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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors describe their experience of war surgery from a period of three months. A total of 635 patients, most of whom were young men, were treated. The journey to hospital was frequently very long, often lasting for several days. The lesions and types of surgery are described. Ketamine was found to be very useful for war anaesthesia.
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PMID:[Experiences of war surgery from the civil war in Afghanistan]. 198 78

Many plastic surgery procedures that have traditionally been performed under general endotracheal anesthesia may safely be undertaken using a ketamine-based intravenous sedation technique. General endotracheal anesthesia has many drawbacks, including lack of patient acceptance. Ketamine-based intravenous sedation technique includes the following steps: 1. The patient is placed in a dissociated state using sedative and narcotic agents accompanied by a subanesthetic dose (0.5 mg/kg) of ketamine. 2. A dilute local anesthetic solution (0.25% lidocaine with 1:2,000,000 epinephrine) is infiltrated into the involved tissues to provide anesthesia and hemostasis. 3. The patient is maintained in a tranquil state throughout the procedure by periodic titration of additional doses of sedative and narcotic agents. Advantages of the technique include reducing the need for intubation and its associated hazards, dramatically decreased blood loss due to use of dilute epinephrine solution, reduced recovery time, ability of patients to respond to commands during surgery, avoidance of positioning injuries and increased rapport between patient, surgeon and anesthetist. Disadvantages include respiratory depression and potential for hypoxia. Dissociative intravenous sedation combined with dilute local anesthetic provides a useful addition to the anesthetist's armamentarium.
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PMID:Reducing the need for intubation in plastic surgery. 189 65

Sixty unpremedicated outpatients undergoing elective extracorporeal shock wave lithotripsy using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive an intravenous infusion of either alfentanil or ketamine as an adjuvant to midazolam for sedation and analgesia. Although both drug regimens allowed the maximal number of shock waves and energy level, the alfentanil group had significantly better calculi fragmentation (78% vs. 50% of patients with fragments less than 2 mm). Ketamine infusion provided superior intraoperative cardiorespiratory stability; however, it was associated with more disruptive movements (22 vs. 5) and dreaming (35% vs. 5%) during the procedure (P less than 0.05). Postoperatively, confusion also occurred more frequently in the ketamine-treated patients (31% vs. 5%, P less than 0.05). Alfentanil infusion was associated with more episodes of hemoglobin oxygen desaturation to less than 90% (12 vs. 2, P less than 0.05), itching (23% vs. 4%, P less than 0.05), and ability to recall intraoperative events (45% vs. 12%, P less than 0.05). The incidence of postoperative nausea was decreased (not significantly) in the alfentanil group (32% vs. 54%). The mean anesthesia time was similar in both groups; however, discharge times (means +/- standard deviations) were shorter in the alfentanil group (142 +/- 42 min vs. 161 +/- 31 min, P = 0.05). These data suggest that although both techniques proved effective for anesthesia in outpatients undergoing immersion lithotripsy, alfentanil is superior to ketamine as part of a sedative-analgesic technique because of the improved recovery profile and calculi fragmentation.
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PMID:Comparison of alfentanil and ketamine infusions in combination with midazolam for outpatient lithotripsy. 204 57

The combination of propofol and ketamine for total intravenous anesthesia was investigated; the intention was to minimize the side effects of each drug by the concomitant application of the other drug. METHODS. Twenty patients scheduled for lower abdominal interventions were divided into two groups. In the first group anesthesia was induced and maintained by a simple administration regimen based upon pharmacokinetic principles. Ketamine and propofol were given as bolus injections (60 mg each) with a time interval of 60 s for induction followed by a two-step infusion regimen for propofol (15.5 mg/min) and later on by an additional ketamine infusion (1-2 mg/min). Bolus injections (20 mg) of ketamine were administered to increase the depth of anesthesia if necessary (Fig. 1). The second group received propofol and ketamine by microprocessor-controlled infusion pumps requiring the anesthetist to operate a single dial to preset the desired blood levels of both drugs according to the needs of the individual patient (Fig. 2). RESULTS. There were no difference (Table 1) between the two groups in the demographic data of the patients or duration of surgery (30-120 min). The total doses of propofol (750 +/- 262 vs 624 +/- 468 mg) and ketamine (158 +/- 41 vs 99 +/- 48 mg) were smaller in the computer-controlled infusion group, though this difference just failed to be significant. The hemodynamic changes during induction were minor, with a small nonsignificant increase in all parameters (Fig. 3) for 10 min. The controllability of the pharmacodynamic effects of both drugs during anesthesia was very satisfactory in the computer-assisted infusion group and quite satisfactory in the first group. There were no psychic disturbances during induction of or recovery from anesthesia. Respiration was adequate within a few minutes after the end of surgery. The patients were awake about 10 min later and fully oriented after 20 min. No major side effects were observed with this anesthetic technique. CONCLUSION. Total intravenous anesthesia with propofol and ketamine proved to be very satisfactory from a clinical point of view. The major known side effects of propofol (reduced hemodynamics during induction) and ketamine (psychic disturbances and cardiovascular stimulation) were absent and respiratory function was adequate after the end of surgery. This technique, therefore, can be used in risk patients and under disaster conditions when i.v. access is the only possible route of drug administration. The use of computer-assisted infusion pumps markedly enhances handling and controllability of total i.v. anesthesia.
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PMID:[Optimal dosage strategies in total intravenous anesthesia using propofol and ketamine]. 163 23

Propofol (Diprivan), a modern intravenous hypnotic, produces a reduction in both cardiac index (CI) and mean arterial pressure (MAP). Ketamine (Ketanest), a potent analgesic, in contrast, causes an increase in MAP and CI. The aim of the present study was to investigate whether the combination of propofol and ketamine can give better hemodynamic stability during the induction and maintenance of general anesthesia than propofol used with fentanyl, whose cardiodepressant actions may cumulate. METHODS. For induction of general anesthesia 10 patients (ASA I and II) each received 3-5 boluses of propofol (0.5 mg.kg-1 during 35 s until predetermined level of anesthesia was reached (stage D2/E0 according to [20]) followed by a continuous propofol infusion (0.120 mg.kg-1.min). Fentanyl 0.1 mg was administered to each patient in group A for induction of anesthesia and again if evident pain was present. In group B ketamine was given following a pharmacokinetic model based on computer-simulated calculation. After an initial bolus of 38 mg injected within 2 min further doses of 42 mg, 35 mg, 32 mg and 28 mg ketamine were administered over 30 min at a time. Signs of evident pain were treated by means of supplementary doses of 0.5 mg.kg-1. RESULTS. In both groups a moderate drop of MAP was observed after the induction of general anesthesia. Two patients in each group showed a distinct decrease in MAP (-32%). The heart rate dropped slightly (-9%) in group A, but did not change in group B. Following intubation the MAP rose by less in group A (+8%) than in group B (+21%). After the beginning of the operation the group treated with propofol/fentanyl showed major hemodynamic changes; in particular, bradycardia with less than 40 bpm was observed in more patients than in the propofol/ketamine group. Postoperatively, fewer patients in group B required rescue doses of analgesics (1 of 10) than these in group A (7 of 10), though vigilance was better in group B. DISCUSSION. The dose of ketamine administered during the induction of general anesthesia may have been not high enough to neutralize the cardiodepressant effect of propofol. But during the maintenance of anesthesia there was in fact better hemodynamic stability in group B than in group A as a result of the neutralization of opposing actions. Fentanyl even intensified the fall in MAP after propofol. Patients in group B showed better vigilance as well as better pain relief postoperatively. The population of the fentanyl group was obviously more deeply sedated and analgesia was still inadequate. In our study general intravenous anesthesia with propofol and ketamine offered the advantages of better analgesia, a higher state of vigilance and the absence of respiratory depression during the postoperative phase compared with the combination of propofol and fentanyl.
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PMID:[The effect of propofol-ketamine anesthesia on hemodynamics and analgesia in comparison with propofol-fentanyl]. 207 45

1. To assess the direct spinal contributions to the depression of reflexes caused by general anaesthetics, the intravenous potency of four injectable anaesthetics has been compared in two preparations: in decerebrate, spinalised rats, using a novel preparation requiring little surgical intervention, and in intact rats with chronically implanted i.v. cannulae. 2. Methohexitone (1-8 mg kg-1 i.v.), alphaxalone/alphadolone (0.5-8 mg kg-1 i.v.), alpha-chloralose (20-80 mg kg-1 i.v.) and ketamine (0.5-16 mg kg-1 i.v.) all produced a dose-dependent depression of single motor unit activity evoked by controlled noxious mechanical stimuli in decerebrate, spinalised animals. 3. The sedative and motor effects brought about by equivalent doses to those used in the electrophysiological experiments were assessed in intact rats. Methohexitone, alphaxalone/alphadolone and alpha-chloralose all caused similar levels of behavioural sedation at the doses that caused depression of spinal reflexes. Ketamine required relatively much higher doses to cause sedation. 4. To determine whether background anaesthesia modulated the potency with which these compounds affected spinal reflex activity, depressant effects in decerebrate, unanaesthetized rats were compared with those in animals maintained under anaesthesia with either alpha-chloralose or the steroid mixture of alphaxalone/alphadolone. The presence of either of these two agents as maintenance anaesthetics did not influence the effectiveness with which other compounds depressed nociceptive responses. However, additional doses of the maintenance anaesthetics were less effective than the same doses tested in decerebrate animals. 5. All the anaesthetics tested produced a significant depression of spinal reflex responses to noxious stimuli at doses well below those required for anaesthesia. Whilst the presence of maintenance anaesthetics appears not to distort pharmacological tests of other agents, there may nonetheless be a biasing of the samples of cells recorded.
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PMID:Spinal effects of four injectable anaesthetics on nociceptive reflexes in rats: a comparison of electrophysiological and behavioural measurements. 207 76

The concept of combined anaesthesia, the centrally-acting muscle relaxant guaifenesin (My 301) in a 5% solution with ketamine (and/or fentanyl) in addition to the inhalation of nitrous oxide and halothane is based upon the principle of "balanced anaesthesia". Guaifenesin amplifies the effect of several anaesthetics, which complement one another, allowing the dosage to be decreased and thereby reducing the cardiovascular stress. To induce anaesthesia, the combination of a cataleptic anaesthetic (ketamine = Ketanest, Ketolar) and a centrally acting skeletal muscle relaxant (guaifenesin = Myolaxin, My 301) is used. Because of the risk of aspiration the animal should be intubated as soon as possible. Anaesthesia will be prolonged by the carrier gas nitrous oxide (65%, weakly analgesic)/oxygen (65%), low concentrations of halothane (1.0 to 0.6 to 0.4%, weakly hypnotic and analgesic) and by a continuous drip infusion of 5% guaifenesin (relaxing, mild analgesic and sedative). The effect of all the other anaesthetics is increased by guaifenesin. To increase the analgesia and to control the cardiovascular parameters the additional injection of ketamine or fentanyl is recommended. The recovery period is short and the general condition is good both after a lengthy anaesthesia of 9 hours (n = 32) and after anaesthesia of 2 hours. No significant adverse effects on the cardiovascular system were detected.
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PMID:[Combination anesthesia in sheep with ketamine-(fentanyl)-guaifenesin (My 301)-laughing gas-halothane]. 208 May 2

The effects of ketamine (3, 10 and 30 mg/kg) alone and in combination with verapamil (10 mg/kg) or diltiazem (30 mg/kg) on the acquisition, consolidation and retrieval of memory using a passive avoidance task in mice were studied. Ketamine significantly inhibited the acquisition and consolidation of memory at 10 and 30 mg/kg dose levels and these effects were antagonized by diltiazem 30 mg/kg but not by verapamil 10 mg/kg. Studies of sleeping time demonstrated that pretreatment with verapamil 10 mg/kg increased the duration of sleeping time. Diltiazem, however, did not potentiate the effects of ketamine on sleeping time. The present findings indicate that diltiazem can counter the effects of ketamine on memory. The data also indicates that pretreatment of surgical patients with verapamil may reduce the dose of ketamine required for anesthesia.
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PMID:Interactions of verapamil and diltiazem with ketamine: effects on memory and sleeping time in mice. 208 52

Experiments were performed on 10 healthy Wistar rats with chronically implanted electrodes for the recording of electrocorticogram (ECoG), electro-oculogram (EOG), and electromyography (EMG). All the rats were prepared for the implantation of recording electrodes under 5% Ketamine (100 mg/kg i.p.) anesthesia. Four to six days after operation, the rat was put in an apparatus which was designed specifically sensitive to detect the movement of the animal without electrode on the body so that electroactogram (EAG) could be recorded readily. One group of experiment animal (n = 5), recorded ECoG, EAG, EOG and EMG simultaneously, was compared to another group (n = 5), recorded ECoG and EAG simultaneously. The results of experiments indicate that the ECoG, recorded from the the mesial frontal and occipital areas, have certain characteristics during different sleep phases, and the characteristics for classifying sleep phases by the two kinds of somnopolygram are similar. Therefore, simultaneous recording of the ECoG and EAG can be used to discriminate the sleep phases in the rat. In this way, the somnopolygraphic recording method for studying sleep in the rat would be simplified.
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PMID:[A simplified polygraphic method for studying sleep in the rat]. 209 36

The effects of general anesthesia on the levels of baseline and inducible splenic natural killer (NK) activity of mice were examined. General anesthesia significantly inhibited the induction of NK activity by Poly I:C, while having no effect on baseline NK. Since this effect was reproduced using three different anesthetics (Avertin, ether, and Ketamine/Xylazan), the inhibition of inducible NK activity is probably due to the state of general anesthesia, rather than to the pharmacological properties of the anesthetics. Inhibition of the Poly I:C mediated induction of NK was observed for at least 4 days after anesthesia. In contrast to anesthesia alone, anesthesia with surgery significantly decreased baseline NK activity. However, the addition of surgery to anesthesia did not significantly alter the level of inhibition of NK stimulation by Poly I:C compared to anesthesia treatment alone. Experiments assessing the NK modulatory effects of surgery alone were not performed. Interestingly, neither anesthesia alone nor anesthesia with surgery were able to significantly decrease splenic NK activity that had been induced with Poly I:C prior to anesthesia. In view of the important role of NK cells in the innate immune defenses, the possible clinical applications of these results are discussed.
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PMID:Anesthesia inhibits poly I:C induced stimulation of natural killer cell cytotoxicity in mice. 211 48


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