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At least 865 records · Page 48Linked to original sources
PubMed1990

Anticonvulsant therapy increases fentanyl requirements during anaesthesia for craniotomy.

This study was designed to determine whether patients receiving chronic anticonvulsant therapy demonstrate an altered requirement for fentanyl during anaesthesia. Sixty-one patients undergoing craniotomy were studied; 20 controls (MED = 0) who had never received anticonvulsants and 41 epileptics in whom therapeutic plasma concentrations of either one (MED = 1), two (MED = 2), or three (MED = 3) different anticonvulsants were documented. During anaesthesia with 60-70 per cent N2O in O2 and 0.2 per cent isoflurane, a maintenance dose (MD) of fentanyl was administered using a continuous variable-rate IV fentanyl infusion, supplemented by intermittent 50 micrograms IV boluses. In order to define the minimal dosage of fentanyl required, the MD was titrated according to increases or decreases in the heart rate and/or mean arterial pressure exceeding 15 per cent of baseline ward values. A progressively higher fentanyl MD was required in the epileptic patients (MED = 1-4.3 +/- 0.5 microgram.kg-1.hr-1; MED = 2-5.4 +/- 0.6; MED = 3-7.6 +/- 0.6) compared with the control MD (MED = 0-2.6 +/- 0.5) (P less than 0.001). These findings indicate that there appears to be a dose-effect relationship between the number of anticonvulsants received and the maintenance dose of fentanyl required during balanced anaesthesia.

Adolescent↗
PubMed1997

[Successful surgical revascularization after 18 hour ischemia below the knee due to complete avulsion of the popliteal artery].

We report the case of a 33-year-old man after knee luxation and disruption of a popliteal artery, which was missed after repositioning at the first clinic. Eighteen hours later complete discontinuity of the popliteal artery was confirmed by arteriography and an immediate reversed, end-to-end auto-venous graft was interposed under general anesthesia with anterior and posterior fasciotomy prior to blood flow restoration. Forced diuresis with a diuretic mixture and balanced fluid intake were used, and the patient was discharged from the intensive care unit on the 10th postoperative day in good condition with normal diuresis.

Acute Kidney Injury↗
PubMed1994

Single versus multiple infusions of fentanyl analogues in a rat EEG model.

Administration of anesthetic agents to rats produces a loss of righting (LOR) which is predictive of clinical anesthesia. Following bolus i.v. administration of fentanyl, sufentanil, alfentanil, and remifentanil, the ED100 doses for LOR were 0.035, 0.003, 0.05, and 0.020 mg/kg, respectively. For the EEG infusion studies, rats were implanted with jugular catheters and 5 cortical electrodes on the surface of the dura mater. Each agent was infused at a rate of 0.02 ml/min such that each animal received the ED100 dose every 60 seconds until LOR was observed and the infusion was stopped. Following a single infusion to LOR, the difference in time from the return of righting (ROR) to baseline EEG for fentanyl, sufentanil, alfentanil, and remifentanil was 30.9, 35.3, 14.9, and 1.3 minutes, respectively. Following a three hour washout period, multiple infusions (three successive infusions to LOR) were administered. Following ROR (after the third LOR) the return to baseline EEG for fentanyl, sufentanil, alfentanil, and remifentanil was 56.1, 58.5, 13.6, and 2.9 minutes, respectively. There were no statistically significant differences between the single and multiple infusions for the return to baseline EEG for alfentanil and remifentanil, but there were significant increases in time to return to baseline following multiple infusions of fentanyl and sufentanil. These results show that there was no cumulation of alfentanil and remifentanil with respect to EEG effects but cumulation was observed for fentanyl and sufentanil.

Alfentanil↗
PubMed2006

Isoflurane exerts neuroprotective actions at or near the time of severe traumatic brain injury.

Isoflurane improves outcome vs. fentanyl anesthesia, in experimental traumatic brain injury (TBI). We assessed the temporal profile of isoflurane neuroprotection and tested whether isoflurane confers benefit at the time of TBI. Adult, male rats were randomized to isoflurane (1%) or fentanyl (10 mcg/kg iv bolus then 50 mcg/kg/h) for 30 min pre-TBI. Anesthesia was discontinued, rats recovered to tail pinch, and TBI was delivered by controlled cortical impact. Immediately post-TBI, rats were randomized to 1 h of isoflurane, fentanyl, or no additional anesthesia, creating 6 anesthetic groups (isoflurane:isoflurane, isoflurane:fentanyl, isoflurane:none, fentanyl:isoflurane, fentanyl:fentanyl, fentanyl:none). Beam balance, beam walking, and Morris water maze (MWM) performances were assessed over post-trauma d1-20. Contusion volume and hippocampal survival were assessed on d21. Rats receiving isoflurane pre- and post-TBI exhibited better beam walking and MWM performances than rats treated with fentanyl pre- and any treatment post-TBI. All rats pretreated with isoflurane had better CA3 neuronal survival than rats receiving fentanyl pre- and post-TBI. In rats pretreated with fentanyl, post-traumatic isoflurane failed to affect function but improved CA3 neuronal survival vs. rats given fentanyl pre- and post-TBI. Post-traumatic isoflurane did not alter histopathological outcomes in rats pretreated with isoflurane. Rats receiving fentanyl pre- and post-TBI had the worst CA1 neuronal survival of all groups. Our data support isoflurane neuroprotection, even when used at the lowest feasible level before TBI (i.e., when discontinued with recovery to tail pinch immediately before injury). Investigators using isoflurane must consider its beneficial effects in the design and interpretation of experimental TBI research.

Anesthetics, Intravenous↗
PubMed1986

Melanocytic precursors of cutaneous melanoma. Estimated risks and guidelines for management.

There are several recognizable melanocytic precursors of cutaneous melanoma. These precursors include lentigo maligna, dysplastic melanocytic nevi, congenital nevi (of any size), and darkly pigmented lesions of acral surfaces and mucous membranes. Lentigo maligna is an uncommon melanocytic dysplasia, present in 3 per 1000 individuals over the age of 50 years and accounting for 4 percent of all cutaneous melanomas. Dysplastic melanocytic nevi are present in 2 per cent of white adults, and may account for at least a fifth of cases of cutaneous melanoma. Congenital nevomelanocytic nevi are present in 1 per cent of newborns; the vast majority of congenital nevi are smaller than 3 to 4 cm in diameter, while very large congenital nevi are present in 1 in 20,000 to 1 in 500,000 newborns. Very large congenital nevi account for less than 0.1 percent of cutaneous melanomas, whereas small varieties of congenital nevi may account for 15 percent of cutaneous melanomas. If individuals with lentigo maligna live long enough, possibly a third to a half are said to develop melanoma. This figure may be biased high. Persons with dysplastic melanocytic nevi in the familial melanoma setting have an estimated lifetime risk of developing melanoma approaching 100 per cent. Persons with dysplastic melanocytic nevi in other settings may have a lifetime melanoma risk of 18 per cent. Persons with congenital nevi of any size may have a lifetime melanoma risk of at least 5 per cent. Early recognition of these precursor melanocytic tumors, particularly in high-risk individuals (i.e., those with a personal or family history of melanoma), and careful photographic follow-up or prophylactic excision of these lesions may be the most effective means of reducing the morbidity and mortality of cutaneous melanoma. The impact of routine screening and excision of presumed melanoma precursors is unknown. Clinical judgment is required to balance the theoretical risk of melanoma associated with a given precursor and the known risks of surgery and anesthesia for a given individual. It must be kept in mind that the vast majority of acquired melanocytic nevi in adults are harmless. Probably even the majority of dysplastic nevi and small congenital nevi will remain unchanged throughout life. The simple recognition of the existence of melanoma precursors will heighten suspicion for these lesions and raise awareness of the earliest signs of malignant change.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Implicit processing and therapeutic suggestion during balanced anaesthesia.

The effect of therapeutic suggestion--implicit processing during balanced anaesthesia was studied in 70 female patients scheduled for elective breast surgery. The patients were randomly allocated to listen to a message with reassuring information focused on minimising postoperative nausea and vomiting, or just a blank tape during surgery. Occurrence of nausea and vomiting was studied during the postoperative period. No patient recalled any explicit memories during the peroperative period. No major differences were observed in the number of patients who experienced nausea or vomiting during the 24 hour observation period. The patients exposed to positive suggestion did, however, have a lower frequency of recall for nausea and vomiting compared to those just listening to the blank tape. We did not observe any major effect of peroperative suggestion for postoperative nausea and vomiting. However, we cannot rule out some implicit processing during balanced anaesthesia.

Adult↗
PubMed1984

Blood pressure effects of renin inhibition by human renin antiserum in normotensive marmosets.

The effects on blood pressure of an antiserum against pure human kidney renin were studied in conscious and anesthetized (pentobarbital, 24 mg X kg-1 i.p.) small new world monkeys (common marmosets). The antiserum inhibited the enzymatic activity of renin by 50% in a dilution of 1:45,000 in marmoset and 1:50,000 in human plasma. The antiserum (0.2 ml i.v.) decreased blood pressure in conscious marmosets on normal sodium intake by 15 +/- 5 (SD) mmHg and after salt depletion by 31 +/- 13 mmHg. A converting enzyme inhibitor (teprotide, 2 mg X kg-1 i.v.) induced a comparable fall in blood pressure: -16 +/- 10 and -30 +/- 10 mmHg, respectively. Similar effects were observed on blood pressure of anesthetized marmosets. The correlation between pretreatment plasma renin concentration and the maximum fall in blood pressure was significant and identical for the experiments with antiserum and teprotide. These results demonstrate that antisera against human renin can be used for the specific blockade of the renin-angiotensin system in primates. In normotensive marmosets the renin-angiotensin system participates in the maintenance of blood pressure, to a degree depending on the state of sodium balance.

Anesthesia, General↗
PubMed2000

Intragastric balloon in obese patients.

BACKGROUND: Since March 1998, 143 BioEnterics Intragastric Balloons (BIB) were placed in 132 obese and morbidly obese patients, to study the clinical possibilities of a new system, both from the point of view of the materials used and the application method. METHODS: 36 patients were male and 96 female; mean age was 43 years (21-70); mean weight was 115.4 kg (67-229), and mean BMI was 41.0 (29-81). 8 patients were affected by severe respiratory insufficiency. We placed and removed the balloon endoscopically under conscious sedation or general anesthesia. BIB was removed in the majority of patients 4 months after insertion. The patients were given a balanced diet of 800-1000 kcal/day; follow-up involved a monthly check-up (routine blood tests, weight control) and a visit every 15 days with the dietitian. RESULTS: Mean weight loss was 14.4 kg; mean reduction in BMI was 5.2. Weight loss was much better in males. The weight loss produced an improvement of the complications associated with the obesity. Complications observed were: balloon intolerance (9 early removals), 1 balloon deflated and passed, 2 cases of gastric ulcer at balloon removal. CONCLUSIONS: The most correct indications for BIB should be: extremely obese patients (BMI>40) in preparation for a bariatric operation; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI<30 in a multidisciplinary approach.

Adult↗
PubMed1975

[The influence of enflurane (ethrane) on surface activity of the lung (author's transl)].

Enflurane (Ethrane), a new inhalation anesthetic, was examined for possible surfactant alterating properties. To elucidate this question two groups of rabbits underwent investigation: the first group (5 animals) was mechanically ventilated with room air over a five hour period. In the second group (7 animals) for the same period Enflurane in clinical dosages was added the inspired gas. At the end of the procedure in neither group could signs of impaired lung surface activity be detected: All rabbits showed normal blood gas values, normal pressure volume diagrams and physiologic behaviour of lung extracts in the wilhelmy balance. We conclude first that artificial ventilation "per se" does not harm lung surfactant and second that Enfluran anesthesia is a good choice for outstanding long procedures as well as for patients with already impaired surface activity of the lung, because there seems to be little risk of aggravating the situation.

Animals↗
PubMed1990

[Low T3 syndrome (3,3',5-triiodothyronine) in relation to the extent of surgical trauma].

Thirty patients undergoing extra-thyroid surgery were divided into two groups (A and B) according to the extent of surgical stress (Group A: major surgery; Group B; minor surgery). Thyroid hormone levels were measured before the operation and up to the 3rd postoperative day in Group B and up to the 7th postoperative day in Group A. A low T3 syndrome was observed in all 30 patients examined of the first postoperative day (reduction of T3 and increase in rT3 without alterations of total thyroxin or signs of hypothyroidism) with normalisation of thyroid values by 3rd postoperative in Group B and later in Group A. The persistence of the syndrome in the latter group was due to the extent of surgical stress, the duration of anesthesia, the presence of stress factors such as staying in intensive therapy, painful symptoms and a negative energy balance during the first days following operation. This syndrome is indicative of a physiological adaptation process to reduce O2 consumption, basal metabolism and in particular protein catabolism.

Adult↗
PubMed1989

Left ventricular oxygen tensions in dogs during coronary vasodilation by enflurane, isoflurane and dipyridamole.

The purpose of this study was to investigate the effects of the anesthetics enflurane and isoflurane and of the coronary vasodilator dipyridamole on myocardial oxygen balance and myocardial tissue oxygen tensions. The studies were performed in 24 open-chest dogs during basal anesthesia with a narcotic. Myocardial blood flow (MBF) was measured using radioactive microspheres, myocardial surface tissue PO2 by means of a platinum multiwire surface electrode. One control group and three experimental groups were studied: enflurane (1.1 vol%), isoflurane (0.7 vol%, both end-tidal concentrations), and dipyridamole (0.4 mg/kg). Mean arterial pressure significantly decreased to an average of 70 mm Hg in all three experimental groups. Although MBF was unchanged during enflurane (-18%) and isoflurane (+20%), it increased during dipyridamole (+304% p less than 0.05 vs baseline and control, enflurane, and isoflurane groups). Myocardial oxygen consumption decreased significantly during enflurane and isoflurane but remained unchanged during dipyridamole. Thus, the ratio between myocardial oxygen delivery and consumption increased 6% with enflurane (p less than 0.05 vs baseline), 47% with isoflurane (p less than 0.05 vs baseline and control group) and 280% with dipyridamole (p less than 0.05 vs baseline and control, enflurane, and isoflurane groups). Coronary venous PO2 remained unchanged during enflurane but increased significantly during isoflurane and dipyridamole. Left ventricular surface tissue PO2 was unchanged in enflurane and isoflurane animals and decreased slightly, yet significantly, during dipyridamole. All variables remained unchanged in the control group. Thus, isoflurane and dipyridamole interfered with MBF autoregulation and increased myocardial oxygen delivery out of proportion to myocardial demands.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗