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1.
J Anesth Hist ; 6(3): 166-167, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32921490

ABSTRACT

Urial K. Mayo (1816-1900) was a successful Boston dentist who was plagued by personal scandal. In 1883 he patented extending the duration of nitrous-oxide anesthesia with an alcoholic tincture of hops and poppies.


Subject(s)
Anesthesia, Dental/history , Anesthetics, Inhalation/history , Nitrous Oxide/history , Opium/history , Anesthetics, Inhalation/chemistry , Ethanol/history , History, 19th Century , Humans , Humulus , Papaver , Solvents/history , United States
2.
J Anesth Hist ; 4(2): 128-129, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29960676

ABSTRACT

The Jackson-Morton 1846 patent for surgical insensibility by means of sulphuric ether states that opiates can be added to the ether and co-administered by inhalation. The erroneous concept that ether could carry opiates in its vapor phase at room temperature was proposed in Boston in 1846 by Elton Romeo Smilie (1819-1889), who believed that the opiates were more important than the ether vehicle.


Subject(s)
Anesthesia/history , Anesthesiology/history , Anesthetics, Inhalation/history , Patents as Topic/history , Anesthesia/methods , Anesthesiology/methods , Anesthetics, Inhalation/pharmacology , Boston , Ether/history , History, 19th Century , Opium/history
4.
AANA J ; 74(1): 39-44, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16483067

ABSTRACT

It is easy to take for granted the seemingly effortless way cardiovascular surgeons are able to bypass atherosclerotic coronary arteries. The process used today was developed over many years of rigorous study, experimentation, success, and failure. Early cardiac surgery was performed blindly, through small incisions, on a beating heart. Advances in medicine allowed surgery to be performed on hearts stilled by cardioplegic arrest, while the circulation was continued through the use of a cardiopulmonary bypass (CPB) machine. The development of the CPB machine allowed surgeons to perform the delicate work of coronary artery bypass grafting (CABG), first attempted on dogs, and then humans. This article briefly outlines the historical evolution of cardiac surgery that led to the development of the technology necessary to perform off-pump coronary artery bypass grafting (OPCAB). A case report of a 72-year-old female who underwent OPCAB is outlined. Included is a discussion of some of the benefits and potential complications of CABG and OPCAB. Anesthetic considerations for OPCAB procedures also are presented.


Subject(s)
Anesthesia, Inhalation/methods , Anesthesia, Intravenous/methods , Coronary Artery Bypass, Off-Pump/methods , Coronary Disease/surgery , Aged , Anesthetics, Inhalation/therapeutic use , Anesthetics, Intravenous/therapeutic use , Animals , Conscious Sedation/methods , Coronary Artery Bypass, Off-Pump/instrumentation , Coronary Artery Bypass, Off-Pump/trends , Coronary Disease/complications , Dogs , Female , Humans , Isoflurane/therapeutic use , Midazolam/therapeutic use , Monitoring, Intraoperative/methods , Neuromuscular Nondepolarizing Agents/therapeutic use , Pancuronium/therapeutic use , Perioperative Care/methods , Sufentanil/therapeutic use , Treatment Outcome
5.
Masui ; 55(7): 873-9, 2006 Jul.
Article in Japanese | MEDLINE | ID: mdl-16856548

ABSTRACT

BACKGROUND: The purpose of this randomized, multi-center phase III trial was to investigate the influence of sevoflurane and propofol on the neuromuscular blocking effects and pharmacokinetic parameters of Org 9426 (rocuronium bromide) in Japanese population. METHODS: Thirty-nine adult Japanese patients participated in this randomized, multi-center study. Neuromuscular function was monitored continuously with TOF-Watch SX (Organon NV, Netherlands) after anesthetic induction with propofol. These subjects randomly received either 0.6 mg x kg(-1) or 0.9 mg x kg(-1) of rocuronium for endotracheal intubation. These two groups were further divided to two anesthetic regiments : sevoflurane group and propofol group. The difference in onset and recovery of rocuronium-induced neuromuscular block was statistically analyzed with two-way ANOVA. RESULTS: Mean duration for maximal block was 76 seconds and 66 seconds, respectively. The duration between Org 9426 administration and 25% recovery of first twitch response was significantly prolonged in patients given 0.9 mg x kg(-1) of Org 9426. Sevoflurane also significantly increased this duration. However, the serum concentration of Org 9426 was not statistically different between the four study groups. CONCLUSIONS: The duration of Org 9426-induced neuromuscular blockade was significantly increased under sevoflurane anesthesia compared to propofol anesthesia. This difference may be attributed to pharmacodynamic change.


Subject(s)
Androstanols/pharmacology , Anesthetics, Inhalation , Anesthetics, Intravenous , Methyl Ethers , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents/pharmacology , Propofol , Adult , Analysis of Variance , Androstanols/pharmacokinetics , Anesthesia Recovery Period , Anesthesia, General , Drug Interactions , Female , Humans , Male , Middle Aged , Neuromuscular Junction/physiology , Neuromuscular Nondepolarizing Agents/pharmacokinetics , Rocuronium , Sevoflurane , Synaptic Transmission , Time Factors
7.
J Pediatr Surg ; 29(8): 983-6, 1994 Aug.
Article in English | MEDLINE | ID: mdl-7965534

ABSTRACT

Nonshivering thermogenesis (NST) is a normal physiological response of the neonate to cold exposure, characterized by increased blood flow to metabolically active brown fat stores. It is standard practice during neonatal surgery to warm the ambient environment in order to avoid consuming vital energy stores. While NST has been well-studied in the neonate, the response during anesthesia and paralysis has not been fully characterized. Rabbit pups (aged 1 to 7 days) were randomized into several groups. The experimental groups consisted of animals mechanically ventilated and administered either metocurine, pancuronium, curare, fentanyl, nitrous oxide (N2O), or halothane. The controls were spontaneously breathing animals. Oxygen consumption (VO2), an index of metabolic activity, was measured at thermoneutrality (39 degrees C) and after cold exposure (25 degrees C). Control and metocurine animals had a significant increase in VO2 in response to cold exposure. The increase in VO2 was not noted in animals that received curare, pancuronium, fentanyl, N2O, or halothane. To test the effect of anesthetic withdrawal during cold exposure on VO2, additional series of animals were studied. One group received continuous halothane throughout the period of cold exposure; the other had cessation of the halothane during cold exposure. Both groups were rewarmed subsequently. The animals that had withdrawal of halothane during cold exposure had a marked and significant increase in VO2 compared with the control group (continuous halothane). VO2 returned to near-baseline levels upon rewarming. The authors conclude that many commonly used anesthetic and paralyzing agents inhibit the thermogenic response to cold exposure. However, cessation of anesthesia (halothane) in a cold environment results in a marked increase in metabolic activity.


Subject(s)
Anesthetics, Inhalation/pharmacology , Body Temperature Regulation/drug effects , Animals , Animals, Newborn , Curare/pharmacology , Fentanyl/pharmacology , Halothane/pharmacology , Nitrous Oxide/pharmacology , Pancuronium/pharmacology , Rabbits , Random Allocation , Tubocurarine/analogs & derivatives , Tubocurarine/pharmacology
8.
Chin Med J (Engl) ; 109(3): 233-7, 1996 Mar.
Article in English | MEDLINE | ID: mdl-8758316

ABSTRACT

OBJECTIVE: To evaluate the effects of 1 MAC of enflurane or isoflurane anesthesia on the pharmacokinetics of pancuronium. METHODS: Eighteen adult patients undergoing the elective plastic surgery were randomly divided equally into 3 groups, namely, Group 1 (control group), Group 2 (enflurane group) and Group 3 (isoflurane group). Anesthesia was maintained with thiopental and 67% N2O-O2 in Group 1, 1 MAC enflurane in Group 2 and 1 MAC isoflurane in Group 3. After administration of a bolus of pancuronium 100 micrograms/kg, an improved fluorimetric assay was used to determine the serum concentrations of pancuronium and the pharmacokinetic variables of pancuronium were calculated with a 3P87 program. RESULTS: The disposition of pancuronium may be well described mathematically by a two-compartment open model. The results showed that in comparison with the control group, patients in Group 2 and Group 3 had a longer T1/2 beta and MRT. The patients in Group 2 had the slower K10 and lower CL than those in the control group. There were no significant differences among the three groups in T1/2 alpha, V1, V2, Vdss, V beta, K21, K12 and AUC. CONCLUSION: During enflurane and isoflurane anesthesia, CL of pancuronium decreased, and T1/2 beta and MRT of pancuronium were prolonged in our patients, so duration of the effective plasma concentrations of pancuronium was much longer. As a result, the effects of enflurane and isoflurane of the pharmacokinetics of pancuronium may be part of reason why two drugs extended the duration of neuromuscular depression produced by pancuronium.


Subject(s)
Anesthesia, Inhalation , Anesthetics, Inhalation/pharmacology , Enflurane/pharmacology , Isoflurane/pharmacology , Neuromuscular Nondepolarizing Agents/pharmacokinetics , Pancuronium/pharmacokinetics , Adolescent , Adult , Drug Synergism , Female , Humans , Male , Surgery, Plastic
9.
Indian Heart J ; 49(2): 173-8, 1997.
Article in English | MEDLINE | ID: mdl-9231550

ABSTRACT

Sixteen patients suffering from various cardiac arrhythmias were treated surgically. Intraoperative computerised electrophysiologic mapping was used in 14. Thirteen patients were suffering from Wolff-Parkinson-White syndrome. They underwent surgical division or cryoablation of accessory pathways. Two patients who had rheumatic mitral stenosis with left atrial clot underwent "Maze III" procedure with open mitral commissurotomy and clot removal. One patient with paroxysmal refractory ventricular tachycardia and a left ventricular aneurysm had an aneurysmectomy with subendocardial resection of the arrhythmic focus. All antiarrhythmic medications were discontinued preoperatively. Morphine was the principal anaesthetic agent, supplemented with halothane. Muscle relaxation was provided with pancuronium bromide. The various problems encountered included hypotension and arrhythmia during placement of epicardial band array for mapping (4 patients), ventricular tachycardia during internal jugular vein cannulation (1 patient) and continuance of delta wave after cryoablation in 2 patients. Halothane may have interfered with electrophysiologic mapping and accurate localization of accessory pathway leading to persistence of delta wave. The choice of anaesthetic agents should be guided by the electrophysiologic effects and potential influence of these agents on the accessory pathways.


Subject(s)
Anesthesia , Tachycardia/surgery , Adult , Anesthetics, Inhalation , Blood Transfusion, Autologous , Cryosurgery , Electrophysiology , Female , Halothane , Heart Conduction System/abnormalities , Heart Conduction System/surgery , Humans , Male , Muscle Relaxation , Neuromuscular Nondepolarizing Agents , Pancuronium , Wolff-Parkinson-White Syndrome/surgery
10.
Acta Anaesthesiol Belg ; 47(4): 187-93, 1996.
Article in English | MEDLINE | ID: mdl-9093646

ABSTRACT

At the end of abdominal surgery deep neuromuscular blockade is required for peritoneal closure. Ideally injecting an intermediate acting drug like atracurium after a long acting drug such as pancuronium should deepen the neuromuscular block without the fear of an inadequate reversal at the completion of surgery. Thirty patients ASA I or II status, without known allergy to myorelaxant and without neuromuscular, hepatic or renal failure were included in this study. Anesthesia was induced and maintained with propofol, fentanyl, and N20. Normal core temperature was maintained by active warming of the upper part of the body. Blood electrolytes and the acid-base status were within the normal range. The accelerographic responses to Train-Of-Four supramaximal stimulation (TOF) of the ulnar nerve was monitored at the thumb. After obtaining a stable response with the accelerograph, the patients randomly received pancuronium (0.10 mg.kg-1, group I, n = 10 and group II, n = 10) or atracurium (0.50 mg.kg-1, group III, n = 10). An additional dose of atracurium (0.16 mg.kg-1, group I and III) or pancuronium (0.03 mg.kg-1, group II) was injected when the first response of TOF stimulation (T1) reached 25% of its initial value. Then the time to obtain a 25% twitch height of T1 (T25), the recovery index (RI 25-75), the delay to obtain 4 responses to TOF and an adequate recovery [TOF ratio of 0.70 (TOF70)] were monitored. Injection of 60% ED95 of atracurium after pancuronium resulted in a similar recovery of neuromuscular function as after 45% ED95 of pancuronium as shown by the same recovery of T25 (66.5 +/- 4.2 min versus 71.4 +/- 7.8 min, group I versus group II, p > 0.05) and TOF70 (131.6 +/- 15.7 min versus 144.0 +/- 17.5, group I versus II, p > 0.05). Nevertheless the RI 25-75 of group I was of intermediate duration between those of group II and III. Electrolytes and acid-base status were similar between groups at the beginning of surgery. Thus this study shows a synergistic effect of the combination of atracurium after pancuronium occurring in non hypothermic patients anesthetized without halogenated agents. Because the duration of action of the drug administered first governs the duration of action of the subsequent neuromuscular myorelaxant, the neuromuscular function should be closely monitored at the end of surgery if neuromuscular drugs are used in combination.


Subject(s)
Anesthetics, Intravenous/administration & dosage , Atracurium/pharmacology , Fentanyl/administration & dosage , Neuromuscular Nondepolarizing Agents/pharmacology , Pancuronium/pharmacology , Propofol/administration & dosage , Anesthetics, Inhalation/administration & dosage , Drug Synergism , Evoked Potentials/drug effects , Female , Humans , Male , Middle Aged , Neuromuscular Junction/drug effects , Nitrous Oxide/administration & dosage , Ulnar Nerve/physiology
11.
Vet Res Commun ; 25(4): 251-9, 2001 May.
Article in English | MEDLINE | ID: mdl-11432427

ABSTRACT

A detailed anaesthetic technique for baboons (Papio anubis) undergoing heterotopic abdominal cardiac xenotransplantation is described. Twenty-two baboons served as transplant recipients. Donors were either crossbred farm pigs (Sus scrofa) (n = 4) or transgenic pigs (Sus scroefa) (n = 18) expressing human complement regulatory proteins on the endothelium. Intra-operative management was complicated by the physiological consequences of infrarenal. abdominal aortic cross-clamping, in addition to the immunological sequelae related to cross-species transplantation. In choosing anaesthetics for this procedure, we considered the need for maximal cardiac stability throughout a long surgical procedure that required abdominal aortic cross-clamping to facilitate the implantation of an oversized porcine cardiac graft. Baboons received a balanced anaesthetic consisting of inhaled isoflurane in oxygen, intravenous fentanyl and intravenous pancuronium. The pharmacological techniques employed were found to be safe and reliable and were well tolerated by our recipients without any significant side-effects.


Subject(s)
Anesthesia/veterinary , Heart Transplantation/veterinary , Papio/surgery , Transplantation, Heterologous/veterinary , Anesthesia/methods , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Animals , Blood Pressure/drug effects , Electrocardiography/drug effects , Electrocardiography/veterinary , Female , Fentanyl/administration & dosage , Heart Transplantation/methods , Isoflurane/administration & dosage , Male , Neuromuscular Depolarizing Agents/administration & dosage , Oximetry/veterinary , Pancuronium/administration & dosage , Swine/surgery , Tissue and Organ Procurement , Transplantation, Heterologous/methods
13.
J Epidemiol Community Health ; 63(6): 497-9, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19228682

ABSTRACT

The accomplishments of John Snow (1813-1858), physician-epidemiologist, inventor and anaesthetist to Queen Victoria, are well documented, but the causes of his untimely death at age 45 remain conjectural. Snow suffered a paralysing stroke while working on his magnum opus, On Chloroform and Other Anaesthetics, and died a few days later on 16 June 1858. Snow had a history of renal problems associated with tuberculosis. He also experimented on himself with ether, chloroform and other agents over several years, but whether this prolonged self-experimentation contributed to his early death is uncertain. A photograph of Snow taken in 1857 shows that the fingers of his right hand were swollen. Could this be a clue to the cause of his death? The "modern" view is that Snow's early tuberculosis and associated renal disease led to hypertension, chronic renal failure and stroke. The tuberculosis and renal involvement may have been worsened by vegetarianism and perhaps resulting vitamin D deficiency. However, the renal damage caused by tuberculosis is unlikely to have been progressive. Based on current evidence of renal toxicity associated with exposure to anaesthetic agents, it is perhaps more likely that extensive and prolonged self-experimentation with anaesthetics over a 9-year period led to Snow's renal failure, swollen fingers and early death from stroke.


Subject(s)
Anesthesiology/history , Anesthetics, Inhalation/adverse effects , Edema/history , Hand , Stroke/history , Anesthetics, Inhalation/history , Autoexperimentation/history , Edema/chemically induced , History, 19th Century , Humans , Kidney Failure, Chronic/chemically induced , Kidney Failure, Chronic/history , Photography/history , Stroke/chemically induced
14.
Paediatr Anaesth ; 17(2): 171-5, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17238890

ABSTRACT

Laryngotracheo-esophageal cleft is a rare congenital anomaly that results from complete or partial failure of the development of the tracheoesophageal septum. The presenting symptoms include stridor, respiratory distress, and coughing or cyanotic episodes with feeding. There are four classifications for laryngeal clefts; the severity depends on the type present. We discuss the anesthesia management of a neonate with a Type IV cleft who presented for an emergency gastric division to prevent pulmonary aspiration and later returned for final repair of the defect.


Subject(s)
Anesthesia/methods , Esophagus/abnormalities , Larynx/abnormalities , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Cardiopulmonary Bypass/methods , Esophagus/surgery , Female , Gastrostomy/methods , Humans , Infant, Newborn , Intubation, Intratracheal/methods , Isoflurane/administration & dosage , Larynx/surgery , Neuromuscular Nondepolarizing Agents/administration & dosage , Pancuronium/administration & dosage , Piperidines/administration & dosage , Pneumonia, Aspiration/complications , Rare Diseases , Remifentanil , Severity of Illness Index , Tracheostomy , Treatment Outcome , Vecuronium Bromide/administration & dosage
16.
Anesthesiology ; 84(2): 300-8, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8602660

ABSTRACT

BACKGROUND: Cisatracurium, one of the ten isomers in atracurium, is a nondepolarizing muscle relaxant with an intermediate duration of action. It is more potent and less likely to release histamine than atracurium. As one of the isomers composing atracurium, it presumably undergoes Hofmann elimination. This study was conducted to describe the pharmacokinetics of cisatracurium and its metabolites and to determine the dose proportionality of cisatracurium after administration of 2 or 4 times the ED(95). METHODS: Twenty ASA physical status 1 or 2 patients undergoing elective surgery under nitrous oxide/opioid/barbiturate anesthesia were studied. Patients received a single rapid intravenous bolus does of 0.1 or 0.2 mg x kg-1 (2 or 4 times the ED(95), respectively) cisatracurium. All patients were allowed to recover spontaneously to a train-of-four ratio > or = 0.70 after cisatracurium-induced neuromuscular block. Plasma was extracted, acidified, and stored frozen before analysis for cisatracurium, laudanosine, the monoquaternary acid, and the monoquaternary alcohol metabolite. RESULTS: The clearances (5.28 +/- 1.23 vs. 4.66 +/- 0.67 ml x min(-1) x kg(-1) and terminal elimination half-lives (22.4 +/- 2.7 vs. 25.5 +/- 4.1 min) were not statistically different between patients receiving 0.1 mg x kg(-1) and 0.2 mg x kg(-1), respectively. Maximum concentration values for laudanosine averaged 38 +/- 21 and 103 +/- 34 ng x ml(-1) for patients receiving the 0.1 and 0.2 mg x kg(-1) doses, respectively. Maximum concentration values for monoquaternary alcohol averaged 101 +/- 27 and 253 +/- 51 ng x ml(-1), respectively. Monoquaternary acid was not quantified in any plasma sample. CONCLUSIONS: Cisatracurium undergoes Hofmann elimination to form laudanosine. The pharmacokinetics of cisatracurium are independent of dose after single intravenous doses of 0.1 and 0.2 mg x kg(-1).


Subject(s)
Anesthetics, Inhalation , Anesthetics, Intravenous , Atracurium/pharmacokinetics , Neuromuscular Nondepolarizing Agents/pharmacokinetics , Adult , Aged , Atracurium/administration & dosage , Female , Fentanyl , Humans , Isoquinolines/pharmacokinetics , Male , Midazolam , Middle Aged , Neuromuscular Nondepolarizing Agents/administration & dosage , Nitrous Oxide , Opium/pharmacokinetics , Stereoisomerism , Thiopental
17.
J Indian Med Assoc ; 93(10): 377-9, 1995 Oct.
Article in English | MEDLINE | ID: mdl-9053410

ABSTRACT

In pedius anaesthesia system, oxygen enriched air and air are generated through an electrically driven oxygen generator 'Permox', obviating the need of compressed gas cylinder or pipe line. Effect of anaesthesia with pedius A anaesthesia system using ketamine or halothane with muscle relaxant in 2 groups of patients had been studied. Both groups had satisfactory results clinically. It appears that if the cases are carefully selected, both the agents have got equal effectiveness.


Subject(s)
Anesthesia, Inhalation/instrumentation , Anesthetics, Inhalation , Halothane , Ketamine , Neuromuscular Depolarizing Agents , Pancuronium , Adult , Anesthesia Recovery Period , Arousal/drug effects , Female , Humans , Male , Nitrous Oxide , Oxygen , Postoperative Complications/etiology
18.
Anesth Analg ; 82(3): 563-7, 1996 Mar.
Article in English | MEDLINE | ID: mdl-8623962

ABSTRACT

Recent technologic advances have contributed to a renewed interest in thoracoscopic surgery. In our institution, thoracoscopy through video-assisted technology has been successfully applied to congenital heart surgery. We reviewed the charts of 45 consecutive patients (ASA physical status 11-IV) who underwent video-assisted thoracoscopic surgery (VATS) for various congenital heart defects. The mean age of the patients was 2.65 yr and the mean weight was 11.78 kg. The surgical procedures included patent ductus arteriosus interruption (n = 28) and vascular ring division (n = 8), and 9 patients had miscellaneous procedures. The most commonly used anesthetic regimen consisted of isoflurane, pancuronium, fentanyl, air, and oxygen. Seven patients were managed with one-lung ventilation, the remainder by two-lung ventilation with surgical lung retraction. Intraoperative desaturation occurred in 12 patients (26.7%) but resolved quickly with brief reexpansion of the lungs. Postoperative complications included: pleural effusions (n = 3), chylothorax (n = 2), right upper lobe atelectasis (n = 1), small pneumothorax (n = 1), and vocal cord paralysis (n = 1). Seven patients (15.5%) required conversion to a thoracotomy for insufficient exposure (n = 4) or due to concern over bleeding (n = 3). This experience with VATS in pediatric patients with congenital heart disease may provide a database for comparison with others who work with the VATS technique.


Subject(s)
Endoscopy , Heart Defects, Congenital/surgery , Thoracoscopy , Video Recording , Adolescent , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Blood Loss, Surgical , Child , Child, Preschool , Chylothorax/etiology , Ductus Arteriosus, Patent/surgery , Fentanyl/administration & dosage , Humans , Infant , Infant, Newborn , Information Systems , Intraoperative Complications , Isoflurane/administration & dosage , Neuromuscular Nondepolarizing Agents/administration & dosage , Oxygen/administration & dosage , Oxygen/blood , Pancuronium/administration & dosage , Pleural Effusion/etiology , Postoperative Complications , Respiration, Artificial , Retrospective Studies , Thoracotomy
19.
Br J Anaesth ; 76(3): 389-95, 1996 Mar.
Article in English | MEDLINE | ID: mdl-8785139

ABSTRACT

We have compared the ability of equipotent concentrations of isoflurane and sevoflurane to enhance the effect of non-depolarizing neuromuscular blocking drugs. Ninety ASA I and II patients of both sexes, aged 18-50 yr, were stratified into three blocker groups (Vec, Pan and Atr), to undergo neuromuscular block with vecuronium (n = 30), pancuronium (n = 30) or atracurium (n = 30), respectively. Within each group, patients were allocated randomly to one of three anaesthetic subgroups to undergo maintenance of anaesthesia with: (1) alfentanil-nitrous oxide-oxygen (n = 10); (2) alfentanil-nitrous oxide-oxygen-isoflurane (n = 10); or (3) alfentanil-nitrous oxide-oxygen-sevoflurane (n = 10) anaesthesia. During maintenance of anaesthesia, end-tidal concentrations of isoflurane, sevoflurane and nitrous oxide were 0.95, 1.70 and 70%, respectively. Both the evoked integrated electromyogram and mechanomyogram of the adductor pollicis brevis muscle were measured simultaneously. In the Vec and Pan groups, a total dose of 40 micrograms kg-1 of vecuronium or pancuronium, respectively, was given, and in the Atr group a total dose of atracurium 100 micrograms kg-1. Each blocker was given in four equal doses and administered cumulatively. We showed that 0.95% isoflurane and 1.70% sevoflurane (corresponding to 0.8 MAC of each inhalation anaesthetic, omitting the MAC contribution of nitrous oxide) augmented and prolonged the neuromuscular block produced by vecuronium, pancuronium and atracurium to a similar degree.


Subject(s)
Anesthetics, Inhalation/pharmacology , Methyl Ethers , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents/pharmacology , Adolescent , Adult , Atracurium/pharmacology , Dose-Response Relationship, Drug , Drug Synergism , Electromyography , Ethers/pharmacology , Female , Humans , Isoflurane/pharmacology , Kinetics , Male , Middle Aged , Nerve Block , Pancuronium/pharmacology , Sevoflurane , Vecuronium Bromide/pharmacology
20.
Anesthesiology ; 101(6): 1298-305, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15564936

ABSTRACT

BACKGROUND: Patients with congenital heart disease characterized by a functional single ventricle make up an increasing number of patients presenting for cardiac or noncardiac surgery. Conventional echocardiographic methods to measure left ventricular function, i.e., ejection fraction, are invalid in these patients because of altered ventricular geometry. Two recently described Doppler echocardiographic modalities, the myocardial performance index and Doppler tissue imaging, can be applied to single-ventricle patients because they are independent of ventricular geometry. This study assessed the changes in myocardial performance index and Doppler tissue imaging in response to two anesthetic regimens, fentanyl-midazolam-pancuronium and sevoflurane-pancuronium. METHODS: Thirty patients aged 4-12 months with a functional single ventricle were randomized to receive fentanyl-midazolam or sevoflurane. Myocardial performance index and Doppler tissue imaging were measured by transthoracic echocardiography at baseline and two clinically relevant dose levels. RESULTS: Sixteen patients receiving sevoflurane and 14 receiving fentanyl-midazolam were studied. Myocardial performance index was unchanged from baseline with either agent (fentanyl-midazolam: 0.50 +/- 15 baseline vs. 0.51 +/- 0.15 at dose 2; sevoflurane: 0.42 +/- 0.14 baseline vs. 0.46 +/- 0.09 at dose 2). Doppler tissue imaging S (systolic)- and E (early diastolic)-wave velocities in the lateral ventricular walls at the level of the atrioventricular valve annulus were unchanged in the sevoflurane group; however, both Doppler tissue imaging S- and E-wave velocities were decreased significantly from baseline at dose 1 and dose 2 with fentanyl-midazolam, consistent with decreased longitudinal systolic and diastolic ventricular function. CONCLUSIONS: Myocardial performance index, a global measurement of combined systolic and diastolic ventricular function, is not affected by commonly used doses of fentanyl-midazolam or sevoflurane in infants with a functional single ventricle.


Subject(s)
Anesthetics, Inhalation , Anesthetics, Intravenous , Fentanyl , Heart Septal Defects, Ventricular/physiopathology , Heart Septal Defects, Ventricular/surgery , Heart/drug effects , Methyl Ethers , Midazolam , Neuromuscular Nondepolarizing Agents , Pancuronium , Coronary Angiography , Dose-Response Relationship, Drug , Echocardiography , Echocardiography, Doppler , Female , Heart Bypass, Right , Heart Function Tests , Hemodynamics/drug effects , Humans , Infant , Male , Oxygen/blood , Sample Size , Sevoflurane
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