Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nitrogen (N2) may accumulate to unacceptable levels during closed-circuit anesthesia (CCA) when the sampled gases are redirected to the anesthesia circuit, because many gas analyzers entrain air as a reference gas to calibrate for oxygen analysis. Using oxygen instead of air as the reference gas for paramagnetic oxygen analysis could attenuate N2 accumulation. Forty-three adult ASA physical status I-III patients undergoing a variety of peripheral and abdominal procedures were assigned to one of two groups, depending on the reference gas used by a paramagnetic oxygen analyzer, either air (group I, n = 23) or oxygen (group II, n = 20). Gases sampled by the multigas analyzer were redirected to the anesthesia circuit. End-expired N2 (N2Et) was calculated as "balance gas": (100 - %O2 - %anesthetic vapor - %CO2). N2Et after 55 min (N2Et55min) was correlated with the end-expired N2 concentration when the circuit was closed (N2Et0min) and 5 min (N2Et5min) thereafter. In group I, N2Et accumulated almost linearly over time (t, min): N2Et (%) = 2.47 + 0.61 * t (r2 = 0.999). N2Et0min, N2Et5min, and N2Et55min were 1.3+/-0.8, 5.3+/-1.7, and 35.3+/-5.3%, respectively (mean +/- SD). The correlation (r2) between N2Et55min and N2Et0min was 0.19, and between N2Et55min and N2Et5min it was 0.56. In group II, N2Et increased exponentially: N2Et (%) = 1.01 + 11.9 * (1 - e(-t/43.5)) (r2 = 0.99). N2Et0min, N2Et5min, and N2Et55min were 0.87+/-0.93, 2.6+/-1.5, and 10.1+/-2.9%, respectively. The correlation (r2) between N2Et55min and N2Et0min was 0.04, and between N2Et55min and N2Et5min it was 0.40. We conclude that paramagnetic oxygen analyzers that use oxygen as the reference gas significantly attenuate N2 accumulation during CCA, which may reduce the need for frequent flushing of the anesthesia system, may provide more constant oxygen and nitrous oxide concentrations, and may simplify pharmacokinetic studies of potent inhaled anesthetics.
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PMID:Influence of the reference gas of paramagnetic oxygen analyzers on nitrogen concentrations during closed-circuit anesthesia. 1002 34

A 32-year-old woman was admitted with a diagnosis of impending premature delivery. In the 37th week of pregnancy, vaginal examination was performed. After ten minutes, vomiting, whole body flushing, and cold sweat appeared suddenly. Because fetal heart rate became 60-70 beats.min-1, emergency caesarean section was scheduled. When she arrived at the operating room, blood pressure was 75/45 and heart rate was 122 beats.min-1. Five minutes later, anesthesia was induced with thiopental and vecuronium, and operation was instituted concomitantly. After the delivery, pentazocine and midazolam were administered. During the operation, premature separation of normally implanted placenta or pressed cord was not observed. Hydrocortisone was administered for circulatory collapse. Gabexate mesilate was administered for the prevention of DIC. The scratch test, performed ten days later, revealed that latex was positive but lidocaine was negative. Therefore, it was concluded that anaphylaxis induced by latex gloves caused shock after internal examination.
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PMID:[A case of emergency caesarean section as a result of anaphylaxis to latex]. 1003 99

Prolonged postoperative recuperation time and restricted exercise were circumvented by using ballistic shock wave lithotripsy to break up an 8-cm diameter vesical calculus and by flushing out the sand-like residue under epidural anesthesia with the horse standing. Recovery was uneventful.
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PMID:Ballistic shock wave lithotripsy in an 18-year-old thoroughbred gelding. 1008 19

We report a case of postoperative apnoea in the recovery room, 25 minutes after tracheal extubation, in a fully awake patient. This event occurred after flushing of an obstructed IV line into which remifentanil had been injected through a 3-way stopcock during anaesthesia. The means for prevention of such an adverse event are discussed.
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PMID:[Remifentanil: postoperative respiratory depression after purging of the infusion line]. 1048 39

We have investigated inspiratory and end-tidal gas composition during sevoflurane anaesthesia in a closed circle system with continuous gas flow (70 litre min-1, Physioflex) to determine possible accumulation of sevoflurane degradation products. During five abdominal operations in adults lasting more than 2 h, anaesthesia was maintained with an end-tidal concentration of 2% sevoflurane in 40% oxygen-air. The circle included an absorbing canister filled with 1 litre of fresh soda lime. Samples were obtained at the end of an expiration from the tracheal tube and from the inspiratory limb before, and at selected times after, addition of sevoflurane. The temperature of soda lime was 24.7 +/- 0.7 degrees C at the beginning and reached a maximum of 31.2 +/- 1.0 degrees C after 20-30 min, followed by a plateau. Inspiratory compound A (CH2F-O-C(= CF2)(CF3)) 3-8 ppm was detected after 10 min, but did not accumulate in the circle over 2 h without flushing. Expired concentrations were consistently lower with 1.5-3 ppm signalling absorption by patients. Calculated total amounts absorbed over 2 h varied between 2.0 and 7.2 ppm h. Other degradation products such as compound B or methanol were not detected. In summary, we did not detect sevoflurane metabolites with soda lime in significant amounts during closed circle anaesthesia with the Physioflex. The observed concentrations of compound A were below the threshold of nephrotoxicity in rats by a factor of more than 20.
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PMID:Compound A does not accumulate during closed circuit sevoflurane anaesthesia with the Physioflex. 1067 71

The high price of xenon has prevented its use in routine, clinic anaesthetic practice. Xenon therefore has to be delivered by closed-circuit anaesthesia. The accumulation of nitrogen is a significant problem within the closed circuit and necessitates flushing, which in turn increases gas expenditure and costs. In previous investigations, nitrogen concentrations between 12% and 16% have been reported in closed-circuit anaesthesia. In order to avoid such nitrogen accumulation, we denitrogenised seven pigs using a non-rebreathing system and connected the animals to a system primed with a xenon/oxygen mixture. In comparison, seven pigs were anaesthetised with xenon using a standard low-flow anaesthetic procedure. Anaesthesia time was 2 h. Nitrogen concentrations in the closed system ranged from 0.08 to 7.04% and were not significantly different from those observed during low-flow anaesthesia. Closed-circuit anaesthesia reduced the xenon expenditure 10-fold compared with low-flow anaesthesia.
Anaesthesia 2001 Apr
PMID:Xenon expenditure and nitrogen accumulation in closed-circuit anaesthesia. 1128 15

BACKGROUND: Infants usually respond differently to a neuromuscular relaxant compared to children or adults. Isoflurane is commonly used as an anesthetic gas in infants. In an RCT design, we investigated whether a dose of mivacurium 250 &mgr;g/kg results in faster onset of action than 200 &mgr;g/kg in infants under isoflurane anesthesia. Spontaneous recovery times and cardiovascular response were also evaluated. METHODS: Twenty-four low surgical risk children, aged 6-24 months, undergoing an elective surgery and requiring tracheal intubation were selected. After anesthetic induction, patients randomly received an iv bolus dose of mivacurium 200 or 250 &mgr;g/kg. After maximal relaxation, the patient was intubated. Isoflurane was administered to maintain anesthetic level during the surgical procedure. Neuromuscular function was monitored by accelerometry (TOF-Guard) at the adductor pollicies. The first twitch (T) of the TOF and the T4/T1 were measured. The time-course of heart rate and systolic and diastolic blood pressure were analysed by transforming them into their respective areas under the curve. RESULTS: Mivacurium 250 &mgr;g/kg produced a maximal T block faster than 200 &mgr;g/kg, i.e. 2.4 +/- 1.1 vs. 3.5 +/- 1.4 min (p < 0.05). Spontaneous recovery times were similar in both groups. Heart rate was similar between doses while systolic and diastolic blood pressures were lower with the higher dose (p < 0.05). Flushing was observed in two cases, one in each group. CONCLUSIONS: The maximal effect of mivacurium 250 &mgr;g/kg, in infants under isoflurane anesthesia, was present one minute faster than 200 &mgr;g/kg. However, it produced a significant cardiovascular response.
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PMID:Effect of mivacurium 200 and 250 &mgr;g/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]. 1172 96

Carcinoids are rare tumors of enterochromaffin cells. The carcinoid-syndrome most often occurs with hepatic metastases of carcinoids and is evoked by release of serotonin and other vasoactive substances, leading to typical symptoms such as hyper- or hypotension, bronchospasm, tachycardia, diarrhoe, and flushing. A lethal perioperative "carcinoid-crisis" may occur. We report on a patient with carcinoid-syndrome due to liver metastases undergoing hemihepatectomy. For prophylaxis, the patient preoperatively received H 1- and H 2-histamine-receptor antagonists, corticosteroids, and a continuous somatostatin infusion. Besides monitoring cardiovascular variables we intermittently measured serotonin- and catecholamine concentrations. Initially increased serotonin concentration decreased during the course of anaesthesia. However, it increased again during liver resection despite Pringle's manoeuvre and was associated with a decrease in arterial pressure, systemic vascular resistance, and central venous pressure. Hypotension was treated by volume and noradrenaline infusion. Thus, despite somatostatin infusion serotonin release is still possible, especially during surgical manipulation.
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PMID:[Anaesthetic management for hemihepatectomy in a patient with carcinoid-syndrome]. 1174 74

Surgical embryo transfer of farmed European polecat (Mustela putorius) was investigated as part of an ex situ preservation project. The long-term objective of the project is to develop effective technology for ex situ conservation of the European mink (Mustela lutreola), which is a highly endangered aboriginal European species. Twenty European polecat females, which served as a model species for the European mink, were humanely killed 4-9 days after first mating and embryos were recovered from oviducts and uteri. Donor-recipient pairs (n = 16) were generated by mating the donors (n = 20) once a day for 2 consecutive days with fertile males and by mating the corresponding recipients (n = 16) on the same days with vasectomized males. An embryo recovery rate of 70% (200 recovered embryos/284 corpora lutea) was achieved from 20 donors. Morulae and blastocysts were recovered between Days 5 and 9 after first mating and were regarded as the best developmental stages for uterine embryo transfer. A total of 172 embryos were transferred surgically under general anaesthesia into the ovarian third of the left uterine horn of 16 recipients with a thin glass capillary. Eleven recipients (69%) produced 72 pups equivalent to an average success rate of 42% (72 pups/172 transferred embryos). The average litter size was 4.5 (range 0-9). These results with this model species, farmed European polecat, demonstrate the potential of embryo transfer as an effective method for the preservation of the endangered European mink (M. lutreola). These species are closely related and have a similar reproductive physiology. However, success of applying embryo transfer in conserving European mink is still dependent on further studies both into its reproductive physiology and developing of improved flushing techniques for anaesthetized donors and the successful transfer of frozen-thawed embryos.
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PMID:Surgical transfer of in vivo produced farmed European polecat (Mustela putorius) embryos. 1214 67

We compared three different methods of anesthesia for outpatient knee arthroscopy in terms of perioperative surgical conditions, pain, and hemodynamics. In a prospective and double-blind study ( n=130) the patients were randomized into three groups. A 50-ml mixture composed of 20 ml 0.5% bupivacaine hydrochloride, 10 ml 2% lidocaine hydrochloride, and 20 ml 0.9% sodium chloride was prepared for local anesthesia. The knee joint was injected with 40 ml of the mixture. The portal sites were then injected with 10 ml of the mixture in group I. Using the same technique 250 micro g epinephrine was added to the same mixture in group II. In group III the knee joint was injected with 40 ml of the mixture, and only 50 micro g epinephrine was then added to 10 ml of the mixture left before the portal site injections. A tourniquet was not used. There were some statistically significant changes in hemodynamic data. Also the data on visual analogue scale scores, time of arthroscopy, and amount of liquid used for intra-articular flushing in group II and III were significantly lower than those in group I. According to our experience, bleeding in arthroscopy comes mostly from portal incision to intra-articular field, except when performing extensive synovial shaving, ligament reconstruction, and lateral retinacular release. Therefore, when hemostasis is obtained at portals, the arthroscopic view becomes clearer. We think that adding epinephrine to only portal site injections is sufficient to obtain a clear view and, furthermore, when carrying out arthroscopy in this manner, no significant changes are encountered in heart rate, mean arterial pressure, pain during arthroscopy, or time of arthroscopy.
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PMID:Effects of epinephrine in local anesthetic mixtures on hemodynamics and view quality during knee arthroscopy. 1217 16


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