Difference In Duration Of Anesthesia Research Articles

Risk factors for PPCs in laparoscopic non–robotic vs. laparoscopic robotic abdominal surgery (LapRas): rationale and protocol for a patient–level analysis of LAS VEGAS and AVATaR

IntroductionPostoperative pulmonary complications (PPCs) vary amongst different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non–robotic versus laparoscopic robotic abdominal surgery. Methods and analysisLapRas (Risk Factors for PPCs in Laparoscopic Non–robotic vs Laparoscopic robotic abdominal surgery) incorporates harmonized data from 2 observational studies on abdominal surgery patients and PPCs: ‘Local ASsessment of VEntilatory management during General Anaesthesia for Surgery’ (LAS VEGAS), and ‘Assessment of Ventilation during general AnesThesia for Robotic surgery' (AVATaR). The primary endpoint is the occurrence of one or more PPCs in the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay and in–hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non–robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the two groups are driven by differences in duration of anesthesia and/or the intensity of mechanical ventilation. Ethics and disseminationThis analysis will address a clinically relevant research question comparing laparoscopic and robotic assisted surgery. No additional ethical committee approval is required for this metanalysis. Data will be shared with the scientific community by abstracts and original articles submitted to peer-reviewed journals. RegistrationThe registration of this post-hoc analysis is pending; individual studies that were merged into the used database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.

Comparison of anesthetic effects of tiletamine–zolazepam–medetomidine or ketamine–medetomidine in captive Amur leopard cats (Prionailurus bengalensis euptailurus)

ObjectiveTo evaluate the effects and utility of tiletamine–zolazepam–medetomidine (TZM) and ketamine–medetomidine (KM) for anesthesia of Amur leopard cats (Prionailurus bengalensis euptailurus). Study designProspective, randomized experimental trial. AnimalsA total of six female (3.70 ± 0.49 kg) and six male (5.03 ± 0.44 kg; mean ± standard deviation) Amur leopard cats aged 2–6 years. MethodsEach animal was administered four protocols separated by ≥3 weeks. Each protocol included medetomidine (0.05 mg kg–1) combined with tiletamine–zolazepam (1 mg kg–1; protocol MTZLO); tiletamine–zolazepam (2 mg kg–1; protocol MTZHI); ketamine (2 mg kg–1; protocol MKLO); or ketamine (4 mg kg–1; MKHI) administered intramuscularly. At time 0 (onset of lateral recumbency) and 30 minutes, heart rate (HR), respiratory rate (fR), rectal temperature, noninvasive mean arterial pressure (MAP) and hemoglobin oxygen saturation (SpO2) were recorded. Times to onset of lateral recumbency, duration of anesthesia and time to standing were recorded. ResultsOverall, animals were anesthetized with all protocols within 10 minutes, anesthesia was maintained ≥57 minutes, and recovery (time from the first head lift to standing) was completed within 5 minutes. During anesthesia with all protocols, HR, fR, rectal temperature, SpO2 and MAP were 99–125 beats minute–1, 33–44 breaths minute–1, 37.6–39.4 °C, 90–95% and 152–177 mmHg, respectively. No adverse event was observed. Conclusions and clinical relevanceTZM and KM at various dosages resulted in rapid onset of anesthesia, duration of >57 minutes and rapid recovery without administration of an antagonist. Accordingly, all these combinations are useful for anesthetizing Amur leopard cats and for performing simple procedures. However, the low doses of the anesthetic agents are recommended because there was no difference in duration of anesthesia between the dose rates studied.

Assessment of photobiomodulation therapy by an 8l0-nm diode laser on the reversal of soft tissue local anesthesia in pediatric dentistry: a preliminary randomized clinical trial.

During the injection of local anesthesia in pediatric dental procedures, from the injection time until the elimination of tissue anesthesia, inevitable problems were reported. According to the encouraging results of previous studies addressing the positive effects of laser therapy on increasing the microcirculation, we aimed to investigate the clinical effect of photobiomodulation therapy on the reversal of soft tissue anesthesia in children. Using a split-mouth design, 34 children aged 4 to 8years old, candidate for receiving local infiltration injection at both right and left side in mandible, were enrolled in the study. The mandibular right and left quadrants were randomly assigned to groups of laser or sham laser: in laser side, patients received 810-nm laser irradiation, and in the sham laser group, the patients had the laser in off mode at 45min after injection with an interval of 7-10days between two sessions of each quadrant treatments. The degree of anesthesia was evaluated using the palpation technique alternately every 15min. Data were analyzed using paired sample t test and multiple linear regression test. The mean duration of anesthesia expressed in minutes was equal to 145.15 ± 23.27 and 188.82 ± 12.31 for the laser group and sham laser group, respectively. There was a significant difference in duration of anesthesia between two groups (P < 0.001). Considering the results and limitations of the present study, photobiomodulation therapy by 810-nm diode laser can be proposed as a non-invasive method in order to reduce the duration of anesthesia in pediatric patients.

Cardiovascular homeostasis during inhalational general anesthesia: a clinical comparison between sevoflurane and isoflurane

Study Objective: To obtain more information on cardiovascular homeostasis and patient discharge from the recovery area after general anesthesia with either sevoflurane or isoflurane as the main anesthetic. Design: Prospective, randomized, multicenter study Setting: Inpatient anesthesia at 13 University Departments of Anesthesia. Patients: 247 ASA physical status I, II, and III patients, aged 18 to 85 years, receiving general anesthesia for elective urological, orthopedic, ENT, vascular, and low abdominal surgery. Interventions: General anesthesia was maintained using a 60% nitrous oxide in oxygen mixture with either isoflurane (n = 125) or sevoflurane (n = 122) adjusted according to hemodynamic variables. Measurements and Main Results: Occurrence of hypotension [systolic arterial blood pressure (SBP) decrease >30% from baseline], hypertension (SBP increase >30% from baseline), bradycardia [heart rate (HR) <50 bpm], or tachycardia (HR>100 bpm) provoked stepwise changes in the inspired concentration of the study drug. If this action proved to be ineffective after an adequate stabilization period, a specific treatment was given, and the need for pharmacological treatment was recorded as a hemodynamic side effect by an independent observer. No differences in duration of anesthesia were observed between sevoflurane (126 ± 76 min) and isoflurane patients (139 ± 60 min). Mean duration from anesthetic discontinuation to fulfillment of discharge criteria was shorter after sevoflurane (21 min; 25 th to 75 th percentiles: 27 to 13 min) than isoflurane (27 min; 25 th to 75 th percentiles: 17 to 35 min) ( p < 0.0005). Hemodynamic side effects requiring therapy occurred in 18 sevoflurane patients (14.6%) and 26 isoflurane patients (20.8%) (p = NS). The risk for hemodynamic side effects increased with age (>50 vs. ≤50 yrs: odds ratio 2.5; 95% CI 1.2 to 5.4; p = 0.015) and ASA physical status (III vs. I and II: odds ratio 2.2; 95% CI 0.9 to 5.7; p = 0.048). When only patients over 50 years of age were considered (72 in the sevoflurane group and 79 in the isoflurane group), the incidence of hemodynamic side effects was higher with isoflurane (29.1%) than with sevoflurane (15.2%) (odds ratio 2.3; 95% CI 1.0 to 5.2; p = 0.04). Conclusions: Sevoflurane provided equally safe and effective control of cardiovascular homeostasis as isoflurane, with a more rapid discharge from the recovery area. Interestingly, patients over 50 years of age showed a lower risk for hemodynamic side effects when receiving sevoflurane than isoflurane.

EFFECT OF β-ADRENORECEPTOR BLOCKADE WITH NADOLOL: ON THE DURATION OF LOCAL ANESTHESIA

beta-adrenoreceptor blockers, or beta-blockers, are drugs commonly prescribed for hypertension, angina and migraine headaches. In a patient taking beta-blocker medication, administration of a local anesthetic containing a vasoconstrictor could result in an adverse interaction. The authors conducted a double-blind, randomized, crossover, placebo-controlled study to test the hypothesis that a nonselective beta-blocker--nadolol--enhances vasoconstriction induced by the epinephrine contained in local anesthetic, thus resulting in an increased duration of anesthesia. Ten healthy male volunteers were given either a placebo or a single, standard oral dose of nadolol (80 milligrams). The upper lateral incisor teeth were anesthetized using lidocaine with or without epinephrine. The mean duration of pulpal and soft-tissue anesthesia was increased in subjects who took nadolol compared with those who took placebo by 17 minutes (58 percent) and 16.5 minutes (19 percent), respectively, when they received 1 milliliter of lidocaine containing 1:100,000 epinephrine. These differences were both clinically and statistically significant (P = .007). Using lidocaine without epinephrine produced no clinically or statistically significant difference in duration of pulpal or soft-tissue anesthesia in the two groups of subjects. The authors noted no significant changes in blood pressure or pulse rate. Administration of local anesthetic containing epinephrine to subjects receiving a beta-blocker increased the duration of pulpal and soft-tissue anesthesia. There was no difference in duration of anesthesia between groups when local anesthetic without epinephrine was used. Use of local anesthetic containing a vasoconstrictor should be avoided in patients taking beta-blocker medication because of a possible adverse drug interaction. However, when a vasoconstrictor is indicated for hemostasis, the local anesthetic should be administered slowly and in small amounts as pulse rate and blood pressure are being monitored. The patient should be informed that the duration of anesthesia might be prolonged.

Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?

Objectives. Return of bowel function after radical prostatectomy surgery may be the limiting factor in discharging these patients from the hospital. Recent studies have shown that postoperative epidural infusion of bupivacaine decreases time to return of bowel function compared with intravenous and epidural morphine in patients after abdominal surgery. This study focuses on the role of the intraoperative anesthetic technique on recovery of bowel function, intraoperative blood loss, and the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing radical retropubic prostatectomy and pelvic lymphadenectomy. Methods. Forty patients undergoing prostatectomy were randomized to either group A (general endotracheal anesthesia, including muscle relaxation and mechanical ventilation, followed by postoperative intravenous morphine patient-controlled analgesia) or group B (thoracic epidural anesthesia using bupivacaine, combined with “light” general anesthesia using a laryngeal mask airway and spontaneous ventilation, followed by epidural morphine analgesia). Intra- and postoperative data were collected on blood loss, volumes of crystalloid and colloid infused, blood transfused, duration of anesthesia and surgery, anesthetic and surgical complications, time to recovery of bowel function, quality of postoperative pain control, and time to discharge from hospital. Each patient underwent lower extremity venous ultrasonography to detect DVT. Results. Twenty-one patients received general anesthesia and 19 received combined epidural and general anesthesia. Intraoperative blood loss was significantly lower in the epidural group, and times to first flatus and first bowel movement were also shorter in this group. There were no significant differences in duration of anesthesia or surgery, quality of postoperative analgesia, side effects of analgesia, or time to discharge from hospital. There was no DVT detected in any patient. Conclusions. The combined anesthetic technique of thoracic epidural anesthesia and “light” general anesthesia with spontaneous ventilation decreased intraoperative blood loss and shortened the time to return of bowel function. However, this earlier return of bowel function was not great enough to realize a difference in time to hospital discharge. There was no evidence of increased complications secondary to epidural anesthesia or of prolonged anesthetic time necessary to place epidural catheters.

Evaluation of the effectiveness and comfort of incisive nerve anesthesia given inside or outside the mental foramen

Thirty volunteer subjects were given bilateral injections of one-half carpule of 2% Xylocaine with 1:100,000 epinephrine to anesthetize the incisive nerve. Injections were given either inside or outside the mental foramen. Success (80/80 reading) and duration of anesthesia were verified with the Analytic Technology pulp tester. Pain and preference for either injection type were evaluated via questionnaire. The mental foramen could be located in 1 min 56.6% of the time. There was a significantly greater chance of success for injections given inside the foramen for the second bicuspid (p = 0.0422) and the canine (p = 0.015). There was no statistically significant difference in success for either type injection for the first bicuspid (p = 0.184). There was no significant difference in duration of anesthesia whether given inside or outside the foramen and no difference in pain of injection with either type. Patients had no clear-cut preference for either injection type.

The physiologic effects of the anesthetic ketamine hydrochloride on two salmonid species

Adult coho salmon and subadult rainbow trout were used in experiments with the anesthetic ketamine hydrochloride. The drug (30 mg/kg) was injected into the dorsal aorta through an indwelling cannula. Intravascular administration of ketamine caused an immediate cessation of ventilation in both species for 10 s to 300 s and a loss of balance. Ventilation rate recovered to pre-anesthesia values within 1–2 h and arterial oxygen values were at pre-anesthesia levels by 3–24 h. Anesthesia caused a significant acidosis in both species. The blood pH and plasma CO 2 values had returned to pre-anesthesia levels by 4–24 h and 0.5-2 h, respectively. For adult salmon, five of seven animals were unresponsive to tail grabbing at 4 h while with juvenile trout, three of five fish were fully responsive to touch at 1 to 2 h. This difference in duration of anesthesia was likely size-related. The applications of this injectable anesthetic for commercial fish use, mainly in the transport of animals, are suggested, but its use with food fish has not been assessed.

Mandibular versus inferior dental anaesthesia: Clinical assessment of 3 different techniques

Inferior dental anaesthesia via the direct intraoral approach, mandibular conduction anaesthesia via extraoral landmarks (Gow-Gates) and mandibular conduction anaesthesia via the tuberosity approach (Akinosi) were evaluated using onsetand duration of anaesthesia, pain during injection, aspiration test, pinprick, depth and frequency of anaesthesia. 90 patients undergoing simple tooth extraction were randomly selected into 3 groups. They were given injections of 2 ml of 2% lidocaine with adrenaline (1:80,000). All techniques were mostly painless, none of them showing any special advantage in that sense. The differences in duration of anaesthesia among the applied techniques were insignificant. Positive aspirations were most frequently observed with the direct method of inferior dental anaesthesia, but this method gave the best result for the frequency of anaesthesia. After using the Gow-Gates method, the external branches of the buccal nerve were usually anaesthetized but the onset of anaesthesia was relatively slow. Mandibular conduction anaesthesia via the tuberosity approach did not show any particular advantage over the other 2 techniques in this investigation. A progress study is needed to determine more precisely the aspiration rate and frequency of anaesthesia for all the techniques.

Experimental and Quantitative Analysis of Local Anesthesia of the Frog's Isolated Sciatic Nerve

ConclusionsSensory anesthesia produced by 0.25 % concentration in normal salt solution on the frog's sciatic nerve has been tested on a considerable series by immersion of the toes in 1% HCl. The results obtained were: 1. The mean and median durations of anesthesia fall in the following ascending order: Procaine HCI, Meta-mine, Cocaine HCI, Panthesine. 2. A high degree of range is found for the 4 drugs studied. 3. The absolute variability in duration of anesthesia falls in the following ascending order : Procaine HCI, Metacaine, Cocaine HCl, Panthesine. 4. The relative varia-bility in duration falls in the following order: Panthesine, Metacaine, Cocaine HCI, Procaine HC1. 5. All distributions of duration of anesthesia show a distinct measure of skewness, those for Procaine HCl and Panthesine being positive and those for Cocaine HC1 and Metacaine being negative. 6. The differences in mean duration of anesthesia between the several drugs is highly significant in 4 pairings, probably significant in one, and ...