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PubMed1995

Postural control after propofol anaesthesia in minor surgery.

There is, not only from an economic perspective, a continuous search for surgical and anaesthetic procedures that allow out-patient surgery to be conducted. Reliable estimators of the patient's street fitness are of the utmost importance. Balancing capacity is one aspect that should be considered. Clinical methods like Romberg's are subjective and imprecise. Dynamic posturography comprises a movable support surface and visual surround that are either stable or referenced to the patient's sway, with eyes open or closed. In this study the recovery from propofol anaesthesia was studied in 8 patients who underwent surgery for minor microlaryngoscopic procedures. Dynamic posturography who performed before, and 2 and 4 h after cessation of anaesthesia. All patients who were awake had normal balancing ability already at 2 h after anaesthesia. Further studies may supply additional information of other aspects of discharge after anaesthesia.

Adult↗

PubMed1999

Experimental critical care in ventilated rats: effect of hypercapnia on arterial oxygen-carrying capacity.

PURPOSE: We have previously demonstrated an increased arterial O2-carrying capacity in normal ventilated dogs subjected to both acute and prolonged exogenous hypercapnia. In the present study, we tested if arterial hypercapnia, during controlled ventilation, can increase O2-carrying capacity also in rats. MATERIALS AND METHODS: Twenty young male Sprague Dawley rats were anesthetized (60 mg/kg pentobarbital), tracheostomized, intubated, and one femoral vein and artery were cannulated. Anesthesia and paralysis were maintained using 15 mg/kg/h pentobarbital intravenously, and 2 mg/kg/h vecuronium bromide. The fluid balance (5 mL/kg/h saline), normothermia, and minute volume were maintained. The mean arterial blood pressure and heart rate were continuously monitored. Experiments included the following: (1) a control group, ventilated with normoxic air for 150 minutes (n = 5); (2) mild hypercapnia, a group of eight rats ventilated with normoxic air for 30 minutes and then ventilated with a mixture of normoxic air at 60 mm Hg CO2 (8 kPa) for 1 hour; and (3) severe hypercapnia, a group of seven rats were treated exactly as in group II, except a 90 mm Hg (12 kPa) CO2 during hypercapnia. Gas-exchange profile, arterial hemoglobin (Hb) concentration, arterial Hb-oxygen saturation (Hb-O2), and arterial O2 content were periodically determined during normocapnia and 1 hour of hypercapnia. RESULTS: Exposures to mild and severe hypercapnia, in rats with maintained ventilation, significantly reduced the arterial O2 content by 20% and 33%, respectively, without significant changes in the arterial Hb concentration (-2%). Severe hypercapnia generated a significant reduction of -14% in the PaO2, but not in PaO2/ FiO2 ratio. CONCLUSION: Rats subjected to controlled ventilation and permissive hypercapnia, unlike dogs and perhaps humans, show no augmentation of Hb concentration. Hypercapnia in rats also provokes much stronger Bohr effect than in dogs. Hypercapnia-induced Bohr effect in rats is accompanied with extreme desaturations of Hb-O2, and substantial reduction in the O2-carrying capacity. We speculate that the strong hypercapnia-induced Bohr effect in rats may prevent hypoxia at the tissue level. However, to maintain a stable oxygen-carrying capacity in rats used for pulmonary critical care studies with hypercapnia, we suggest to use hyperoxia, with or without a mild hypothermia.

Analysis of Variance↗

PubMed2003

Thyrotropin-releasing hormone administration does not affect seizure threshold during electroconvulsive therapy.

SUMMARY: Despite the fact that a role for thyrotropin-releasing hormone (TRH) in seizure modulation has been consistently hypothesized, the exact nature of this role remains unclear. In this study, we investigated the effects of TRH administration on seizure threshold and seizure duration in 13 depressed inpatients undergoing electroconvulsive therapy (ECT). In a balanced order crossover design, an intravenous bolus of 0.4 mg TRH or placebo was administered immediately before anesthesia, during the first two sessions, in a series of bilateral ECT. In both of these sessions, a threshold titration procedure was applied by using gradual increments of the electrical charge delivered until seizure elicitation, a procedure that has been safely used in the past. Seizure threshold was defined as the lowest energy level required for induction of a grand mal seizure, by use of this titration procedure. Seizure duration was estimated both by simultaneous EEG recording and by the cuff method. Results showed that neither seizure threshold, nor seizure duration (either by cuff or by EEG) differed between the TRH and the placebo conditions, regardless of the order in which TRH or placebo were administered in the two ECT sessions. This was the case regardless of whether the patients had at baseline a blunted TSH response to TRH or not. Our findings do not support a role for TRH on seizure modulation, at least when TRH is administered exogenously. Such an effect, if it exists, could be obscured, however, by several factors, including pharmacokinetics.

Adult↗

PubMedDate not supplied

[Basis for indicators of acid-base status of blood and metabolic processes in rats under hibernation and under trivial analgesia for foreleg amputation].

The article deals with some data on investigation of the blood acid-base balance main blood indices and metabolic processes in the rats organism under the artificial hibernation and trivial anesthesia at the foreleg amputation. This model of the artificial hibernation was shown as capable to be promising the hard and complicated operative intrusions in the organism.

Acid-Base Equilibrium↗

PubMed1991

[Absorption of adrenaline after local administration to the eye].

Twenty patients undergoing surgery for correction of strabismus under general anesthesia were randomly selected to receive conjunctival application of 100 microliters (20 micrograms) adrenaline in both eyes or in neither (controls). A further 20 patients undergoing cataract surgery with local anesthesia were randomly selected to receive 1 ml adrenaline 1:10 000 (100 micrograms) or 1 ml balanced salt solution (controls) in the anterior chamber. Adrenaline in plasma was measured in six time points within 15 min (correction of strabismus) or at seven within 30 min (cataract surgery). Plasma levels of adrenaline, mean arterial pressure, and heart rate were comparable in treatment groups and controls. No severe arrhythmias were observed. Neither conjunctival application of 20 micrograms adrenaline or instillation of 100 micrograms adrenaline into the anterior chamber increases adrenaline levels in plasma, and there is no reason to suspect cardiovascular interactions.

Adolescent↗

PubMed1986

Delayed enhancement of acetaminophen hepatotoxicity by general anesthesia using diethyl ether or halothane.

Acetaminophen (Tylenol) is a widely used analgesic/antipyretic drug which is enzymatically bioactivated, or toxified, by the cytochromes P-450 to a hepatotoxic reactive intermediary metabolite. Brief general anesthesia with diethyl ether has been shown to inhibit both the toxifying cytochromes P-450 and enzymatic glucuronidation, the latter constituting up to 60% of acetaminophen elimination via a nontoxifying pathway. Thus ether potentially could produce a temporally differentiated inhibition of bioactivating and "detoxifying" pathways, resulting in an enhancement of acetaminophen hepatotoxicity if the balance favored bioactivation. To evaluate this possibility, separate groups of male NIH strain mice were treated with acetaminophen at different times after 5 min of anesthesia with ether. Ether produced a 40-fold enhancement in acetaminophen hepatotoxicity as determined by plasma glutamic-pyruvic transaminase (GPT) concentrations. This toxicologic enhancement was observed only if acetaminophen administration was delayed, with a maximal enhancement when acetaminophen was given 6 hr after ether, and no effect with a delay of 16 hr. Similar studies in male CD-1 mice were carried out using halothane (Fluothane) as the general anesthetic given either over 5 min or over 1 hr. While halothane given over 5 min had no effect, a 1 hr anesthetic duration produced a 10-fold increase in acetaminophen hepatotoxicity as determined by peak GPT concentration, with no observed hepatotoxicity in the halothane controls. Toxicologic enhancement occurred only with delayed administration of acetaminophen; however, the maximal enhancement observed with a 6-hr delay was still evident with a 12-hr delay. Conversely, inhibition of acetaminophen hepatotoxicity was observed if acetaminophen was given either 2 hr or 18 hr after halothane.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen↗

PubMed1998

Safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation.

PURPOSE: To determine the safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation. SETTING: Carolina Eye Associates, Southern Pines, North Carolina, USA. METHODS: In this prospective study, 100 patients having phacoemulsification under topical anesthesia were randomly assigned to receive an intracameral injection of unpreserved lidocaine (0.5 cc of a 1% unpreserved solution) or balanced salt solution. RESULTS: Ninety-three patients completed the study. There were no significant between-group differences in cell density parameters or Kowa laser flare-cell meter measurements. Seventy-eight percent of lidocaine patients and 56% of controls reported no sensation (P = .048, Fisher's exact test). CONCLUSION: Intracameral injections of unpreserved lidocaine safely and effectively reduced intraocular sensation during phacoemulsification.

Anesthesia, Local↗

PubMed1995

Cortical cerebral blood flow cycling: anesthesia and arterial blood pressure.

Cycling of various cerebral metabolic substances, arterial vascular diameter, and flow has been noted by many workers at a frequency near 0.1 Hz. Suspicion that this phenomenon is dependent on the type of anesthesia led us to investigate the occurrence of cerebral blood flow (CBF) cycling with different anesthetics. Fifteen Sprague-Dawley rats were anesthetized with either pentobarbital (n = 5, 40-50 mg/kg), alpha-chloralose (n = 5, 60 mg/kg), or halothane (n = 5, 1-0.5%). Body temperature was maintained at 37 degrees C. Femoral arterial and venous catheters were placed, and a tracheotomy was performed, permitting artificial ventilation with 30% O2-70% N2. A closed cranial window was formed over a 3-mm diameter craniotomy. Mean arterial pressure (MABP), arterial partial pressures of CO2 and O2 (PaCO2 and PaO2), and pH were controlled and stabilized at normal values. CBF was determined using laser Doppler flowmetry. To induce cycling, MABP was transiently and repeatedly lowered by exsanguination. Fast Fourier analysis of selected 64-s flow recordings (n = 38) was performed. CBF cycling was observed, independent of the type of anesthesia, in all animals. In 36 epochs, cycling was induced when MABP was reduced to a mean pressure of 65 +/- 1.5 mmHg. The mean frequency and amplitude were 0.094 +/- 0.003 Hz and 6.6 +/- 0.5%, respectively. Cycling occurred without blood withdrawal in two epochs. With the use of the blood-withdrawal epochs (n = 36), all three anesthetics shared a common linear slope between amplitude and blood pressure (P < 0.02) and blood pressure change (P < 0.01). Pentobarbital differed from alpha-chloralose and halothane in the relation between cycling frequency and blood pressure. Only pentobarbital exhibited correlation between frequency and blood pressure (P < 0.02) and blood pressure change (P < 0.001). The occurrence of these oscillations is not related to the type of anesthesia, and they usually occur at MABP values that are near or just above the lower limit of autoregulation. At this pressure level, CBF oscillations would suggest that vasoconstrictive and dilatory forces are no longer in balance, but alternatively vying for control.

Analysis of Variance↗

PubMed1995

Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium.

The purpose of this study was to measure the degree of residual neuromuscular block at different times after a single dose of vecuronium, and to evaluate the effectiveness of two different doses of neostigmine in antagonizing this residual block. Train-of-four (TOF) ratios were examined for up to 4 h after a single dose of vecuronium, 0.1 mg/kg, in 60 patients during nitrous oxide/isoflurane/fentanyl anesthesia. The effect of neostigmine, 40 micrograms/kg, was studied at 1,2,3, or 4 h. The effect of neostigmine, 20 micrograms/kg, was studied at 2 or 4 h after the vecuronium. Before neostigmine administration, the TOF ratio was less than 0.75 in 17 patients (including one patient at 4 h). Neostigmine produced an increase in TOF ratio in 52 patients and a decrease in 8. The TOF ratio decreased after neostigmine only, at 2,3, or 4 h after vecuronium, when the TOF ratio was > or = 0.9 and when neostigmine 40 micrograms/kg was administered. One patient, at 1 h, had a TOF ratio of 0.00 and this did not reach 0.75 until 57 min after neostigmine, 40 micrograms/kg. There was a high incidence (50%) of adverse cardiovascular effects after both doses of neostigmine. In making the decision as to whether neostigmine should be administered, the risk to the patient of residual neuromuscular block must be balanced against the adverse cardiovascular effects of the neostigmine.

Adult↗

PubMed1997

Anesthetic management of children with moyamoya disease.

A review of the surgical and postoperative records of 127 revascularization procedures performed on 82 children with Moyamoya disease was done to evaluate changes we made in anesthetic management in response to perioperative complications. From 1982 to 1996, out of 82 children who underwent revascularization surgery at our hospital, five developed perioperative complications. One developed circulatory instability during surgery; the cause seemed to be a depth of anesthesia insufficient for preventing surgical stress. To rectify this problem, an increased dose of fentanyl was used to improve the maintenance of anesthesia. Four patients developed cerebral infarction during the early postoperative period due, in part, to inadequate management of postoperative pain. We began to administer supplemental doses of meperidine to patients after they emerged from anesthesia to provide better control of postoperative pain. Our review confirmed the effectiveness of these measures. The data suggest that during the perioperative management of children with Moyamoya disease, close attention should be paid to balancing the patients' anesthetic state against surgical stress and providing adequate postoperative analgesia.

Analgesics, Opioid↗

PubMedDate not supplied

The changing profile of anesthetic practice: an update for internists.

BACKGROUND: Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught. OBJECTIVE: To update internists on recent changes in anesthetic management and how they affect the preoperative evaluation. SUMMARY: Recent advances in anesthetic management include new monitoring standards, balanced anesthetic technique, new agents, equipment changes, better understanding of human factors, and expanded pain management techniques. CONCLUSIONS: Postoperative care will likely assume increasing importance in determining anesthesia-related morbidity and mortality. For this reason, increased interaction and cooperation between surgeons, internists, and anesthesiologists are needed.

Anesthesiology↗

PubMedDate not supplied

[The problem of airtightness during the use of a laryngeal mask under conditions of carboperitoneum and muscle relaxation].

This study was aimed at assessing the airtightness of the airways during the use of a laryngeal mask (LM) under conditions of myoplegia and traditional forced ventilation of the lungs (FVL) with carboperitoneum (CP) during laparoscopic cholecystectomy (LCE). A total of 146 anesthesias for LCE were carried out using LM (n = 86) or endotracheal tube (ETT) (n = 60). The groups did not differ by the demographic characteristics or concomitant diseases. After premedication and induction of anesthesia it was maintained with N2O:O2--2/1 (Fi O2 = 0.3), fractionated administration of fentanyl (0.1-0.2 mg), and pipecuronium bromide (0.06 mg/kg). A gastric tube was inserted. Two variants of FVL were used: 1) permanent minute respiration volume (MRV) was maintained and 2) MRV was increased in order to maintain the Et CO2 at a constant level. The amount of gastric contents was measured and its pH assessed. Regurgitation and aspiration was assessed (in 33 patients) using methylene blue in gelatin capsules administered orally 10 min before anesthesia. Gas exchange was monitored by the Datex Capnomac-Ultima and by check-ups of acid base balance in the arterial capillary blood, hemodynamics was monitored by noninvasive Criticon Dynamap monitor. Manual FVL with inhalation P no more than 10 cm H2O completely prevented the entry of gas narcotic mixture into the stomach. Application of LM under conditions of total myoplegia and FVL with inhalation P of 23-25 cm H2O provided a satisfactory airtightness of the LM-airways contact without audible (appreciable) leaking of gas narcotic mixture. Leakage of gas narcotic mixture during LM application under total myoplegia and carboperitoneum (with CO2 pressure in the abdominal cavity 12 cm Hg) is no more than 6%, which indicates that LM is a reliable air guide providing good airtightness of the LM-airways contact even under conditions of increased abdominal pressure. No cases of regurgitation and aspiration were observed.

Adjuvants, Anesthesia↗

PubMed2003

Hyponatremia after hip arthroplasty may be related to a translocational rather than to a dilutional mechanism.

OBJECTIVE: Postoperative hyponatremia is a frequent metabolic disturbance that may cause life-threatening complications. It results from both a positive electrolyte-free water (EFW) balance and an antidiuretic hormone release. During surgery, intracellular solutes may leak out of cells because of an increased membrane permeability leading to increased osmolality, cellular water shift, and redistribution hyponatremia, a concept coined the sick cell syndrome. Because of release of osmotically active solutes, plasma or urinary osmolar gap should increase. Therefore, we tested the hypothesis that postoperative hyponatremia may be related to a translocational mechanism evidenced by a postoperative increase of the osmolar gap rather than to a positive EFW balance. SETTING: An anesthesiology department in a 1,200-bed university hospital. DESIGN: A 5-month prospective observational study. SUBJECTS: Thirty-three consecutive patients undergoing elective hip arthroplasty under general anesthesia. They were divided into two groups whether the postoperative plasma sodium concentration decrease was > or = 2 mmol/L (group 1) or <2 mmol/L (group 2). MEASUREMENTS: Plasma sodium concentration ([Na+]p) and plasma osmolality were measured before induction of anesthesia and at skin closure. Osmolality was calculated at the same times. Plasma osmolar gap (OG(p)) was calculated as the difference between measured and calculated osmolality. Postoperative urinary osmolar gap (OG(u)) was calculated in the same way. EFW balance was calculated as the ratio of (infused EFW - excreted urinary EFW) to total body water. RESULTS: In 33 patients, a significant [Na+]p decrease of -2.0 was observed. No relationship was demonstrated between EFW balance and perioperative [Na+]p variation (r =.28; p=.12). A relationship was observed between perioperative OG(p) variation and perioperative [Na+]p variation (r =.74; p<.0001). In the 19 group 1 patients, [Na+]p decreased by -3.0 mmol/L. EFW balance did not differ between group 1 and group 2 patients. No statistical relationship was observed between EFW balance and perioperative [Na+]p variation in group 1 (r =.20; p=.40) and in group 2 (r =.43; p=.14). OG(p) increased only in group 1 but not in group 2 patients, and postoperative OG(u) was greater in group 1 than in group 2 patients. A relationship was observed between perioperative OG(p) variation and perioperative [Na+]p variation in group 1 (r =.53; p=.02) but not in group 2 (r =.32; p=.26). CONCLUSION: Hyponatremia after hip arthroplasty may not be related to a positive EFW balance. The postoperative increase of the OG(p) and the greater postoperative OG(u) in patients developing postoperative hyponatremia suggest the release of osmotically active solutes leading to cellular water shift from intracellular to extracellular spaces. These data may support the clinical relevance of the sick cell syndrome in the postoperative context.

Female↗

PubMed2001

Wavelet transform of heart rate variability to assess autonomic nervous system activity does not predict arousal from general anesthesia.

PURPOSE: The relationship between autonomic nervous system (ANS) activity and general anesthesia has been explored. Studies have demonstrated partial recovery of heart rate variability (HRV), representative of ANS activity, in the postoperative period, but the arousal period has not been precisely studied. The goals of this study were to analyze modifications of ANS activity during general anesthesia and, more particularly, around the arousal period, to look for predictors of arousal. METHODS: We analyzed HRV changes using wavelet transform, a time-frequency analysis that, in contrast to Fourier transform, is able to assess abrupt changes of ANS activity. Seventeen patients (mean +/- SD age: 40.9 +/- 16.4 yr) under general anesthesia for hip or knee surgery, were included in the study. The analysis began one hour before anesthesia, focussed on eye opening, and ended three hours after arousal. RESULTS: There was a dramatic decrease in HRV after induction, that extended throughout anesthesia and represented a decrease in global autonomic regulation with, however, a relative predominance of vagal tone. At the moment of eye opening, there was an abrupt change in HRV, representing a sudden shift of ANS balance towards the predominance of sympathetic activity, while none of these indices changed seconds before arousal. CONCLUSIONS: Wavelet analysis of HRV appears to be powerful tool to precisely assess instantaneous changes of HRV during anesthesia. Using this method, there were no identifiable precursory HRV indices of arousal.

Adult↗

PubMed1988

Barbiturate anesthesia and alcohol tolerance in a rat model.

Anesthetic responses to a variety of barbiturates were examined in adult male rats rendered alcohol-tolerant by administration of an ethanol-containing balanced liquid diet for 3 weeks. Within 9 hours of withdrawing the diets, groups of 10-15 ethanol-fed rats and pair-fed controls were injected intraperitoneally with one of the following drug/dose combinations: thiamylal 20, 40, or 60 mg/kg; methohexital 10, 20, or 40 mg/kg; secobarbital 20, 30, or 40 mg/kg; pentobarbital 10, 20, or 40 mg/kg; or phenobarbital 80, 120, or 160 mg/kg. Each animal was monitored for time to loss of righting reflex (onset of anesthesia), absence of response to a painful stimulus (analgesia), and sleeping time (duration of anesthesia). None of these three anesthetic responses differed significantly in ethanol-fed and control rats with any dose of thiamylal, methohexital, or secobarbital. In contrast, all three responses were significantly less in rats given the middle dose of pentobarbital (20 mg/kg) than they were in control rats. Onset and duration of anesthesia were also shorter with the middle dose of phenobarbital (120 mg/kg), but analgesia was not. The results of this study, in combination with others, suggest that 1) cross-tolerance to anesthetic effects of barbiturates in ethanol-tolerant rats is not uniform with all barbiturates: and 2) because shorter-acting barbiturates show negligible cross-tolerance with alcohol, higher doses of these agents may not be required for satisfactory anesthesia in chronically alcoholic humans.

Animals↗

PubMed2006

A multicenter clinical study of the safety and activity of maleimide-polyethylene glycol-modified Hemoglobin (Hemospan) in patients undergoing major orthopedic surgery.

BACKGROUND: Hemospan (Sangart Inc., San Diego, CA), a polyethylene glycol-modified hemoglobin with unique oxygen transport properties, has successfully completed a phase I trial in healthy volunteers. Because adverse events are expected to increase with age, the authors conducted a phase II safety study of Hemospan in elderly patients undergoing elective hip arthroplasty during spinal anesthesia. METHODS: Ninety male and female patients, American Society of Anesthesiologists physical status I-III, aged 50-89 yr, in six Swedish academic hospitals were randomly assigned to receive either 250 or 500 ml Hemospan or Ringer's acetate (30 patients/group) before induction of spinal anesthesia. Safety assessment included vital signs and Holter monitoring from infusion to 24 h, evaluation of laboratory values, and fluid balance. The hypothesis to be tested was that the incidence of adverse events would be no more frequent in patients who received Hemospan compared with standard of care (Ringer's acetate). RESULTS: Three serious adverse events were noted, none of which was deemed related to study treatment. Liver enzymes, amylase, and lipase increased transiently in patients in all three groups. There were no significant differences in electrocardiogram or Holter parameters, but there was a suggestion of more bradycardic events in the treated groups. Hypotension was less frequent in the treated patients compared with controls. CONCLUSIONS: In comparison with Ringer's acetate, Hemospan mildly elevates hepatic enzymes and lipase and is associated with less hypotension and more bradycardic events. The absence of a high frequency of serious adverse events suggests that further clinical trials should be undertaken.

Aged↗

PubMed2003

[Regional anesthesia in newborn infants, infants and children--what prerequisites must be met?].

UNLABELLED: In general, every anaesthetic technique should only be used with a given indication after a careful risk-benefit evaluation, when there are no contraindications and when the physician has sufficient knowledge and skill to safely perform the technique. INDICATION: the great advantage of regional blocks is that they can be administered without the risks of opioids, e.g. respiratory depression, nausea, vomiting and delayed gastric emptying. Regional anaesthesia is rarely indicated instead of general anaesthesia: even ex-premature babies can safely undergo general anaesthesia supplemented with a regional block. Special risks occur when regional blocks are performed in anaesthetised children, and special care is needed. However, in contrast to adult practice, this is a generally accepted modality of paediatric anaesthesia worldwide. In addition, perfect analgesia may obscure the signs of compartment syndrome and beginning pressure sores. Preoperative evaluation: the preoperative evaluation relies mainly on the patient's history. Coagulation tests are not performed as routine screening. However, even with a careful history, bleeding disorders can be overlooked, especially in neonates and infants. Mastering the technique: caudal anaesthesia can be used for a large variety of interventions below the umbilicus; therefore, a sufficient caseload can be achieved by most anaesthetists, and the technique can be easily learned. It should belong, together with wound infiltration, ilioinguinal and penile block, to the armamentarium of all anaesthetists caring for children. However, regional blocks are of limited duration and are therefore only part of a concept of balanced analgesia, which also involves nonsteroidals, paracetamol and opioids.

Analgesia, Epidural↗

PubMed1989

Sufentanil does not block sympathetic responses to surgical stimuli in patients having coronary artery revascularization surgery.

The effects of a moderate dose of sufentanil (1 microgram.kg-1 + 0.015 micrograms.kg-1.min-1) plus nitrous oxide (30% O2/70% N2O) anesthesia (group I; n = 8) and of high-dose sufentanil/O2 anesthesia (10 micrograms.kg-1 + 0.15 micrograms.kg-1.min-1) without N2O (group II; n = 8) on cardiovascular dynamics, myocardial blood flow, myocardial oxygen consumption, myocardial lactate balance, and hypoxanthine release were studied in two groups of male patients scheduled for elective coronary artery bypass surgery. All patients were on maintenance doses of calcium channel blockers and nitrates with the last doses of medications given the morning of operation. All patients were premedicated with flunitrazepam (2 mg orally), piritramide (7.5 mg IM) and promethazine (25 mg IM). Measurements were performed before the induction of anesthesia with the patients premedicated but awake; 20 min after induction of anesthesia with sufentanil plus pancuronium 0.1 mg.kg-1 for muscle relaxation before surgery; and during sternotomy and sternal spread. Sufentanil at either dose decreased mean arterial pressure, as well as cardiac and stroke volume index while heart rate remained unchanged. Following the induction myocardial blood flow and myocardial oxygen consumption decreased 23% (79 ml.min-1.100 g-1 to 61 ml.min-1.100 g-1 and 28% (9.2 ml O2.min-1.100 g-1 to 6.6 ml O2.min-1.100 g-1) in group I and 14% (78 ml.min-1.100 g-1 to 67 ml.min-1.100 g-1 and 18% (8.7 ml O2.min-1.100 g-1 to 7.1 ml O2.min-1.100 g-1) in group II. Myocardial ischemia was seen in one patient of group II (patient No. 4), as indicated by a hypoxanthine release into the coronary sinus, when after the induction MAP decreased from 93 to 67 mm Hg and heart rate increased from 56 to 71 min-1. During sternotomy 8 of 16 patients (50%) developed hypertension and 9 of 16 patients (56%) showed signs of myocardial ischemia, i.e., a lactate and hypoxanthine release.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗