Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1996
Pseudoankylosis of the mandible after supratentorial craniotomy.
After temporal craniotomy, pseudoankylosis of the mandible can cause difficult airway management during subsequent anesthesia. However, postcraniotomy changes in maximal mouth opening and the incidence of limited mouth opening have not been characterized. Ninety-two adult patients who underwent elective craniotomy were divided into three groups: Group A (n = 28) included patients who underwent parietal, occipital, or frontal craniotomy without incision of the temporalis muscles; Group B (n = 25) included patients who underwent temporal craniotomy; and Group C (n = 39) included patients who underwent frontotemporal craniotomy. ⋯ In Group C, the incidence of limited mouth opening was 33.3% and 20.5% 2 wk and 1 mo after operation, respectively; however, limited mouth opening resolved within 3 mo in most patients. Supratentorial craniotomies separated by short intervals can increase the risk of limiting the mandibular opening, which may result in a difficult intubation. Careful preoperative assessment of the airway is mandatory if patients have previously undergone temporal or frontotemporal craniotomy.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialTranscutaneous cranial electrical stimulation (Limoge's currents) decreases early buprenorphine analgesic requirements after abdominal surgery.
Transcutaneous cranial electrical stimulation with Limoge's currents (TCES) consists of high frequency, low intensity currents which decreased anesthetic requirements during elective surgery. This action is likely to be mediated by the release of central endogenous opioids. In the present study, we hypothesized that TCES applied intraoperatively may decrease early postoperative narcotic requirements. ⋯ Intraoperative isoflurane anesthetic requirements, as well as hourly postoperative scores for pain and sedation, were the same for the two groups. These data indicate that TCES reduces narcotic requirements for early postoperative analgesia. This technique might have potential to facilitate early postoperative analgesia in patients undergoing elective abdominal surgery.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialAwakening, clinical recovery, and psychomotor effects after desflurane and propofol anesthesia.
We compared postanesthetic and residual recovery of desflurane versus propofol anesthesia. Twenty volunteers were anesthetized for 1 h at 1-wk intervals with either propofol (induction) plus desflurane (1.25 minimum alveolar anesthetic concentration) in O2 (PD), propofol plus desflurane in N2O-O2 (PDN), propofol plus propofol infusion with N2O-O2 (PPN), or desflurane (induction) plus desflurane in O2 (DD). Awakening and clinical recovery were measured. ⋯ At 1 h after anesthesia, the subjects given desflurane for maintenance (PD, PDN, and DD) performed significantly (P < 0.05-0.01) better in several psychomotor tests compared with those whose anesthesia was maintained with propofol (PPN). However, subjects met criteria for home readiness as fast after PPN as after PDN anesthesia (mean times +/- SE until fitness for discharge were 126 +/- 20, 81 +/- 14, 70 +/- 7, and 106 +/- 14 min after PD, PDN, PPN, and DD, respectively). Awakening and early psychomotor recovery for as long as 1 h after anesthesia is faster after desflurane than after propofol, but there was no difference in time to home readiness or in residual effects thereafter between propofol and desflurane with N2O in O2.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialPropofol and alfentanil prevent the increase in intraocular pressure caused by succinylcholine and endotracheal intubation during a rapid sequence induction of anesthesia.
The increase in intraocular pressure (IOP) associated with succinylcholine (Sch) has made its use in patients with open globe injuries controversial. Studies that have examined techniques to prevent the increase in IOP due to Sch have shown a larger increase in IOP from the stimulus of laryngoscopy and endotracheal intubation. The purpose of our study was to examine whether the combination of propofol and alfentanil would prevent the increase in IOP due to Sch as well as endotracheal intubation during a rapid sequence induction of anesthesia. ⋯ During the entire study period, the IOP in Group III never increased above baseline. The IOP in Groups I and II had already begun to decline by 15 s postintubation, suggesting that laryngoscopy and intubation have the greatest effect on increasing IOP. We conclude that the combination of propofol and alfentanil prevents the increase in IOP from Sch as well as the increase associated with endotracheal intubation during a rapid sequence induction of anesthesia.