Anaesthesia preference, neuraxial vs general, and outcome after caesarean section.

We investigated parturients' preference for neuraxial vs general anaesthesia, while they have experienced both techniques in the past. A total of 102 parturients who underwent elective caesarean section under general or neuraxial anaesthesia at different times completed a questionnaire comparing the two techniques. According to our results, 98% vs 51% (p < 0.001) of the women saw the baby and 51% vs 29% (p = 0.003) ambulated in the neuraxial and general anaesthesia groups, respectively, within the first 24 h postoperatively. Neuraxial anaesthesia was associated with less pain assessed by the Verbal Analogue Scale (VAS) (54 ± 21 vs 72 ± 20 p < 0.001), fewer days of hospital stay (4 ± 0.5 vs 5 ± 1.5, p = 0.001) and higher satisfaction scores (77 ± 18 vs 52 ± 24, p = 0.001) vs general anaesthesia. Finally, 80% of the women would choose neuraxial anaesthesia for a future caesarean section.

Pre-oxygenation enhances induction with sevoflurane as assessed using bispectral index monitoring.

BACKGROUND: Several methods may enhance the inhalational induction of anesthesia. In this randomized double-blind study, we evaluated the speed of induction of anesthesia with sevoflurane with or without pre-oxygenation. METHODS: Fifty-four patients scheduled for hysteroscopy received for 10 min air or 100% oxygen via a facemask followed by > or = 7% sevoflurane in 100% oxygen. During the first 300 s of sevoflurane administration, bispectral index (BIS) values were recorded every 30 s in all patients. In 14 patients, seven in each group, BIS, endtidal CO(2), tidal volume, respiratory rate, SpO(2), and heart rate were recorded every minute during the pre-induction period and every 30 s during the first 5 min of sevoflurane administration. RESULTS: The BIS, endtidal CO(2), tidal volume and respiratory rate did not differ between the oxygen or air breathing groups (P = 0.696, P = 0.999, P = 0.388, and P = 0.875, respectively), though the oxygen group exhibited lower tidal volumes by 16-20%. The SpO(2) and heart rates were higher in the oxygen breathing group (P < 0.001 and P = 0.042, respectively). During sevoflurane administration, BIS values were lower in the oxygen group vs. the group breathing air, in particular at 90, 120, 150, 180 and 210 s (P = 0.001, P = 0.001, P = 0.001, P = 0.001 and P = 0.030, respectively). The endtidal CO(2) and the tidal volumes between the groups did not differ. The two groups differed in the SpO(2) and the heart rates during induction (P = 0.004 and 0.003, respectively). CONCLUSIONS: Before sevoflurane administration, breathing 100% oxygen for 10 min enhances induction of anesthesia with sevoflurane.

Influence of ondansetron on thiopental hypnotic requirements.

Ondansetron, a selective 5-HT3 antagonist has been proved to be an effective antiemetic agent for prophylaxis of nausea and vomiting after surgery. This study was conducted to determine whether ondansetron changes thiopental requirements for induction of anesthesia in patients unpremedicated and premedicated with diazepam. One hundred sixty eight adult female patients classified as American Society of Anesthesiologists (ASA) physical status I (normal healthy patient) or II (patient with mild systemic disease) participated in this prospective, double blinded, randomized study. Patients were assigned to receive either 0.07 mg/Kg diazepam orally or no premedication. They then received saline and ondansetron 0.1 mg/Kg or 0.2 mg/Kg intravenously 5 minutes before thiopental induction. Thiopental was administered at a rate of 25 mg/min until the patient lost the ability to open eyes on command. Thiopental requirements were not significantly different among groups. The results indicate that ondansetron in clinically used doses does not influence the hypnotic requirements of thiopental.

Flumazenil in reversal of the central effects of midazolam used as induction agent in general anesthesia.

Flumazenil (Anexate), a new benzodiazepine antagonist, was administered in doses of 0.2-0.4 mg to 40 patients for reversing the sedative effects of midazolam used as the sole induction agent in doses of 0.15-0.25 mg x kg-1 for short operations with a mean duration of 35 +/- 10 min. Five min after flumazenil was given, 33 patients (82.5%) were fully conscious, while 38 patients (95%) were able to converse 30 min after administration. Flumazenil was very well tolerated in almost all cases, the only side effects being mild confusion in 3 patients and nausea in 3 other cases.