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Nitrous oxide fraction in the carbon dioxide pneumoperitoneum during laparoscopy under general inhaled anesthesia in pigs.

UNLABELLED: During prolonged laparoscopy, the diffusion of other gases in the carbon dioxide (CO(2)) pneumoperitoneum may lessen its safety. Nitrous oxide (N(2)O)/CO(2) gas mixtures may become hazardous with regard to gas embolization and fire risk. We therefore evaluated the kinetics of pneumoperitoneal intrusion of N(2)O. In five anesthetized domestic pigs, controlled ventilation, with an initial fraction of inspired oxygen = 1.0, was adjusted to keep ETCO(2) pressure between 35 and 45 mm Hg. The peritoneum was insufflated with CO(2) to a pressure of 12 mm Hg, which was maintained throughout the procedure. T0 was defined as the time when N(2)O was introduced in the breathing circuit (N(2)O end-tidal fraction = 66%). Gas samples (10 mL) from the pneumoperitoneum were analyzed every 10 min after T0. The N(2)O concentration was measured by using capillary gas chromatography coupled with mass spectrometry. Percentages of N(2)O in the CO(2) increased with time (t) according to the ideal equation: N(2)O((t)) = 66 (1 - exp(-0.005t)). In the peritoneal cavity, <2 h were required for the N(2)O to reach the concentration of 29%, which can support combustion. Eight hours to 10 h after T0, the intraperitoneal N(2)O fraction approaches the level of the N(2)O end-tidal fraction. Options to prevent accumulation of N(2)O are suggested. IMPLICATIONS: Pig models were used to evaluate the time course of nitrous oxide (N(2)O) diffusion in the pneumoperitoneum during nitrous oxide/oxygen anesthesia. Although peritoneal N(2)O concentration approaches the end-expiratory value after 8-10 h, it reaches 29% within 2 h. At this level, N(2)O is known to support combustion. This N(2)O pollution should be prevented.

Anesthesia, Inhalation↗

Recovery, psychomotor skills, and simulated driving after brief inhalational anesthesia with halothane or enflurane combined with nitrous oxide and oxygen.

Recovery from anesthesia was assessed in a controlled manner in 34 healthy student volunteers, using a psychomotor test battery 1 and 5 hours and a driving simulator 2, 4.5, and 7 hours after 3.5 minutes of anesthesia with halothane or enflurane combined with nitrous oxide and oxygen. Psychomotor performances remained significantly (P less than 0.05 to P less than 0.001) worse than in an unanesthetized control group for 5 hours after both halothane and enflurane. However, impairment of driving skills 4.5 hours after anesthesia was measurable only after halothane (P less than 0.05). It is concluded that after even brief periods of halothane or enflurane anesthesia patients should not drive or operate machinery for at least 7 hours. The magnitudes and durations of the residual effects of both agents on psychomotor performance were, however, less than those previously found after thiopental, methohexital, or diazepam.

Adult↗

The lung volume at which shunting occurs with inhalation anesthesia.

The relationship between functional residual capacity (FRC) and shunt development with halothane anesthesia in 18 nonobese surgical patients (age, 21-34 yr) was studied. FRC was measured by helium dilution, and intrapulmonary shunt was distinguished from ventilation-perfusion inequality by multiple tracer inert gas elimination analysis. Awake supine FRC was 34.6 +/- 6.6% (mean +/- SD) of total lung capacity (TLC), and closing capacity (CC) was 29.8 +/- 5.3% of TLC. Anesthesia, muscle paralysis, tracheal intubation, and mechanical ventilation produced an average 14.6 +/- 13.3% FRC reduction to an average anesthesia FRC 29.8% of TLC (P = 0.002). Shunt increased from 1.2% +/- 1.5% awake to 8.6 +/- 8.3% during anesthesia (P = 0.005). A nonlinear relationship was found between shunt and FRC/TLC so that anesthetized subjects with an FRC less than awake CC had an average 11.4 +/- 8.3% shunt, whereas subjects with an FRC greater than CC had a 2.4 +/- 2.8% shunt (P = 0.025). Nonsmokers developed shunt only if FRC was less than CC. Smokers showed a significantly higher shunt for a given (FRC-CC)/TLC compared to nonsmokers (P less than 0.001). The slope of the regression of shunt on BMI (body mass index = weight/height2) showed a significant increase during anesthesia (P = 0.005), and smokers had a significantly higher slope compared to nonsmokers (P = 0.001). These findings suggest a gravity-dependent mechanism for intrapulmonary shunting during anesthesia. Therefore, shunting was due to dependent regional lung volume reduction associated with an FRC decrease to less than closing capacity. The enhanced intrapulmonary shunting in smokers may have been related to the increased dependent regional residual volume associated with smoking.

Adult↗

Local coupling of cerebral blood flow to cerebral glucose metabolism during inhalational anesthesia in rats: desflurane versus isoflurane.

BACKGROUND: It is not known whether the effects of desflurane on local cerebral glucose utilization (LCGU) and local cerebral blood flow (LCBF) are different from those of other volatile anesthetics. METHODS: Using the autoradiographic iodoantipyrine and deoxyglucose methods, LCGU, LCBF, and their overall means were measured in 60 Sprague-Dawley rats (10 groups, n = 6 each) during desflurane and isoflurane anesthesia and in conscious controls. RESULTS: During anesthesia, mean cerebral glucose utilization was decreased compared with conscious controls: 1 minimum alveolar concentration (MAC) desflurane: -52%; 1 MAC isoflurane: -44%; 2 MAC desflurane: -62%; and 2 MAC isoflurane: -60%. Local analysis showed a reduction of LCGU in the majority of the 40 brain regions analyzed. Mean cerebral blood flow was increased: 1 MAC desflurane: +40%; 1 MAC isoflurane: +43%; 2 MAC desflurane and 2 MAC isoflurane: +70%. LCBF was increased in all brain structures investigated except in the auditory cortex. No significant differences (P < 0.05) could be observed between both anesthetics for mean values of cerebral glucose use and blood flow. Correlation coefficients obtained for the relation between LCGU and LCBF were as follows: controls: 0.95; 1 MAC desflurane: 0.89; 2 MAC desflurane: 0.60; 1 MAC isoflurane: 0.87; and 2 MAC isoflurane: 0.68. CONCLUSION: Differences in the physicochemical properties of desflurane compared with isoflurane are not associated with major differences in the effects of both volatile anesthetics on cerebral glucose utilization, blood flow, and the coupling between LCBF and LCGU.

Anesthesia, Inhalation↗

Effects of halothane-nitrous oxide inhalation anesthesia and Inactin on overall renal and tubular function in Sprague-Dawley and Wistar rats.

Real function, plasma renin concentration (PRC) and prostaglandin (PG) excretion rate was studied in groups of Sprague-Dawley (SPRD) and Wistar (WIST) rats anesthetized with either Halothane-N2O or Inactin. Conscious rats were used as controls. A. In Halothane-N2O anesthesia inulin clearance (CIN) and absolute proximal reabsorption rate (APR) was moderately decreased (by about 20%), while renal plasma flow (RPF), urine flow and solute excretion remained unchanged as compared to conscious rats. There was a linear relationship between the reciprocal of the proximal occlusion time (OT) and CIN in Halothane anesthesia indicating that the proximal luminal diameter was constant and independent of CIN. B. Inactin anesthesia CIN was similarly reduced but APR was more depressed (by about 35%). RPF and solute excretion rate decreased only in SPRD rats, while urine flow was significantly reduced in both strains. 1/OT was invariant to changes in CIN indicating luminal diameter variations in proportion to CIN. Urinary PGE2-and PGF2 alpha excretion rates and PRC were moderately elevated in operated animals of both strains regardless of the anesthetics used. It is concluded that renal functional parameters in surgically prepared rats are more severely depressed by Inactin than by Halothane-N2O anesthesia. The gas anesthesia is equally well tolerated by both strains of rats.

Anesthesia, Inhalation↗

The anesthetic conserving device compared with conventional circle system used under different flow conditions for inhaled anesthesia.

UNLABELLED: The Anesthetic Conserving Device (ACD) is a high-flow anesthesia system closed to volatile anesthetics only. We compared the ACD with a circle system under different fresh gas flow (FGF) conditions. Eighty-one patients undergoing major surgery were randomly allocated to receive sevoflurane from a circle circuit combined either with the ACD placed at the Y-piece (n = 41) or with a vaporizer (n = 40). The FGF was set to 8 L/min in the ACD system, where the circle circuit served as a nonrebreather. In the conventional circle system without ACD, the vaporizer was supplied with 1-, 1.5-, 3-, and 6-L/min FGFs. We compared the ACD with the circle system under the four FGFs in terms of sevoflurane dosing, sevoflurane consumption, humidification efficiency, and environmental pollution. The ACD and the low-flow circle system (1.5- and 1-L/min FGFs) resulted in the smallest sevoflurane consumption. The increase in inspired sevoflurane concentration was faster with the circle system than with the ACD only with FGFs > or =3 L/min. The removal of ACD from the circuit allowed the fastest washout of sevoflurane. Respiratory gas humidification was always adequate. Sevoflurane ambient concentration with the ACD was 1-70 ppb. The ACD is a valid and simple alternative to low-flow systems. IMPLICATIONS: The Anesthetic Conserving Device (ACD) is a new device for anesthetic vapor delivery. We demonstrated that the ACD reduces anesthetic consumption and environmental pollution similarly to a low-flow circle system, offering advantages such as simplicity, no toxicity from compounds produced in the absorber, and potential cost savings.

Aged↗

A new method of inhalation anesthesia with nasopharyngeal insufflation in rat experiment.

We have established a new method of anesthesia with nasopharyngeal insufflation for intraoral procedure in rodents. Twelve male Wistar rats weighing 330-390 g were used in this study. Insertion of a feeding tube 1.0 mm in diameter coated with 2% xylocaine jelly was inserted into the nasal cavity approximately 25 mm from the naris, and anesthetization with mixed gas of 100% oxygen with 3-4% enflurane at 0.25-0.5 l/min flow rate was achieved. Using this anesthetic method, a chronic experiment comprising 1-h/day experimental procedure was carried out for 14 days. This method enabled, 1) simple and safe operation of the induction, emergence and anesthetic depth, 2) experimental procedures on the dental/oral region, 3) avoidance of the dyspnea and tachypnea, and 4) avoidance of cumulative effects in daily anesthesia.

Anesthesia, Inhalation↗