Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1993
Brain energy metabolism and blood flow during sevoflurane and halothane anesthesia: effects of hypocapnia and blood pressure fluctuations.
The effects of halothane and sevoflurane on cat brain energy metabolism and regional cerebral blood flow (rCBF) were evaluated during normo- and hypocapnia. Brain energy status was evaluated with phosphorous nuclear magnetic resonance spectroscopy (31P-MRS) and rCBF was measured by the hydrogen clearance method. A high concentration of halothane (3 MAC) impaired brain energy metabolism, while even a higher concentration of sevoflurane (4 MAC) had no untoward effect on brain energy metabolism. ⋯ Following administration of a vasopressor, metaraminol, the abnormal brain energy metabolism induced by 2 MAC of halothane at a PaCO2 of 1.33 kPa was normalized in parallel with the improved rCBF values. We conclude that hyperventilation and fluctuating blood pressure contribute to the occurrence of abnormal brain energy metabolism during halothane and sevoflurane anesthesia. This is more pronounced with halothane than with sevoflurane.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of cardiovascular changes during anaesthesia and recovery from propofol-alfentanil-nitrous oxide and thiopentone-halothane-nitrous oxide anaesthesia in children undergoing otolaryngological surgery.
Propofol/alfentanil anaesthesia was compared with thiopentone/halothane anaesthesia in 86 midazolam-atropine premedicated children undergoing minor otolaryngological surgery. The study was randomised, and evaluation of recovery from anaesthesia was double-blind. The children were divided into two age groups: 1-3 years and 4 years and older. ⋯ Recovery with respect to times to eye opening or response to verbal contact was significantly faster after propofol/alfentanil anaesthesia than after thiopentone/halothane anaesthesia in the older but not in the younger age group. Furthermore, in the younger age group significantly more crying occurred after propofol/alfentanil than after thiopentone/halothane anaesthesia. On the basis of this study, thiopentone/halothane anaesthesia is recommended for children aged 1-3 years and propofol/alfentanil anaesthesia for older children undergoing adenoidectomy and/or tonsillectomy.
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of two fentanyl doses to improve epidural anaesthesia with 0.5% bupivacaine for caesarean section.
Ninety women undergoing elective caesarean section under epidural anaesthesia were double blindly randomised into three groups to receive either 2 ml of saline or 50 or 100 micrograms of fentanyl in 2 ml volume added to 0.5% bupivacaine. Both doses of fentanyl intensified the epidural anaesthesia and reduced patient discomfort during the operation. In both fentanyl groups the epidural blockade more often reached the 5th thoracic segment (P = 0.0258), the patients had significantly less pain (P = 0.0256), needed less intravenous diazepam medication during the operation (P = 0.0005) and the operating conditions were were better when compared to the saline group (P = 0.0416). ⋯ The postoperative time until treatment for pain was requested by the patients was more than 1 h longer in the fentanyl groups, but there was no difference in the total amount of postoperative analgesics needed during the first 24 h when compared to the saline group. Mild pruritus not requiring treatment was more common in fentanyl groups than in the saline group (P = 0.0187). The results suggest that 50 micrograms of fentanyl added to 0.5% bupivacaine increases patient comfort and improves the quality of epidural anaesthesia for caesarean section, and that adding 100 micrograms does not give further advantage.
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Clinical TrialTracheal intubation after induction of anaesthesia with propofol, alfentanil and lidocaine without neuromuscular blocking drugs in children.
In a double-blind study, intubating conditions and haemodynamic responses were assessed in two age-groups of 45 ASA I-II children, with mean ages of 2.4 and 6.3 years, premedicated with oral midazolam and atropine. The children were randomly allocated to one of three groups: alfentanil 20 micrograms.kg-1 + lidocaine 1 mg.kg-1 (Alf20 + Lign); alfentanil 20 micrograms.kg-1 (Alf20); or alfentanil 40 micrograms.kg-1 (Alf40), followed by propofol 3.5 mg.kg-1 in the children aged 1-3 years and 3.0 mg.kg-1 in the older children. Intubating conditions, 40 s after the administration of propofol, were assessed as good, moderate or impossible on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing during intubation. ⋯ The QTc interval of the ECG was always in the normal range. Clinically important bradycardia did not occur. In conclusion, the best intubating conditions occurred after propofol 3.5 mg.kg-1 and alfentanil 40 micrograms.kg-1 in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialEarly and late recovery after major abdominal surgery. Comparison between propofol anaesthesia with and without nitrous oxide and isoflurane anaesthesia.
A comparison was made between early and late recovery after major abdominal surgery under intravenous anaesthesia with propofol (with and without nitrous oxide) or inhalational anaesthesia with isoflurane. Sixty patients were randomly allocated to one of three forms of anaesthesia: propofol, propofol/nitrous oxide, or isoflurane/nitrous oxide anaesthesia. All received fentanyl and vecuronium. ⋯ The difference in vegetative symptoms between groups was most obvious on day 7. Patients anaesthetised with propofol reported better subjective control (P < 0.02) and were more socially oriented (P < 0.05) than patients anaesthetised with isoflurane. We conclude that early recovery was similar in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)