Articles: general-anesthesia.
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Br Med J (Clin Res Ed) · Mar 1988
Randomized Controlled Trial Clinical TrialDoes halothane anaesthesia decrease the metabolic and endocrine stress responses of newborn infants undergoing operation?
Concern about the side effects of various anaesthetic agents in newborn infants has led to the widespread use of anaesthesia with unsupplemented nitrous oxide and oxygen with muscle relaxants in such patients. To investigate the efficacy of such a regimen 36 neonates undergoing operations were randomised to two groups: one group received anaesthesia with nitrous oxide and curare alone and the other was additionally given halothane. Concentrations of metabolites and hormones were measured before and at the end of operation and at six, 12, and 24 hours after operation and the values compared between the two groups. ⋯ Changes in blood concentrations of glucose and total ketone bodies and plasma concentrations of non-esterified fatty acids were also decreased in neonates receiving halothane anaesthesia. Neonates given anaesthesia with unsupplemented nitrous oxide showed significantly greater increases in the urinary ratio of 3-methylhistidine to creatinine concentration and their clinical condition was also more unstable during and after operation. Unless specifically contraindicated potent anaesthesia with halothane or other anaesthetic agents should be given to all neonates undergoing surgical operations as it decreases their stress responses and improves their clinical stability during and after operation.
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Comparative Study
Infusions of propofol to supplement nitrous oxide-oxygen for the maintenance of anaesthesia. A comparison with halothane.
The peri-operative and postoperative effects of propofol given by infusion were compared with halothane as a supplement to nitrous oxide-oxygen anaesthesia for body surface surgery in patients who breathed spontaneously. Anaesthesia was induced after opioid premedication, with either propofol 2.5 mg/kg or thiopentone 4-5 mg/kg which were followed respectively by an infusion of propofol 12 mg/kg/hour for 10 minutes and at a variable rate thereafter, or by halothane at a mean inspired concentration of 1.2%. ⋯ The cardiovascular effects during induction and maintenance of anaesthesia were similar in the two groups. The overall incidence of side effects was low but immediate recovery was significantly faster in patients who received propofol.
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Clinical Trial Controlled Clinical Trial
Serum myoglobin following tourniquet release under anaesthesia.
Serum myoglobin concentrations were studied in 34 patients during tendon and nerve reconstruction operations that required the application of a pneumatic limb tourniquet. Seventeen patients received general anaesthesia without the use of suxamethonium, while the remaining 17 were given suxamethonium as part of the anaesthetic technique. Tourniquet times of up to 2.5 h were associated with negligible myoglobin release, but the use of suxamethonium administration resulted in a rise of serum myoglobin in some subjects, reaching a maximum of 300 micrograms litre-1 20-40 min after induction. ⋯ Three of the four patients who required a re-application of the tourniquet (after a short reperfusion time) had rises of serum myoglobin up to 120 micrograms litre-1 following the second deflation. Pneumatic tourniquets appear to cause no detectable ischaemic damage for up to 2.5 h, with or without prior use of suxamethonium. Re-application after only a short period of reperfusion may be inadvisable.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia.
Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone-isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4-2.0%. ⋯ The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone-isoflurane group.
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Randomized Controlled Trial Clinical Trial
Pain-free injection in infants. Use of a lignocaine-prilocaine cream to prevent pain at intravenous induction of general anaesthesia in 1-5-year-old children.
A randomised, placebo-controlled, double-blind study was undertaken in 111 children between the ages of 1 and 5 years to assess the efficacy of EMLA 5% cream in the alleviation of venepuncture pain at intravenous induction of general anaesthesia using 27-gauge needles. Pain assessment was made by an operating department assistant using both verbal rating scale and visual analogue scale methods. ⋯ Significantly lower pain scores were recorded in the children treated with EMLA cream (verbal rating scale: premedicated p less than 0.05, unpremedicated p less than 0.001; visual analogue scale: premedicated p less than 0.0005, unpremedicated p less than 0.0002). No variation in analgesia was found for application times between 30 and 300 minutes and there were no serious side effects.