Ideal Anesthetic Research Articles

Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity

Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and appearance of clinical symptomatology. Anaesthesia for these patients always poses a challenge for anaesthetist, because they need to find and use drugs that do not trigger or aggravate symptoms of disease. Therefore, sevoflurane in these circumstances might be the ideal anaesthetic. Performing general anaesthesia with sevoflurane as sole anaesthetic agent, together with a series of environmental measures formed basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome.

Comparison of haemodynamic parameters and recovery characteristics between sevoflurane and desflurane in patients undergoing day-care surgical procedure

Background: Smooth and rapid induction, optimal operating conditions and rapid recovery with minimal side effects such as nausea, vomiting, bleeding and post-operative pain are the characteristics of ideal anaesthetic. Objectives: The objective of the study was to compare the haemodynamic parameters and recovery characteristics of desflurane with sevoflurane. Materials and Methods: This was a prospective study conducted from January to December 2016. Using convenient sampling technique, a total of 40 adult patients of American Society of Anesthesiologists (ASA) physical status Grade I or II, aged between 18 and 60 years, of either sex, who were scheduled for elective day-care surgeries of

Use of anaesthetic agents in farmed fish

Anaesthetic agents are routinely used in farmed fish to permit the performance of painful procedures, ease handling and reduce stress during grading, tagging, transport, blood sampling, artificial breeding and vaccination of fish. An ideal anaesthetic for fish should induce anaesthesia rapidly, allow a rapid recovery, be safe to both fish and user, leave low tissue residues and be inexpensive and easy to use. A variety of factors, including species, size, body weight, gill surface area to body weight ratio, lipid content, sex, sexual maturity, physical condition and health state of the fish, as well as temperature, pH, salinity and oxygen and mineral content of the water may affect the anaesthetic process in fish. The most commonly used anaesthetics are tricaine, benzocaine, phenoxyethanol, quinaldine, quinate, clove oil and metomidate. Tricaine is the only anaesthetic licensed for farmed fish use in the USA. It is easy to use and safe, but also expensive. Benzocaine is cheaper, but poorly water-soluble and has to be prepared in either ethanol or acetone. Phenoxyethanol is considered by most fish farmers as the anaesthetic of choice for farmed fish, because of its easy preparation, low price, rapid action and bactericidal and fungicidal properties. Quin aldine and quinate are effective and easy to use anaesthetic agents, however, a number of adverse effects have been reported to both fish and users. The active ingredients of clove oil are eugenol and isoeugenol and have been introduced only recently as fish anaesthetics. Apart from being inexpensive and easy to use, clove oil has also bactericidal and fungicidal properties. Metomidate may have a certain advantage as it probably evokes a less severe stress response in fish than the other anaesthetic agents.

Basil, tea tree and clove essential oils as analgesics and anaesthetics in Amphiprion clarkii (Bennett, 1830).

In this study were evaluated the anaesthesia and analgesic effects of clove Eugenia caryophyllata, tea tree Melaleuca alternifolia and basil Ocimum basilicum essential oils (EO) during handling of yellowtail clownfish Amphiprion clarkii. Juveniles (3.70 ± 0.75 cm and 1.03 ± 0.50 g; mean ± standard deviation) were submitted to concentrations of 40, 50, 60, 70 and 80 µl L-1 of clove, 150, 200, 250, 300 and 350 µl L-1 of basil and 200, 300, 400, 500 and 600 µl L-1 of tea tree oils (n=10/concentration), previously defined in pilot tests. Individually and only once, fish from each treatment were placed in a glass recipient containing 1 L of seawater at a temperature of 25 °C, salinity of 35 g L-1 and the specific concentration of diluted EO (stock solution). Control (only seawater) and blank (seawater and ethanol at the highest concentration used to dilute the oils) treatments were also conducted. After reaching the stage of surgical anaesthesia, fish were submitted to biometry and a sensibility test. After that, they were transferred to clean seawater for anaesthesia recovery. The times of induction needed to reach each anaesthesia stage and anaesthesia recovery were recorded. Animals were observed for 72 hours after the procedures. All the EO provoked anaesthesia and analgesic effects in A. clarkii, but basil oil is not recommended because it caused involuntary muscle contractions and mortality in 100% and 12% of fish, respectively. The lower concentrations that promote suitable induction and recovery times are 50 µl L-1 of clove oil and 500 µl L-1 of tea tree oil. However, due to its complementary high analgesic efficiency, clove oil is recommended as the ideal anaesthetic for A. clarkii.

Cooling combined with hyperoxic CO2 anesthesia is effective in improving the air exposure duration of tilapia

Tilapia were subjected to cooling (CO, a stepwise reduction in temperature from 30 °C to 15 °C), anesthesia (AN, anesthetized by hyperoxic carbon dioxide), air exposure (AE, exposed to air) and cold tolerance (CT, in 15 °C water) treatments, and the physiological responses were determined after the treatments. CO followed by AN treatment for tilapia could meet the criteria of an ideal anesthetic. Fish were deeply sedated within 69 s, completely anesthetized within 276 s and recovered within 308 s without any mortality. The stress responses induced by the CO&AN treatment were mild, whereas they were consistently increased in the AE treatment. Furthermore, the AE treatment caused tissue damage. The AE duration was significantly improved by CO&AN treatment, and the survival time of the CO&AE, AN&AE and CO&AN&AE treatments were 313 min, 351 min and 561 min, respectively, in the laboratory experiments, whereas the survival rate of the CO&AN&AE treatment group after 240-min air exposure was 95.2% in the pilot test. It appeared that cooling followed by hyperoxic CO2 anesthesia would be suitable for handling tilapia in a short-time air exposure procedure.

Anesthesia-Related Outcomes for Endovascular Stroke Revascularization: A Systematic Review and Meta-Analysis.

There is currently controversy on the ideal anesthesia strategy during mechanical thrombectomy for acute ischemic stroke. We performed a systematic review and meta-analysis of studies comparing clinical and angiographic outcomes of patients undergoing general anesthesia (GA group) and those receiving either local anesthesia or conscious sedation (non-GA group). A literature search on anesthesia and endovascular treatment of acute ischemic stroke was performed. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome at 90 days (modified Rankin Score≤2), symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, and time to groin puncture. Twenty-two studies (3 randomized controlled trials and 19 observational studies), including 4716 patients (1819 GA and 2897 non-GA) were included. In the nonadjusted analysis, patients in the GA group had higher odds of death (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.45) and respiratory complications (OR, 1.70; 95% CI, 1.22-2.37) and lower odds of good functional outcome (OR, 0.58; 95% CI, 0.48-0.64) compared with the non-GA group. There was no difference in procedure time between the 2 primary comparison groups. When adjusting for baseline National Institutes of Health Stroke Scale, GA was still associated with lower odds of good functional outcome (OR, 0.59; 95% CI, 0.29-0.94). When considering studies performed in the stent-retriever/aspiration era, there was no significant difference in good neurological outcome rates (OR, 0.84; 95% CI, 0.67-1.06). Acute ischemic stroke patients undergoing intra-arterial therapy may have worse outcomes when treated with GA as compared with conscious sedation/local anesthesia. However, major limitations of current evidence (ie, retrospective studies and selection bias) indicate a need for adequately powered, multicenter randomized controlled trials to answer this question.

Protection of xenon against postoperative oxygen impairment in adults undergoing Stanford Type-A acute aortic dissection surgery: Study protocol for a prospective, randomized controlled clinical trial.

Objectives:The available evidence shows that hypoxemia after Stanford Type-A acute aortic dissection (AAD) surgery is a frequent cause of several adverse consequences. The pathogenesis of postoperative hypoxemia after AAD surgery is complex, and ischemia/reperfusion and inflammation are likely to be underlying risk factors. Xenon, recognized as an ideal anesthetic and anti-inflammatory treatment, might be a possible treatment for these adverse effects.Methods/Design:The trial is a prospective, double-blind, 4-group, parallel, randomized controlled, a signal-center clinical trial. We will recruit 160 adult patients undergoing Stanford type-A AAD surgery. Patients will be allocated a study number and will be randomized on a 1:1:1:1 basis to receive 1 of the 3 treatment options (pulmonary inflated with 50% xenon, 75% xenon, or 100% xenon) or no treatment (control group, pulmonary inflated with 50% nitrogen). The aims of this study are to clarify the lung protection capability of xenon and its possible mechanisms in patients undergoing the Stanford type-A AAD surgery.Discussion:This trial uses an innovative design to account for the xenon effects of postoperative oxygen impairment, and it also delineates the mechanism for any benefit from xenon. The investigational xenon group is considered a treatment intervention, as it includes 3 groups of pulmonary static inflation with 50%, 75%, and 100% xenon. It is suggested that future trials might define an appropriate concentration of xenon for the best practice intervention.

ДОСТАВКА КИСЛОРОДА, ГАЗОВЫЙ СОСТАВ И КИСЛОТНО-ОСНОВНОЕ СОСТОЯНИЕ АРТЕРИАЛЬНОЙ КРОВИ ВО ВРЕМЯ КСЕНОНОВОЙ АНЕСТЕЗИИ ПО ЗАКРЫТОМУ КОНТУРУ

Xenon is an inert gas being very close to an ideal anesthetic. Goal of the study: to evaluate changes in gases and acid-base balance of arterial blood during general xenon anesthesia with the closed circuit and to compare it with general anesthesia with sevoflurane. Methods. The article describes a prospective assessment of anesthesia with expanded hemodynamic monitoring in 50 patients undergoing planned surgery. Based on the main inhalation anesthetic (xenon or sevoflurane) patients were divided into two groups. The monitoring included blood gases and O 2 delivery; cardiac output was evaluated through analysis of arterial pressure pulse wave after calibration by transpulmonary thermodilution (PiCCO). Results. Xenon anesthesia did not result in serious disorders of acid-base balance and O2 delivery and compared to sevoflurane the metabolic acidosis was less frequent as well as the need to manage it. Changes in the lactate level provided the evidence that both inhalation anesthetics did not result in serious disorders of tissue perfusion and gas exchange.

Propofol inhibits lung cancer cell viability and induces cell apoptosis by upregulating microRNA-486 expression

Propofol is a frequently used intravenous anesthetic agent. Recent studies show that propofol exerts a number of non-anesthetic effects. The present study aimed to investigate the effects of propofol on lung cancer cell lines H1299 and H1792 and functional role of microRNA (miR)-486 in these effects. H1299 and/or H1792 cells were treated with or without propofol and transfected or not with miR-486 inhibitor, and then cell viability and apoptosis were analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and flow cytometry. The expression of miR-486 was determined by quantitative real-time polymerase chain reaction (qRT-PCR) with or without propofol treatment. Western blot was performed to analyze the protein expression of Forkhead box, class O (FOXO) 1 and 3, Bcl-2 interacting mediator of cell death (Bim), and pro- and activated caspases-3. Results showed that propofol significantly increased the miR-486 levels in both H1299 and H1792 cells compared to untreated cells in a dose-dependent manner (P<0.05 or P<0.01). Propofol statistically decreased cell viability but increased the percentages of apoptotic cells and protein expressions of FOXO1, FOXO3, Bim, and pro- and activated caspases-3; however, miR-486 inhibitor reversed the effects of propofol on cell viability, apoptosis, and protein expression (P<0.05 or P<0.01). In conclusion, propofol might be an ideal anesthetic for lung cancer surgery by effectively inhibiting lung cancer cell viability and inducing cell apoptosis. Modulation of miR-486 might contribute to the anti-tumor activity of propofol.

Comparison of emergence and recovery characteristics of sevoflurane and desflurane in pediatric ambulatory surgery

A big number ofshort-time surgery performed in one-day pediatric department requires the permanent search of an ideal anesthetic for the maximum quickly children ' take home with the minimum ofpostoperation complications. to compare the emergence and recovery characteristics ofsevoflurane and desflurane maintenance ofanesthe- sia in children undergoing ambulatory surgery. There were no significant differences among the two groups in hemodynamic parameters, the incidence of postoperative vomiting and cough. But desflurane maintenance of anesthesia resulted in the fastest early emergence from anesthesia, the lack of incidence ofpostoperative agitation compared with sevoflurane.

General anesthesia management in carotid endarterectomy surgery: a single center experience

Carotid endarterectomy (CEA) is an effective surgery which is applied in order to reduce the risk of stroke associated with severe stenosis of the carotid artery. Anesthesia management is important in these patients due to high incidence of cardiovascular disease and studies are in progress for ideal anesthesia management. In this study, we aimed to share our experience in carotis endarterectomy and evaluate the clinical outcomes and review retrospectively. Patients informations were obtained from the patients and anesthesia records. Age, ASA physical status, Mallampati score (MP), anesthesia and surgery duration, ICU and discharge time, blood transfusion rate, anesthetic and analgesic drugs, invasive procedures, complications, smoking, stenosis side and ratio, comorbid conditions of patients and drugs were recorded. The mean age of patients was 67.19±1.07 (33-98). It was evaluated that 44 patients (61.2%) were ASA II, 28 patients (38.8%) were ASA III. It was recorded that mean duration of anesthesia was 226.25 ± 37.99 min, duration of surgery was 195.83±38 min, ICU stay was 2.45 ± 2.52 days and hospital stay time was 5.23 ± 2.77 days. 29 of patients (40.3%) were smokers and 7 of patients (9.7%) were identified as secondary smokers. The mortality rate was 6.9% (5 patients). Clinical experience and outcome data from our study are consistent with the literature. In CEA surgery, anesthetic technique that is safe enough to guide the evidence is not there yet. Experience of the anesthesiologist and the surgeon as surgical anesthetic management of CEA is an important point to be noted that the current developments in the patient's characteristics and monitoring.

HYPOTHESIS OF RFMRA DEVELOPMENT – THE RECEPTOR-FOCUSED MAGNETIC AND RESONANT ANESTHESIA

This article is described the hypothesis of the solution how to create the "ideal anesthesia". Theoretical justification of the innovative technique of the Receptor-focused Magnetic Resonance anesthesia is offered. It should be use the "ideal anesthetic" as which the electromagnetic model of a medicinal preparation for anesthesia acts. Stages of carrying out the offered type of anesthesia have offered. For the practical application of the proposed idea it would be implemented a number of innovations. First, it includes technologies of a magnetic and resonant tomography of high resolution (less than 100 microns). At the second, it would be technologies of creation electromagnetic models of the existing medical preparations. Than it would be on-line technologies of formation the 3D base of addresses of receptors for anesthesia of organism of a particular person. In addition, technologies of a triggering the cascade of biochemical reactions is proposed, by the modeling of pharmacodynamics electromagnetic models of a medicinal preparation. Such type of anesthesia will allow to avoid side effects of medical preparations at stages of an absorption, distribution, removal that are caused by the mass of drug and, in addition, respectively, to reach therapeutic effect only by means of electromagnetic model of a medicinal preparation for anesthesia.

Anaesthetic and genotoxic effect of medicinal plant extracts in gilthead seabream (Sparus aurata L.)

Anaesthetic properties and potential genotoxicity of six essential oils extracted from the medicinal plants Origanum vulgare, Eugenia aromatica, Aloysia triphylla, Melaleuca alternifolia, Juniperus communis, Cinnamomum zeylanicum, are presently assessed in gilthead seabream. Essential oils are an alternative option for fish anaesthesia, which is necessary in order to ensure welfare under intensively reared conditions. Their anaesthetic efficacy was assessed in comparison with chemical agents, by monitoring fish behavior throughout the anaesthesia and recovery stages, while the post-treatment mortality rate was also recorded. Genotoxicity was evaluated using the single cell gel comet assay in vitro and in vivo. DNA migration (tail moment) and the percentage of cells with increased level of DNA damage in hepatocytes were assessed. All essential oils proved to qualify as anaesthetic agents achieving deep narcosis and behavioural recovery. Essential oils indicated higher efficiency compared to chemicals, mitigating the side-effects that are often associated with synthetic substances. E. aromatic, O. vulgare and A. triphylla induced genotoxic effects at applied doses. However, as genotoxicity is dose dependent and most essential oils usually devoid of long-term genotoxic risk, lower anaesthetic doses have to be tested in order to be proposed for commercial use in aquaculture species. M. alternifolia and J. communis did not induced genotoxicity, maintaining DNA damage at control group level. Finally, C. zeylanicum was evaluated as equal competent anaesthetic agent satisfying the criteria of the ideal anaesthetic, reducing DNA strand breakage and indicating anti-stress, anti-genotoxic and geno-protective effect. Statement of relevance•Genotoxicity of anaesthetic agents used for fish anaesthesia is an important issue in aquaculture production. As aquaculture fish are intended for human consumption, essential oils are an alternative option for anaesthesia, providing low cost, easy accessibility, efficacy and environmental safety.•Due to the fact that essential oils may display dose-dependent toxicity, research on their genotoxic effect is very important before they are suggested for commercial use in aquaculture.•The essential oils extracted from medicinal plants Origanum vulgare, Eugenia aromatica, Aloysia triphylla, Melaleuca alternifolia, Juniperus communis, Cinnamomum zeylanicum have never been assessed for their anaesthetic and genotoxic effect in seabream. Furthermore, comet assay is considered as an innovative and validated molecular assay for reliable detection of genotoxicants.

Application of laryngeal mask airway anesthesia combined with sacral canal block in pediatric surgery

Objective To observe differences between the application of laryngeal mask anesthesia combined with sacral canal block and single intratracheal anesthesia in African pediatric surgery and provide references for child anaesthesia. Methods Sixty 4-6 year-old children for lower abdominal or lower limb surgerywere randomly divided into two groups(n=30): laryngeal mask airway anaesthesia combined with sacral canal block group(group A) and single intratracheal anaesthesia group(group B). MAP, HR and SpO2 were recorded before induction of anaesthesia(T0), before and after intubation of laryngeal mask airway or tracheal tube (T1, T2) and after removal of laryngeal mask airway or tracheal tube(T3). The waking-up time, VAS pain scores and adverse reaction were recorded after surgery. Results There were no significant differences in MAP, HR and SpO2 between the two groups at T0 and T1 (P>0.05). The MAP and HR [(68±10) mmHg(1 mmHg=0.133 kPa), (108±17) bpm] values in group A were significantly lower than the MAP and HR [(91±8) mmHg, (139±18) bpm] values in group B at T2(P<0.05). The MAP and HR [(67±9) mmHg, (121±16) bpm] values in the group A were also significantly lower than the MAP and HR [(85 ± 9) mmHg, (141 ± 17) bpm] values in the group B at T3(P<0.05). The postoperative VAS values (1.5±0.5) in groups A were significantly lower than values (6.5±1.5) in the group B (P<0.05). The waking-up time [(5.8±2.4) min] in group A was significantly shorter than the time [(12.2±2.8) min] in group B (P<0.05). There are only 4 cases of postoperative agitation in group A which was significantly lower than that in group B (P<0.05). The frequencies of postoperative cry and cough in group A were significantly lower than that in group B. Conclusions The general anesthesia via laryngeal mask airway combined with sacral canal block in children during the induction and the waking-up time guaranteed more stable hemodynamics and significantly reduce postoperative pain, the waking-up time significantly shorten, significantly reduce the incidence of postoperative mania ,so it is an more ideal anesthesia methed in lower abdominal or lower limb surgery. Key words: Laryngeal mask airway; Anesthesia, general; Sacral canal block; African child

Comparison of hemodynamic parameters and recovery characteristics between sevoflurane and desflurane in patients undergoing day care gynecological laparoscopic surgery

Background: General anesthesia is the most commonly used technique in day care setup. An ideal general anesthetic should provide smooth and rapid induction, optimal operating conditions, and rapid recovery with minimal side effects such as nausea, vomiting, bleeding, and postoperative pain. Inhaled anesthetics allow rapid emergence from anesthesia because of easy titrability with inherent neuromuscular blocking effects that make them more suitable for day care anesthesia. Objective: To compare intraoperative hemodynamic profile of desflurane and sevoflurane as maintenance anesthetic in patients undergoing day care gynecological laparoscopic surgery. Materials and Methods: This was a prospective randomized single-blind study that was conducted by the Department of Anesthesiology at Krishna Institute of Medical Science, Secunderabad, India, during the period of January 2010 to May 2011 in patients undergoing day care gynecological laparoscopic surgery. The study was approved by the hospital ethics committee. A total of 100 female patients belonging to the American Society of Anesthesiologists grade I or II, scheduled to undergo day care laparoscopic gynecological surgery were recruited for the study. Patients were randomized into two groups to receive either desflurane (group D; n = 50) or sevoflurane (group S; n = 50) for maintenance of anesthesia. Result: All demographic parameters, such as age, weight, and height, were compared in both the groups and all parameters are statistically insignificant. The mean duration of surgery in the groups of desflurane and sevoflurane was 38.90 and 41.30 min, respectively. The groups did not differ in blood pressure (systolic, diastolic, and mean) or heart rate throughout the surgery. During the maintenance period, heart rate and mean arterial pressure were satisfactorily maintained within 20% of baseline values with both anesthetics. The time from administration of reversal agent to response to painful stimuli, to eye opening, to verbal commands, and spontaneous eye opening were significantly shorter in patients given desflurane than in patients given sevoflurane (p = 0.000). For a given duration of anesthesia, emergence from anesthesia was significantly faster in desflurane group as compared to sevoflurane group. There was no difference in both the groups as far as the incidence of complications is concerned. Conclusion: Desflurane anesthesia produces faster emergence and early recovery from anesthesia compared to sevoflurane anesthesia. Time to home readiness is similar with both agents. Intraoperative hemodynamic parameters are similar in both desflurane and sevoflurane anesthesia.

The application of ketamine combined with butorphanol intravenous anesthesia for pediatric day surgery

Objective To compare the effects of ketamine combined with butorphanol for intravenous anesthesia with ketamine separately for pediatric day surgery.Methods In this double-blind trial,200 pediatric patients (ASA physical status 1 or 2,1 to 6 years old) undergoing inguinal hernia repair or circumcisions undergoing intravenous anesthesia were randomly allocated into two groups.Intravenous anesthesia was induced with 2 mg/kg ketamine combined with 2 ml saline (group KS,n=100) or 2 mg/ kg ketamine combined with 30 μg/kg butorphanol in the volume of 2 ml respectively (group KB,n=100).Repeat doses of ketamine 1 mg/kg were administered when the patients had motor responses.Total dosage of ketamine,variation of circulation and breath,awaken time were observed.Agitation and pain were assessed with sedative score and CHEOPS score respectively.The patients' parents were interviewed 24 h after surgery,and the adverse events were recorded.Results Group KB showed less consumption of ketamine (42.2±12.9) mg vs (75.0±25.3) mg (P＜0.05).Furthermore,the mean level of postoperative CHEOPS score and sedative score in the group KB was significantly lower than that in the group KS (P＜0.05).Awaken time was statistically longer in the group KS (P＜0.05),but the time spent in the PACU was similar in both groups.There was no significantly airway or hemodynamic effects observed in both groups.Conclusions Ketamine combined with butorphanol for pediatric day surgery is an ideal anesthesia and it has advantages such as safty,low dosage of keatmine to eliminate the adverse effect,providing a more comprehensive sedative and analgesic effect to reduce emergence agitation and postoperative pain in pediatric day surgery. Key words: Ketamine; Butorphanol; Intravenous anesthesia; Pediatric; Day surgery

Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey.

Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%.1–3 As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world.4 Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic),5,6 the ideal anesthesia (general, local, or regional),7,8 and the ideal mesh (standard polypropylene or newer meshes).9,10

Comparison of Intrathecal Use of Isobaric and Hyperbaric Bupivacaine during Lower Abdomen Surgery

Objective. The ideal local anesthetic solution for intrathecal use has rapid onset and reliable duration, with less incidence of adverse events. This study was aiming to compare the onset of anesthesia and duration of action of isobaric and hyperbaric bupivacaine for subarachnoid block (SAB). Methods. Sixty patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups. Group I received 20 mg of 0.5% isobaric bupivacaine, while Group H received 20 mg of 0.5% hyperbaric bupivacaine. Injection was made intrattecally in midline position at L3-4 interspace in sitting position. Results. The onset of analgesia and motor blocks with isobaric was faster when compared to hyperbaric bupivacaine (4.8 ± 2.2 versus 7.5 ± 2.2 minutes and 4.1 ± 2.1 versus 6.4 ± 2.4 minutes, resp., P&lt;0.001). The duration of sensory and motor blocks was longer in isobaric when compared to hyperbaric bupivacaine (276 ± 30 versus 163 ± 22 minutes and 266 ± 32 versus 163 ± 24 minutes, P&lt;0.001). In both groups, hemodynamic changes were not clinically relevant, and the adverse effects were comparable. Conclusion. Isobaric produced more rapid onset and longer duration when compared to hyperbaric bupivacaine.

Anesthetic management of a patient with acute myocardial infarction undergoing coated stent-grant implantation for abdominal aortic aneurysm

Patients with acute myocardial infarction have a high risk of perioperative cardiac complications,simultaneously implantation of coated stent-graft in abdominal aortic aneurysm also increases the risk of adverse cardiac event.In this report,a patient with acute myocardial infarction for 8 days was scheduled for coated stent-graft implantation for abdominal aortic aneurysm.Based on fully understanding about surgical characteristics,the ideal anesthesia program was developed by the following factors:titration of anesthetic drugs according to surgical requirements,stable hemodynamics,the balance of myocardial oxygen supply and demand,appropriate analgesia/sedation.Finally,the patient pulled through perioperative period stably without serious complications. Key words: Stent implant; Abdominal aortic aneurysm; Myocardial infarction; Anesthesia

Comparative efficacy of two anesthetic agents in the Sobaity sea bream, Sparidentex hasta (Valenciennes 1830)

It is known that responses to the same anesthetic can vary considerably among different fish species. In this investigation, the efficacy of two anesthetic agents (clove powder and 2-phenoxyethanol) was compared in Sobaity sea bream, Sparidentex hasta (Valenciennes 1830). Induction and recovery times for S. hasta anesthetized with anesthetic agents were dose-dependent (P < 0.05). The onset of individual phases of anesthesia and recovery times depended significantly on the concentration of the anesthetic used (P < 0.05). An inverse exponential relationship was observed between concentrations of anesthetic and induction time, whereas exponential relationships were observed between concentrations and recovery times for both anesthetic agents evaluated. The lowest effective concentrations based on the efficacy criteria of complete anesthetic induction within 180 s and recovery within 300 s were determined to be 100 mg L−1 (induction time 1.92 ± 0.10 min and recovery time 2.48 ± 0.17 min) for clove powder and 200 μL L−1 (induction time 2.55 ± 0.14 min and recovery time 5.66 ± 0.62 min) for 2-phenoxyethanol. Clove powder was proven to be more effective, and the latter appears to meet many of the criteria of an ideal anesthetic for this fish species.