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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Auditory evoked potentials have been used as an indicator of awareness. During combined local and general anesthesia clinical signs of adequate anesthesia are difficult to evaluate. In the present study we combined peridural analgesia with three techniques of general anesthesia. Intraoperative wakefulness was documented and correlated with cardiocirculatory parameters as well as with mid-latency auditory evoked potentials (MLAEP). METHODS. After institutional approval and informed consent 30 patients undergoing elective laparotomy were studied as follows: first, continuous peridural analgesia was instituted in all patients to block painful sensation of surgical stimuli and the anesthetic level was maintained at T5. Then general anesthesia was induced with propofol 2.5 mg/kg i.v. (group I, n = 10), thiopental 5 mg/kg i.v. (group II, n = 10), or etomidate 0.2 mg/kg i.v. (group III, n = 10) and maintained with propofol 3-5 mg/kg per hour i.v. (group I), isoflurane 0.4-0.8 vol.-% (group II), or flunitrazepam 0.005-0.01 mg/kg i.v. and fentanyl 0.0025-0.005 mg/kg i.v. bolus injections every 20-30 min (group III). Heart rate and arterial pressure were registered continuously. Purposeful movements of the limbs, eye-opening, or other movements as well as coughing were documented as signs of intraoperative wakefulness. AEP were recorded in the awake state, after induction, and during maintenance of general anesthesia. Latencies of the peaks V, Na, and Pa were measured. By fast-Fourier transformation corresponding power-spectra were calculated to analyze the energy content of the AEP frequency components. RESULTS. Intraoperative wakefulness occurred statistically significantly more often in the patients of group III than in those of groups I and II. There was no correlation between wakefulness and cardiocirculatory parameters. Latencies of peaks V, Na, and Pa in the awake patients were in the normal range; the corresponding power-spectra had their major energy content in the 30-40-Hz range. After induction of general anesthesia with propofol, thiopentone, and etomidate as well as during maintenance of general anesthesia with propofol and isoflurane peak latencies of Na and Pa increased, frequencies in the 30-40 Hz range became suppressed, and MLAEP energy maxima shifted to the low-frequency range. In contrast, during maintenance of general anesthesia with flunitrazepam/fentanyl peak latencies of Na and Pa returned to awake values and frequencies in the range of 30 Hz regained energy dominance in the corresponding power-spectra. CONCLUSIONS. The maintenance of MLAEP and the primary cortical complex Na/Pa correlates with the incidence of motor signs of wakefulness. During the combination of regional and general anesthesia, isoflurane and propofol seem to provide better suppression of intraoperative wakefulness than bolus injections of flunitrazepam/fentanyl.
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PMID:[Acoustic evoked potentials of medium latency and intraoperative wakefulness during anesthesia maintenance using propofol, isoflurane and flunitrazepam/fentanyl]. 205 23

Three basic techniques (and one modified technique) were developed, allowing successful excision of subepiglottic cysts in 10 horses (5 Standardbreds, 4 Thoroughbreds, and 1 Quarter Horse; mean age, 3.5 years) via peroral approach. This approach eliminated the need for laryngotomy or pharyngotomy and reduced postoperative care. None of the cysts redeveloped. Clinical signs of disease before surgery included respiratory noise, exercise intolerance, coughing, and dysphagia and were eliminated in all horses except one that raced successfully, but in which some respiratory noise was detected. Peroral subepiglottic cyst excision was performed on anesthetized horses that were positioned in lateral recumbency and intubated via the nares and trachea. General anesthesia allowed careful intraoral palpation and endoscopic visualization of the oropharynx on a television monitor. Custom-designed instruments, including a guide tube, cyst snare, and long grasping forceps, facilitated either laser or snare, or laser and snare cyst excision. Hemorrhage was negligible in all horses. Initial attempts to develop a technique to submucosally excise subepiglottic cysts through a transnasal transendoscopic approach in conscious horses, using a contact neodymium:yttrium aluminum garnet laser, were unsuccessful. In each of 3 horses, the cyst was inadvertently penetrated before it could be excised, causing it to collapse and disappear beneath the soft palate. Postoperative complications were excessive subepiglottic swelling after laser excision (n = 1 horse), which resolved completely in response to anti-inflammatory treatment, and subepiglottic cicatrix formation after snare excision (n = 1 horse), which required surgical excision of the cicatrix.
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PMID:Evaluation of peroral transendoscopic contact neodymium:yttrium aluminum garnet laser and snare excision of subepiglottic cysts in horses. 206 Nov 80

Anesthesia of the tracheobronchial (TB) pathways during laser therapy (LT) faces a variety of problems including analgesia and sedation in patients with respiratory difficulties or who continue to breathe spontaneously while the airways are occupied by operating instruments. During the course of the study, two methods of anesthesia were compared in 36 patients undergoing LT of the TB pathways. The first method (Group A, n = 16) involved the use of Diazepam as an hypnotic starter and Fentanyl as an opioid analgesic in continuous infusion. Propofol was used both as an inducer and as the main drug in the second method (Group B, n = 20) in order to reduce the opioid dose required. The following variables were studied: heart rate, systolic and diastolic blood pressure, blood gas analytic parameters, side-effects such as cough and intraoperative movement, and disturbances of heart rhythm and conduction; in addition, the duration of operations and the time taken to regain consciousness were recorded, together with the total dose of Fentanyl used. An improved hematosis was observed in patients treated with Propofol during the operation and on regaining consciousness, and the time taken to regain consciousness was significantly reduced. No significant differences were observed between the two groups with regard to cardiocirculatory variables or undesirable effects.
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PMID:[Use of propofol during laser therapy of the tracheobronchial tract]. 208 86

Urinary incontinence was observed in 19 patients after bladder neck elevation or vaginal repair operations. Characteristically, patients could not suppress their urge to micturate on getting up in the morning, and they wet before arrival at the toilet. Urodynamically, a high posterior cough transmission ratio was noted. A 1.5 cm longitudinal incision in the vagina, dissected free and resutured horizontally (I-plasty), immediately cured this particular condition, but ultimately failed in 1/3 cases. Most of these failed patients were subsequently cured by further adjustment of vaginal tension under local anaesthesia (Tuck procedure). These findings confirm the emphasis given by the Integral Theory of Female Urinary Incontinence as to maintain adequate elasticity in the zone of critical elasticity (ZCE) of the supralevator vagina. The ZCE acts as an elastic hinge, allowing (i.e. facilitates) the separate and opposite contractile forces of anterior pubococcygeus, and levator plate which are necessary to close off urethra and bladder neck respectively. Inadequate elasticity at the ZCE converts the ZCE's role from facilitation to opposition. The stronger levator muscle contraction counteracts the forward section of the weaker anterior part of pubococcygeus muscle, preventing bladder neck closure.
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PMID:The tethered vagina syndrome, post surgical incontinence and I-plasty operation for cure. 209 76

50 non-premedicated ASA class I or II patients were allocated randomly into two groups and received either a variable infusion of propofol or midazolam for sedation during orthopaedic surgery with regional blockade. To achieve a well-sedated patient with eyes closed and able to follow commands, the dose requirements for propofol were 1.25 mg/kg +/- 0.5 as a loading dose followed by a mean infusion rate of 3.17 mg kg-1 h-1 +/- 1.4 and for midazolam 0.073 mg/kg +/-0.02 and 0.074 mg kg-1 h-1 +/- 0.14. Steady-state plasma concentrations of propofol averaged 1.23 micrograms/kg +/- 0.75 and of midazolam 134 ng/ml +/- 62. Recovery was significantly shorter for propofol: 3.42 +/- 2.5 versus 8.05 min +/6.2 for midazolam. Perioperative cooperation was similar in both groups providing good or excellent conditions in 76% with propofol and in 52% with midazolam. 2h after discontinuation of the infusion 92% of the propofol patients were alert, while 36% of the midazolam were sleeping again. Cardiovascular effects of both drugs were minimal; however significant respiratory depression and/or airway obstruction developed in both groups (propofol 48%, midazolam 52%) requiring therapeutic intervention. Additional undesirable effects were: severe cough (propofol 40%, midazolam 20%), inadvertent movements (propofol 36%, midazolam 24%), confusion (propofol 24%, midazolam 20%), euphoria (propofol 44%), pain on injection (propofol 32%). The results of the study indicate that both drugs are useful and controllable sedative agents for surgery under regional anaesthesia, provided that measures for continuous monitoring of respiration and emergency care are guaranteed.
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PMID:[Propofol infusion for sedation in regional anesthesia. A comparison with midazolam]. 220 73

The larynx normally functions in vocalization, deglutition, and respiration. There is no substitute for direct laryngoscopy in animals suspected of having laryngeal disease. Clinical signs that should alert the veterinarian include cough, choking while eating or drinking, exertional cyanosis and syncope, noisy breathing, inspiratory dyspnea, stridor, and significant change in sound production. Controlled anesthesia is mandatory for animals with suspected laryngeal disease because many of these patients have compromised respiratory function. Laryngoscopy is used to note abnormalities in the shape, color, and motility of the larynx with special attention to correlating the movement of the arytenoid cartilages and vocal folds with the respiratory cycle.
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PMID:Laryngoscopy. 223 71

Prolonged (several days or repeated) exposure to nitrous oxide (N2O) can cause injury or death. To assess whether relatively prolonged anesthesia with N2O in normal patients might similarly cause untoward effects, we investigated whether the addition of N2O to isoflurane anesthesia caused injury to patients having surgical resection of acoustic neuroma lasting approximately 10 h. Twenty-six patients undergoing surgical resection of acoustic neuroma were randomly assigned to a regimen that included or excluded N2O (50%-60%) during isoflurane anesthesia plus intravenous adjuvants. On average, slightly less isoflurane (0.24%) was used during anesthesia with N2O. We measured standard clinical variables (blood pressure, heart rate), oxygen saturation, neurologic status, pain, and the incidence and type of morbid outcomes. Exposure to N2O did not increase the incidence of morbid outcomes (including hepatic injury, infection, or hypoxemia), prolong hospitalization, or increase common postoperative complaints such as nausea, vomiting, coughing, or headache. Patients anesthetized with either regimen were equally satisfied with their anesthetic.
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PMID:Effect on outcome of prolonged exposure of patients to nitrous oxide. 224 Jun 28

We tested whether anesthesia that includes nitrous oxide (N2O) results in the development of intraoperative and postoperative pulmonary complications, including hypoxemia. We also tested whether aging contributes to the development of such complications, particularly when anesthesia includes N2O. We randomly allocated patients having total hip replacements, carotid endarterectomies, or transsphenoidal hypophysectomies (total n = 270) to an anesthetic regimen with and without N2O (stratified within surgical group). A heat-and-moisture exchanger was included in the anesthetic circuit of all patients. Patients were monitored perioperatively and for 1 wk after surgery using intermittent and continuous pulse oximetry to determine oxyhemoglobin saturation. Intraoperatively, mean oxygen (O2) saturations were lower in patients given N2O, particularly older patients. Hypoxemia (O2 saturation less than 86%) developed in five patients receiving N2O and in one receiving O2. This difference was not significant. Administration of N2O did not decrease postoperative O2 saturation, nor did it alter the incidence of postoperative hypoxemia, cough, or sputum production.
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PMID:Postoperative hypoxemia after nonabdominal surgery: a frequent event not caused by nitrous oxide. 224 Jun 30

Smooth emergence from general endotracheal anesthesia is frequently complicated by coughing induced by stimulation from an endotracheal tube. Lidocaine and other local anesthetics have been shown to anesthetize important rapidly adpating stretch receptors in the dog trachea. With the aim of providing a reservoir for continuous lidocaine release to adjacent tracheal tissue, we examined the ability of clinically used concentrations of lidocaine to diffuse across a commonly used endotracheal tube cuff. Cuffs were filled with either 2% or 4% lidocaine and placed in a 200 mL bath with samples drawn at time intervals up to 360 minutes. Samples were then analyzed for lidocaine concentration. Another set of endotracheal tube cuffs were prefilled for one or 2.5 hours with 2% or 4% lidocaine, emptied, and then refilled with 2% lidocaine. They were then bathed and sampled as above. Cuffs exposed to 4% lidocaine during the prefilling or the diffusion stages resulted in significantly higher concentrations of lidocaine in the baths throughout the time course of the experiment, although all groups demonstrated a rise in the concentration of lidocaine in the baths with time. The highest concentration obtained was 17.49 +/- 2.03 micrograms/mL after 360 minutes. We conclude lidocaine diffuses across endotracheal tube cuffs in a fashion that may enable the cuff to serve a potentially useful role as a reservoir for local anesthetic. This in turn appears to have the potential to smooth emergence from general endotracheal anesthesia in those patients in whom tracheal stimulation may be a complicating factor.
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PMID:In vitro diffusion of lidocaine across endotracheal tube cuffs. 227 11

One hundred and ten male patients scheduled for coronary artery bypass grafting were allocated randomly into one of three groups. Patients in group A received fentanyl 7 micrograms/kg via a central venous catheter, those in group B were given fentanyl 7 micrograms/kg through a peripheral venous cannula, and patients in group C received sterile water via a central venous catheter. In group A, 45.9% of patients coughed after injection of fentanyl; the mean onset time from the end of fentanyl administration to the beginning of coughing was 10.6 seconds. Only one patient in group B and no patient in the control group exhibited a cough response (p less than 0.0001). We hypothesise that fentanyl can evoke the pulmonary chemoreflex.
Anaesthesia 1990 Jan
PMID:Tussive effect of a fentanyl bolus administered through a central venous catheter. 238 94


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