Sevoflurane In Oxygen Research Articles

Effects of maternal exposure to sevoflurane for anesthesia or surgery on social interaction behaviors in offspring mice

Objective To evaluate the effects of maternal exposure to sevoflurane for anesthesia or surgery on social interaction behaviors in offspring mice. Methods Fifteen pregnant C57BL/6 mice on gestational day 18 were assigned into 3 groups (n=5 each) using a random number table: control group (group C), sevoflurane anesthesia group (group Sevo) and surgery group (group Surg). Group C inhaled 100% oxygen for 2 h in group C. Group Sevo inhaled 3% sevoflurane in oxygen for 2 h. In group Surg, 3% sevoflurane in oxygen was inhaled for 2 h and exploratory laparotomy was performed.At juvenile age (on 30th day after births) and in early adulthood (on 60th day after births), the offspring mice underwent social interaction tests using the three-chambered sociability paradigm, including sociability and preference for social novelty. Results During 1st testing phase: there was no significant difference in time spent in exploring the chamber on the left and right sides or in sniffing directed at the empty wire cage on the left and right sides among the three groups (P>0.05). During 2nd testing phase: time spent in exploring the chamber containing stranger-1 mouse in the wire cage and in sniffing directed at the wire cage containing stranger-1 mouse was significantly prolonged at juvenile age and in early adulthood in three groups when compared with the empty wire cage (P<0.05). During 3rd testing phase: compared with stranger-1 mouse, time spent in exploring the chamber containing stranger-2 mouse at juvenile age and in sniffing directed at the wire cage containing stranger-2 mouse at juvenile age and in early adulthood was significantly prolonged in group C, time spent in exploring the chamber containing stranger-2 mouse and in sniffing directed at the wire cage containing stranger-2 mouse was significantly prolonged in early adulthood in group Sevo, and time spent in sniffing directed at the wire cage containing stranger-2 mouse was significantly prolonged in early adulthood in group Surg (P<0.05). Conclusion Maternal exposure to sevoflurane for anesthesia or surgery induces social interaction deficits in the offspring mice in which lower levels of preference for social novelty are detected, especially at juvenile age. Key words: Anesthetics, inhalation; Surgical procedures; Pregnant; Social interaction behavior

Effects of constant rate infusions of dexmedetomidine or MK-467 on the minimum alveolar concentration of sevoflurane in dogs

ObjectiveTo determine the effects of low and high dose infusions of dexmedetomidine and a peripheral α2-adrenoceptor antagonist, MK-467, on sevoflurane minimum alveolar concentration (MAC) in dogs. Study designCrossover experimental study. AnimalsSix healthy, adult Beagle dogs weighing 12.6±0.9 kg (mean±standard deviation). MethodsDogs were anesthetized with sevoflurane in oxygen. After a 60-minute instrumentation and equilibration period, the MAC of sevoflurane was determined in triplicate using the tail clamp technique. PaCO2 and temperature were maintained at 40±5 mmHg (5.3±0.7 kPa) and 38±0.5 ºC, respectively. After baseline MAC determination, dogs were administered two incremental loading and infusion doses of either dexmedetomidine (1.5 μg kg−1 then 1.5 μg kg−1 hour−1 and 4.5 μg kg−1 then 4.5 μg kg−1 hour−1) or MK-467 (90 μg kg−1 then 90 μg kg−1 hour−1 and 180 μg kg−1 then 180 μg kg−1 hour−1); loading doses were administered over 10 minutes. MAC was redetermined in duplicate starting 30 minutes after the start of drug administration at each dose. End-tidal sevoflurane concentrations were corrected for calibration and adjusted to sea level. A repeated-measures analysis was performed and comparisons between doses were conducted using Tukey's method. Statistical significance was considered at p<0.05. ResultsSevoflurane MAC decreased significantly from 1.86±0.3% to 1.04±0.1% and 0.57±0.1% with incremental doses of dexmedetomidine. Sevoflurane MAC significantly increased with high dose MK-467, from 1.93±0.3% to 2.29±0.5%. Conclusions and clinical relevanceDexmedetomidine caused a dose-dependent decrease in sevoflurane MAC, whereas MK-467 caused an increase in MAC at the higher infusion dose. Further studies evaluating the combined effects of dexmedetomidine and MK-467 on MAC and cardiovascular function may elucidate potential benefits of the addition of a peripheral α2-adrenergic antagonist to inhalation anesthesia in dogs.

Effects of acepromazine and trazodone on anesthetic induction dose of propofol and cardiovascular variables in dogs undergoing general anesthesia for orthopedic surgery.

OBJECTIVE To compare the doses of propofol required to induce general anesthesia in dogs premedicated with acepromazine maleate or trazodone hydrochloride and compare the effects of these premedicants on cardiovascular variables in dogs anesthetized for orthopedic surgery. DESIGN Prospective, randomized study. ANIMALS 30 systemically healthy client-owned dogs. PROCEDURES 15 dogs received acepromazine (0.01 to 0.03 mg/kg [0.005 to 0.014 mg/lb], IM) 30 minutes before anesthetic induction and 15 received trazodone (5 mg/kg [2.27 mg/lb] for patients > 10 kg or 7 mg/kg [3.18 mg/lb] for patients ≤ 10 kg, PO) 2 hours before induction. Both groups received morphine sulfate (1 mg/kg [0.45 mg/lb], IM) 30 minutes before induction. Anesthesia was induced with propofol (4 to 6 mg/kg [1.82 to 2.73 mg/lb], IV, to effect) and maintained with isoflurane or sevoflurane in oxygen. Bupivacaine (0.5 mg/kg [0.227 mg/lb]) and morphine (0.1 mg/kg [0.045 mg/lb]) were administered epidurally. Dogs underwent tibial plateau leveling osteotomy (n = 22) or tibial tuberosity advancement (8) and were monitored throughout anesthesia. Propofol induction doses and cardiovascular variables (heart rate and systemic, mean, and diastolic arterial blood pressures) were compared between groups. RESULTS The mean dose of propofol required for anesthetic induction and all cardiovascular variables evaluated did not differ between groups. Intraoperative hypotension developed in 6 and 5 dogs of the acepromazine and trazodone groups, respectively; bradycardia requiring intervention developed in 3 dogs/group. One dog that received trazodone had priapism 24 hours later and was treated successfully. No other adverse effects were reported. CONCLUSIONS AND CLINICAL RELEVANCE At the described dosages, cardiovascular effects of trazodone were similar to those of acepromazine in healthy dogs undergoing anesthesia for orthopedic surgery.

Occurrence of Kounis syndrome under anesthesia.

Occurrence of Kounis syndrome under anesthesia.

Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children.

Background and Aims:It is not known whether trapezius squeeze test (TPZ) is a better clinical test than jaw thrust (JT) to assess laryngeal mask airway (LMA) insertion conditions in children under sevoflurane anesthesia.Material and Methods:After the Institutional Ethics Committee approval and written informed parental consent, 124 American Society of Anesthesiologists I and II children of 2–8 years of age undergoing minor surgical procedures were randomized into TPZ and JT groups. The children were induced with 8% sevoflurane in oxygen at a fresh gas flow of 4 L/min. TPZ or JT was performed after 1 min of start of sevoflurane and then every 20 s till the test was negative, when end-tidal (ET) sevoflurane concentration was noted. Classic LMA of requisite size was inserted by a blinded anesthetist and conditions at the insertion of LMA, insertion time, and the number of attempts of LMA insertion were recorded.Results:The mean LMA insertion time was significantly longer (P < 0.001) for TPZ (145 ± 28.7 sec) compared to JT group (111.8 ± 31.0 sec). ET sevoflurane concentration at the time of LMA insertion was comparable in the two groups. LMA insertion conditions were similar in the two groups. There was no difference between the two groups regarding total number of attempts of LMA insertion. Heart rate (HR) decreased in both groups after LMA insertion (P < 0.001) but TPZ group had significantly lower HR compared with the JT group up to 5 min after LMA insertion (P = 0.03).Conclusion:Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

Effect of fentanyl and lidocaine on the end-tidal sevoflurane concentration preventing motor movement in dogs.

OBJECTIVE To determine effects of fentanyl, lidocaine, and a fentanyl-lidocaine combination on the minimum alveolar concentration of sevoflurane preventing motor movement (MACNM) in dogs. ANIMALS 6 adult Beagles. PROCEDURES Dogs were anesthetized with sevoflurane in oxygen 3 times (1-week intervals). Baseline MACNM (MACNM-B) was determined starting 45 minutes after induction of anesthesia. Dogs then received 1 of 3 treatments IV: fentanyl (loading dose, 15 μg/kg; constant rate infusion [CRI], 6 μg/kg/h), lidocaine (loading dose, 2 mg/kg; CRI, 6 mg/kg/h), and the fentanyl-lidocaine combination at the same doses. Determination of treatment MACNM (MACNM-T) was initiated 90 minutes after start of the CRI. Venous blood samples were collected at the time of each treatment MACNM measurement for determination of plasma concentrations of fentanyl and lidocaine. RESULTS Mean ± SEM overall MACNM-B for the 3 treatments was 2.70 ± 0.27 vol%. The MACNM decreased from MACNM-B to MACNM-T by 39%, 21%, and 55% for fentanyl, lidocaine, and the fentanyl-lidocaine combination, respectively. This decrease differed significantly among treatments. Plasma fentanyl concentration was 3.25 and 2.94 ng/mL for fentanyl and the fentanyl-lidocaine combination, respectively. Plasma lidocaine concentration was 2,570 and 2,417 ng/mL for lidocaine and the fentanyl-lidocaine combination, respectively. Plasma fentanyl and lidocaine concentrations did not differ significantly between fentanyl and the fentanyl-lidocaine combination or between lidocaine and the fentanyl-lidocaine combination. CONCLUSIONS AND CLINICAL RELEVANCE CRIs of fentanyl, lidocaine, and the fentanyl-lidocaine combination at the doses used were associated with clinically important and significant decreases in the MACNM of sevoflurane in dogs.

Abstract PR243

Background & Objectives: Previous study by our group showed that maximum flexion of head and neck results in increase in oropharangeal leak pressures (OPLP) and deterioration of ventilation with I-gel™. However the degree of neck flexion which increases OPLP without compromising ventilation is still not known. So we conducted a prospective self controlled trial evaluating the ventilation and oropharangeal leak pressures with I-Gel in mild, moderate and maximum degree of neck flexion in anaesthetized paralysed children. Materials & Methods: Anesthesia was induced with sevoflurane in oxygen. Atracurium intravenously was administered to facilitate neuromuscular relaxation. I-gel™ was inserted in 60 anaesthetised children. Recordings of Peak Inspiratory Pressures in flexion at 15°, 30° and 45° were compared with neutral and taken as primary outcome. Expired tidal volume, Ventilation scoring, Fiberoptic gradings and OPLP was also measured in different degrees of flexion as secondary outcomes. Results: Significant change in the mean difference of PIP (95%CI) cmH2O was seen at flexion 30° [2.4 (-2.9 to -1.9) cm H20, p<0.001] and flexion 45° [-5.6 (-6.1 to -5.0) cm H20, p <0.001] from neutral. There was significant decrease in the expired tidal volume with flexion 30° (p<0.001) and 45° (p<0.001) and increase in the OPLP at neck flexion of 15° (p<0.001), 30° (p<0.001) and 45° (p<0.001) compared with neutral position. Significant deterioration of ventilation score, mean [range] was seen with flexion of 30°, 2[0-3], p<0.05 and 45°, 1[0-3], p<0.05 compared to the neutral 3[2-3]. Conclusion: Although a consistent increase in OPLP is seen with flexion, caution is warranted with flexion of 30° and more due to deterioration of ventilation parameters.

Is Neuromuscular Blocker Necessary in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing?

Purpose The aim of this study is to evaluate operating conditions during general anesthesia with or without neuromuscular blocker (NMB) in patients undergoing percutaneous internal ring suturing (PIRS). Materials and Methods In this study, 40 patients, with American Society of Anesthesiologists I and II between the ages of 1 and 12 years, were randomly assigned to two groups to receive muscle relaxant with endotracheal tube (ETT) (ETT group) or without muscle relaxant with supreme laryngeal mask airway (sLMA) (LMA group). Anesthesia was maintained with sevoflurane in oxygen (Fio 2 0.3-0.5), thiopental sodium, fentanyl, and rocuronium in ETT group. In LMA group, same protocol was used without rocuronium. Heart rate, blood pressure, peak airway pressure, end-tidal carbon dioxide (EtCO2), and Spo 2 were recorded before and during pneumoperitoneum maintained at a pressure of 8 to 10 mm Hg. Duration of surgery, recovery time, anesthetic time, and grade of quality view were also recorded. Airway problems (cough, hoarseness, laryngospasm, and aspiration) were recorded. Results In LMA group, there was a statistically significant reduction in recovery time versus ETT group (11.6 ± 4.08 vs. 17.15 ± 5.32 minutes; p = 0,001). There were no statistically significant differences grade of quality view between the two groups (p = 0.548). There were no statistically significant differences in oxygen saturation (Spo 2), peak airway pressure, and EtCO2 between the two groups before or during insufflation (p > 0.05). Postoperative airway complications were significantly more prevalent in the ETT group. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. Conclusion sLMA is safe and suitable alternative to ETT and NMB is not necessary in general anesthesia with sLMA, pediatric patients undergoing laparoscopic hernia repair with PIRS.

Comparison of cardiac output measurements using transpulmonary thermodilution and conventional thermodilution techniques in anaesthetized dogs with fluid overload

ObjectiveTo evaluate the agreement between cardiac output (CO) values obtained using a transpulmonary thermodilution technique (TPTDCO) and conventional thermodilution technique (TDCO) in anaesthetized dogs with fluid overload. Study designProspective experimental study. AnimalsSix healthy Beagle dogs aged 7–8 years. MethodsDogs were anaesthetized with sevoflurane in oxygen, and catheters were inserted for TPTDCO and TDCO measurement. After instrumentation, baseline CO was measured using each technique at a central venous pressure (CVP) of 3–7 mmHg. Dogs were subsequently administered lactated Ringer’s solution and 6% hydroxyethyl starch to induce fluid overload. CO measurements were obtained using each technique at CVP values of 8–12 mmHg, 13–17 mmHg, 18–22 mmHg and 23–27 mmHg. Agreements between CO measurements obtained with the respective techniques were analysed using Dunnett’s test, Pearson’s correlation coefficient and Bland–Altman analysis. ResultsThirty pairs of CO values were obtained, ranging from 1.45 L minute−1 to 4.69 L minute−1 for TPTDCO and from 1.30 L minute−1 to 4.61 L minute−1 for TDCO. TPTDCO and TDCO values correlated strongly (r2 = 0.915, p< 0.001). The bias and mean relative bias between TPTDCO and TDCO were 0.26 ± 0.30 L minute−1 (limits of agreement - 0.29 to 0.81 L minute−1) and 9.7%, respectively. Conclusions and clinical relevanceTPTDCO and TDCO measurements obtained in anaesthetized dogs during fluid overload exhibited good agreement. Accordingly, transpulmonary thermodilution provides an accurate measurement of CO in dogs with fluid overload.

General anesthesia with an injectable 8% v/v sevoflurane lipid emulsion administered intravenously to dogs

ObjectiveTo evaluate the potential of an intravenous (IV) sevoflurane formulation for maintenance of general anesthesia in dogs. Study designProspective crossover design. AnimalsSix healthy, mature, mixed-breed dogs, four males and two females, weighing 11.7 ± 3.4 kg. MethodsAnesthesia was induced and maintained with propofol IV for instrumentation. Baseline measurements were recorded before administration of either sevoflurane in oxygen (Sevo-Inh) or lipid-emulsified sevoflurane 8% v/v in 30% Intralipid IV (Sevo-E), 0.5 mL kg-1 over 5 minutes followed by an infusion at 0.1–0.3 mL kg-1 minute-1. Dogs were breathing spontaneously. The ‘up-and-down’ technique was used to determine the minimum alveolar concentration (MAC) of sevoflurane. Over 120 minutes, a tail clamp was applied every 15 minutes and sevoflurane administration was adjusted depending on the response. End-tidal sevoflurane concentration and variables were recorded at 30, 60, 90, and 120 minutes: heart rate (HR), systemic arterial pressure (sAP), respiratory rate (fR), end-tidal carbon dioxide tension, hemoglobin oxygen saturation (SaO2), arterial pH and blood gases, blood urea nitrogen, alanine aminotransferase, creatine kinase, gamma-glutamyl transferase, and aspartate aminotransferase. ResultsThere were no significant differences between treatments for HR, sAP, fR, SaO2, and biochemical variables (p > 0.05). pH and HCO3-were significantly decreased, and PaCO2 increased from baseline in Sevo-E (p < 0.05). MAC was significantly lower for Sevo-E than for Sevo-Inh, although the required dose of sevoflurane (g hour-1) to maintain general anesthesia was not significantly different between treatments. Conclusions and clinical relevanceAdministration of 8% v/v sevoflurane lipid emulsion IV was effective in maintaining general anesthesia in dogs, but resulted in moderate cardiopulmonary depression, metabolic and respiratory acidosis. The amount of sevoflurane (g hour-1) required to maintain general anesthesia was significantly lower for inhaled than for IV sevoflurane.

SURGICAL MUSCLE RELAXATION

In Anesthesia practice neuromuscular blocking agents (muscle relaxants) areused for intubation and surgical muscle relaxation. The use of modern inhalational anestheticslike sevoflurane is commonly practiced in paediatric anesthesia for induction and endotrachealintubation. LMA (Laryngeal Mask Airway) is alternative to endotracheal intubation. It iscommonly used supraglotic device for the elective surgical procedures in adults and paediatricpopulation. We conducted this study to see whether sevoflurane produces enough surgicalmuscle relaxation so that the use of neuromuscular blocking agents can be avoided. StudyDesign: Observational study. Setting: King Khalid Hospital (KSA). Period: April 2013 toFebruary 2014. Material and Methods: 84 paediatric patients posted for elective surgicalprocedure were included. Regarding the adequacy of surgical muscle relaxation. Induction ofanesthesia was done with propofol 2mg/kg and Fentanyl 2 mcg/kg. Airway was maintained withLMA. Anesthesia was maintained by sevoflurane in oxygen and air. Blood pressure and Heartrate was kept with 20 % of baseline reading. Adequacy of surgical muscle relaxation was askedby the surgeon during surgery and was graded as good, fair or poor. Results: Mean age of thepatients was 2.4 year. There were 76 male and 8 female patients. 47 patients were operatedfor inguinal herniotomy, 32 for orchedopexy and 5 for umbilical herniotomy. Surgical musclerelaxation was good in all of the patients and none of them required use of muscle relaxants.Recovery of all patients was smooth. Discussion: Adequate surgical muscle relaxation isimportant to facilitate surgery. In paediatric population sevoflurane produces enough musclerelaxation for intubation and surgical muscle relaxation. Monitoring of muscle relaxation can beclinical as well as through muscle twitches. Conclusion: Our study showed that in paediatricpopulation

To study the adequacy of surgical muscle relaxation in paediatric patients scheduled for elective groin surgeries under general anesthesia using sevoflurane without using neuromuscular blocking agents

AbstractIntroduction:In Anesthesia practice neuromuscular blocking agents (muscle relaxants) are used for intubation and surgical muscle relaxation. The use of modern inhalational anesthetics like sevoflurane is commonly practiced in paediatric anesthesia for induction and endotracheal intubation. LMA is alternative to endotracheal intubation. It is commonly used supraglotic device for the elective surgical procedures in adults and paediatric population. We conducted this study to see whether sevoflurane produces enough surgical muscle relaxation so that the use of neuromuscular blocking agents can be avoided.Patients and Methods:84 paediatric patients of King Khalid Hospital (KSA) from April 2013 to February 2014 posted for elective surgical procedure were included in this observational study regarding the adequacy of surgical muscle relaxation. Induction of anesthesia was done with propofol 2mg/kg and Fentanyl 2 mcg/ kg. Airway was maintained with LMA. Anesthesia was maintained by sevoflurane in oxygen and air. Blood pressure and Heart rate was kept with 20% of baseline reading. Adequacy of surgical muscle relaxation was asked by the surgeon during surgery and was graded as good, fair or poor.Results:Mean age of the patients was 2.4 year. There were 76 male and 8 female patients. 47 patients were operated for inguinal herniotomy, 32 for orchedopexy and 5 for umbilical herniotomy. Surgical muscle relax-ation was good in all of the patients and none of them required use of muscle relaxants. Recovery of all patients was smooth.Discussion:Adequate surgical muscle relaxation is important to facilitate surgery. In paediatric population sevoflurane produces enough muscle relaxation for intubation and surgical muscle relaxation. Monitoring of muscle relaxation can be clinical as well as through muscle twitches.Conclusion:Our study showed that in paediatric population the elective surgical procedures of groin region can be done without using muscle relaxants.Keywords:Paediatric anesthesia, LMA, neuromuscular blocking agents, surgical muscle relaxation.

Meconium peritonitis: A rare neonatal surgical emergency.

Sir, We present two cases of meconium peritonitis, a rare neonatal surgical emergency. The first baby, 1.8 Kg in weight, born at 32 weeks gestation had Apgar score of 8/10 at 1 min, heart rate (HR) was 164/min, respiratory rate (RR) 54/min and capillary refill time (CRT) 3 s. Abdomen was distended with a hard palpable lump in the supra-umbilical region. There was respiratory distress with intermittent apnoeic episodes for which the baby was intubated. Ultrasonography at 29 weeks showed ascites, bilateral pleural effusion, calcification along the liver surface and an abdominal lump. Abdominal radiograph revealed a centrally located large calcific lesion [Figure 1]. Haemoglobin was 19.2 g %, leucocyte count 17,700/mm3, C-reactive protein (CRP) 192 mg/L (normal <10 mg/L), creatinine 1.3 mg% and electrolytes and blood gases were normal. Diagnosis of meconium peritonitis was made and baby was posted for emergency laparotomy on day 1 of life. Anaesthesia was induced with sevoflurane in oxygen (O2) and maintained on sevoflurane, O2, air (50:50) with fentanyl 2 μg/kg for analgesia. Peripherally inserted central catheter (PICC) (1 Fr G) was inserted through the right cephalic vein. There was an episode of hypotension where blood pressure fell to 42/20 mm Hg for which fluid bolus was given and dopamine infusion started at 10 μg/kg/min. The large calcific deposit was removed, meconium was aspirated and suture of ileal perforation was done. Baby was electively ventilated and extubated on the 4th post-operative day. Figure 1 Chest and abdominal radiograph showing intra-abdominal calcification in the central location The second baby weighing 2 kg was delivered at term by caesarean section. Apgar score was 9/10 at 1 min, HR: 142/min, RR: 48/min and CRT < 3 s. Abdomen was distended. Ultrasound revealed dilated bowel loops with echogenic contents and free fluid suggestive of meconium peritonitis. Haematological investigations were normal. Baby was posted for emergency laparotomy on day 1 of life. Anaesthesia was induced with sevoflurane in O2. Rocuronium 1.2 mg/kg was administered and modified rapid sequence induction was performed with cricoid pressure and gentle ventilation. Exactly 45 s later airway was secured with 3.5 mm ID endotracheal tube. Anaesthesia was maintained on sevoflurane at 1.2 MAC, air, O2 mixture (50:50) and fentanyl 2 μg/kg. Adhesiolysis with excision of meconium pseudocyst in jejunum was performed. PICC (1 Fr G) was inserted through left great saphenous vein. Trachea was extubated on table. Meconium peritonitis is an aseptic chemical peritonitis which results from perforation of the gut in utero.[1] Incidence is 1 in 35,000 live births.[2] Possible causes include mesenteric ischaemia, volvulus, intestinal atresia, meconium plugs, internal hernia and Hirschsprung's disease.[3] Other associations include chromosomal aberrations and cystic fibrosis. Perforation of the intestines in utero results in leakage of meconium into the peritoneal cavity. Inflammatory reaction and chemical peritonitis occurs, which subsequently seals forming intra-abdominal calcifications. Huge abdominal cyst formation and ascites may develop which can cause foetal cardiac insufficiency and cardiorespiratory compromise after birth.[3] Prenatal ultrasound is diagnostic.[4] Management begins at delivery. Fluid resuscitation may be needed if the baby is in shock. Bag-mask ventilation may further aggravate bowel distension. Endotracheal intubation with controlled ventilation is preferable. Initial stabilisation of cardiopulmonary parameters and blood gas analysis, CRP, lactates, haematocrit, blood count, platelets, electrolytes, culture and cross match are done. Inotropes are started early if haemodynamic instability does not respond to fluid boluses. Chest and abdominal radiographs, ultrasound of abdomen and echocardiography are preferable as persistent pulmonary hypertension may complicate the management. These babies are then managed in a staged approach. An abdominal drainage with ultrasound guidance under local anaesthesia is preferred in critical neonates. Exploratory laparotomy with adhesiolysis and enterostomy is done in haemodynamically stable babies. Finally, stoma closure is performed. Prolonged antibiotic administration postoperatively and enteral nutrition may warrant PICC insertion. Complications such as wound infection, intestinal fistula, abdominal abscess, cerebral haemorrhage due to disseminated intra-vascular coagulation, sepsis and multi-organ failure may occur.[3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Cardiopulmonary and acid-base effects of tramadol in cats anesthetized with sevoflurane

The experiment assessed the cardiorespiratory and hemogasometric profiles in female cats under sevoflurane resulting from the administration of tramadol. Twenty clinically healthy adult female cats separated equally into two groups: control group (CG) and tramadol group (TG) were sedated with intramuscular acepromazine (0.05 mg/kg), followed by anesthetic induction intravenous propofol (5mg/kg). After endotracheal intubation, animals were maintained on sevoflurane in oxygen administered using a non-rebreathing (Baraka) circuit. The oxygen flow-rate was maintained at 2 L per minute. Fifteen minutes after induction, either 0.05 ml/kg 0.9% saline solution or 2mg/kg tramadol were administered, both intramuscularly, to the animals in CG and TG, respectively. The period of time immediately previous to these administrations was considered as moment zero (T0). The variables were again measured 15 minutes later (T15) and subsequently in 15 minute intervals for a total of sixty minutes (T30, T45 and T60). The results were statistically evaluated through variance analysis of repeated measures (ANOVA) followed by a Tukey test or Student t-test with the nullity hypothesis rejection level set to p<0.05. The use of tramadol reduced cardiac frequency (CF), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP). There was a reduction of the respiratory frequency (RF) and an elevation of the PaCO 2 . The body temperature (oC) lowered in both groups throughout the experiment. The results allow us to conclude that tramadol in cats anesthetized with sevoflurane does not undergo significant cardiorespiratory and blood-gas changes, although there are significant differences in some parameters between groups, all results remained within feline standard physiological values.

Rectus sheath block for postoperative analgesia in patients with mesenteric vascular occlusion undergoing laparotomy: A randomized single-blinded study.

Background:Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis, immediate anticoagulation, and intervention to restore mesenteric blood flow adequately.Aims:To investigate the effect of rectus sheath block (RSB) for postoperative analgesia in patients with mesenteric vascular occlusion.Settings and Design:Forty patients with mesenteric vascular occlusion, American Society of Anesthesiologists physical status I or II or III, scheduled for laparotomy were enrolled in this study.Subjects and Methods:Patients were randomized into two groups; control group (C Group) and rectus block group (RB Group). In both groups, general anesthesia was induced fentanyl 1 μg/kg with sleeping dose of propofol and 0.15 mg/kg cisatracurium. Then, anesthesia was maintained with sevoflurane in oxygen 100%. In RB Group, under aseptic condition, RSB guided by ultrasound was performed. Surgery is then continued and intravenous fentanyl patient-controlled analgesia pump started. Postoperative pain, sedation, and opioid side effects were assessed.Statistical Analysis Used:Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA).Results:Patients in the RB Group consumed statistically significant less opioid in comparison to control group either intraoperatively or postoperatively. Mean pain scores were statistically significant less in RB Group than in the control group at 2, 4, and 6 h postoperatively. Sedation score, incidence of nausea and vomiting were statistically significant less in the RB Group in comparison to control group. More patients’ satisfaction was reported in the RB Group.Conclusions:Ultrasound-guided RSB resulted in postoperative reduction of pain scores and opioid consumption compared with general anesthesia alone. Moreover, RSB was associated with better patient satisfaction and less nausea and vomiting.

Ventilation with facial mask in the prone position for radiotherapy procedures in children

ObjectivesVentilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position. Materials and methodsA prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded. ResultsAll sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9min (mean±SD). ConclusionsThe prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge.

Evaluation of I-gel™ airway in different head and neck positions in anesthetized paralyzed children.

Studies that have compared and quantified the oropharyngeal leak pressure (OPLP) and adequacy of ventilation with supraglottic airway devices in different head and neck positions have been done in adult populations. The effects of head-neck position changes on the functioning of I-gel(™) in pediatric population still remain unevaluated. This study aimed to quantify the influence of different head and neck positions namely neutral, maximum flexion, and maximum extension on OPLP, ventilation scoring, and fiberoptic grading using I-gel(™) in anesthetized, paralyzed children. I-gel(™) was inserted in 30 paralyzed, anesthetized children scheduled for elective urological and orthopedic procedures. Anesthesia was induced with sevoflurane in oxygen. Atracurium was administered intravenously to facilitate neuromuscular relaxation. Recordings of OPLP in neutral, maximum flexion, and maximum extension were taken as primary outcome. Fiberoptic grading, insertion of ryle's tube and ventilation scoring were also measured in different head and neck positions as secondary outcomes. The OPLP was significantly higher in flexion (27.6 ± 3.3 cm H2 O, P = 0.000) and lower in extension (19.6 ± 3.2 cm H2 O, P = 0.006) in comparison to the neutral position (23.2 ± 3.2 cm H2 O). There was a worsening of the fiberoptic view in flexion compared to neutral position (0/5/19/6 vs 5/21/4/0). The ventilation score was poorer (1 [0-3], P < 0.05) and peak inspiratory pressures higher in flexion (15.2 ± 1.4 cm H2 O, P = 0.000) compared to the neutral position (10.4 ± 1.6 cm H2 O). Caution is warranted in pediatric patients while ventilating with I-gel(™) in extreme flexion of head and neck owing to poor ventilation despite increase in OPLP.

Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries.

To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded. Pulmonary function tests were performed before surgery and repeated 4h, days 1, 2 and 3 post-operative for evaluation of forced vital capacity, forced expiratory volume in 1s and peak expiratory flow rate. Occurrence of post-operative complications, re-admission to ICU, hospital stay and morbidities were also recorded. Induction of anesthesia using remifentanil bolus injection resulted in significant decrease of heart rate and arterial pressures compared to pre-operative and pre-induction values. Recovery times were significantly shorter in obese compared to morbidly obese women. Post-operative pulmonary function tests showed significant deterioration compared to pre-operative measures but showed progressive improvement through first 3 post-operative days. Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries.

Ventilación con mascarilla facial en decúbito prono para tratamiento radioterápico en niños

ObjectivesVentilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position. Material and methodsA prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded. ResultsAll sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9min (mean±SD). ConclusionsThe prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge.

The effects of bispectral index monitoring on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery.

General anesthesia is often preferred for dental surgery or rehabilitation in developmentally delayed pediatric patients. Bispectral index monitoring is used to monitor the depth of anesthesia and to ensure early recovery. However, studies on the topic in developmentally delayed pediatric patients are limited. To evaluate the effects of Bispectral Index Scale (BIS) on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery. Forty children between the ages of 6-16 years were studied in this prospective and randomized study. The children were randomized into two groups. In Group 1 (n = 20), general anesthesia was maintained with 1-2 minimum alveolar concentration (MAC) of sevoflurane in oxygen by standard practice. In Group 2 (n = 20), the depth of anesthesia was monitored by BIS. BIS values were continuously recorded from awake status to tracheal extubation. The duration of the surgical procedure, anesthesia, postanesthesia care unit (PACU) stay was noted. To evaluate recovery profile, time to spontaneous ventilation, extubation, open eyes, and PACU discharge were also noted. There were significant differences between recovery times and Non-communicating Children's Pain Checklist - Postoperative Version (NCCPC-PV) scores of two groups. Time to spontaneous ventilation [Difference in means (95% CI); 3.17 (1.79-4.54) P < 0.001], extubation [Difference in means (95% CI); 3.13 (1.66-4.60) P < 0.001], open eyes [Difference in means (95% CI); 3.97 (2.34-5.59) P < 0.001], and PACU stay time [Difference in means (95% CI); 23.55 (18.08-29.01) P < 0.001] were significantly shorter in Group 2. In conclusion, results suggest that routine BIS monitoring may be beneficial due to its favorable effects on the recovery profile in developmentally delayed pediatric patients.