Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1997
Biotransformation of halothane, enflurane, isoflurane, and desflurane to trifluoroacetylated liver proteins: association between protein acylation and hepatic injury.
In susceptible patients, halothane, enflurane, isoflurane, and desflurane can produce severe hepatic injury by an immune response directed against reactive anesthetic metabolites covalently bound to hepatic proteins. The incidence of hepatotoxicity appears to directly correlate with anesthetic metabolism catalyzed by cytochrome P450 2E1 to trifluoroacetylated hepatic proteins. In the present study, we examined whether the extent of acylation of hepatic proteins in rats by halothane, enflurane, isoflurane, and desflurane correlated with reported relative rates of metabolism. ⋯ Sera from patients with a clinical diagnosis of halothane hepatitis showed antibody reactivity against hepatic proteins from rats exposed to halothane or enflurane. No reactivity was detected in rats exposed to isoflurane, desflurane, or oxygen alone. These results indicate that production of acylated proteins may be an important mediator of anesthetic-induced hepatotoxicity.
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Anesthesia and analgesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialSmall-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.
A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. ⋯ On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.
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Anesthesia and analgesia · Jan 1997
Randomized Controlled Trial Clinical TrialEffects of epidural and intravenous buprenorphine on halothane minimum alveolar anesthetic concentration and hemodynamic responses.
There is limited information regarding the effects of epidural or intravenous (i.v.) buprenorphine on minimum alveolar anesthetic concentration (MAC) of volatile anesthetic and hemodynamic responses to tracheal intubation and surgical incision. This study was conducted to find the effects of i.v. and epidural buprenorphine required for postoperative pain relief on halothane MAC and hemodynamic responses to tracheal intubation and surgical incision in 126 female patients. Patients were randomly assigned to the four groups: Group I received i.v. and epidural saline as a control; Group II was given buprenorphine 4 micrograms/kg i.v.; and Groups III and IV received buprenorphine 2 and 4 micrograms/kg epidurally, respectively. ⋯ Systolic blood pressure did not change significantly in Groups II-OR and IV-OR after tracheal intubation and in Group III-Ward and IV-Ward after surgical incision but increased significantly (P < 0.05) in the remaining groups in response to noxious stimuli. Heart rate responses to tracheal intubation and surgical incision were similar to those in systolic blood pressure. These results indicate that preanesthetic administration of epidural or IV buprenorphine required for postoperative analgesia reduces halothane MAC and attenuates hemodynamic responses to tracheal intubation and surgical incision according to the dose, route, and timing of administration.
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Anesthesia and analgesia · Jan 1997
Comparative StudyNephrotoxicity of sevoflurane versus desflurane anesthesia in volunteers.
Present package labeling for sevoflurane recommends the use of fresh gas flow rates of 2 L/min or more when delivering anesthesia with sevoflurane. This recommendation resulted from a concern about the potential nephrotoxicity of a degradation product of sevoflurane, "Compound A," produced by the action of carbon dioxide absorbents on sevoflurane. To assess the adequacy of this recommendation, we compared the nephrotoxicity of 8 h of 1.25 minimum alveolar anesthetic concentration (MAC) sevoflurane (n = 10) versus desflurane (n = 9) in fluid-restricted (i.e., nothing by mouth overnight) volunteers when the anesthetic was given in a standard circle absorber anesthetic system at 2 L/min. ⋯ These effects varied greatly (e.g., on postanesthesia Day 3, the 24-h albumin excretion was < 0.03 g (normal) for one volunteer; 0.03-1 g for five others; 1-2 g for two others; 2.1 g for one volunteer; and 4.4 g for another volunteer). Neither anesthetic affected serum creatinine or BUN, nor changed the ability of the kidney to concentrate urine in response to vasopressin, 5 U/70 kg subcutaneously (i.e., these measures failed to reveal the injury produced). In addition, sevoflurane, but not desflurane, caused small postanesthetic increases in serum alanine aminotransferase (ALT), suggesting mild, transient hepatic injury.