[Relationship between demand and supply of oxygen during the immediate postoperative period: comparison between blended anesthesia and general anesthesia].
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Results for “Anesthesia, General”
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The effect of ephedrine bolus administration on left ventricular loading and systolic performance during high thoracic epidural anesthesia combined with general anesthesia.
We investigated the effect of ephedrine on left ventricular function in patients without cardiovascular disease under high thoracic epidural anesthesia combined with general anesthesia. Because the epidural block was extended to all cardiac segments, ephedrine was assumed to be deprived of its centrally mediated actions. Left ventricular (LV) function was assessed using transesophageal echocardiography. We measured arterial pressure (AP), heart rate (HR), LV end-systolic and end-diastolic diameter and area (ESA, EDA), wall thickness, and LV ejection time before and after intravenous ephedrine bolus administration. We calculated area ejection fraction (EFA), end-systolic wall stress (ESWS), and mean velocity of circumferential fiber shortening (mVcfc). Ephedrine had a biphasic effect on left ventricular function. It transiently decreased EDA from 18.9 to 16.5 cm2 (mean), whereas EFA and mVcfc were increased from 33% to 49%, and from 1.88 to 2.67 circumferences/s, respectively. During the second phase, ephedrine increased mean arterial pressure (MAP) from a baseline value of 62 to 87 mm Hg, EDA was restored to 19.3 cm2, and EFA and mVcfc remained above baseline (52% and 2.64 circumferences/s, respectively). ESWS was not significantly increased from baseline. We conclude that ephedrine improves left ventricular contractility, even in the presence of high thoracic epidural anesthesia, without causing relevant changes of left ventricular afterload.
Adult↗
Prevention of atelectasis formation during induction of general anesthesia.
UNLABELLED: General anesthesia promotes atelectasis formation, which is augmented by administration of large oxygen concentrations. We studied the efficacy of positive end-expiratory pressure (PEEP) application during the induction of general anesthesia (fraction of inspired oxygen [FIO(2)] 1.0) to prevent atelectasis. Sixteen adult patients were randomly assigned to one of two groups. Both groups breathed 100% O(2) for 5 min and, after a general anesthesia induction, mechanical ventilation via a face mask with a FIO(2) of 1.0 for another 5 min before endotracheal intubation. Patients in the first group (PEEP group) had continuous positive airway pressure (CPAP) (6 cm H(2)O) and mechanical ventilation via a face mask with a PEEP of 6 cm H(2)O. No CPAP or PEEP was applied in the control group. Atelectasis, determined by computed radiograph tomography, and analysis of blood gases were measured twice: before the beginning of anesthesia and directly after the intubation. There was no difference between groups before the anesthesia induction. After endotracheal intubation, patients in the control group showed an increase of the mean area of atelectasis from 0.8% +/- 0.9% to 4.1% +/- 2.0% (P = 0.0002), whereas the patients of the PEEP group showed no change (0.5% +/- 0.6% versus 0.4% +/- 0.7%). After the intubation with a FIO(2) of 1.0, PaO(2) was significantly higher in the PEEP group than in the control (591 +/- 54 mm Hg versus 457 +/- 99 mm Hg; P = 0.005). Atelectasis formation is prevented by application of PEEP during the anesthesia induction despite the use of large oxygen concentrations, resulting in improved oxygenation. IMPLICATIONS: Application of positive end-expiratory pressure during the induction of general anesthesia prevents atelectasis formation. Furthermore, it improves oxygenation and probably increases the margin of safety before intubation. Therefore, this technique should be considered for all anesthesia induction, at least in patients at risk of difficult airway management during the anesthesia induction.
Adolescent↗
[Local anesthesia associated with general anesthesia potentiated with M1 plus hydergine lyticcocktail in otorhinolaryngoiatric surgery].
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Anesthesia↗
[Local versus general anesthesia in neurosurgery. The advantages of general anesthesia in neurosurgery and reservations after an experience with 235 cases].
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Anesthesia↗
[Relation between fingertip temperature pattern and epidural puncture site during epidural anesthesia combined with general anesthesia].
We are employing fingertip temperature monitoring to estimate the spread of epidural anesthesia in patients who received combined epidural and general anesthesia. In this study we examined the relation between fingertip temperature pattern and epidural puncture site. One hundred patients scheduled for elective digestive tract surgery were studied. They were divided into three groups according to the epidural puncture sites as follow; Group 1, T7-9 (n = 26); group 2, T9-12 (n = 48); and group 3, T12-L5 (n = 26). Fingertip temperature was determined by Anritsu thermocouples. These probes were attached to the thumb and the big toe (hand and foot fingertip). The changes of these temperatures were classified to four types. In type 1, the hand fingertip temperatures were elevated after administration of the local anesthetics. In type 2, both hand and foot fingertip temperatures were elevated. In type 3, the foot fingertip temperature was elevated. In type 4, the hand and foot fingertip temperatures were unchanged. In group 1, we found 10 cases of type 1, 13 cases of type 2 and 3 cases of type 3. In group 2; 15, 22, 11 cases respectively. In group 3; 1, 16 cases respectively and 1 case in type 4. In group 1 and 2, the type 1 temperature pattern was observed more than in group 3 (P < 0.01). And in group 3, the type 3 temperature pattern was observed more than in group 1 and 2 (P < 0.01). We found no intergroup difference in type 2 pattern. But there were some exceptions.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesia, Epidural↗
[Analysis of cost minimization of epidural anesthesia compared with general anesthesia in oncologic coloproctologic surgery].
BACKGROUND: Combined general and epidural anaesthesia in abdominal surgery has shown, both, protective and no effect on final outcome. The aim of this study was to evaluate combined epidural and general anesthesia. METHODS: One hundred and eighty four patients, diagnosed of neoplastic process, in whom an elective procedure of coloproctologic resection and reconstruction was scheduled during the period between January-1993 and December 1994, were studied. In thirty consecutive patients a combined general-epidural anaesthesia (EA) was performed. These patients were compared to thirty general anaesthesia patients (GA), selected randomly from the same period. RESULTS: Both groups were comparable for demographic characteristics and for the type and duration of the surgical procedure. Red Blood Cells units transfused were 1.7 +/- 3 in the EA group and 1.4 +/- 1.9 in the GA group. After the operation, most of patients went to SICU. The length of the hospital stay was 13 +/- 6 days for GA group, while for EA group was .13 +/- 5. The hospital mortality for all operated patients (N = 184) was 1.1%, which were directly related to failure of surgical anastomosis. The need for mechanical ventilation and pulmonary complications were similar in both groups. When analyzing costs, EA group represented a value (pesetas) of 433,501 +/- 183,337 for GA group and 437,735 +/- 149,572 for EA group. CONCLUSIONS: As shown, in the actual context, we conclude that the anaesthetic technique did not have any influence on outcome or on cost.
Adolescent↗
Brachial plexus anesthesia compared to general anesthesia when a block room is available.
PURPOSE: Regional anesthesia is often felt to be beneficial to patient care but detrimental to operating room (OR) efficiency. In this report we compare how a block room (BR) affects OR time (ORT) utilization for brachial plexus anesthesia (BPA) in a busy upper limb practice. We also compare how anesthetic technique, BPA or general anesthesia (GA), impacts on the time to recovery and discharge in patients having outpatient upper limb surgery. METHODS: With the Ethics Committee's approval, a prospective study using hospital databases was undertaken. All patients presenting for surgery on the upper limb between November 1999 and April 2000 were eligible for analysis. A comparison was made of the various time intervals that comprise a patient's hospital stay for either GA or BPA. Demographic data (ASA, age, outpatient status), and location of BPA were analyzed. RESULTS: Use of the BR for BPA significantly reduced the pre-procedure anesthesia ORT when compared to BPA done in the OR (11.4 vs 32.9 min, P < 0.05; GA pre-procedure time was 17.8 min). In the ambulatory patient, BPA alone reduced post procedure anesthesia ORT, postanesthetic care unit, surgical day care unit, and total hospital times when compared to those receiving GA. On average those receiving a BPA spent 1.5 hr less in hospital (P < 0.01). Additionally, fewer admissions (2.4 vs 5.4%) occurred in the BPA group. CONCLUSION: The use of a BR reduces the anesthesia ORT associated with BPA. Secondly, BPA improves the recovery time phase of outpatients undergoing surgery on the upper limb.
Adolescent↗
Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography.
Patients scheduled for vascular surgery are considered at risk for perioperative cardiac complications. Choice of anesthetic in such patients is guided by a desire not to adversely affect myocardial function. On the basis of data from laboratory studies, thoracic epidural anesthesia (TEA) has been advocated to prevent myocardial ischemia. The aim of this study was to assess whether TEA combined with general anesthesia has any effect on segmental wall motion (SWM) monitored by transesophageal echocardiography in these patients. Patients received alfentanil, midazolam, vecuronium, and 50% N2O in oxygen, and ventilation was controlled after orotracheal intubation; 12.5 mL of 2% lidocaine HCl was injected through an epidural catheter placed at T6-7 or T7-8. Hemodynamic measurements and transesophageal echocardiographic recordings were obtained before and 10, 20, 30, 40, and 60 min after lidocaine injection. Segmental wall motion was graded a posteriori by two independent experts on a predetermined scale (from 1 = normal to 5 = dyskinesia). A decrease greater than or equal to 2 grades was considered an SWM abnormality indicative of ischemia. Thoracic epidural anesthesia induced a decrease in systemic arterial blood pressure, heart rate, and cardiac index. The SWM score decreased slightly from 1.34 +/- 0.68 to 1.27 +/- 0.64 (mean +/- SD) (at 10 and 20 min, respectively) (P less than 0.05). Patients were a posteriori analyzed according to whether they had documented coronary artery disease or not. The SWM score before TEA was significantly higher in patients with documented coronary artery disease (1.51 +/- 0.88 vs 1.17 +/- 0.51, respectively; P less than 0.05) and did not change significantly after TEA.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abdominal wall lifting with spinal anesthesia vs pneumoperitoneum with general anesthesia for laparoscopic herniorrhaphy.
BACKGROUND: Laparoscopic herniorrhaphy has generally been very successful since any postoperative inguinal pain or tension is considerably less troublesome than after other open methods. The conventional laparoscopic approach in the treatment of inguinal hernia involves the use of pneumoperitoneum and general anesthesia. Nevertheless, some complications can be encountered and the procedure is costly. We, therefore, examined the possibility of using a more practical and cost efficient method. MATERIALS AND METHODS: Based on our findings, we propose the use of a Kirschner lifting wire as a means of separating the abdominal wall during laparoscopic herniorrhaphy. Two Kirschner wires are introduced through the subcutaneous tissue, between the umbilicus and inguinal ligament, and parallel to the inguinal ligament. Furthermore, we recommend the use of spinal anesthesia as a means by which the problems associated with general anesthesia and the potential cardiopulmonary complications of carbon dioxide insufflation, are circumvented. Fifteen cases of inguinal hernia have been treated with this new method and compared to the more conventional procedure of pneumoperitoneum under general anesthesia. RESULTS: Visibility of the operative field when used in the inguinal region was not limited at all, and Kirschner wire is considerably less expensive. The postoperative course for the patients who were operated by the new method was uneventful. CONCLUSIONS: Our results indicate that this new method can be useful for the treatment of inguinal hernia.
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Con: regional anesthesia is not preferable to general anesthesia for the patient with heart disease.
The debate over regional anesthesia and general anesthesia with respect to relative risk in different classes of patients will probably be interminable until studies addressing the issue begin to specify the treatment protocols more carefully and to control as many variables as possible. Patients with cardiovascular disease who undergo major surgery are special cases in which either form of anesthesia may be acceptable or preferable. The benefits of lesser regional procedures do not necessarily extend to major conduction blockade in these individuals. Appropriate monitoring and goal-directed control of physiologic variables throughout the entire perioperative period may be more important than the type of anesthesia. General anesthesia that is carefully prepared, monitored, and conducted cannot be ruled out in the seriously ill.
Anesthesia, Conduction↗
Effects of subtenon anesthesia combined with general anesthesia on perioperative analgesic requirements in pediatric strabismus surgery.
BACKGROUND AND OBJECTIVES: Pediatric strabismus surgery leads to undesirable intraoperative and postoperative side effects that include pain, postoperative nausea and vomiting (PONV), and oculocardiac reflex (OCR). We hypothesized that subtenon anesthesia performed before the start of surgery and combined with general intravenous anesthesia would reduce these adverse effects. METHODS: Forty children (2.5 to 6 years of age, ASA status I to II) were prospectively randomized to receive either subtenon bupivacaine 0.5% or a saline injection before the beginning of surgery in a double-blind manner. Perioperative analgesic requirements, pain scores (CHEOPS scale), hemodynamics, and incidence of OCR and PONV were compared. RESULTS: Postoperative pain scores were lower (P < .001) at removal of the laryngeal mask and 30 minutes later in the bupivacaine group. Intraoperative and postoperative analgesic requirements were significantly reduced in this group (P < .01). The incidence of OCR and PONV were also significantly decreased (P < .01). Intraoperative values of blood pressure were significantly higher in the saline group at 20 minutes (P < .02). CONCLUSION: We conclude that preoperative subtenon bupivacaine 0.5% compared with a saline injection contributed to reduction of perioperative pain and undesirable side effects in pediatric strabismus surgery performed under general anesthesia.
Anesthesia, General↗
Anesthesia associated depression in lymphocyte traffic: less with regional anesthesia than with general anesthesia in sheep.
In the sheep single peripheral lymph node model of Hall and Morris, it is possible to cannulate efferent and afferent lymphatic vessels for long-term study of cells and substances in lymph and for short- and long-term infusions. By supporting the sheep in sternal recumbency (upright) to avoid positional alterations in lymphocyte traffic in short-term studies and by precise timing and measurement of lymph output and cell counts, it is possible to accumulate data on lymphocyte output into efferent lymph on a consecutive, cumulative basis and to detect long- and short-term alterations in lymphocyte traffic. With this model, studies on the effects of general and regional anesthesia were carried out on 42 unstimulated primary peripheral lymph nodes of sheep in vivo. The lymphocyte traffic depressing effects of general anesthesia were found to be significantly less when regional epidural anesthesia was employed. The duration of depression also was less. In the general anesthesia studies, the depth of depression in lymphocyte traffic appeared related to the dose and length of anesthesia. These alterations may play important roles in the immunologic responses to anesthetic compounds and approaches.
Anesthesia, Epidural↗
Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Ropivacaine Hip Replacement Multicenter Study Group.
UNLABELLED: The aim of our study was to compare epidural anesthesia and analgesia (EDA) with ropivacaine versus general anesthesia followed by IV patient-controlled analgesia with morphine (GA/PCA) after hip replacement regarding pain, side effects, and discharge from the postanesthesia care unit. After ethics committee approval, randomization, and informed consent, 90 patients were enrolled. In Group EDA, epidural anesthesia (ropivacaine 10 mg/mL, 15-25 mL) was followed by an epidural infusion (2 mg/mL, 4-6 mL/h for 24 h, plus top-up doses of 6-10 mL for 48 h). GA/PCA patients received general anesthesia (isoflurane/N2O/fentanyl) followed by IV patient-controlled analgesia with morphine postoperatively. Pain was assessed by using visual analog scales (0-100 mm) at rest and during physiotherapy. Pain at rest was less in the EDA (n = 43) group than in the GA/PCA (n = 45) group (at 10 h: 11.8+/-12.9 vs. 28.4+/-17.1 [P< 0.001]; at 24 h: 14.3+/-11.7 vs. 24.0+/-17 [P<0.01]; in 48 h: 14.3+/-9.3 vs. 21.1+/-17.4 [P = 0.1]). Whereas EDA patients were deemed ready for discharge from the postanesthesia care unit earlier than GA/PCA patients (5.6+/-8.9 vs. 39.7+/-41.5 min), the actual discharge time was comparable. The median time for first passage of flatus was shorter in the EDA group than in the GA/PCA group (26 vs. 47 h). Nausea and vomiting were more common in the GA/PCA group than in the EDA group (16% vs. 28% and 11% vs. 22%, respectively), whereas hypotension (11% vs. 4%) and bradycardia (14% vs. 2%) were less frequent. Under the conditions of the present study, EDA with ropivacaine provided pain control after hip replacement superior to that provided by IV patient-controlled analgesia with morphine, particularly during the first 24 h. Both approaches to pain management were equally safe. IMPLICATIONS: Compared with general anesthesia and postoperative IV patient-controlled analgesia with morphine, epidural anesthesia and analgesia with the new local anesthetic ropivacaine enables patients to be discharged sooner from a postanesthesia care unit and provides superior pain relief during the first 24 h after hip replacement.
Amides↗
Neurological evaluation by intraoperative wake-up during carotid endarterectomy under general anesthesia.
Although general anesthesia allows relief from stressors such as pain, discomfort, or anxiety for patients undergoing carotid endarterectomy, neurologic assessment is less reliable than under local anesthesia. We describe a unique anesthetic management strategy for carotid endarterectomy patients incorporating the advantages of both general and local anesthesia. The technique allows thorough assessment of neurologic function during carotid cross-clamping by intraoperative wake-up, and guarantees airway management by tracheal intubation.
Anesthesia, General↗
Intraoperative adjustment of eye muscle surgery. Correction based on eye position during general anesthesia.
During general anesthesia, the eye position of patients with strabismus, measured by Krimsky's test at 1 m, 30 minutes after induction, has a linear correlation with the eye position measured clinically preoperatively. A similar study was performed on 77 patients; however, Hirschberg's test was used for simplicity and was performed as soon as the patient was in a surgical plane of anesthesia. We confirmed that there was a linear correlation. We also adjusted the surgery performed in seven cases where the test was anomalous, ie, when the eye position under anesthesia was more than 15 prism diopters more or less than expected based on preoperative clinical measurements. We did approximately 1 mm more or less surgery than we had planned on each eye muscle. This significantly improved the final results in anomalous cases. Patients with anomalous tests who did not have such adjustments had significantly poorer results.
Adolescent↗
Mechanisms of general anesthesia.
Although general anesthetics are often said to be nonspecific agents, it is likely that they act at a much more restricted set of target sites than commonly believed. The traditional view has been that the primary targets are lipid portions of nerve membranes, but recent evidence shows that the effects on lipid bilayers of clinically relevant levels of anesthetics are very small. Effects on most proteins are also small, but there are notable examples of proteins that are extremely sensitive to anesthetics and mimic the pharmacological profile of anesthetic target sites in animals. Such target sites are amphiphilic in nature, having both hydrophobic and polar components. The polar components appear to behave as good hydrogen-bond acceptors but poor hydrogen-bond donors. Although the targets can accept molecules with a wide variety of shapes and chemical groupings, they are unaffected by molecules exceeding a certain size. Overall, the data can be explained by supposing that the primary target sites underlying general anesthesia are amphiphilic pockets of circumscribed dimensions on particularly sensitive proteins in the central nervous system.
Anesthesia, General↗
[Study of 100 cesarean sections under general anesthesia with alfathesine. Comparison with 100 cesarean sections under general anesthesia with pentobarbital and with Na gamma hydroxybutyrate].
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Alfaxalone Alfadolone Mixture↗