Average Duration Of Anesthesia Research Articles

Whole-Course Intraperitoneal Robot-Assisted Choledochal Cyst Excision with a Hidden Incision in Children Under 1 Year Old.

Background: Whole-course intraperitoneal robot-assisted choledochal cyst resection in children under 1 year of age is controversial due to its technical challenges. Current Pfannenstiel incision is widely used in adults for its cosmetic effects but is rarely used in children. Materials and Methods: We conducted a prospective, single-center study to assess the feasibility, safety, and cosmesis of whole-course intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year of age. Results: Ten patients were treated with our surgical protocol, and there was no conversion to laparotomy. The average total operation time was 223 minutes. The average duration of anesthesia was 260.2 minutes. The average docking time between the robot arm and Trocar was 17.5 minutes. The average intraoperative blood loss was 16 mL. No postoperative complications occurred in the 10 patients. The mean time to start drinking water after surgery was 2.4 days. The mean postoperative drainage tube removal time was 2.6 days. The average length of stay was 8.5 days. The scar assessment scale total scores of the 2 observers were (6.8 ± 1.23) and (7.4 ± 1.84), respectively. For every patient, there are only four abdominal surgery scars of which 75% of scars were hidden by underpants and 25% of scars were not covered. Conclusion: It is feasible and safe to perform whole-courses intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year old. It also has a hidden incision effect and is worthy of promotion.

A Split-Mouth Clinical Comparative Evaluation of the Anesthetic Efficacy of Articaine and Lignocaine for Maxillary Bicuspids Extraction.

Aim The study compared the anesthetic effectiveness of articaine and lignocaine when premolars are extracted bilaterally for orthodontic purposes. Material and methods This prospective split-mouth study was performed on 30 cases selected from orthodontic referral patients reporting to the Oral and Maxillofacial Surgery Department at Maharaja Ganga Singh Dental College and Research Center, Rajasthan, India, for bilateral extraction of premolars under local anesthesia. We used 4% articaine hydrochloride and adrenaline 1:100000 (AH) as group A and 2% lignocaine hydrochloride with adrenaline 1:100000 (LH) on the control side as group B. For premolar anesthetization, 0.6-1.6 ml of AH and 1-2 ml of LH were injected submucosally in the buccal vestibular area. The extraction procedure was then carried out after achieving adequate anesthesia. The pain was assessed with Visual Analog Scale. The average onset time and duration of anesthesia were recorded. Data collected were summarized with descriptive statistics.The SPSSversion 23.0 (IBM Corp., Armonk, New York) was used for data entry, validation, and analysis. Means of continuous variables were compared using the student t-test. All tests were 2-tailed and significant at equal or less than 0.05. (p≤0.05). Results When comparing the overall anesthetic efficiency, Group A had a lower overall pain score of 0.43 while Group B had a higher overall pain score of 2.9. The average onset time of anesthesia in Group A was 1.2 minutes and 2.55 minutes in Group B. In Group A, the average duration of anesthesia was 70 minutes, and 46.5 minutes in Group B. These parameters were statistically significant with a p-value of <0.05. Conclusion The study concluded that as an alternative to lignocaine, articaine could be used effectively for maxillary premolar extractions for orthodontic reasons obviating palatal injection which is very painful to the patient.

Anesthesiological Management of Acute Generalized Peritonitis at Chu Kara

The aim of our work was to make an inventory of the anesthesiological management of acute generalized peritonitis at the CHU-Kara. To determine the frequency of acute generalized peritonitis; to describe their treatment in pre, per and postoperative; to analyze the postoperative follow-up. This work was a retrospective descriptive study carried out on the files of patients operated for acute generalized peritonitis from November 1, 2019 to October 31, 2020. The study was performed in the surgical resuscitation department and in the operating room. Fifty-eight cases of generalized peritonitis were selected for the study. Peritonitis represented 27.8% of abdominal surgical emergencies. The patients were male dominated with a mean age of 29.6 years. The average consultation time was 3.5 days. Fever was the predominant clinical sign on admission (72.4%). The average duration of preoperative resuscitation was 17 hours and 18 minutes. The combination of Ceftriaxone and Metronidazole was the most used antibiotic therapy. General anesthesia was standard. Spinal anaesthesia was the second technique used. Preoxygenation was systematic for general anesthesia. Pancuronium (72.2%) was the most used curare. The average duration of anesthesia was 105 minutes. Laparotomy, peritoneal cleansing and drainage were performed in all patients, followed by excision-suture of the stomach (43.1%). Peritonitis due to peptic ulcer perforation predominated (43.1%) followed by typhoid perforation of the small intestine (24.1%). The morbidity rate was 41.4%, dominated by parietal suppurations (15.5%). The mortality rate was 8.6%. The average length of stay in intensive care was 8.7 days. The anesthesiological management of acute peritonitis remains a real challenge for anesthesiologists, given the major volume disturbances, the delay in diagnosis with its corollary of septic shock, and the lack of qualified personnel with which they are faced. Peritonitis is a real public health problem because of its still very high mortality. It was carried out with insufficiencies related to the poverty of the population, the inexistence of universal health insurance, the insufficiency of the technical platform and the insufficiency of organization.

Сравнительная оценка эффективности использования пахового и мошоночного доступов при лечении рецидива крипторхизма.

Introduction. The average recurrence rate after inguinal orchiopexy is 1%, and with scrotal access – 3%. The high incidence of cryptorchidism determines a relatively large number of patients who need redo orchiopexy, which explains the interest in studying the results of the use of inguinal and scrotal approaches in the surgical treatment of recurrent cryptorchidism. Materials and methods. In the period from 2016 to 2021, 36 operations were performed for relapses of cryptorchidism. Right-sided cryptorchidism was in 22 (61.1%) patients, left-sided – 14 (38.9%) boys. The average age of patients was 6.4 ± 3.6 years (1.5-17.1 years). The study included patients whose entire testicular volume was located outside the scrotum. The patients were divided into two groups: group I, 21 (58.3%) children who had relapse eliminated by scrotal access, group II, 15 (41.7%) who used inguinal access. The duration of the operation and the time spent in the hospital, the frequency of repeated malposition and testicular atrophy, the duration of the use of analgesics were studied. Results. In group I patients, the median time of the operation was 35 minutes [25;100], the average length of hospital stay was 2.5 days, and the average duration of anesthesia was 0.4 days. In group II, the median time of the operation was is 90 minutes [60;130], which is significantly longer than in group I (p=0.002), the average length of stay in the hospital is 4 days, the average time of anesthesia is 1.4 days. In 2 (12.5%) patients of group I, there was a need for conversion and the use of inguinal access. 7 (19.4%) patients did not come for a follow-up examination. Group I included 16 (55.2%), group II 13 (44.8%) boys. Testicular atrophy was in group I in 1 (6.25%) patient, there was no malposition, in group II 2 (15.3%) there was atrophy, malposition in 1 (7.6%) case. Conclusion. Both scrotal and inguinal access during repeated orchiopexy are highly effective in the treatment of recurrent cryptorchidism, while scrotal access reduces the time of surgery and the extent of injury

Retrospective analysis of the patients undergoing neuroanaesthesia between the years 2015-2019

This study aimed to retrospectively evaluate the patients who underwent neuroanesthesia at Ondokuz Mayıs University Faculty of Medicine Hospital between 2015 and 2019. We included all patients who underwent neuroanesthesia between 01.01.2015 and 31.12.2019 and recorded demographic characteristics, comorbidities, type of surgery performed, anesthesia management and complications. We included a total of 5172 patients in the study. 52.9% of the patients were male and the mean age was 43.2%. We observed that the patients were operated most frequently for herniopathy (21.3%), shunt/external ventricular drainage (19.7%) and cranial mass (18.7%), and 77.3% of the cases were elective surgery. The average duration of anesthesia was 145.9 minutes. Thiopental (46.7%) and propofol (45.6%) were used most frequently as induction agents, while rocuronium (93.7%) was preferred as the neuromuscular blocking agent in almost all patients. Remifentanil (81.4%) was the most commonly used intraoperative analgesic. While inhalation anesthesia was preferred for maintenance in 3077 (59.5%) patients, total intravenous anesthesia was used in 1811 (35.1%) patients. Complications developed in 24.1% of the patients, and cardiovascular complications were observed in 71.9%. The study evinced that 1282 patients (24.8%) needed postoperative intensive care. This study revealed that the repetition of retrospective studies at regular intervals would contribute to the development of anesthesiology by enabling both the evaluation of the practices in the same clinic and the comparison between clinics.

Clinico-physiological and haemato-biochemical evaluation of midazolam-ketofol anaesthesia in atropinized goats

The study was conducted on six healthy non-descript goats of either sex weighing between 20-25 kg by administrating atropine sulphate (0.04 mg/kg I/M) followed by midazolam (0.4 mg/kg I/M) and 15 min. later followed by induction of anaesthesia with ketofol (5mg/kg I/V). Sedation with drooping of head after midazolam administration within 8.20±0.58 min. After ketofol administration went into lateral recumbency and onset of anaesthesia was 0.62±0.14 min. Corneal, palpebral and anal pinch reflexes were abolished completely. Complete relaxation of all muscles of jaw, tail, anus, prepuce, neck and limb was observed but for short duration. There was complete analgesia and moderated salivation after ketofol anaesthesia. The average duration of anaesthesia was 33.71±1.08 min. after which sign of recovery such as raising of head, tail flicking appeared and complete recovery took 62.14±1.53 min. after ketofol anaesthesia. There was no significant variations in rectal temperature whereas a significant (P

Comparison of economic effectiveness of desflurane and sevoflurane in ENT surgery

Purpose . To determine the clinical and economic effectiveness of using desflurane and sevoflurane as components of general balanced anesthesia when performing ENT surgeries in children. Methods . 132 cases of general anesthesia were analyzed during adeno- and/or tonsillotomy. The mean age of patients was 6.2±2.8 years. The average duration of anesthesia was 44.1±13.3 min. Direct medical costs, cost efficiency and budgetary impact were analyzed based on the weighted average prices in 2018. Results . In adeno- or tonsillotomy of mid-duration in children the cost of anesthesia support was 483.31 RUB for desflurane, and 283.48 RUB for sevoflurane. The expenditure difference amounted to 199.83 in favor of sevoflurane. Changing from desflurane to sevoflurane in 1,000 patients under 18 years old who require inhalation anesthesia will be accompanied by cost saving in the amount of 199,830 RUB. When the anesthetic concentration is changed, sevoflurane is also a less expensive technology in patients aged 1–3, 3–5 and 5–12 years old. While using the minimum recommended flows of fresh gas, the cost of anesthesia support will constitute 295.3 RUB for desflurane and 173.69 RUB for sevoflurane with the difference in favor of sevoflurane being 121,61 RUB for 44.1-min surgery with 3-min initial narcosis. Conclusion . Use of sevoflurane as a component of general combined balanced anesthesia in adeno- and/or tonsillotomy in children is more cost-efficient as compared to desflurane.

Anesthesia Practice in Pediatric Radiation Oncology: Mayo Clinic Arizona's Experience 2014-2016.

Understanding the goals of targeted radiation therapy in pediatrics is critical to developing high quality and safe anesthetic plans in this patient population. An ideal anesthetic plan includes allaying anxiety and achieving optimal immobilization, while ensuring rapid and efficient recovery. We conducted a retrospective chart review of children receiving anesthesia for radiation oncology procedures from 1/1/2014 to 7/31/2016. No anesthetics were excluded from the analysis. The electronic anesthesia records were analyzed for perianesthetic complications along with efficiency data. To compare our results to past and current data, we identified relevant medical literature covering a period from 1984-2017. A total of 997 anesthetic procedures were delivered in 58 unique patients. The vast majority of anesthetics were single-agent anesthesia with propofol. The average duration of radiation treatment was 13.24min. The average duration of anesthesia was 37.81min, and the average duration to meet discharge criteria in the recovery room was 29.50min. There were seven instances of perianesthetic complications (0.7%) and no complications noted for the 80 CT simulations. Two of the seven complications occurred in patients receiving total body irradiation. The 5-year survival rate for pediatric cancers has improved greatly in part due to more effective and targeted radiation therapy. Providing an anesthetic with minimal complications is critical for successful daily radiation treatment. The results of our data analysis corroborate other contemporary studies showing minimal risk to patients undergoing radiation therapy under general anesthesia with propofol. Our data reveal that single-agent anesthesia with propofol administered by a dedicated anesthesia team is safe and efficient and should be considered for patients requiring multiple radiation treatments under anesthesia.

Realistic and unrealistic direst costs in pharmacoeconomic anesthesia studies

Introduction: Multiplicity of anesthetic services and practice consume few resources individually, but collectively, they mean significant cost. Economic and pharmacoeconomic studies are done in order to rationalize resources. Aim: 1. To calculate the direct expense in anesthesia and reanimation; 2. To compare expenses to the price of anesthesia according to the unit prices of National Health Insurance Fund (NHIF); 3. To compare the duration of general anesthesia with costs in anesthesia departments. Methodology: This paper is a part of the retrospectively-prospective academic study of fourth phase carried out in the Clinical Center of Serbia. With permission of Ethical committee, we have set for 2005 and 2006, the direct cost of 148.876 anesthetic services in 11 departments of Clinical Center of Serbia as tertiary-type institution of medical health care. Research group included all patients of both sexes, children and adults. We compared the direct cost per minute of general anesthesia with average duration of anesthesia in every anesthesia department of surgical clinics. The direct cost was compared with the same, 'unit' prices of NHIF. The direct cost was compared with the same, 'unit' prices of RHIF. We have used linear and regression statistical product and service solutions model for component cost analysis /SPSS 15/. Results: Most budget resources are selected for the employees' sallaries (40%), then the medicines and supplies (31,80%) and the other expenses including the analysis and analytic devices (28,20%). Direct costs indicate a linear correlation and statistically marked difference p=0,012, F=9,270 compared to anesthesia duration indicating the coefficient of correlation r=0,694. Direct costs are highest considering longest segment of anesthesia. We have obtained linear correlation R=0,706 for direct costs excluding the neurosurgical anesthesia with 'unit prices'of anesthesia and anesthetic services indicating F=9,951 and p=0,01. Conclusions: Anesthesia and anesthetic services show statistically significant and financially significant correlation with the direct costs and duration of anesthesia within different surgical specialties. Cosidering direct costs, only the costs of anesthetic drugs and materials are realistic, and all other elements are determined by law and by contract with NHIF. Other costs, out of the direct costs group shall be theoretically reduced by running the analyzes required for anesthesia and for the planned surgical intervention in primary health care protection. Data base related to surgical data and better computer programs able to monitor multiple parameters during hospital treatment, could determine more precisely the value of anesthetic services.

Laparoscopic Colonic Resection Without Urinary Drainage: Is It “Feasible”?

BackgroundUrinary retention following colorectal surgery is a known and costly morbidity. Increasing effort is being made to streamline patient recovery following colon resection, though the ideal timing and duration of urinary catheterization (UC) and its effect on urinary retention (UR) and urinary tract infection (UTI) remain controversial. MethodsOur program prospectively enrolled patients undergoing elective segmental colon resection through our “fast track” protocol, in which UC is completely avoided unless required for fluid management or to facilitate dissection. Patient demographics and perioperative data including type of analgesia, duration of anesthesia, timing of UC, and rates of perioperative UR and UTI were prospectively recorded. ResultsSixty-five patients met inclusion criteria. Sigmoid colectomy was the most common procedure (76.9 %). The average duration of anesthesia was 274 min, and epidural analgesia was employed in 32 (49.2 %). Twenty-two patients (33.8 %) required temporary perioperative UC. All patients left the operating room without a urinary catheter. Urinary retention occurred in six patients (9.2 %, three with and three without epidural analgesia). One patient who was not catheterized developed a UTI (1.5 %). There was no perioperative mortality. Overall, 39 (60.0 %) patients successfully underwent segmental colon resection and hospital discharge without any UC. Conclusions“Fast track” enhanced recovery after elective segmental colon resection without requiring UC is safe and feasible. Epidural analgesia does not mandate the use of UC. In light of the considerable morbidity and cost of UR and UTI, this approach merits further investigation for this patient population.

A study on total intravenous anesthesia in orthognathic surgical procedures

Aims and Objective:To assess the use of propofol for induction and maintenance of anaesthesia among patients undergoing various combinations of orthognathic surgical procedures.Materials and Methods:Following Preoperative evaluation, patients were given Fentanyl (2 micrograms/kg) intravenously. Induction (2 mg/kg) and maintenance (10 mg/kg/hr) of anaesthesia was achieved by Propofol infusion. Blood Pressure and heart rate were maintained at >70 or 80 mm Hg and >50 respectively and were monitored continuously. Infusion was stopped approximately 30 to 40 minutes before the end of surgery. Immediate recovery recorded and was assessed.Results:The average duration of anaesthesia and surgery were found to be 4 hrs 28 min (SD= 1 hr. 35 min) and 4 hrs 3 min (SD=1 hr 38 min). None of the patients experienced pain on injection of induction agent. No significant change was observed in the mean heart rate and mean BP at different time intervals from baseline value to 30 minutes after the recovery. The average time taken to obey simple commands after stopping Propofol infusion was 42.60 ± 9.09 min. Time taken for spontaneous eye opening, full orientation and to count backwards was 43.45 ± 9.11, 47.85 ± 8.18 and 50.9 ± 9.14 respectively. Face-Hand test performed at 15 min after extubation was positive in all the patients. The mean Aldrete score at 15 min after extubation was 11.65 ± 0.75. The mean value of unaided sitting time for at least 2 min was after 119.00 ± 20.56 min. The average score of picture card test, time taken in “picking up matches” test, Ball bearing test, time taken to walk and to void urine were 5.80 ± 1.47, 67.95 ± 5.72, 9.80 ± 2.57, 172.75 ± 39.25 and 163.75 ± 55.96 respectively. Ninety percent of the patients were amenable for a repeat of this anaesthetic using the same regime but 10% of them did not answer anything. Seven patients (35%) had chills post-operatively.Conclusion:Propofol is an excellent anaesthetic for day care procedures.

Regional anesthesia alone for pediatric free flaps

Microvascular surgery plays an important reconstructive role in the pediatric population. Successful outcomes rely on surgical technique as well as anesthesia. Regional anesthesia contributes to successful free tissue transfer through sympathetic blockade, postoperative pain control, and elimination of risks and costs associated with general anesthesia. While regional anesthesia in microsurgery is discussed in the literature for adult and elderly patients, no studies focus on the pediatric population. Accordingly, this paper reviews 20 pediatric patients undergoing microvascular surgery (anterolateral thigh, n=9; gracilis, n=3; toe transfer, n=6; and fibula, n=2) with regional anesthesia and sedation. All patients underwent spinal epidural anesthesia, and seven also received brachial plexus blocks. The average duration of anesthesia was 3-4h (anterolateral thigh (ALT) and gracilis) and 6-8h (toe transfer and fibula). No anesthesia-related complications or flap failures occurred. We conclude that regional anesthesia has important benefits in pediatric microsurgery and it is a safe and cost-effective alternative to general anesthesia.

PS-137b Anesthesiology And Intensive Care For Renal Transplantation In Children

Introduction Renal transplantation in children has special anaesthesia and postoperative intensive care, mainly for low birth weight. These features concern methods of intraoperative filling, surgical techniques and postoperative immediate resuscitation. Thus, maintaining adequate perfusion of the graft and the prevention of thrombosis of vascular anastomoses remain the main objectives of the perioperative phase. The aim of this study is to describe the procedures for anaesthesia and intensive care during surgery and immediate postoperative in paediatric renal transplantation in our unit. Materials and methods Prospective descriptive study spread over 7 years, from January 2007 to February 2014, covering all paediatric renal transplant patients admitted to the children of our university hospital. Were collected epidemiological data of patients and grafts, duration of intubation and intensive care unit stay, haemodynamic, biological and therapeutic settings, and changing data of our patients. Results Fourteen cases were collected with an average age of 11.32 years (range 6.5 to 16 years). Antecedents were repeated urinary tract infection (21.4%), nephrectomy (21.4%) and heart disease in one case. Nephropathy was the most common cause of chronic terminal renal failure (6 cases), followed by uropathies (5 cases). The dialysis modalities were peritoneal dialysis (66.7%) and hemodialysis (33.3%). The anaesthetic technique was by inhalation of sevoflurane in 10 cases and intravenously in 4 cases. Consisted of monitoring an invasive blood pressure (radial artery) and a central venous pressure (CVP) (jugular) in all patients. The average duration of anaesthesia was 6.64 h. The extubation was performed after surgery in 9 cases and resuscitation in 5 cases with a mean duration of postoperative ventilation 4.6 h. The average time of warm ischemia was 1.85 h and that of the 1.07 h of cold ischemia. Mannitol was administered in 14.3% of cases, and two cases were transfused red blood cells. Drugs administered intraoperatively were : dopamine (21.4%), diuretics (21.4%) and antihypertensive (14.3%). The period of normalisation of renal function postoperatively was : day 1 (71.4%), day 3 (14.3%), day 6 and day 25 in the same proportion (7.1%). Postoperative complications were kind of viral pneumonia in a patient, hyperglycemia in two patients, infection of the peritoneal fluid drainage in a patient and hypertension in 4 patients. The average length of intensive care unit stay was 1.28 days (range of 0.7 to 3 days). No deaths have been deplored. Conclusion In paediatric renal transplantation, intraoperative and immediate postoperative periods emerge as the main objective of the graft infusion sufficient to prevent the occurrence of complications and ensure its survival. Although the activity of paediatric renal transplantation remains generally low in Morocco since 2007, this practice has made much progress in our country, for the survival and rehabilitation of children, once condemned.

Safety of inhalation anesthesia in preterm children of different corrected gestational ages undergoing ocular fundus examination

Objective To observe the systemic inhalation anesthetic effects of preterm children with different gestational ages under ocular fundus examination,and to assess its safety.Methods Fifty-one preterm children with retinopathy of prematurity (ROP) were included in the study.These kids were divided into 2 groups,group Ⅰ included 24 kids with a corrected gestational age of 33 to ＜44 weeks,and group Ⅱ included 27 kids with a corrected gestational age of 44 to 64 weeks.The preterm months were same (t=-1.3,P＞0.05),but the body weights were different (t=-10.5,P＜0.05) between these two groups.Anesthesia was induced by inhalation of 6％ sevoflurane,and the period from the beginning of inhalation to disappearance of body movement was the induction time.6％ sevoflurane was inhaled continuously for another period of the induction time,and then the concentration of sevoflurane was adjusted to a maintenance concentration.The initial maintenance concentration was 3％,and was adjusted by 0.5％ each time.Sequential method was used to determine the subsequent maintenance concentration.If the preceding patient had not moved during the maintenance period,the sevoflurane concentration was decreased by 0.5％ for the next patient.If the preceding patient had moved during the maintenance period,the sevoflurane concentration was increased by 0.5％ for the next patient.Respiratory depression and cough during the induction and maintenance period,duration of anesthesia and recovery time were recorded.Choking and vomiting during drinking or milk-feeding in one hour after the ocular fundus examination were also recorded.Results The effective inhale concentration in 50％ patient of sevoflurane was 2.5％ in group Ⅰ,2.9％ in group Ⅱ.The average maintenance concentration was (2.5 ± 0.5) ％ in group Ⅰ,(3.0 ±0.5)％ in group lⅡ.The difference was statistically significant (t =-3.3,P＜0.05).The average duration of anesthesia and the average awake time were the same (t =0.04 and 1.0 respectively,P＞ 0.05)between these two groups.The average induction time was significantly shorter in group Ⅰ than in group Ⅱ,the difference was statistically significant (t =-4.9,P ＜ 0.05).All patients were successfully completed the ocular examination.No respiratory depression or cough occurred during and after the examination.No choking and vomiting during drinking or milk-feeding in one hour after the ocular fundus examination.Conclusion Anesthesia with inhaled sevoflurane by a face mask is safe for preterm outpatients undergoing fundus examination. Key words: Retinopathy of prematurity/diagnosis; Anesthetics, inhalation/diagnostic use; Neonatal screening

Anesthetic and Cardiopulmonary Effects of Total Intravenous Anesthesia Using a Midazolam, Ketamine and Medetomidine Drug Combination in Horses

The anesthetic and cardiopulmonary effects of midazolam, ketamine and medetomidine for total intravenous anesthesia (MKM-TIVA) were evaluated in 14 horses. Horses were administered medetomidine 5 microg/kg intravenously as pre-anesthetic medication and anesthetized with an intravenous injection of ketamine 2.5 mg/kg and midazolam 0.04 mg/kg followed by the infusion of MKM-drug combination (midazolam 0.8 mg/ml-ketamine 40 mg/ml-medetomidine 0.1 mg/ml). Nine stallions (3 thoroughbred and 6 draft horses) were castrated during infusion of MKM-drug combination. The average duration of anesthesia was 38 +/- 8 min and infusion rate of MKM-drug combination was 0.091 +/- 0.021 ml/kg/hr. Time to standing after discontinuing MKM-TIVA was 33 +/- 13 min. The quality of recovery from anesthesia was satisfactory in 3 horses and good in 6 horses. An additional 5 healthy thoroughbred horses were anesthetized with MKM- TIVA in order to assess cardiopulmonary effects. These 5 horses were anesthetized for 60 min and administered MKM-drug combination at 0.1 ml/kg/hr. Cardiac output and cardiac index decreased to 70-80%, stroke volume increased to 110% and systemic vascular resistance increased to 130% of baseline value. The partial pressure of arterial blood carbon dioxide was maintained at approximately 50 mmHg while the arterial partial pressure of oxygen pressure decreased to 50-60 mmHg. MKM-TIVA provides clinically acceptable general anesthesia with mild cardiopulmonary depression in horses. Inspired air should be supplemented with oxygen to prevent hypoxemia during MKM-TIVA.

Anaesthesia for surgical decompression of the orbit in severe thyroid orbitiopathy

Anaesthesia for surgical decompression of the orbit in severe thyroid orbitiopathy has rarely been reported in the literature. This review highlights patients’, anaesthetic and surgical factors of relevance. We carried out a retrospective analysis over a 3-year period of the records of 35 patients who had undergone surgical orbital decompression via a trans-lid approach under general anaesthesia. A total of 58 decompressions were performed on 35 subjects (26 women, 9 men; age range 34–76 years). Twenty-four patients had bilateral decompressions (seven had both sides performed simultaneously, whereas 17 had each side performed separately at least one month apart). Eleven required unilateral decompression only. Surgery was repeated on six occasions in four of the 35 patients. The main indications for surgery were compressive optic neuropathy (n = 17) and disfiguring proptosis (n = 19). Fourteen patients had more than one indication. Of the 35 patients, 33 had a history of hyperthyroidism whereas the remaining two were clinically and biochemically euthyroid. In all cases, T4/TSH levels were normal pre-operatively. Two thirds were smokers (the majority smoking 10–20 cigarettes/day). Pre-operative morbidities were as follows: diabetes mellitus (n = 5), chronic airflow limitation (n = 4), asthma (n = 4), hypertension (n = 4), obesity (n = 3), ischaemic heart disease (n = 2), arrhythmias (n = 2) and CVA (n = 1). Five had 2–3 comorbidities. Fifty-one percent were taking prednisolone pre-operatively (dose range 10–80 mg). Average duration of anaesthesia was 119 min for unilateral surgery and 184 min for bilateral surgery. In 88% of cases, balanced anaesthesia involved a volatile agent (isoflurane > sevoflurane > enflurane), O2 /N2 O mixture and either remifentanil or fentanyl ± morphine, whereas in the remaining 12% of cases remifentanil, target-controlled infusion of propofol and O2/air mixtures were used. Normotensive anaesthesia was used throughout. Intravenous acetazolamide was given on induction to reduce intraocular pressure. Subcutaneous local anaesthetic (bupivacaine with epinephrine) was infiltrated under the eyelid before starting surgery. Ketorolac and pethidine were given as adjuncts in 29% and < 1% of cases respectively. In 26% of cases, anticholinergic therapy was required for bradycardia resulting from orbital traction. Postoperatively, nausea and/or vomiting was absent in 93% of cases, 57% of whom had not had antiemetic therapy intraoperatively. Postoperative pain scores of zero were recorded in 88% of cases, with the use of simple analgesics (paracetamol/codeine) or no analgesics recorded in 43% and 36%, respectively (for the entire hospital stay). Discharge home was on the first postoperative day in 76% of cases. Significant peri-operative complications were as follows: one patient suffered a CVA two days postoperatively and a CSF leak developed intra-operatively in another case (this resolved within 24 h and according to protocol a lumbar drain was inserted). Infraorbital anaesthesia was experienced in five cases (9%) (with complete resolution of symptoms after several months) and diplopia developed (15%) or worsened (22%) overall in 37% of cases. In our experience, anaesthesia for surgical decompression of the orbit is generally safe, has a low incidence of postoperative pain and nausea and vomiting and requires only a short hospital stay. However, one must be aware of the need to provide anaesthesia of long duration, and of the high incidence of pre-operative morbidities, smoking and high-dose steroid therapy.

Sevoflurane anaesthesia does not induce the formation of sister chromatid exchanges in peripheral blood lymphocytes of children

Compound A, a degradation product of sevoflurane, has been demonstrated to induce sister chromatid exchanges (SCE) in Chinese hamster ovary cells in vitro as a marker for possible genotoxicity. We investigated the formation of SCE in mitogen-stimulated T-lymphocytes of 40 children undergoing sevoflurane anaesthesia for minor surgical procedures. Anaesthesia was induced by inhalation of up to 8% sevoflurane and maintained at 2.5-3% in oxygen/nitrous oxide (65/35%) at a fresh gas flow of 3 litre min(-1). Soda lime (humidity 12-15%) was used as a carbon dioxide absorbent. Blood was drawn directly before induction and after termination of anaesthesia. Twenty-five second division metaphases of mitogen-stimulated T-lymphocytes per blood sample were screened for SCE rates using standard techniques. Average duration of anaesthesia was 49.6 (SD 24.0) min. Before anaesthesia induction, 7.93 (1.23) SCE per metaphase were determined. After sevoflurane anaesthesia [1.40 (0.77) MAC h] 7.92 (1.19) SCE per metaphase were observed. Additionally, no differences were evident between male or female children. Short-term administration of sevoflurane anaesthesia did not induce SCE in T-lymphocytes of children. No indication for a possible genotoxic effect has been observed.

Anaesthesia for advanced rectal cancer patients treated with combined major resections and intraoperative radiotherapy.

Multimodality treatment for patients with locally advanced primary or locally recurrent rectal cancer, including high-dose preoperative external beam radiotherapy, extensive surgery and intraoperative radiation therapy, decreases the local recurrence rates and improves survival. During this aggressive operation, the anaesthesiologist is faced with potential problems such as major transfusion requirements, hypothermia, intraoperative position changes, the need to transport the patient to the intraoperative radiation therapy applicator, and the risks associated with remote monitoring of the patient during the 10 min intraoperative radiation therapy application. The anaesthetic management and perioperative results were evaluated for the anaesthetic results and the complications. One-hundred-and-six patients undergoing the multimodality treatment between February 1994 and March 2000 for locally advanced primary (n = 50) and locally recurrent rectal cancer (n = 56) were retrospectively evaluated for their anaesthetic results and complications. All patients were operated upon using a combination of general and epidural anaesthesia. The average duration of anaesthesia was 6 (range 3-10.5) h and the mean blood loss 3.6 (range 0.4-14) L. All patients recovered well from anaesthesia. Two patients (2%) died in the intensive care unit (34 and 48 days postoperatively) because of adult respiratory distress syndrome following postoperative haemorrhage. Severe haemorrhage during or after the operation was significantly related with the development of adult respiratory distress syndrome (P < 0.0001). With adequate preoperative assessment and optimalization of the patient's condition, maintaining peroperative haemodynamic stability with the help of adequate remote monitoring, early and fast transfusion, and multidisciplinary communication, anaesthetic complications can be minimized.

Gastroesophageal reflux during spontaneous respiration with the laryngeal mask airway.

To determine the incidence of gastroesophageal reflux during general anesthesia with the Laryngeal Mask Airway (LMA). Twenty unpremedicated patients with no risk factors for reflux having day case anesthesia were included. Type of surgery was Orthopedic (n=8), General (n=7) and Gynecological (n=5). The average duration of anesthesia was 38.1 min, range 12 - 71 min. Anesthesia was induced with 1-2 microg x kg(-1) fentanyl and 2-3 mg x kg(-1) propofol and maintained with oxygen 33%, nitrous oxide 66% and isoflurane 1% (end-tidal). Ventilation by hand was performed until spontaneous respiration resumed. To facilitate surgery, 13 patients were placed in the supine and seven in the lithotomy positions. Two pH-sensitive electrodes were used to identify reflux. One was placed in the oesophagus 20 cm from the anterior nares to detect esophageal reflux and the other was placed through the bars of the LMA to detect refluxing material around the LMA. Esophageal reflux occurred in 12 patients (60%), in five of the 13 in the supine position and in all patients in the lithotomy position. The LMA electrode detected a decrease in pH in four cases (20%), all in the lithotomy position. The incidence reflux in the lithotomy and supine positions was different (Exact Probability test; P = 0.01). This study suggests that the lithotomy position predisposes patients to a higher risk of aspiration than the supine position when using a LMA.

Safety of paranasal sinus surgery in patients with cystic fibrosis.

Document the safety of paranasal sinus surgery in cystic fibrosis patients and review the changing trends in paranasal sinus surgery in the cystic fibrosis population. Retrospective review. Chart review of cystic fibrosis patients who underwent paranasal sinus surgery from 1955 to 1997. Indications for surgery included chronic sinusitis, nasal obstruction, purulent rhinorrhea, head pain, and pyocele. Average duration of anesthesia was 2.1 hours. The complication rate from general anesthesia was zero. Excessive bleeding and significant hypoxia did not occur. Paranasal sinus surgery and general anesthesia can be safely performed in cystic fibrosis patients. The indications for paranasal sinus surgery are changing from symptomatic nasal obstruction to pre-lung transplantation care. Today, treatment has evolved to include placement of sinus catheters for direct topical instillation of antibiotics and consideration of maxillary and frontal sinus obliteration.