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1.
Anaesth Rep ; 11(2): e12244, 2023.
Article in English | MEDLINE | ID: mdl-37700794

ABSTRACT

The influence of general anaesthetic agents on intra-operative neurophysiological monitoring in neonates and infants has rarely been reported. Propofol-based anaesthesia is recommended to avoid suppression of neurophysiological monitoring. However, the administration of propofol in children undergoing prolonged procedures, especially those younger than six months, should be carefully controlled due to the potential risk of propofol infusion syndrome. Adding a small dose of inhalational anaesthetic can be an option to reduce propofol requirements. Recent guidelines in Japan suggest limiting inhalational anaesthetics to less than 0.5 minimum alveolar concentrations when co-administered with low-dose propofol during intra-operative neuromonitoring. However, there is still insufficient evidence regarding the impact of sevoflurane on neurophysiological monitoring when co-administered with propofol in infants. This report describes a case of a three-month-old infant undergoing spinal lipoma resection in which there was a dramatic suppression of neurophysiological monitoring with the addition of 0.35-0.45% sevoflurane to propofol-based anaesthesia.

3.
Urol Clin North Am ; 22(1): 189-203, 1995 Feb.
Article in English | MEDLINE | ID: mdl-7855954

ABSTRACT

The issues relating to postoperative pain management for pediatric urologic surgery have been discussed. Child development and the behavioral responses to pain have been reviewed, with emphasis on their relation to pain assessment in the pediatric patient. The benefits and limitations of various modalities for the treatment of postoperative pain have been reviewed, and their appropriate use for different urologic surgical procedures has been presented.


Subject(s)
Analgesia/methods , Analgesics, Non-Narcotic , Analgesics, Opioid , Pain Measurement/methods , Pain, Postoperative/therapy , Urogenital System/surgery , Child , Child, Preschool , Female , Humans , Male , Nerve Block
4.
Anesth Analg ; 79(3): 455-9, 1994 Sep.
Article in English | MEDLINE | ID: mdl-8067548

ABSTRACT

This study compares effects of equipotent concentrations of halothane, enflurane, and isoflurane on atrioventricular (AV) function in dogs. Enflurane anesthesia was associated with more AV nodal depression, only at faster heart rates than either halothane or isoflurane. These rate-related effects are important in the genesis of supraventricular reentrant tachyarrhythmias. Subsidiary pacemaker function exhibited marked variability between and within animals with no demonstrable difference between anesthetic drugs. Enflurane has more depressant effects on AV nodal recovery properties than halothane or isoflurane; however, there were no differences demonstrated on slow AV nodal conduction. This suggests that enflurane would be the most effective volatile anesthetic in converting or slowing supraventricular tachyarrhythmias, while carrying no more risk of causing advanced heart block.


Subject(s)
Atrioventricular Node/drug effects , Enflurane/pharmacology , Halothane/pharmacology , Isoflurane/pharmacology , Pacemaker, Artificial , Animals , Atrioventricular Node/physiology , Dogs
5.
Br J Anaesth ; 72(6): 624-8, 1994 Jun.
Article in English | MEDLINE | ID: mdl-8024908

ABSTRACT

In a prospective, double-blind, randomized study, we have compared i.v. ketorolac and morphine in paediatric outpatients undergoing strabismus surgery. Forty-two ASA I or II children, aged 2-12 yr, were allocated randomly to receive either ketorolac 0.75 mg kg-1 i.v. or morphine 0.1 mg kg-1 i.v. and metoclopramide 0.15 mg kg-1. Anaesthesia was induced with propofol and maintained with propofol and nitrous oxide. Pain was assessed at 15-min intervals until discharge, and the incidence of nausea and vomiting was recorded for the first 24 h. There was no difference in pain behaviour scores or recovery times. The incidence of nausea and vomiting during the first 24 h was 19% in the ketorolac group and 71% in the morphine group (P < 0.001). We concluded that ketorolac was an effective analgesic for this type of surgery and that it was associated with less postoperative emesis than morphine and metoclopramide.


Subject(s)
Analgesics/therapeutic use , Morphine/therapeutic use , Pain, Postoperative/prevention & control , Tolmetin/analogs & derivatives , Vomiting/prevention & control , Ambulatory Surgical Procedures , Child , Child, Preschool , Double-Blind Method , Female , Humans , Incidence , Ketorolac , Male , Nausea/prevention & control , Pain Measurement , Postoperative Complications/prevention & control , Prospective Studies , Strabismus/surgery , Tolmetin/therapeutic use
6.
Anesth Analg ; 76(4): 760-4, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8466013

ABSTRACT

A prospective, randomized, double-blind study was conducted to examine the effect of a propofol infusion on the incidence of postoperative emesis in children undergoing outpatient strabismus surgery. Seventy-eight children, aged 3-12 yr, were allocated randomly to receive either nitrous oxide and halothane or nitrous oxide and a propofol infusion for the maintenance of anesthesia. The overall incidence of vomiting during the first 24 h was 64% in those receiving halothane and 41% in those receiving the propofol infusion; this difference was statistically significant (P < 0.05). In children who received no opioids postoperatively, the incidence of vomiting in the first 24 h was 71% in the halothane group and 24% in the propofol group; this difference was also significant (P = 0.001). We conclude that propofol was effective in reducing the incidence of postoperative emesis in pediatric outpatient strabismus surgery.


Subject(s)
Anesthesia , Propofol , Strabismus/surgery , Vomiting/etiology , Child , Child, Preschool , Double-Blind Method , Female , Halothane , Humans , Infusions, Intravenous , Male , Nitrous Oxide , Propofol/therapeutic use , Prospective Studies , Vomiting/prevention & control
7.
Anesthesiology ; 78(3): 510-23, 1993 Mar.
Article in English | MEDLINE | ID: mdl-8457052

ABSTRACT

BACKGROUND: The effects of isoflurane on the transmural distribution of myocardial blood flow distal to an acute critical coronary stenosis and the relationship between the changes in regional blood flow and function were studied to determine whether isoflurane can produce a transmural "steal" phenomenon and to assess the role of this phenomenon in producing changes in regional myocardial function. METHODS: After production of acute critical coronary stenosis under baseline chloralose and fentanyl anesthesia, the animals were exposed to increasing end-tidal concentrations of isoflurane (0.7%, 1.4%, and 2.1%) without control of the hemodynamic parameters. At 2.1% isoflurane, the blood pressure then was restored to the baseline level by administration of phenylephrine. Changes in the following parameters were assessed: global contractility (measured by changes in pressure with time), regional myocardial function (assessed by systolic wall thickening and measured by sonomicrometers), transmural distribution of myocardial perfusion (measured by the radioactive microsphere method), and regional oxygen consumption and extraction. RESULTS: Distal to the critical stenosis, a transmural redistribution of myocardial blood flow (endocardial-epicardial ratio < 1) occurred with all concentrations of isoflurane. With higher concentrations (1.4% and 2.1%), a significant decrease in subendocardial blood flow occurred only in the presence of hemodynamic changes and was restored by phenylephrine. In this area, changes in regional myocardial function correlated most strongly with changes in subendocardial perfusion (y = -0.17 + 1.70x -0.58x2, r2 = 0.90). In the stenotic region, oxygen extraction remained stable, but oxygen consumption decreased in parallel with reductions in regional myocardial function. In the normal region, oxygen consumption did not change, but oxygen extraction decreased with increasing isoflurane concentrations. CONCLUSIONS: These results show that isoflurane is a coronary vasodilator able to induce a transmural redistribution of myocardial blood flow distal to an acute critical coronary stenosis. A true transmural steal, however, was not produced reliably in the absence of hemodynamic changes, suggesting that isoflurane either is only a moderate vasodilator, or that the decrease in subendocardial blood flow is offset by the negative inotropic action of the drug. When regional myocardial dysfunction distal to a severe coronary stenosis occurs, this correlates with decreasing subendocardial blood flow during isoflurane anesthesia, suggesting ischemia as the cause.


Subject(s)
Anesthesia, Inhalation , Coronary Circulation/drug effects , Coronary Disease/physiopathology , Isoflurane/pharmacology , Animals , Blood Pressure/drug effects , Blood Pressure/physiology , Constriction, Pathologic/physiopathology , Coronary Vessels/drug effects , Coronary Vessels/physiopathology , Dogs , Endocardium/drug effects , Female , Heart/drug effects , Heart/physiopathology , Male , Myocardial Contraction/drug effects , Myocardial Contraction/physiology , Myocardium/metabolism , Oxygen/blood , Oxygen Consumption/drug effects , Oxygen Consumption/physiology , Pericardium/drug effects , Regional Blood Flow/drug effects , Regional Blood Flow/physiology , Vascular Resistance/drug effects , Vascular Resistance/physiology
9.
Circulation ; 84(5 Suppl): III364-8, 1991 Nov.
Article in English | MEDLINE | ID: mdl-1934431

ABSTRACT

Pulmonary vascular resistance is an important determinant of cardiac output after the Fontan procedure and is adversely affected by elevated mean airway pressure. High-frequency jet ventilation (HFJV) is an alternate form of mechanical ventilation which supports gas exchange at lower mean airway pressure. This study was performed to determine if HFJV could lower mean airway pressure and pulmonary vascular resistance and result in an increase in cardiac output after the Fontan procedure. We prospectively evaluated 13 patients ranging in age from 0.9 to 8.5 years (mean, 3.9 years) and in weight from 6.2 to 20.1 kg (mean, 13.9 kg). Right atrial, left atrial and pulmonary artery catheters were used to measure hemodynamic parameters. Cardiac index was measured by dye dilution technique, and pulmonary vascular resistance was calculated. The patients were stabilized on mechanical ventilation to achieve a PaCO2 = 30 +/- 5 mm Hg, and baseline hemodynamic and respiratory measurements were made. HFJV was begun at settings adjusted to achieve similar gas exchange. Respiratory and hemodynamic measurements were repeated after 30-60 minutes of HFJV. Mechanical ventilation was then resumed at baseline settings, and measurements were repeated 0.5-1 hour later. There was no significant change in gas exchange. HFJV resulted in a 50% reduction in mean airway pressure (9.2 +/- 0.2 cm H2O to 4.6 +/- 0.1 cm H2O, p less than 0.001), a 59% reduction in pulmonary vascular resistance (3.82 +/- 0.36 to 1.52 +/- 0.16 Woods units, p less than 0.001), and a 25% increase in cardiac index (2.32 +/- 0.12 l/min/m2 to 2.91 +/- 0.12 l/min/m2, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Heart Defects, Congenital/surgery , Hemodynamics/physiology , High-Frequency Jet Ventilation , Pulmonary Artery/surgery , Child, Preschool , Heart Atria/surgery , Heart Defects, Congenital/therapy , Humans , Postoperative Care , Prospective Studies , Pulmonary Circulation/physiology , Pulmonary Gas Exchange/physiology , Respiration, Artificial , Vascular Resistance/physiology
11.
Br J Anaesth ; 67(1): 73-8, 1991 Jul.
Article in English | MEDLINE | ID: mdl-1859764

ABSTRACT

A prospective, double-blind study was conducted to compare the effect of pressure at the P6 (Neikuan) point with placebo as an antiemetic in children. Sixty-six patients, ages 3-12 yr, undergoing outpatient surgery for correction of strabismus, were allocated randomly to receive either bilateral P6 acupressure or placebo during the perioperative period. The study was designed to detect a 50% difference in the incidence of postoperative vomiting between the two groups, with a 90% power of achieving a statistically significant result at the 5% level (two-tailed). The incidence of postoperative vomiting for the placebo group was 58% before discharge from hospital, 73% at home and 82% in the first 24 h after surgery. The corresponding results for the acupressure group were 58% before discharge, 71% at home and 94% in the first 24 h. These differences were not significant; P6 acupressure did not reduce the incidence of postoperative vomiting in children undergoing strabismus surgery.


Subject(s)
Acupuncture Therapy , Ophthalmologic Surgical Procedures , Postoperative Complications/prevention & control , Strabismus/surgery , Vomiting/prevention & control , Ambulatory Surgical Procedures , Child , Child, Preschool , Double-Blind Method , Female , Humans , Male , Prospective Studies
12.
Br J Anaesth ; 62(4): 434-8, 1989 Apr.
Article in English | MEDLINE | ID: mdl-2706181

ABSTRACT

We describe the successful management of a 25-yr-old primigravida with uncorrected truncus arteriosus, requiring an urgent Caesarean section for delivery of a live infant and we discuss the rationale of using the chosen drug combination and the importance of adequate monitoring in selecting an anaesthetic technique based on the pathophysiology of the congenital cardiac lesion.


Subject(s)
Anesthesia, General , Anesthesia, Obstetrical/methods , Cesarean Section , Pregnancy Complications, Cardiovascular , Truncus Arteriosus, Persistent/complications , Adult , Female , Hemodynamics , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathology , Truncus Arteriosus, Persistent/physiopathology
14.
Anaesthesia ; 43(7): 554-6, 1988 Jul.
Article in English | MEDLINE | ID: mdl-3414916

ABSTRACT

A single-breath technique of inhalational induction of anaesthesia allows intravenous induction agents to be avoided. We have investigated recovery from anaesthesia in 40 daycase patients, using tests of psychomotor function. Patients anaesthetised with inhalational induction awaken earlier than those who receive thiopentone, but not significantly earlier. There were no significant differences in postoperative psychomotor function between patients who received thiopentone and those who had inhalational inductions. Single-breath halothane, nitrous-oxide, oxygen induction is an alternative to intravenous induction in cooperative adults, but does not confer significant benefits in terms of recovery.


Subject(s)
Ambulatory Surgical Procedures , Anesthesia Recovery Period , Anesthesia, Inhalation , Halothane , Postoperative Period , Anesthesia, General , Female , Halothane/pharmacology , Humans , Male , Middle Aged , Psychomotor Performance/drug effects , Thiopental/pharmacology
15.
Spine (Phila Pa 1976) ; 13(5): 490-3, 1988 May.
Article in English | MEDLINE | ID: mdl-3187693

ABSTRACT

Controlled hypotension which is used during scoliosis surgery to improve operating conditions and minimize transfusion requirements may decrease spinal cord blood flow (SCBF). Previous studies using hydrogen washout, an invasive technique, have shown that trimethaphan-induced hypotension is associated with a decrease in SCBF, whereas hypotension induced with sodium nitroprusside or nitroglycerin is not. To determine whether the decrease seen with trimethaphan represented a generalized rather than regional spinal cord phenomenon, SCBF was measured at three separate cord levels (T2-3, 7-8, L2-3) using a noninvasive radionuclide-labelled microsphere technique. When the mean arterial pressure was reduced by 50%, SCBF decreased 35 to 45% at all levels of the cord examined, and remained at this reduced level during the period of hypotension. The results confirm that trimethaphan-induced hypotension is associated with a significant reduction in SCBF and that this occurs throughout the spinal cord during the period of hypotension.


Subject(s)
Hypotension, Controlled/adverse effects , Spinal Cord/blood supply , Trimethaphan/adverse effects , Animals , Dogs , Hemodynamics/drug effects , Lumbosacral Region , Microspheres , Regional Blood Flow/drug effects , Thorax
16.
J Cardiothorac Anesth ; 2(2): 188-93, 1988 Apr.
Article in English | MEDLINE | ID: mdl-17171911

ABSTRACT

The effects of equipotent concentrations (1.5 times minimum alveolar concentration) of the inhalational agents halothane, enflurane, and isoflurane on sinus node function, and atrioventricular (A-V) conduction and refractoriness were compared with chloralose anesthesia in 49 mongrel dogs. Sinus node function was assessed using corrected sinus node recovery time. Atrial-His and His-ventricular conduction times were measured at paced heart rates of 150, 180, and 200 beats/min, and A-V refractoriness was assessed by Wenckebach periodicity. There was no evidence that sinus node function was impaired by any of the inhalational agents. Enflurane anesthesia was associated with a significant prolongation of atrial-His conduction at paced heart rates of 180 and 200 beats/min when compared to chloralose anesthesia and the other two inhalational agents (P < .001). Atrioventricular refractoriness was impaired by enflurane (P < .001) and halothane (P < .05), but not isoflurane, when compared with chloralose anesthesia. Ventricular-His conduction was not altered by any of the agents. The authors conclude that enflurane is associated with a greater impairment of A-V conduction and refractoriness than halothane or isoflurane, and that these changes are related to the anesthetic agent and not the anesthetic state.


Subject(s)
Anesthetics, Inhalation/pharmacology , Anesthetics, Intravenous/pharmacology , Atrioventricular Node/drug effects , Chloralose/pharmacology , Heart Conduction System/drug effects , Sinoatrial Node/drug effects , Animals , Atrioventricular Node/physiology , Blood Pressure/drug effects , Dogs , Electrocardiography/methods , Electrophysiologic Techniques, Cardiac/methods , Enflurane/pharmacology , Female , Halothane/pharmacology , Heart Rate/drug effects , Isoflurane/pharmacology , Male , Sinoatrial Node/physiology
18.
Can Anaesth Soc J ; 33(6): 741-4, 1986 Nov.
Article in English | MEDLINE | ID: mdl-3779496

ABSTRACT

The contribution of papavaretum to the incidence of vomiting observed in the 24 hours after paediatric outpatient anaesthesia was assessed in 129 children undergoing circumcision. Postoperative analgesia in all patients was achieved using caudal extradural blockade. The incidence of vomiting in the 24 hours after discharge from hospital was 56 per cent in those receiving papavaretum, compared with 15 per cent in those who did not (p less than 0.0001). The significance of this finding and the use of opiates in paediatric outpatient anaesthesia are discussed.


Subject(s)
Opium/adverse effects , Preanesthetic Medication/adverse effects , Vomiting/chemically induced , Ambulatory Surgical Procedures , Child , Child, Preschool , Circumcision, Male , Humans , Male , Morphine/adverse effects , Time Factors
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