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[Comparison of oxygen saturations in mixed venous and central blood during thoracic anesthesia with selective single-lung ventilation].

OBJECTIVES: To establish the ratio of oxygen saturation in mixed venous to that of central venous blood in patients undergoing thoracic surgery, in order to rationalize use of the pulmonary arterial catheter. MATERIAL AND METHODS: We compared simultaneous spectrophotometric in vivo measurements for SvO2 [Abbott Oximetrix 3/SvO2 (O)] and in vitro analysis of blood taken from the distal opening of the catheter (co-oximeter/SvO2 [CO]), with in vitro analysis of central venous blood from the superior vena cava (co-oximetry/SvcO2 [CO]) for 23 patients scheduled for lung resection by thoracotomy in lateral decubitus with single lung ventilation and the same type of monitoring and anesthesia. Measurements were taken 15 min after induction (M1), after 15 minutes in lateral decubitus (M2), 5 minutes after pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6) and after 5 min supine (M7). RESULTS: SvO2(O) was higher than SvcO2 (CO) at M1, M3, M6 and M7 and the mean difference between the two concentrations was always less than 0.9%. SvcO2 (CO) was always higher than SvO2 (CO) (M1 to M7) and the mean difference was less than 1.3%. Simple linear correlation was significant (p < 0.001) for each of the measurements as well as for the whole sample. Both bias (0.2 and 0.7%) and its standard deviation (2.7 and 2.5%) between the two techniques were small and the differences between all measurements were less than 5% in 97 and 95.6%. CONCLUSION: For thoracic anesthesia in patients who are not good candidates for catheterization of the pulmonary artery, continuous measurement of SvO2 may be substituted for that of SvcO2 in order to monitor the balance of supply/demand.

Adult↗
PubMed1981

Evaluation of instrumented force platform as a test to measure residual effects of anesthetics.

Recovery from anesthesia was assessed in a controlled manner in 38 healthy student volunteers, using two psychomotor tests (perceptual speed and tapping board) and an instrumented force platform 1, 3, 5 and 7 h after intravenous injection of 0.3 mg/kg diazepam, 2.0 mg/kg methohexital, 6.0 mg/kg thiopental or saline. Postural stability remained unaltered but the performance on psychomotor tests improved when the tests were repeated after saline injection. Methohexital did not induce any changes in body sway or psychomotor performance at the time periods tested when compared with saline. Postural stability of subjects receiving thiopental or diazepam was imparied (P less than 0.001) for 1 and 7 hours after anesthesia, respectively, when compared with saline. The impairment on performance in the psychomotor tests induced by thiopental or diazepam was of smaller magnitude and for diazepam of shorter duration than balance disturbances measured with the body sway tests. Further clinical studies on the use of the instrumented force platform as a fast and easily interpretable guideline for discharge from hospital after different modes of outpatient anesthesia are warranted.

Adult↗
PubMed1999

Cost analysis of target-controlled infusion-based anesthesia compared with standard anesthesia regimens.

UNLABELLED: With the development of new computer-assisted target-controlled infusion (TCI) systems and the availability of short-acting anesthetics, total IV anesthesia (TIVA) has become increasingly popular. The aim of this study was to compare costs of TCI-based anesthesia with two standard anesthesia regimens. Sixty patients undergoing elective laparoscopic cholecystectomy were randomly divided into three groups. Group 1 (TIVA/TCI) received TIVA using a propofol-based TCI system and continuous administration of remifentanil; Group 2 (isoflurane) underwent inhaled anesthesia with isoflurane, fentanyl, and N2O; Group 3 (standard propofol) received fentanyl and N2O and a continuous infusion of propofol using a standard delivery system. Maintenance doses for anesthetics were adjusted according to the patient's need. Isoflurane consumption was measured by weighing the vaporizer by using a precision weighing machine. Duration of surgery and of anesthesia was similar in the three groups. Time from stopping administration of anesthetics until tracheal extubation (6+/-2 min) and stay in the postanesthesia care unit (PACU; 70+/-12 min) were shorter in Group 1 than in the Groups 2 (15+/-3 and 87+/-13 min, respectively) and 3 (10+/-4 and 81+/-14 min, respectively) (P < 0.05). Episodes of postoperative nausea and vomiting in the PACU and on the surgical ward were less common in Group 1 than in the other two groups. Intraoperative costs were higher in Group 1 ($62.19/patient; $0.55/min of anesthesia) than in Groups 2 ($16.97/patient; $0.13/min of anesthesia) and 3 ($34.68/patient; $0.32/min of anesthesia). Cost for discarded anesthetic drugs accounted for almost 18% of total intraoperative costs in Group 1. We conclude that TIVA/TCI anesthesia using propofol/remifentanil was associated with the highest intraoperative costs but the fewest postoperative side effects. An overall cost-effectiveness analysis of new anesthetic regimens must balance the direct cost of anesthetics and beneficial effects leading to improved patients' comfort. IMPLICATIONS: In today's climate of cost-consciousness, careful economic evaluation of new anesthetic regimens is necessary. A target-controlled infusion (TCI)-based total IV anesthesia (TIVA) regimen using propofol and remifentanil was compared with a standard propofol anesthesia regimen and an inhaled anesthetic technique using isoflurane. Target-controlled infusion/total IV anesthesia was associated with the largest intraoperative costs but allowed the most rapid recovery from anesthesia, was associated with fewest postoperative side effects, and permitted earlier discharge from the postanesthesia care unit.

Adult↗
PubMed1999

Increased reading speed for stories presented during general anesthesia.

BACKGROUND: In the absence of explicit memories such as the recall and recognition of intraoperative events, memory of auditory information played during general anesthesia has been demonstrated with several tests of implicit memory. In contrast to explicit memory, which requires conscious recollection, implicit memory does not require recollection of previous experiences and is evidenced by a priming effect on task performance. The authors evaluated the effect of a standardized anesthetic technique on implicit memory, first using a word stem completion task, and then a reading speed task in a subsequent study. METHODS: While undergoing lumbar disc surgery, 60 patients were exposed to auditory materials via headphones in two successive experiments. A balanced intravenous technique with propofol and alfentanil infusions and a nitrous oxide-oxygen mixture was used to maintain adequate anesthesia. In the first experiment, 30 patients were exposed randomly to one of the two lists of 34 repeated German nouns; in the second experiment, 30 patients were exposed to one of two tapes containing two short stories. Thirty control patients for each experiment heard the tapes without receiving anesthesia. All patients were tested for implicit memory 6-8 h later: A word stem completion task for the words and a reading speed task for the stories were used as measures of implicit memory. RESULTS: The control group completed the word stems significantly more often with the words that they had heard previously, but no such effect was found in the anesthetized group. However, both the control and patient groups showed a decreased reading time of about 40 ms per word for the previously presented stories compared with the new stories. The patients had no explicit memory of intraoperative events. CONCLUSIONS: Implicit memory was demonstrated after anesthesia by the reading speed task but not by the word stem completion task. Some methodologic aspects, such as using low frequency words or varying study and test modalities, may account for the negative results of the word stem completion task. Another explanation is that anesthesia with propofol, alfentanil, and nitrous oxide suppressed the word priming but not the reading speed measure of implicit memory. The reading speed paradigm seems to provide a stable and reliable measurement of implicit memory.

Adult↗
PubMed2001

Computerised dynamic posturography to assess recovery comparing general anaesthesia with sedation and local anaesthesia for day case nasal surgery.

Computerised dynamic posturography (CDP) can be used as an early marker of recovery to street fitness in patients undergoing ambulatory surgery. We studied three groups of patients undergoing nasal surgery. The goal of this study was to determine whether recovery, as assessed by CDP, is more rapid in patients having nasal surgery under sedation coupled with local anaesthesia or those having surgery under general anaesthesia. We further assessed the acceptability of sedation accompanied by local anaesthesia. A control group was included to determine if there is a learning curve to posturography. There was no difference between the two study groups in terms of balance. Balance was not significantly impaired at 3 h postoperative testing.

Adult↗
PubMed2006

[Perioperative changes in the circulatory blood volumes in patients undergoing the abdominal aortic aneurysm repair].

BACKGROUND: The effect of the intraoperative volume load on the circulating blood volume is unclear. Therefore, we investigated the changes of the perioperative blood volume in patients undergoing major surgery. METHODS: In 16 patients undergoing abdominal aortic aneurysm repair, we measured the circulating blood volume (BV x kg(-1)) with the pulse dyedensitometry method (DDG analyzer) before operation, just after operation, on the first postoperative day (1POD) and 2POD. Anesthesia was maintained with general anesthesia and epidural analgesia. The volume of infusion depended on empiric judgment by an anesthesiologist. RESULTS: Mean anesthesia time was 390 minutes, the mean volume of infusion 4225 ml, transfusion 1329 g, blood loss 1567 g, urine output 729 ml, and mean water balance +3287 ml. The mean body weight (BW) was 59.2 +/- 13.7 (before), 60.2 +/- 14.4 (just after), 60.5 +/- 14.3 (1POD), and 60.3 +/- 14.3 (2POD) kg, respectively. The mean BV x kg(-1) was 78.0 +/- 19.0 (before), 65.6 +/- 13.4 (just after), 70.4 +/- 15.7 (1POD), and 76.5 +/- 18.2 (2POD) ml x kg(-1), respectively. The mean BW after operation increased significantly from the value before surgery. However, the mean BV x kg(-1) decreased significantly. There was a significant correlation between the intraoperative increase in BW and intraanesthetic water balance (Y = -2.91 + 0.071X; R = 0.66, P = 0.0412), but there was no significant correlation between the change in BV x kg(-1) and intraanesthetic water balance. CONCLUSIONS: Intraoperative water balance influenced a change of BW significantly, but did not affect BV x kg(-1).

Aged↗
PubMed1996

[Effect of efonidipine hydrochloride on myocardial oxygen balance in anesthetized dogs].

The aim of the present study was to investigate the effect of efonidipine hydrochloride (efonidipine) on myocardial oxygen balance in anesthetized open-chest dogs, and the results were compared to those of nifedipine or nisoldipine. Efonidipine (10 and 30 micrograms/kg) lowered the mean blood pressure, and the extent of the hypotension was similar to those induced by nifedipine (1 and 3 micrograms/kg) and nisoldipine (1 and 3 micrograms/kg). The hypotensive effect of efonidipine was very slow in onset and long-lasting as compared with that of nifedipine. Efonidipine and nisoldipine decreased the heart rate, but nifedipine increased it. Efonidipine (30 micrograms/kg) and nifedipine (1 and 3 micrograms/kg) slightly increased myocardial oxygen consumption. Nisoldipine (3 micrograms/kg) tended to increase myocardial oxygen consumption. Since efonidipine, nifedipine and nisoldipine decreased the arterio-venous oxygen difference and increased coronary sinus outflow, these drugs increased the oxygen supply to the myocardium. Furthermore, these drugs decreased myocardial oxygen demand. From these results, it is suggested that efonidipine may be useful for improving myocardial oxygen balance.

Anesthesia↗
PubMed1994

[Effects of total spinal block on the circulatory system and myocardial oxygen demand and supply balance].

Total spinal block with 1.5% lidocaine was performed in adult mongrel dogs, and its effects on circulatory system and myocardial oxygen demand and supply balance were investigated. The study demonstrates that the circulatory system is depressed under induced total spinal block, as manifested by a marked decrease in HR, MAP, CI, and LV dp/dt max. A decrease in SvO2 suggests that total spinal block places the animals in lack of oxygen supply. On the other hand, coronary arterial blood flow was significantly reduced by total spinal block. With reduction in myocardial oxygen consumption, however, coronary venous oxygen saturation (ScvO2) and myocardial oxygen extraction rate remained unaffected, and myocardial lactate uptake was also affected little. The results suggest that sufficient coronary arterial blood flow is maintained during total spinal block to respond to the myocardial oxygen demand. There is a possibility that myocardial oxygen demand and supply are well balanced under total spinal block.

Anesthesia, Spinal↗
PubMed1996

Cerebral microregional oxygen balance during chronic versus acute hypertension in middle cerebral artery occluded rats.

This study was performed to compare microregional 0(2) supply and consumption balance in spontaneously hypertensive rats (SHR), normotensive Wistar Kyoto rats (WKY), and in phenylephrine-induced acutely hypertensive WKY (WKY + ph) rats. Under isoflurane anesthesia, a middle cerebral artery (MCA) of SHR (n = 7) and WKY (n = 14) rats was occluded. Seven of the WKY rats were infused with phenylephrine (WKY + ph) to keep the mean arterial pressure (MAP) at the same level as that of the SHR. In all animals, 1 h after MCA occlusion, regional cerebral blood flow (rCBF) was determined using an autoradiographic technique, and microregional arterial and venous 02 saturations were determined using microspectrophotometry. MAP was 76 +/- 4 (SD), 136 +/- 15, and 132 +/- 12 mm Hg for the WKY, WKY + ph, and SHR groups, respectively. All variables describing regional O2 balance and rCBF were similar between the SHR and the WKY groups in the ischemic cortex as well as in the contralateral cortex. With phenylephrine infusion, rCBF of both the ischemic cortex and the contralateral cortex were increased in the WKY group. The average 02 supply-to-consumption ratio in the ischemic cortex was higher in the WKY + ph than in the WKY or SHR group. In the ischemic cortex, heterogeneity of venous 02 saturation (SvO2), expressed as a coefficient of variation (CV = 100 X SD/mean), was significantly lower in the WKY + ph (18.3 +/- 2.4) group than in the SHR (30.5 +/- 11.8) or in the WKY (31.3 +/- 9.0) group. The number of veins with low 02 saturation (SvO2 < 40%) in the ischemic cortex was significantly lower in the WKY + ph than in the SHR or in the WKY group. Our data suggest that in chronically hypertensive animals, cerebrovascular adaptations enable the microregional 02 balance in focal ischemia to be maintained at a level similar to that of normotensive animals. However, in normotensive animals with focal cerebral ischemia, an acute increase of MAP improves microregional O2 balance.

Acute Disease↗
PubMed1991

Some aspects of clinical & anesthetic management of heart transplantation.

Heart transplantation has become a widely and frequently used therapeutic approach for end stage cardiac disease. However, there is no absolute agreement concerning certain aspects related to the clinical and anesthetic management of the donor and the recipient. The most common indications for heart transplantation are the dilated cardiomyopathy of idiopathic origin and the ischemic cardiomyopathy. There are several contraindications for transplantation. Once a patient is initially accepted as a possible candidate for transplantation, it is important to rule out the presence of fixed pulmonary vascular hypertension, since its presence has been associated with dismal results. The immunosuppression protocols are multiple and diverse. Use of sterile intubation techniques, rapid induction anesthesia and vasopressors as needed are the hallmarks of the anesthetic management of the recipient. Among the most challenging problems in the immediate post-operative period are the low cardiac output and the control of potassium balance. These and other problems will be addressed in the following article.

Adult↗
PubMed1993

[Is thoracic epidural anesthesia beneficial to myocardial ischemia?--Influence of hemodynamics].

The effects of thoracic epidural anesthesia (TEA) on regional myocardial blood flow (RMBF) and hemodynamics were evaluated in open-chest dogs with coronary artery stenosis. In the 6 dogs with pressure-rate quotients (PRQ) of greater than 0.8, TEA caused a significant increase of the ratio of endocardial to epicardial RMBF in the ischemic region and tended to increase the ratio of RMBF in the ischemic to normal area, resulting in improved myocardial ischemia. There was no reduction of myocardial ischemia in the 11 dogs with PRQ of less than 0.8. The hemodynamic effects determine whether TEA is favorable for the ischemic heart or not. It appears that PRQ is useful as an indicator of myocardial oxygen balance during TEA.

Anesthesia, Epidural↗
PubMed2005

Intravenous administration of amino acids during anesthesia stimulates muscle protein synthesis and heat accumulation in the body.

The present study was conducted to determine the contribution of muscle protein synthesis to the prevention of anesthesia-induced hypothermia by intravenous administration of an amino acid (AA) mixture. We examined the changes of intraperitoneal temperature (Tcore) and the rates of protein synthesis (K(s)) and the phosphorylation states of translation initiation regulators and their upstream signaling components in skeletal muscle in conscious (Nor) or propofol-anesthetized (Ane) rats after a 3-h intravenous administration of a balanced AA mixture or saline (Sal). Compared with Sal administration, the AA mixture administration markedly attenuated the decrease in Tcore in rats during anesthesia, whereas Tcore in the Nor-AA group became slightly elevated during treatment. Stimulation of muscle protein synthesis resulting from AA administration was observed in each case, although K(s) remained lower in the Ane-AA group than in the Nor-Sal group. AA administration during anesthesia significantly increased insulin concentrations to levels approximately 6-fold greater than in the Nor-AA group and enhanced phosphorylation of eukaryotic initiation factor 4E-binding protein-1 (4E-BP1) and ribosomal protein S6 protein kinase relative to all other groups and treatments. The alterations in the Ane-AA group were accompanied by hyperphosphorylation of protein kinase B and the mammalian target of rapamycin (mTOR). These results suggest that administration of an AA mixture during anesthesia stimulates muscle protein synthesis via insulin-mTOR-dependent activation of translation initiation regulators caused by markedly elevated insulin and, thereby, facilitates thermal accumulation in the body.

3-Phosphoinositide-Dependent Protein Kinases↗
PubMed2003

Preload indexes in thoracic anesthesia.

PURPOSE OF THE REVIEW: An adequate cardiac preload is essential in the treatment of critically ill patients. During anesthesia for thoracic surgery, volume and vasoactive therapy to optimize cardiac output, oxygen delivery (tissue perfusion) and to avoid pulmonary edema is a central therapeutic aspect. Cardiac preload has been estimated with different techniques in clinical practice, even though studies performed on thoracic anesthesia are lacking. RECENT FINDINGS: We analyze the conventional pulmonary artery catheter, transesophageal echocardiography and the transpulmonary indicator dilution technique as preload monitoring devices with their indications and limits in thoracic anesthesia. SUMMARY: The pulmonary artery catheter is confirmed as a fundamental device particularly in patients with pulmonary hypertension. For transesophageal echocardiography monitoring, the dependency on operator experience, the low repeatability and the high costs limit its interpretation and diffusion in clinical practice. During lung transplantation, Swan Ganz catheter monitoring is recommended. The optimization of fluid balance and vasoactive drug administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system during anesthesia for thoracic surgery when intravascular volume management is a primary objective.

Journal Article↗
PubMed1995

[Quantitative assessment of catecholamine secretion as a rational principle of anesthesia management in pheochromocytoma surgery].

AIM OF THE STUDY: Fifteen patients with phaeochromocytoma who underwent surgery were studied consecutively. METHODS: They received either (10) a balanced anaesthesia technique with isoflurane and fentanyl or (5) a combination of propofol and alfentanil for total intravenous anaesthesia. EEG processing was performed in order to guarantee adequate anaesthetic depth. Antihypertensive therapy was performed with sodium nitropusside. Continuous blood sampling was performed with a roller pump and an autosampler system in order to get high resolution measured of plasma catecholamines. Their concentration was measured by HPLC with electrochemical detection. RESULTS: There were 100fold differences in the maximal catecholamine concentrations during phaeochromocytoma resection between patients. In some cases adrenaline and noradrenaline levels exceeded normal values by a factor of 1000 to 1500. Secretion rates were calculated on a pharmacokinetic basis an revealed secretion rates of 0.3 to 97.3 micrograms/min for adrenalin and 6.7 und 402.8 micrograms/min for noradrenaline. If systolic blood pressures were greater than 160 mmHg sodium nitroprusside was given by infusion with a rate of 300 +/- 315 micrograms/min. Over a period of 69.2 +/- 39.8 min during resection of the tumor the total dose was 7017 +/- 12433 micrograms. CONCLUSIONS: There were positive correlations between plasma catecholamine concentrations, systolic blood pressure values, and infusion rates of sodium nitroprusside. The comparison of the two anaesthetic techniques resulted in a significant reduction of antihypertensive therapy and more stable haemodynamics in patients with total intravenous anaesthesia. However, the beneficial effect of this anaesthesia regimen has to be proven on a larger basis of patients in a randomized manner.

Adolescent↗
PubMed1998

[Intracameral lidocaine and phacoemulsification under topical anesthesia. Apropos of 80 operations].

PURPOSE: To evaluate the advantage of intracameral unpreserved lidocaine for patient comfort during phacoemulsification under topical anesthesia. METHODS: In this prospective study, we performed 80 phacoemulsifications under topical anesthesia, with tetracaine 1% drops, 10 minutes before and at the start of surgery: 40 patients received 0.3 cc balanced salt solution (BSS) intracameral injection; 40 patients received 0.3 cc unpreserved lidocaine 1% intracameral injection. The same surgical procedure was performed in both groups: 3.2 mm temporal corneal self-sealing incision, capsulorhexis, foldable polyHEMA IOL implantation into the capsular bag. There was no intravenous sedation. RESULTS: Forty-eight percent (19) in the BSS group and 70% (28) in the lidocaine group felt no pain. 10% (4) in the BSS group reported sharp pain during phacoemulsification. During IOL insertion, no pain was reported by 48% (19) in the BSS group, and 75% (30) in the lidocaine group; 10% (4) in the BSS group felt severe pain (significant difference: p < 0.05). Endothelial cell loss was 6% in the BSS group, and 6.4% in the lidocaine group (non significant difference). CONCLUSION: Intracameral lidocaine is safe and effective in decreasing discomfort among patients undergoing phacoemulsification under topical anesthesia.

Administration, Topical↗