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PubMed1986

Effects of dose and concentration of rectal methohexitone for induction of anaesthesia in children.

To investigate the effect of dose and concentration of rectal methohexitone for induction of anaesthesia, 60 children (ASA physical status 1 or 2) undergoing outpatient surgery were studied. Each child was randomly assigned to receive one of three rectal solutions (each containing atropine 0.02 mg X kg-1): Group A - ten per cent methohexitone, 25 mg X kg-1 (n = 20); Group B - ten per cent methohexitone, 15 mg X kg-1 (n = 20); or Group C - one per cent methohexitone, 15 mg X kg-1 (n = 20). After induction of anaesthesia, or a maximum period of 20 minutes following rectal administration of methohexitone, halothane, nitrous oxide, and oxygen were administered by mask. The time to induction of anaesthesia, complications, postanaesthetic recovery scores, and recovery time did not differ significantly among the three groups. The incidence of failed inductions did not differ significantly between Group A (zero per cent) and Group C (ten per cent) but both were significantly less than Group B (45 per cent) (p less than 0.05). Heart rate increased significantly between 10 and 30 minutes after rectal administration of methohexitone and atropine. The authors conclude that ten per cent rectal methohexitone 25 mg X kg-1 and one per cent rectal methohexitone 15 mg X kg-1 are equally effective for induction of anaesthesia in children and both are significantly more effective than ten per cent methohexitone 15 mg X kg-1.

Anesthesia, Rectal↗
PubMed1986

Intravenous or rectal diazepam for outpatient sedation in minor oral surgery.

In a randomized cross-over study on sedation in outpatient oral surgery, intravenous and rectal administration of diazepam were compared. The mean dose for intravenous diazepam was 0.22 mg X kg-1 (range 0.15-0.38) and for rectal diazepam 0.58 mg X kg-1 (range 0.50-0.71). The determining factors for the patients' preference for sedation method, apprehension, effect produced by the sedative, recovery from sedation and the postoperative course were studied. The patients preferred the session in which they experienced stronger effect, regardless of the route of administration. Patient preference for sedation method did not differ when optimal dose regimens were used, and a preset dose of 10 mg rectal diazepam did not produce the desired effect. Apprehension was significantly higher prior to and during the first operation than the second operation, and all patients recovered from sedation within 2 1/2 hours after the administration.

Adolescent↗
PubMedDate not supplied

Conscious sedation and analgesia with rectal ketamine in the Macaca fuscata monkey.

Conscious sedation is commonly utilized in pediatric dentistry. Although opioid analgesics are often employed, patient safety would be enhanced if nonopioid drugs were used. The purpose of this study was to determine if rectal ketamine could produce plasma concentrations that would achieve both conscious sedation and analgesia to gingival needle puncture. Five 2-year-old male Macaca fuscata monkeys were given rectal ketamine at a dosage of 60 mg/kg and 90 mg/kg one week apart. Blood was drawn at selected times after administration, and vital signs, level of sedation, and consciousness were assessed. Plasma ketamine concentrations ranged from 240 to 820 ng/mL and from 390 to 3120 ng/mL after rectal administration at doses of 60 mg/kg and 90 mg/kg, respectively. Two monkeys after the high dose showed analgesia to a gingival needle puncture at plasma ketamine concentrations that ranged from 1390 to 3120 ng/mL. A good level of sedation was consistently observed in four monkeys (80%) following rectal ketamine at a dosage of 90 mg/kg, whereas one monkey showed a consistently good level at a dosage of 60 mg/kg. Sedation and dose were significantly (P less than 0.001) associated with plasma ketamine concentrations; physiologic parameters were not (P greater than 0.05). The results of this study suggest that rectal ketamine can produce plasma concentrations of the drug sufficient to achieve sedation in the monkey. The attainment of concomitant analgesia to a gingival needle puncture was not as predictable.

Analysis of Variance↗
PubMed1982

[Methohexital for rectal anesthetic induction in children].

To induce anaesthesia, 100 children between 18 months and 7 years of age who had been selected for surgery or invasive diagnosis, received a 10% methohexitone solution in a dosage of 20-30 mg/kg body weight by rectal instillation. The time until onset of sleep, the pulse rate and blood pressure changes, duration of operation, recovery time and any special observations were recorded. Methohexitone concentrations in the plasma were measured in 7 children during rectal induction of anaesthesia. It was found that induction of anaesthesia in children by rectal application of 20-30 mg/kg body weight methohexitone is a safe procedure which does not cause discomfort to the children and is easily handled by the physician. The methohexitone levels in the plasma are not higher than those after intravenous administration.

Anesthesia, Inhalation↗
PubMed1981

Tolerance to rectal ketamine in paediatric anaesthesia.

The use of rectal ketamine as the sole anaesthetic for short, minor procedures in young children is discussed. A case in which 18 anaesthetics were administered by this route, to facilitate radiotherapy, is reported and the subsequent development of tolerance and its possible mechanisms are discussed.

Anesthesia, Rectal↗
PubMed1989

Rectal induction of anaesthesia in children. A comparison between ketamine-midazolam and halothane for induction and maintenance of anaesthesia.

Thirty children were randomly allocated to one of three anaesthetic techniques. Rectal anaesthesia induction with a mixture of ketamine 10 mg.kg-1 BW and midazolam 0.2 mg.kg-1 BW and maintenance of anaesthesia with either intravenous ketamine or halothane were compared to induction and maintenance with halothane. Rectal induction was found reliable and useful. The frequency of side effects, the recovery time, and the time until the child could be discharged were similar in the groups maintained with halothane, whereas recovery was prolonged when intravenous ketamine was used for maintenance.

Anesthesia, Inhalation↗
PubMed1992

Continuous oxygen saturation monitoring following rectal methohexitone induction in paediatric patients.

Rectal methohexitone has been used to induce anaesthesia in paediatric patients for a number of years. This study was conducted in order to confirm the safety of this method of induction for uncomplicated routine paediatric patients. Children between the ages of six months and six years were considered candidates for induction with methohexitone (10%, 25-30 mg.kg-1). Patients were monitored with a continuous oxygen saturation recording. Forty-nine patients participated in this study and anaesthesia was induced successfully in 44. The mean age of the patients was 2.7 +/- 1.6 yr. The mean weight was 13.8 +/- 4.3 kg and the mean dose of methohexitone for successful induction was 27.0 +/- 3.0 mg.kg-1. Continuous oximeter recordings were available in 31 of the 42 patients who allowed oximeter placement prior to administration of methohexitone. No major desaturation events were noted in any patient. Two brief episodes of desaturation occurred. One with a nadir of 90% which lasted for 45 sec and another with a nadir of 86% which lasted for 26 sec. Both children had their heads flexed over their parents' shoulders at the time of the event resulting in partial airway obstruction. Both of these episodes were the result of upper airway obstruction which was clinically diagnosed by the anesthetist and readily corrected by repositioning the head. This study confirms the efficacy and safety of rectal methohexitone for induction of general anaesthesia in children. Mechanical obstruction of the airway following induction seems to be the most likely cause for oxygen desaturation. Monitoring of pulse oximetry does not appear necessary provided the child is carefully observed for adequacy of air exchange.

Anesthesia, Rectal↗
PubMedDate not supplied

[Complications of transrectal biopsy of the prostate].

The aim of the study was to assess frequency of various complications of transrectal multifocal biopsy of the prostate (TMBP), to specify prophylactic measures against such complications. Primary TMBP under US guidance was made in 612 patients (mean age 65.8 years, mean level of PSA 12.6 ng/ml). TMBP complications include: hematuria (220 patients, 35.9%), hemospermia (166 patients, 27.1%), pain in the perineum and the rectum (189, 30.9%), acute prostatitis (21 patients, 3.4%), acute orchiepididymitis (7 patients, 1.1%), acute urine retention (9 patients, 1.5%), long-term rectal hemorrhage (13 patients, 2.1%), loss of consciousness during the biopsy (7 patients, 1.1%). The analysis of TMBP complications leads to the conclusion that adequate preparation of the patients and accurate conduction of the prostatic biopsy technique under US guidance make this invasive manipulation diagnostically effective and safe.

Aged↗
PubMed1983

Etomidate as a rectal induction agent. Part II. A clinical study in children.

Following the preliminary study in rats, etomidate (Hypnomidate; Janssen) 1,25% in sterile water (pH 3,5) was administered rectally to 40 children aged between 6 months and 5 years to induce general anaesthesia for scheduled minor surgical procedures. The doses given ranged from 3,0 mg/kg to 6,5 mg/kg. The time taken for hypnosis to occur and the incidence of muscle movements were recorded. Cardiovascular and respiratory parameters were monitored. Anaesthesia was maintained with nitrous oxide/oxygen and halothane as needed. The time taken for recovery from anaesthesia was recorded and the children were observed for 24 hours postoperatively. The lowest hypnotic dose was 4,5 mg/kg, when 2 out of 5 children fell asleep. In all children given 6,5 mg/kg hypnosis occurred within 4 minutes. Cardiovascular and respiratory parameters were stable. There did not appear to be any delay in the recovery of the children from inhalational anaesthesia. There was no clinical evidence of irritation of the rectal mucosa by the etomidate solution. This study shows that rectal administration of etomidate 1,25% in sterile water at a dose of approximately 20 times the recommended intravenous dose in children produces a rapid, predictable onset of hypnosis within 4 minutes and allows rapid recovery. This is highly suitable for outpatient anaesthesia in unpremedicated children who will accept neither inhalational nor intravenous induction.

Anesthesia, Rectal↗
PubMed1979

Rectal thiopental for sedation of children for computed tomography.

Rectally administered thiopental was evaluated for sedation in pediatric computed tomography and compared with "cardiac cocktail" sedation. The drug produced sedation as effective as the "cocktail" with easier administration, more rapid onset, and shorter duration of sedation. Although no complications were observed, careful observation for respiratory depression is suggested.

Anesthesia, General↗
PubMed2006

Comparison of three anesthetic protocols for intraduodenal drug administration using endoscopy in rhesus monkeys (Macaca mulatta).

The purpose of this study was to evaluate 3 anesthetic protocols for intraduodenal drug administration by endoscopy in rhesus monkeys (Macaca mulatta). Anesthesia was induced using intramuscular ketamine and midazolam, isoflurane (inhalant gas), or intravenous propofol in male and female rhesus monkeys. A noninvasive dosing line was placed in the duodenum by use of endoscopy, and 50% dextrose (3 ml/kg) was administered. Blood pressure, heart rate, body temperature, and reflexes (corneal, palpebral, pharyngeal) and myorelaxation (mandibular reflex and reaction to limb manipulation) were evaluated every 5 min. To estimate intestinal absorption, glycemia was evaluated prior to dextrose administration and at 2, 5, 10, 15, 20, 30, 45, and 60 min after dosing. All 3 protocols resulted in successful induction of anesthesia. Recovery from isoflurane and propofol was significantly faster than from ketamine-midazolam. Duration of the recovery period after isoflurane was less variable than with propofol, but isoflurane produced greater hypothermia. Isoflurane and propofol resulted in predictable glucose absorption after intraduodenal dextrose administration, whereas ketamine-midazolam led to an inconsistent increase in glycemia.

Administration, Rectal↗
PubMed1984

Comparison of sedation, amnesia, and patient comfort produced by intravenous and rectal diazepam.

In a cross-over study, intravenous diazepam was compared with rectal diazepam for sedation in outpatient oral surgery. Fifty-four operations were performed on 27 patients. Recovery from sedation, experience during the postoperative course, amnesia, estimation of the sedative effect, and patient preference of method of sedation were studied. The recovery times of the sedation methods did not differ. Sedative effects after the first operation were estimated as good by 87% of patients given intravenous sedation and by 75% of those given rectal sedation. However, there was a significant relationship between the subjective experience of stronger sedative effect and preference of sedation method that favored the intravenous technique. The degree of amnesia was significantly higher during intravenous sedation, but a high degree of amnesia was not related to patients' preference for a sedation method. Neither sedation method produced any local side effects.

Adolescent↗
PubMed1987

[Anesthesia for congenital diaphragmatic hernia].

Hypoplasia of the lungs is the cause of the high mortality of newborns with diaphragmatic hernia. Survival depends mainly on the development of the contralateral lung. Eighty percent of diaphragmatic hernias are postolateral hernias of the left side. The most serious postoperative complication is a relapse into fetal circulation with increased pulmonary vascular resistance and right-to-left shunting (Fig. 2). The clinical signs of diaphragmatic hernia are cyanosis and tachypnea. Intermittent suction via a nasogastric tube and early intubation without mask ventilation should be performed. The inspiratory pressure should not exceed 25 cm H2O to minimize the risk of pneumothorax. Survival of the baby is unlikely if the initial blood gas analysis shows pH less than 7.10, pO2 less than 50 mmHg, and pCO2 greater than 65 mmHg. Hypothermia should be strictly avoided because it leads to increased oxygen consumption. Intraoperative monitoring should include a precordial stethoscope, ECG, blood pressure, and rectal temperature. Anesthesia is maintained with fentanyl 0.02-0.03 mg/kg body wt. and pancuronium 0.08-0.1 mg/kg. One dose of atropine (0.02 mg/kg) is administered before fentanyl. Intraoperative ventilation is performed by hand or by use of a Siemens Servo ventilator. Thirty newborns were anesthetized for repair of a congenital diaphragmatic hernia with no intraoperative complication and an overall mortality of 27%.

Anesthesia↗
PubMed1992

Anaesthesia without tears.

Rectal induction of anaesthesia is a useful method but is not widely used in South Africa. We studied the onset of action and side-effects of 1% methohexitone administered rectally in a dose of 20 mg/kg to 110 preschool children. Ninety-one per cent were adequately sedated for inhalation induction by mask within 10 minutes, and all by 15 minutes, of drug administration. There was no evidence of significant cardiovascular or respiratory depression and only minor complications such as faecal soiling (11.8%) and hiccough (3.6%) were noted. The technique has been favourably received by parents, surgeons and nursing staff and has now become routine practice.

Anesthesia, Rectal↗
PubMed2001

Diazepam submicron emulsions containing soya-bean oil and intended for oral or rectal delivery.

Physically stable diazepam submicron emulsions were prepared using soya-bean oil. Diazepam concentration 4 mg/ml, suitable for rectal or oral delivery, was achieved in 20% emulsions. Mixture of egg lecithin (1.2%) and poloxamer (2.0%) has been chosen as the most suitable emulsifying agent. Composition of the emulsion may be supplemented with alpha-tocopherol and parabens. However, the system was not stable when either phenylethanol or chlorhexidine gluconate was added. Taste masking agents commonly used as food additives decreased stability of the preparation and were not efficient in elimination of a bitter taste of the drug-loaded emulsions.

Administration, Oral↗
PubMed1988

Comparison of two and ten per cent rectal methohexitone for induction of anaesthesia in children.

Plasma methohexitone concentrations were determined in 30 children, aged one to six years, who received 25 mg.kg-1 rectal methohexitone as either a two per cent or ten per cent solution for induction of anaesthesia. Venous blood samples were obtained 15, 30, 45 and 120 minutes following drug administration. Twenty-six of 30 children were asleep within fifteen minutes. Mean plasma methohexitone concentrations were 5.39, 4.42, 3.40 and 1.54 micrograms.ml-1 at 15, 30, 45 and 120 minutes following administration of two per cent methohexitone. Use of the ten per cent solution resulted in mean plasma methohexitone concentrations of 3.81, 3.12, 2.31 and 1.07 micrograms.ml-1 at the same time intervals. Plasma methohexitone concentrations were significantly higher at 15, 30 and 45 minutes following administration of two per cent methohexitone, when compared to the ten per cent solution.

Anesthesia Recovery Period↗