebral energy metabolites in the pups at birth have not been systematically measured in this model. To develop and characterize a C-section model with relevance to the human situation, the present study measured arterial/venous blood gases and pH and brain ATP and lactate, a widely accepted measure of CNS hypoxia, in pups born either vaginally, by C-section from decapitated dams, or by C-section from dams anesthetized with nitrous oxide (N2O) and increasing concentrations of isoflurane under well-defined conditions. Immediately after birth, pups born vaginally, by C-section with maternal decapitation, or by C-section with 2.5% isoflurane showed no group differences in systemic pO2 or pH or brain ATP levels, but pCO2 was elevated in the C-section/2.5% isoflurane group. Pups born by C-section with 3.0, 3.5, or 4.0% isoflurane, showed progressive reductions in blood pO2 and increases in pCO2 and blood pH was reduced with 3.5% isoflurane. Relative to vaginal birth, brain lactate levels were unchanged in pups born by C-section with any concentration (2.5-4.0%) of isoflurane, but reduced in pups born by C-section from decapitated dams. At 1 h (and 4 h) after birth, in both vaginally born controls and the 2.5% isoflurane group, brain lactate fell while blood pO2 and brain ATP remained stable. In the 3.0, 3.5, or 4.0% isoflurane groups, blood gases and pH and brain lactate also normalized to control values. In conclusion, rat neonates show minimal signs of systemic or CNS hypoxia following C-section birth under 2.5% isoflurane with N2O. However, there is a rather narrow window of isoflurane concentrations which produces effective maternal anesthesia without producing respiratory compromise in the neonate. Thus the results indicate that the level of maternal anesthesia employed is an important factor influencing neonatal systemic and CNS oxygenation during C-section birth.

Adenosine Triphosphate↗
PubMed1995

Haemodynamic instability and myocardial ischaemia during carotid endarterectomy: a comparison of propofol and isoflurane.

The purpose of this study was to compare two anaesthetic protocols for haemodynamic instability (heart rate (HR) or mean arterial pressure (MAP) < 80 or > 120% of ward baseline values) measured at one-minute intervals during carotid endarterectomy (CEA). One group received propofol/alfentanil (Group Prop; n = 14) and the other isoflurane/alfentanil (Group Iso; n = 13). Periods of haemodynamic instability were correlated to episodes of myocardial ischaemia as assessed by Holter monitoring (begun the evening before surgery and ceasing the morning of the first postoperative day). In Group Prop, anaesthesia was induced with alfentanil 30 micrograms.kg-1 i.v., propofol up to 1.5 mg.kg-1 and vecuronium 0.15 mg.kg-1, and maintained with infusions of propofol at 3-12 mg.kg-1.hr-1 and alfentanil at 30 micrograms.kg-1.hr-1. In Group Iso, anaesthesia was induced with alfentanil and vecuronium as above, thiopentone up to 4 mg.kg-1 and maintained with isoflurane and alfentanil infusion. Phenylephrine was infused to support MAP at 110 +/- 10% of ward values during cross-clamp of the internal carotid artery (ICA) in both groups. Emergence hypertension and/or tachycardia was treated with labetalol, diazoxide or propranolol. Myocardial ischaemia was defined as ST-segment depression of > or = 1 mm (60 msec past the J-point) persisting for > or = one minute. For the entire anaesthetic course (induction to post-emergence), there was no difference between groups for either duration or magnitude outside the < 80 or > 120% range for HR or MAP. However, when the period of emergence from anaesthesia (reversal of neuromuscular blockade to post-extubation) was assessed, more patients were hypertensive (P = 0.004) and required vasodilator therapy in Group Iso (10/13 vs 5/14; P = 0.038 Fisher's Exact Test). The mean dose of labetalol was greater in Group Iso (P = 0.035). No patient demonstrated myocardial ischaemia during ICA cross-clamp. On emergence, 6/13 patients in Group Iso demonstrated myocardial ischaemia compared with 1/14 in Group Prop (P = 0.029). Therefore, supporting the blood pressure with phenylephrine, during the period of ICA cross-clamping, appears to be safe as we did not observe any myocardial ischaemia at this time. During emergence from anaesthesia, haemodynamic instability was associated with myocardial ischaemia. Under these specific experimental conditions, with emergence, hypertension and myocardial ischaemia were more prevalent with more frequent pharmacological interventions in patients receiving isoflurane.

Aged↗
PubMed1998

Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia.

PURPOSE: To determine the magnitude of the potentiation of rocuronium by desflurane, isoflurane and sevoflurane 1.5 MAC anaesthesia. METHODS: In a prospective, randomised, study in 80 patients, the cumulative dose-effect curves for rocuronium were determined during anaesthesia with desflurane, sevoflurane and isoflurane (with N2O 70%, 15 min steady state) or total intravenous anaesthesia (TIVA) using propofol/fentanyl. Neuromuscular block was assessed by acceleromyography (TOF-Guard) after train-of-four (TOF) stimulation of the ulnar nerve (2 Hz every 12 sec, 200 microseconds duration). Rocuronium was administered in increments of 100 micrograms.kg-1 until first twitch (T1) depression > 95%. RESULTS: Rocuronium led to more pronounced T1 depression with desflurane or sevoflurane anaesthesia than with TIVA. The ED50 and ED95 were lower during desflurane (95 +/- 25 and 190 +/- 80 micrograms.kg-1) and sevoflurane (120 +/- 30 and 210 +/- 40 micrograms.kg-1) than with TIVA (150 +/- 40 and 310 +/- 90 micrograms.kg-1) (P < .01), while the difference was not significant for isoflurane (130 +/- 40 and 250 +/- 90 micrograms.kg-1). Following equi-effective dosing (T1 > 95%) the duration to 25% T1 recovery, recovery index (25/75), and TOF0.70 was: 13.2 +/- 1.8, 12.7 +/- 3.4, and 26.9 +/- 5.7 min during anaesthesia with desflurane; 15.5 +/- 5.0, 11.4 +/- 3.8, and 31.0 +/- 6.0 min with sevoflurane; 13.9 +/- 4.7, 10.7 +/- 3.3, and 26.3 +/- 8.9 min with isoflurane; and 13.9 +/- 3.9, 11.3 +/- 5.7, and 27.5 +/- 8.2 min with TIVA anaesthesia (P: NS). CONCLUSION: Interaction of rocuronium and volatile anaesthetics resulted in augmentation of the intensity of neuromuscular block but did not result in significant effects on duration of or recovery from the block.

Adult↗
PubMed2004

Sevoflurane for interventional neuroradiology procedures is associated with more rapid early recovery than propofol.

PURPOSE: Sevoflurane and propofol are both suitable for neuroanesthesia but have not previously been compared as maintenance agents for long duration (one to five hours) procedures. METHODS: Using a multicentre international study protocol, 103 patients were randomized to receive either sevoflurane or propofol for maintenance of anesthesia during interventional neuroradiology procedures. After a standardized induction of anesthesia with propofol, 53 patients received sevoflurane 1 to 3% with 60% nitrous oxide (N(2)O) in oxygen (O(2)), and 50 patients received propofol 4 to 10 mg x kg(-1) x hr(-1) with 60% N(2)O in O(2). Maintenance agents were titrated against systemic arterial blood pressure (baseline mean arterial pressure +/- 20%). Recovery times, changes in sedation, pain, nausea and vomiting and psychomotor function during recovery and use of rescue medication were recorded. RESULTS: The group receiving sevoflurane had a more rapid recovery to spontaneous ventilation, extubation, eye opening and orientation compared to the group receiving propofol (3 vs 4 min, P = 0.01; 5 vs 6 min, P = 0.015; 7 vs 10 min, P < 0.001; 13 vs 17 min, P = 0.028; respectively). Sedation, pain, nausea and vomiting, and psychomotor function scores were similar in the two groups. Use of opioid boluses and vasopressors were similar. CONCLUSION: The use of sevoflurane for maintenance of anesthesia for prolonged neuroradiological procedures is associated with more rapid early recovery than propofol and is associated with similar side effects. Sevoflurane and propofol can both be recommended for these procedures. The clinical benefit of the more rapid recovery with sevoflurane is unknown.

Adolescent↗
PubMed2002

[Pharmacoeconomical model for cost calculation using a study on prophylaxis of nausea and vomiting in the postoperative phase as an example. Cost effectiveness analysis of a tropisetron supplemented desflurane anaesthesia in comparison to a propofol total intravenous anaesthesia (TIVA)].

AIM OF THE STUDY: Postoperative nausea and vomiting (PONV) are among the most frequent complications after general anaesthesia. Avoiding these symptoms is of utmost importance for most patients; PONV is not only a major source of discomfort for patients but also a cause of additional costs for the patients and the health care provider. The economical impact of PONV will become even more important in the near future because the number of surgical procedures performed on an ambulatory basis is increasing. The following article gives a short overview of the terminology and measures used in pharmacoeconomical studies concerning PONV. Furthermore the economical aspects of a low-flow anaesthesia supplemented with the 5-HT(3)-antagonist tropisetron compared with a total intravenous anaesthesia (TIVA) using propofol are described. METHODS: For this comparison a decision analysis was performed using data of a randomised control trial on 150 female patients undergoing major gynaecological surgery. The patients were randomised to receive a total intravenous anaesthesia with propofol-alfentanil or a balanced anaesthesia with desfluran (fresh gas flow 1 l.min(-1)) supplemented by 2 mg tropisetron at the end of surgery. RESULTS: Indirect costs associated with anaesthesia using desflurane-tropisetron (4.94 Euro) are not different from that of propofol-TIVA (4.81 Euro) because of a similar incidence of PONV in the PACU. Furthermore, the total cost for 100 min general anaesthesia is higher in the desflurane-tropisetron group (30.94 Euro) compared with the TIVA group (24.55 Euro) due to the decreasing acquisition costs of propofol in the last 2 years. CONCLUSION: Total intravenous anaesthesia with propofol is more cost-efficient than balanced anaesthesia with desflurane and additional tropisetron as a prophylactic antiemetic.

Adult↗