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PubMed1982

The elimination of inorganic fluoride after enflurane anesthesia--transitory action on parathyroid tissue.

Enflurane has been introduced as a potentially useful clinical anesthetic compound. Its administration is followed by elevations of blood and urine concentrations of inorganic fluoride, whose nephrotoxicity has been previously described. Although the action of this element on the skeleton is well documented when ingested orally, its influence has not yet been investigated when it results from the metabolism of fluorinated anesthetic drugs. The present study examines renal function and calcium-phosphorus balance after administration of low concentration of enflurane. Twenty-one patients of both sexes undergoing minor surgery were selected. A statistical analysis of biologic items determined before and after anesthesia showed no significant variations of parameters involved in renal function. On the contrary, it was shown that biodegradation of enflurane was responsible for a significant change in blood and urine phosphorus concentrations. Moreover variations in phosphorus clearance suggested a transitory hypersecretion of parathyroid hormones, probably related to inorganic fluoride metabolism. Such a result is interesting because of the low blood concentration of inorganic fluoride and its transitory character.

Adult↗
PubMed1992

Anaesthesia for intraperitoneal hyperthermic perfusion.

Intraperitoneal hyperthermic perfusion is a method of regional chemotherapy shown to be effective in the prevention and treatment of peritoneal metastases. General anaesthesia for a patient who required this procedure is described. Guidelines for management are suggested, with particular emphasis on temperature control, fluid and electrolyte balance and postoperative care.

Acid-Base Equilibrium↗
PubMed1984

T-lymphocytes and the subpopulations of T-helper and T-suppressor cells measured by monoclonal antibodies (T11, T4, and T8) in relation to surgery under epidural and general anaesthesia.

Monoclonal antibodies reacting with specific determinants on lymphocytes and their subpopulations were used to study the influence of surgery under general or epidural anaesthesia on the number of T-cell (T11), T-suppressor cells (T8), and T-helper cells (T4). The T-cell fraction decreased significantly during surgery, but was only moderately reduced on the first postoperative day. The change in the T-cell fraction was the same under both types of anaesthesia. The helper and suppressor cell fractions were not significantly altered at any time during the study, and again there was no difference between the two anaesthetic regimens. The ratio of helper cells to suppressor cells (the T4/T8 ratio), which is widely used as an indicator of immunosuppression, showed no significant variations during the study, even though there were individual variations. Changes in the T4/T8 ratio were not correlated to the amount of blood transfusions, nor was there any correlation between the T4/T8 ratio and the thymidine uptake in mitogen-(PHA)-stimulated lymphocytes. T-lymphocytes are depressed during and after surgery under general anaesthesia. From the present study, this does not seem to be due to changes in the balance between helper- and suppressor T-cells.

Aged↗
PubMed2005

General anaesthesia for emergency caesarian section in a patient with Eisenmenger's syndrome and pre-eclampsia.

Pregnancy is poorly tolerated in patients with Eisenmenger syndrome (ES) with maternal mortality of 30-50%. Physiological changes of pregnancy decreases systemic vascular resistance that further aggravates the bi-directional or right to left shunt associated with ES. When it occurs with eclampsia, the morbidity and mortality are even higher. We report a case of 30 weeks pregnant woman with ES, who underwent emergency caesarian section because of pre-eclampsia. The intra-operative course was uneventful but she died on the second post-operative day. Post-operatively she was managed by the cardiologist in the coronary care unit. The probable cause being that she was over transfused, as the fluid status was not assessed by any invasive monitoring (like CVP). It was concluded that patients should be monitored closely in the post-operative period in the intensive care unit with complete invasive monitoring for up to a week to prevent factors resulting in worsening of the shunt (such as fluid balance) and thromboembolic phenomenon.

Adult↗
PubMed2003

Effects of propofol-sevoflurane anesthesia on the maternal and fetal hemodynamics blood gases, and uterine activity in pregnant goats.

To determine the effects of propofol and sevoflurane on hemodynamics, acid-base balance and uterine activity in pregnant animals, a prospective experimental study was designed by use of ten pregnant goats. Propofol was intravenously administered at a bolus dose of 5 mg/kg and then infused a rate of 0.3 mg/kg/min for 5 min. Following the induction, the animals were incrementally inhaled 2.7 and 4.1% of end-tidal concentration of sevoflurane each for 30 min, and then recovered. The maternal and fetal heart rate (HR), arterial blood pressure (BP) and acid-base balance, the intrauterine pressure (IUP), and the uterine blood flow (UBF) were measured. Following the pre-anesthetic data, the parameters were measured 7 times throughout the anesthetic and recovering periods. The propofol infusion induced 1.37 times of HR increase and produced decrease in PO(2) and a relevant metabolic acidemia in the mother, with no effect in the fetus. Sevoflurane reduced BP in the fetus from 30 (2.7%) to 60 (4.1%) min of inhalation. The uterine contractions disappeared throughout sevoflurane inhalation, and then recurred within 15 min after the cessation of sevoflurane. Propofol injection increases HR, and induces a moderate hypoxemia and metabolic acidemia associated with the suppressed ventilation for pregnant goats, with less effect on the fetal hemodinamics. Sevoflurane causes minimal change in maternal hemodynamics, but induces significant hypotension in the fetus and reduction of uterine activity. These data may be useful in making anesthetic choices combined with analgesia for Caesarian section in goats.

Anesthetics, Inhalation↗
PubMedDate not supplied

[Combined spinal epidural anesthesia during endoprosthetic surgeries for bone tumors in old-age children].

Thirty-five patients (ASA II-III) aged 12 to 17 years, diagnosed as having osteogenic sarcoma and Ewing's sarcoma localizing in the femur and tibia, were examined. Surgery was performed as sectoral resection of the affected bone along with knee joint endoprosthesis. Surgical intervention was made under combined spinal and epidural anesthesia (CSEA) with sedation, by using the methods for exact dosing of propofol (6-4 mg/kg x h). During intervention, a child's respiration remains is kept spontaneous with oxygen insufflation through a nasal catheter. CSEA was performed in two-segmental fashion. The epidural space was first catheterized. After administration of a test dose, 0.5% marcaine spinal was injected into dermatomas below the subarachnoidal space, depending on body weight (3.0-4.0 ml). Sensory blockade developed following 3-5 min and lasted 90-120 min, thereafter a local anesthetic (bupivacaine) or its mixture plus promedole was epidurally administered. ??Anesthesia was effective in all cases, motor blockade. During surgery, there was a moderate arterial hypotension that did not require the use of vasopressors. The acid-alkali balance suggested the adequacy of spontaneous respiration. The only significant complication we observed was atony of the bladder that requires its catheterization till the following day. An epidural catheter makes it possible to effect adequate postoperative analgesia.

Adolescent↗
PubMed1986

Can etomidate cause an Addisonian crisis?

The purpose of this study was to assess if it could have been possible to discover the side effects of etomidate by infusion in an earlier phase of its introduction on the market, using the routine parameters of everyday anesthesiological practice. The study was undertaken in twelve patients scheduled for major abdominal vascular surgery. The effect of etomidate-fentanyl and air anesthesia was compared with the effects of neurolept anesthesia. Arterial blood-pressure, central venous blood pressure, pulse rate, peripheral and central body temperature were recorded continuously. Blood samples were taken every two hours during anesthesia for the estimation of arterial blood gases, cortisol, sodium, potassium and chloride. Significant differences were found mainly for the peripheral-, core temperature difference, the cumulative sodium and cumulative fluid balance from which the diagnosis addisonian crisis could have been made. There were also differences in the incidence of early and late complications and in the recovery rate of the patients after etomidate infusions.

Addison Disease↗
PubMed1994

Medicolegal considerations for anesthesia in the ambulatory setting.

Low cost and an impressive safety record portend the continued growth of ambulatory surgery centers. Just as in the inpatient setting, the patient's welfare and the quality of care must be balanced with cost considerations. Liability in the ambulatory surgery center rests on many of the same legal principles applicable in the inpatient setting. Anesthesiologists in the ambulatory setting must comply with standards of care; plan for complications; obtain informed consent; properly discharge their patients; and completely document the care given. They must give special consideration to the limited time available for pre-anesthetic assessment and the pressure for timely discharge home, and develop safeguards to minimize the attendant risks. Recognizing the legal hazards of anesthesia in the ambulatory setting can both improve patient treatment and reduce the legal perils of patient care.

Ambulatory Surgical Procedures↗
PubMed1997

Effects of concentration and volume of 2-chloroprocaine on epidural anesthesia in volunteers.

BACKGROUND: Effect of local anesthetic concentration and volume on the spread and density of epidural anesthesia is unclear. This study was performed to delineate effects of a threefold difference in concentration and volume of 2-chloroprocaine on epidural anesthesia. METHODS: Twelve healthy volunteers underwent lumbar epidural anesthesia with 300 mg of 2-chloroprocaine as a 3% (10 ml) and a 1% (30 ml) solution in a randomized, double-blind, balanced, crossover fashion. Sensory block was assessed with pinprick, touch (calibrated plastic filament), cold, and electrical stimulation. Motor block was assessed at the quadriceps and gastrocnemius muscles with isometric force dynamometry. Differences between solutions were assessed with repeated measures analysis of variance followed by post hoc testing. RESULTS: The number of dermatomes blocked to pinprick, touch, and cold was significantly greater with the 1% concentration (2 dermatomes greater than the 3% concentration on average, P < 0.05). Similar intensity of sensory block to electrical stimulation developed at the hip and knee and was unaffected by concentration of 2-chloroprocaine. Similar intensity of motor block developed at the quadriceps with both concentrations. CONCLUSIONS: Intensity of sensory and motor block from epidural anesthesia with 2-chloroprocaine appears to depend primarily on total milligram dose.

Adult↗
PubMed1999

CO(2)-induced expression of c-fos in the nucleus of the solitary tract and the area postrema of developing swine.

This investigation was performed to determine whether hypercapnic exposure elicited expression of the c-fos protooncogene product, FOS, in nucleus of the solitary tract (NTS) and area postrema (AP) neurons of developing swine. Mean arterial blood pressure (MAP) and heart rate (HR) were also monitored to evaluate whether numbers of neurons containing FOS were related to changes of MAP and HR. In each experiment, two litter-matched piglets were prepared simultaneously, i.e., Saffan anesthesia, paralysis, and artificial ventilation (100% O(2)). One animal was exposed to hypercapnia (1 h of 10% CO(2), balance oxygen), while the other continued to breathe 100% O(2). Animals were studied at three different ages: 5-8 days, 13-15 days, and 26-34 days old. In the NTS, FOS expression was prominent in regions corresponding to the general visceral afferent subdivision; the AP showed no such topographic distribution. The number of NTS and AP neurons with FOS in hypercapnic-exposed animals was significantly greater than those of unexposed animals. However, an age-related increase of FOS was observed only for NTS neurons, with the greatest number observed in 13- to 15-day-old animals. Increases of MAP, not HR, were noted during the early part of hypercapnia in the 5- to 8-day-old group; older animals exhibited no change of MAP. Our findings demonstrated that prolonged hypercapnic stimulation elicited FOS expression in AP and NTS neurons of developing animals, and that such expression was non-uniform, depending upon the region studied.

Aging↗
PubMed1999

Effect of intravenous omega-6 and omega-3 fat emulsions on nitrogen retention and protein kinetics in burned rats.

The effect of omega-3 fat emulsion on nitrogen retention and kinetics in relation to fatty acid profile were investigated in burned rats receiving total parenteral nutrition (TPN). A fat emulsion of a structured symmetrical triacylglycerol containing only eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (2:1) was prepared. Sprague-Dawley rats were fed by fat-free chow for 2 wk. Then rats were fed exclusively with one of three types of TPN for 7 d. Animals in group C received fat-free TPN (n = 11). Group omega 6 received safflower oil fat emulsion, which accounted for 20% of total caloric intake (n = 11). Group omega 3 received fat emulsion containing only EPA and DHA (1% of total calories, n = 11), in addition to safflower oil emulsion (19% of total calories). On day 5, each rat was subjected to 20% full-thickness scald burns. Rats were sacrificed under ether anesthesia 48 h after burning. The rats in group C became deficient in omega-6 essential fatty acids. Cumulative nitrogen balance was decreased significantly in group omega 6. The rates of whole-body protein synthesis were increased significantly in both groups omega 6 and omega 3. In omega 6, however, the rates of whole-body protein breakdown were increased significantly. In conclusion, the rates of whole-body protein breakdown increased and nitrogen retention was aggravated significantly in animals administered the safflower oil emulsion. Significant increases of urinary excretion of total catecholamine were also observed. Prostaglandin E2 and thromboxane B2 concentrations were not significantly different among three groups. Supplementation with the new omega-3 fat emulsion, however, improved protein metabolism in burned rats receiving TPN.

Animals↗
PubMed1997

Management of acute and surgical pain.

Effective treatment of acute pain secondary to surgery and trauma is often a complex and perplexing task. Concern about potential adverse effects of analgesic drugs on cardiovascular, respiratory, renal, and central nervous system functions often limits the use of analgesics in the very patients that could benefit from them the most. Combining drugs of different classes and with different mechanisms of action is an established anesthesia technique used to achieve a desired effect with a minimum of adverse side effects. Similarly, the use of a balanced or multimodal approach to the treatment of acute pain can greatly enhance the clinician's ability to safely provide effective analgesia. Systemic opioids, alpha-2 agonists, nonsteroidal antiinflammatory drugs, and local or regional analgesic techniques can be used in varying combinations to meet the needs of the painful animal and hasten recovery.

Acute Disease↗
PubMed1992

[pO2, pCO2 and acid-base balance in the human vitreous sample].

In order to clarify the physiological profile in vitreous cavity undergoing vitrectomy, both human vitreous and venous blood samples were obtained to measure pO2, pCO2, acid-base balance and potassium. A new collection system was employed to obtain vitreous samples from 15 eyes under local or general anesthesia. The mean vitreous pO2 was higher than that of venous blood, and was affected by irrigative air more than breathed oxygen. Irrigating air was considered to be one of the best methods to supply enough oxygen concentration to the inner retina during the vitrectomy. Although the vitreous pH showed alkalosis during the air irrigation, it was suggested that to protecting the retina, the vitreous bicarbonate buffer was not enough to compensate for the decrease in the vitreous pH.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Perioperative dynamics of the parameters of acid-base equilibrium in patients with lung cancer in relation to the type of anesthesia].

Acid-base parameters of the venous blood have been studied in 60 patients with lung cancer randomized into two groups prior to and following lung resection and on days 2, 4 and 9 postoperatively. In group I multicomponent endotracheal anesthesia using controlled lung ventilation and postoperative intramuscular analgesia with non-narcotic and narcotic analgesics were employed. In group II anesthesia and controlled lung ventilation were supplemented by epidural anesthesia with 2.5% trimecaine solution combined with adrenaline and small morphine doses at the upper thoracic segment level, postoperative analgesia for 18 hours was performed likewise. Perioperative acid-base balance changes were found to be more favourable in patients of group II, which was manifested in weaker acidosis by the end of the operation and in the absence of remote pathological changes in the acid-base balance. In patients of group I gradual repeated increase in metabolic acidosis was observed, which by day 9 postoperatively assumed a complicated clinical course.

Acid-Base Equilibrium↗