Incidence of bradycardia during recovery from spinal anaesthesia: influence of patient position.
We administered 0.5% plain bupivacaine 4 ml intrathecally (L2-3 or L3-4) in three groups of 20 patients, according to the position in which they were nursed in the post-anaesthesia care unit (PACU): supine horizontal, 30 degrees Trendelenburg or hammock position (trunk and legs 30 degrees elevated). Patients were observed until anaesthesia descended to less than S1. The incidence of severe bradycardia (heart rate < 50 beat min-1) in the PACU was significantly higher in patients in the Trendelenburg position (60%) than in the horizontal (20%, P < 0.01) or hammock (10%, P < 0.005) position. After 90 min, following admission to the PACU, only patients in the hammock position did not have severe bradycardia. In this late phase, the incidence of severe bradycardia in the Trendelenburg group was 35% (P < 0.005) and 10% in patients in the supine horizontal position. In four patients, severe bradycardia first occurred later than 90 min after admission to the PACU. The latest occurrence of severe bradycardia was recorded 320 min after admission to the PACU. We conclude that for recovery from spinal anaesthesia, the Trendelenburg position should not be used and the hammock position is preferred. (+info)
Tramadol or morphine administered during operation: a study of immediate postoperative effects after abdominal hysterectomy.
Tramadol may cause awareness and EEG activation during anaesthesia. We compared tramadol with morphine, administered during wound-closure, surmising that tramadol may cause earlier awakening, more rapid recovery, less respiratory depression and equivalent pain relief. Forty patients received nitrous oxide-enflurane for abdominal surgery. At wound closure, patients received tramadol 3 mg kg-1 or morphine 0.2 mg kg-1 and end-tidal enflurane concentrations were maintained at 0.5 kPa until skin closure, whereupon anaesthesia was discontinued. Times to spontaneous respiration, awakening and orientation were similar in the two groups, as were blood-gas tensions, ventilatory frequency, pain scores and incidence of nausea. Half of each group required supplementary analgesia during their 90-min stay in the recovery room. P-deletion counts improved more rapidly in the tramadol group. This study confirms previous reports that tramadol did not antagonize the hypnotic effects of volatile anaesthetics. Tramadol, administered during operation, was as effective as morphine in providing postoperative analgesia while permitting more rapid psychomotor recovery. (+info)
Propofol infusion for induction and maintenance of anaesthesia in patients with end-stage renal disease.
We have investigated the pharmacokinetics and pharmacodynamics of propofol in 11 patients with end-stage renal disease (ESRD) compared with nine healthy patients during and after a manually controlled three-stage infusion of propofol 21, 12 and 6 mg kg-1 h-1 lasting a minimum of 2 h. Mean total body clearance was not reduced significantly in the ESRD group (30.66 (SD 8.47) ml kg-1 min-1) compared with the control group (33.75 (7.8) ml kg-1 min-1). ESRD patients exhibited a greater, but not statistically significant, volume of distribution at steady state compared with patients in the control group (11.25 (8.86) vs 5.79 (2.14) litre kg-1, respectively). Elimination half-life values were unchanged by renal failure. Mean times to induction of anaesthesia were similar in both groups: 177 (SD 57) and 167 (58) s for the ESRD and control groups, respectively. Waking time after cessation of propofol infusion was significantly shorter in the ESRD group (474 (156) s) compared with the control group (714 (240) s) (P < 0.05). Mean plasma concentrations on waking were similar. We conclude that the pharmacokinetic and pharmacodynamic profiles of propofol after infusion were not markedly affected by renal failure. (+info)
Recovery after halothane anaesthesia induced with thiopental, propofol-alfentanil or halothane for day-case adenoidectomy in small children.
We studied recovery from halothane anaesthesia in 93 children, aged 1-3 yr, undergoing day-case adenoidectomy. Children were allocated randomly to receive thiopental 5 mg kg-1 (group TH), alfentanil 10 micrograms kg-1 and propofol 3 mg kg-1 (group PAH) or 5% halothane (group HH) for induction of anaesthesia. In group TH, tracheal intubation was facilitated with succinylcholine (suxamethonium) 1.5 mg kg-1. In groups PAH and HH, tracheal intubation was performed without neuromuscular block, and succinylcholine was used only if required. Anaesthesia was maintained with 1-3% halothane during spontaneous respiration. Times to achieving predetermined recovery end-points were recorded. Quality of recovery was assessed using a score of 1-9 (best to worst) for sedation, crying, restlessness and agitation. A postoperative questionnaire was used to determine the well-being of the child at home, 24 h after operation. Emergence from anaesthesia (response to non-painful stimuli) occurred earlier in group HH (mean 9 (SD 6) min) than in groups PAH (13 (6) min, P < 0.01) and TH (18 (14) min, P < 0.01). Sitting up, walking and home readiness were achieved earlier in groups PAH and HH than in group TH (P < 0.05 for each variable). Children in group TH were more sedated during the first 30 min after anaesthesia than those in the two other groups (P < 0.05) while emergence-related delirium was more common in group HH than in group TH (P < 0.01). Well-being at home was similar in all groups. We conclude that induction of halothane anaesthesia with propofol-alfentanil or halothane provided more rapid recovery and earlier discharge than that with thiopental. (+info)
Comparison of recovery of propofol and methohexital sedation using an infusion pump.
Two sedative anesthetic agents administered by an infusion pump were compared during third molar surgery. Forty American Society of Anesthesiologists (ASA) class I or II volunteers were randomly allocated to two groups. All subjects received supplemental oxygen via a nasal hood, fentanyl (0.0007 mg/kg intravenous [i.v.] bolus), and midazolam (1 mg/2 min) titrated to effect. Patients then received either 0.3 mg/kg of methohexital or 0.5 mg/kg of propofol via an infusion pump. Upon completion of the bolus, a continuous infusion of 0.05 mg/kg/min methohexital or 0.066 mg/kg/min propofol was administered throughout the procedure. Hemo-dynamic and respiratory parameters and psychomotor performance were compared for the two groups and no significant differences were found. The continuous infusion method maintained a steady level of sedation. Patients receiving propofol had a smoother sedation as judged by the surgeon and anesthetist. (+info)
Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane.
We have studied maintenance and recovery profiles after general anaesthesia with sevoflurane, desflurane and isoflurane in 100 patients undergoing pulmonary surgery. End-tidal concentrations of anaesthetic required to maintain mean arterial pressure and heart rate within 20% of baseline values were 1.4 +/- 0.6% for sevoflurane, 3.4 +/- 0.9% for desflurane and 0.7 +/- 0.3% for isoflurane. The three anaesthetics had comparable haemodynamic effects and arterial oxygenation during one-lung ventilation. Emergence was twice as fast with desflurane than with sevoflurane or isoflurane (mean times to extubation: 8.9 (SD 5.0) min, 18.0 (17.0) min and 16.2 (11.0) min for desflurane, sevoflurane and isoflurane, respectively). Early recovery (Aldrete score, cognitive and psychomotor functions) was also more rapid after desflurane. In pulmonary surgery, desflurane, but not sevoflurane, allowed more rapid emergence and earlier recovery than isoflurane. (+info)
General anesthesia for disabled patients in dental practice.
We reviewed the cases of 91 consecutive patients with disabilities who required general anesthesia at a tertiary referral center for dental treatment with a view to determining the factors that create difficulties in the anesthetic management. The more important of these are the special difficulties involved in making preoperative assessments of these patients and the difficulty in establishing monitoring. Other difficulties in anesthesia for these patients involve problems with gaining intravenous access, problems in determining when there has been adequate recovery from anesthesia, and problems in determining the degree of discomfort or pain the patients experience after dental treatment. Another potential hazard in this group of patients is the risk of drug interactions. We emphasize the need to train anesthetists in the care of disabled patients. (+info)
Tactile evaluation of fade of the train-of-four and double-burst stimulation using the anaesthetist's non-dominant hand.
We have studied detection of fade in response to train-of-four (TOF), double-burst stimulation3,3 (DBS3,3) or DBS3,2, assessed tactilely by the anaesthetist using the index finger of the non-dominant hand and the thumb of the patient, compared with that assessed when the index finger of the dominant hand was used. The probability of detection of any fade in response to TOF or DBS3,3 using the non-dominant hand was significantly less than when the dominant hand was used (P < 0.05). The probability of identification of fade in response to DBS3,2 assessed using the non-dominant hand was comparable with that evaluated using the dominant hand when TOF ratios were 0-0.9, but when TOF ratios reached 0.91-1.00, detection using the non-dominant hand was significantly less common than with the dominant hand (12% vs 33%; P < 0.05). Using the non-dominant hand, the probability of detection of fade in response to ulnar nerve stimulation was less than that with the dominant hand and only the absence of DBS3,2 fade ensured sufficient recovery of neuromuscular block. (+info)