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PubMed2006

Postanesthetic hyperthermia in cats: a retrospective comparison between hydromorphone and buprenorphine.

OBJECTIVE: To determine the prevalence of postanesthetic hyperthermia [rectal temperature >40 degrees C (104 degrees F)] in a clinical population of cats. STUDY DESIGN: Retrospective study. ANIMAL POPULATION: One hundred and twenty-five cats with an age range of 2 months to 16.1 years, and weighing 3.9 +/- 1.5 kg. MATERIALS AND METHODS: Data were obtained from the medical records of 125 cats that underwent general anesthesia. Information on perioperative rectal temperatures, breed, sex, weight, surgical procedure, anesthetic time, surgery time, anesthetic and analgesic drugs were retrieved. STATISTICAL ANALYSES: Five groups of cats were compared; group 1 (n = 15) received acepromazine and no opioids; group 2 (n = 17) received acepromazine and buprenorphine; group 3 (n = 19) received acepromazine, buprenorphine and ketoprofen; group 4 (n = 45) received acepromazine and hydromorphone and group 5 (n = 29) received acepromazine, hydromorphone and ketoprofen. Data conformed to a split-plot repeated measures analysis of variance and was analyzed using SAS PROC MIXED. Post hoc tests were by means of Bonferroni t-test; < or = 0.05 was considered significant. RESULTS: Rectal temperature was significantly decreased in all groups at the end of anesthesia. Rectal temperature was significantly elevated at 1, 1.5, 2, 3, 4 and 5 hours after the end of anesthesia in group 4, and at 2, 3 and 4 hours in group 5. Sixty-four percent of cats in group 4 and 69% in group 5 had rectal temperatures >40 degrees C (104 degrees F) at one or more times in the postanesthetic period. The highest temperature recorded was 42.5 degrees C (108.5 degrees F) in one cat in group 4. Mean rectal temperature did not exceed the preoperative temperature at any time during the postanesthetic period in group 1, 2 and 3 animals. CONCLUSIONS: This study indicates an association between hyperthermia and perioperative administration of hydromorphone in cats. CLINICAL RELEVANCE: When hydromorphone is used in cats their body temperature should be closely monitored.

Analgesics, Opioid↗
PubMedDate not supplied

[Obstetric and gynecologic anesthesia reported in the "Revista Española de Obstetricia y Ginecología" (1916-1936)].

This study follows the evolution of anesthesia in gynecology and obstetrics in Spain between 1916 and 1936. Research included revising all articles and references concerning anesthesiology appearing in the Revista Española de Obstetricia y Ginecologia over the 20 years during which that journal was published. Eighty-three articles were found: 18 (21.6%) original research reports, 37 (44.6%) reviews of the Spanish professional literature and 28 (33.7%) summaries and descriptions of meetings of scientific organizations. Spanish references constituted 39.8% with the remaining 60.2% coming from European and Hispano-American sources. Twenty-four (34.9%) were related to spinal anesthesia, 15 (18%) covered various methods for analgesia during childbirth and 14 (16.8%) were on barbiturates. The remaining articles referred to rectally administered anesthesia, local anesthesia, inhalatory anesthesia and pain in gynecology. In conclusion, our review reveals the strong international contacts in Spanish gynecology during this period, as well as the interest of gynecologists and obstetricians in various anesthetic techniques and the rapid incorporation of new methods into their therapeutic arsenal.

Anesthesia↗
PubMedDate not supplied

Intrathecal lidocaine and sufentanil shorten postoperative recovery after outpatient rectal surgery.

PURPOSE: A short recovery time for same day surgery is important to the patient and the hospital. A prospective, randomized, double-blinded study in the postanesthetic care unit was designed to compare the recovery time from spinal anesthesia with low-dose intrathecal (IT) lidocaine and sufentanil to that with IT lidocaine alone. The incidence of adverse effects was also assessed. METHODS: Forty-nine patients (ASA I-III, age 20-69 yr) underwent spinal anesthesia for rectal surgery. The patients were randomized into two groups. One group (n = 28) received low-dose IT lidocaine (15 mg) and sufentanil (10 microg) and the other group (n = 21) received IT lidocaine (50 mg). The time to ambulation, the incidence of pruritus, and other variables were recorded. Statistical difference was assumed if P < 0.05. RESULTS: Our results show a significantly shorter ambulation time (120 +/- 26 min) after IT low-dose lidocaine (15 mg) and 10 microg sufentanil vs 50 mg IT lidocaine (162 +/- 32 min, P < 0.0001). Patients who received IT lidocaine and sufentanil recovered faster. Fifty percent of the patients who received IT sufentanil suffered from pruritus. CONCLUSION: IT lidocaine (15 mg) and sufentanil resulted in a shorter time to ambulation compared to IT lidocaine (50 mg) alone and provided excellent anesthesia despite its disadvantage of pruritus.

Adult↗
PubMed1983

Rectal ketamine for induction of anaesthesia in children.

Rectal premedication with atropine and diazepam and rectal induction of anaesthesia with ketamine have been used in 30 healthy children undergoing minor surgery. The anticholinergic and sedative effects of the premedication were satisfactory. Induction of anaesthesia was smooth with no adverse circulatory or respiratory effects. No psychotomimetic side-effects were seen, and analgesia persisted into the recovery period. Plasma concentrations of ketamine and norketamine were measured in eight children and revealed a pharmacokinetic pattern indicating comparatively low bioavailability probably due to incomplete absorption from the rectum and a high 'first-pass' metabolism. The technique of rectal administration of ketamine needs further pharmacokinetic evaluation before it can be generally recommended.

Anesthesia, Rectal↗
PubMed1990

[Epidural sacral anesthesia with 3% mepivacaine in rectal surgery].

The authors think that the sacral epidural anaesthesia effected with Mepivacaine 3%, 6 ml (180 mg) and Fentanyl 2 ml (100 mcg) is perfectly indicated for the proctologic surgery as it is of simple execution and presents a short latency (12 min.), good deepness and perfect haemodynamic stability. Besides, it does not endanger the lower limbs innervation. No urinary retention.

Adult↗
PubMed1986

[The effect of rectal pH values on the absorption of methohexital].

The factors underlying the unpredictability of the pharmacokinetics of rectally administered methohexitone remain unclear. The "pH partition hypothesis" offers an explanation. We investigated six children with rectal pH values ranging from 7.5 to 9.8, who were given 25 mg/kg methohexitone 10% via the rectal route under general anaesthesia. Blood samples were taken at zero, 3, 5, 7, 10, 15, 20, 30, 40, 60, 90 and 120 min; rectal pH was measured at zero and 1 min. The methohexitone plasma levels reached a maximum (Cmax) of 2.63 micrograms/ml (median) after 17.5 min (median). The elimination half-life ranged from 37 to 218 min. No positive correlation between lower pH and better resorption (AUC and Cmax) was found. The resorption kinetics of rectally administered methohexitone cannot be explained by its electrochemical properties alone.

Anesthesia, Rectal↗
PubMed1997

Role of pudendal canal syndrome in the etiology of fecal incontinence in rectal prolapse.

BACKGROUND: The current communication investigates the role of pudendal canal syndrome in the genesis of fecal incontinence (FI) in complete rectal prolapse (CRP). METHODS: 89 patients with CRP (group A, 45 with FI, and group B, 44 without FI) were studied. Ten healthy volunteers in group C acted as controls. The subjects were assessed for rectal and rectal neck pressures, electromyographic (EMG) activity of the external anal sphincter (EAS) and levator ani, as well as for pudendal nerve terminal motor latency (PNTML). RESULTS: Group-A patients manifested perianal hypo- or anesthesia, diminished rectal neck pressure (p < 0.05) and EMG activity of EAS and levator muscle and prolonged PNTML (p < 0.05). In group B, rectal neck pressure was diminished (p < 0.05) in all patients. The EMG activity of the EAS and PNTML (p > 0.05) were normal in 34 patients, while the EMG activity was reduced and the PNTML prolonged (p < 0.05) in the remaining 10. The levator ani muscle showed diminished activity in the 44 patients of this group. CONCLUSION: The results of group A point to pudendal neuropathy as a cause of FI. In group B, 10 patients showed manifestations of subclinical pudendal neuropathy which may present later on with FI. The constant prolongation of PNTML in patients with FI postulates a relationship between the two. The cause of prolonged PNTML seems to be attributable to pudendal neuropathy due probably to pudendal nerve entrapment in the pudendal canal with a resulting pudendal canal syndrome. Therefore, pudendal canal syndrome is suggested to play a significant role in the genesis of FI in CRP.

Anal Canal↗
PubMed1985

Rectal induction of anaesthesia in children with methohexitone. Patient acceptability and clinical pharmacokinetics.

Rectal induction of anaesthesia with 10% methohexitone 100 mg ml-1 was used in 50 healthy children, using a standard dose of 25 mg/kg body weight. The absorption of methohexitone was rapid and reliable: the children fell asleep within 10-15 min. The plasma concentration peaked at 10-15 min and then decayed rapidly. The terminal half-life of rectal methohexitone was 1-2 h. Overall patient acceptability was good, and there were no major complications.

Anesthesia, Rectal↗
PubMed1979

Rectal methohexitone for induction of anaesthesia in children.

Rectal induction of anaesthesia using ten per cent methohexitone is a safe and effective method for young children. It is particularly applicable to the child three months to four years of age. Twenty-five mg.kg-1 of methohexitone should be given and the child should be observed continuously by the anaesthetist until he falls asleep. Equipment to establish an artificial airway and to ventilate the lungs should be immediately at hand. The use of rectal methohexitone does not significantly delay immediate or late recovery after short (30-minute) surgical procedures.

Age Factors↗
PubMed1984

[Ketamine via rectal route for the induction of pediatric anesthesia].

Three groups of children: 6 months to 3 years old with congenital heart disease, and 4 to 12 years old, and mentally retarded 14 to 18 years old affected by pneumopathia received 10 mg kg-1 ketamine by rectal administration. Induction was smooth and well tolerated. From onset of effects with nystagmus to full action 9 to 25 minutes elapsed.

Adolescent↗
PubMed1989

Haemodynamic effects of rectal methohexitone for induction of anaesthesia in children.

Pulsed Doppler and two-dimensional echocardiography were used to determine the haemodynamic effects of rectal methohexitone in 12 children 32.4 +/- 3.8 months old and weighing 13.3 +/- 1.1 kg (mean +/- SEM). Heart rate, blood pressure and echocardiographic measurements of cardiac output, stroke volume and left ventricular end-diastolic and end-systolic volumes were obtained prior to the induction of anaesthesia. Anaesthesia was induced with 25 mg.kg-1 two per cent rectal methohexitone. Immediately following the onset of sleep all cardiovascular measurements were repeated. Following the induction of anaesthesia with rectal methohexitone there was a significant increase in heart rate. Blood pressure, cardiac index, stroke volume and ejection fraction were unchanged. It is concluded that rectal administration of two per cent methohexitone for the induction of anaesthesia in healthy paediatric patients has minimal haemodynamic effect.

Anesthesia, Rectal↗
PubMedDate not supplied

Double-blind comparison of rectally administered diazepam to placebo for pediatric sedation: the cardiovascular response.

The sedative and cardiovascular effects of rectally administered diazepam (0.6 mg/kg) were compared to placebo in uncooperative children who required sedation during dental treatment. Twelve healthy preschool children, who required amalgam restorations, were treated during two standardized restorative appointments in a double-blind, crossover study. Blood pressure and pulse were obtained during four specified intervals during the appointment. The behavior of the children during the treatment visits was videotaped and later statistically analyzed using a kinesics/vocalization instrument. Behavioral ratings of cooperation were significantly improved during the treatment visit following diazepam. All interfering bodily movements, patient vocalizations and operator commands for the diazepam group were reduced significantly (p≤0.0001). No significant differences were observed for noninterfering behavioral response. Rectally administered diazepam did not alter blood pressure or pulse significantly in these sedated children when compared to the placebo. These findings indicate that rectal diazepam is an effective sedative agent with minimal effect on the cardiovascular system for the management of the young pediatric dental patient.

Anesthesia, Dental↗
PubMedDate not supplied

Cardiovascular effects of rectal methohexital in children.

STUDY OBJECTIVE: To define the cardiovascular effects of rectal methohexital in children with normal cardiac function. DESIGN: Cardiovascular evaluation of each patient was performed before and after medication. Each patient's predrug results were used as control measurements for comparison with measurements made after methohexital administration. SETTING: Inpatient operating room induction area in a privately endowed philanthropic children's hospital. PATIENTS: Forty-seven children age 35 +/- 22 months (mean +/- SD) scheduled for elective orthopedic or plastic surgery, free of cardiac or pulmonary disease, and receiving no medication with central nervous system activity. INTERVENTIONS: Control measurements of heart rate (HR), blood pressure (BP), and echocardiographic evaluations were obtained on the day before scheduled surgery. Repeat measurements were performed after the onset of methohexital-induced sleep. The time span of the measurements was designed to include the period of peak plasma methohexital concentration. In the preoperative holding area, 30 mg/kg of a 10% methohexital solution was administered rectally. If sleep did not occur in 15 minutes, an additional 15 mg/kg was given. MEASUREMENTS AND MAIN RESULTS: HR increased markedly after rectal methohexital [126 +/- 23 beats per minute (bpm) to 144 +/- 21 bpm, p less than 0.001], and stroke volume (SV) decreased (24 +/- 9 ml to 21 +/- 8 ml, p less than 0.01). There were no significant changes in BP or cardiac index. The shortening fraction and ejection fraction remained within the normal range for this age-group. CONCLUSIONS: Rectal methohexital induces sleep in healthy pediatric patients with minimal cardiovascular side effects. The primary effects are increased HR and decreased SV.

Anesthesia, Rectal↗
PubMed1983

Etomidate as a rectal induction agent. Part I. A preliminary study in rats.

Etomidate (Hypnomidate; Janssen) 1,25% in sterile water was given rectally on 100 occasions to 50 male Long-Evans rats in doses ranging from 4 mg/kg to 12 mg/kg. The onset and duration of ataxia and hypnosis (i.e. loss of righting ability) were recorded. Ataxia was observed in all rats, even at the lowest dose levels. The lowest hypnotic dose was 6 mg/kg, when 2 out of 5 rats lost their righting ability. In all 50 rats given 8 mg/kg or more hypnosis occurred within 4 minutes (range 2-4 minutes, average 3,3 minutes), from which they recovered within an average of 10,4 minutes. The duration of hypnosis and time to full recovery from ataxia were dose-dependent. The rectal hypnotic dose of etomidate in rats has been found to be approximately ten times the documented intravenous dose. No mortality was recorded despite the rectal administration of ten times the intravenous lethal dose (LD50) for rats. Histological examination of the rectal and colonic mucosa showed that etomidate 1,25% in sterile water (pH 3,5) caused no significant mucosal change, but undiluted etomidate 12,5% (pH 1,8) caused haemorrhagic necrosis. We conclude that rectal etomidate 1,25% in sterile water is an efficient, predictable, evanescent and safe method of inducing anaesthesia in rats and warrants further investigation in clinical anaesthesia in children.

Anesthesia, Rectal↗
PubMed1984

[Comparison of midazolam and flunitrazepam as premedication administered rectally in infants].

The present study aimed to assess the pharmaco-clinical profile of infants premedicated with rectal midazolam. The results were compared with those of a reference drug, flunitrazepam. Infants undergoing minor surgery were divided into three groups: group A (n = 30), with a mean age of 15.8 +/- 13.2 months and a mean weight of 8.6 +/- 3.3 kg, receiving 0.33 mg X kg-1 flunitrazepam; group B (n = 15), with a mean age of 11.2 +/- 10.7 months and a mean weight of 9.3 +/- 3.1 kg, receiving 0.3 mg X kg-1 midazolam; and group C (n = 30), with a mean age of 15.5 +/- 9.1 months and a mean weight of 10.7 +/- 2.5 kg, receiving 0.4 mg X kg-1 midazolam. An aqueous solution of each drug was administered with atropine sulfate (0.02 mg X kg-1) 20 min prior to induction of anaesthesia. The drug was well tolerated in 84% of cases. Statistically significant haemodynamic changes consisted of: a 9 c X min-1 decrease in heart rate (p less than 0.05) and a 12 mmHg decrease in systolic and diastolic blood pressures (p less than 0.05) in group C; a 6 mmHg decrease in systolic blood pressure (p less than 0.05) in group B. The tranquilizer action was either excellent or good in 93% of groups B and C compared with only 40% in group A (p less than 0.001 in both cases). Somnolence was attained in 60% of group A, 26.6% of group B and 30% of group C. A mask was much better accepted in group C (86.6%) than in group B (66.6%; p less than 0.05) or in group A (36.6%; p less than 0.01). Therefore, midazolam given rectally at 0.4 mg X kg-1 was better than flunitrazepam, because of a greater therapeutic effect for an equivalent rate of side effects.

Age Factors↗
PubMed1993

Serum potassium and sodium levels following intravenous suxamethonium in pediatric dental anesthesia.

The effects of rectally administered midazolam (.35 mg/kg), diazepam (.70 mg/kg), and placebo used as preanesthetic medications on serum levels of potassium after intravenous suxamethonium in children undergoing dental extractions under halothane anesthesia were examined. Ninety patients between the ages of 2 and 7 years were randomly allocated into three groups in this double-blind parallel study. Blood samples were taken immediately after induction with halothane (Pre-S) and at 1, 3, 5, 10, and 15 minutes after administration of suxamethonium (Post-S). Serum from these samples was analyzed in duplicate for potassium and sodium and the data analyzed statistically. The results showed that mean serum potassium levels tended to remain higher in the two groups that had received a benzodiazepine than in the controls at 5, 10, and 15 minutes Post-S. Although the increases in plasma potassium differed significantly from Pre-S at the various times within each patient group, no significant intergroup differences could be shown except at the 15 minute Post-S stage, when the mean serum potassium level of the placebo group was significantly closer to its Pre-S value than that of the diazepam group. At all stages Post-S the mean serum sodium levels for each of the three groups showed statistically significant decreases from their Pre-S values. However, no statistically significant intergroup differences could be shown.

Administration, Rectal↗