Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Plasma lidocaine concentrations, latency of onset, and duration of anaesthesia, were determined after interscalene brachial plexus block in 16 patients presenting for elective upper limb surgery. Eight patients had normal renal function and eight had chronic renal failure, as determined by creatinine clearance. Significantly higher plasma lidocaine levels were recorded ten minutes after infiltration in patients with chronic renal failure (p less than 0.05). Cmax plasma levels for normal patients (5.6 +/- 1.1 micrograms.ml-1) and for patients with chronic renal failure (6.6 +/- 1.6 micrograms.ml-1) were not significantly different. The latency of onset and duration of anaesthesia were similar in both groups. One per cent lidocaine solution may be administered to patients with normal and impaired renal function to provide effective brachial plexus blockade for short surgical procedures.
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PMID:Interscalene brachial plexus blockade with lidocaine in chronic renal failure--a pharmacokinetic study. 291 37

The hyperglycemia usually observed in patients undergoing heart surgery with extracorporeal circulation (EC) represents a difficult therapeutic problem. We studied the effects of several regimens of insulin therapy on serum glucose (SG) in 24 noninsulin dependent diabetic patients (NIDDs). The patients were randomly divided in five groups; group A received on IV bolus of 10.0-50.0 U/h according to glycosuria; groups B, C, D and E were given a continuous iv insulin infusion of 2.5, 5.0, 7.5 and 10.0 U/h respectively. In 10 non-diabetic patients (NDP) SG levels were also measured, but insulin was not given. A mean of 5.0 l/m2 of body surface of fluids containing 300 g of glucose were administered to all patients during surgery. At the operations SG levels rose progressively soon after the anesthesia was started, reached the highest values during the period of EC, and decreased slowly in blood samples taken after the EC phase and by 24h. This patterns was shown by all groups studied statistically significant lower SG levels, however, were observed in patients of group C, whose values were similar to those seen in the NDP group. Groups D and E had slightly higher SG levels than those of group C. An additional NIDDM patient with advanced chronic renal failure (CRF), had a tendency to hypoglycemia even during the EC period in response to relatively low doses of insulin (2.5 U/h), given by a continuous iv infusion and, although the insulin administration was stopped, his SG levels remained well below the mean values of the other patients for the rest of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Perioperative management of the diabetic patient in cardiac surgery with extracorporeal circulation]. 293 94

Renal failure and chronic haemodialysis are often associated with alterations in fluid status and plasma proteins. These changes, in turn, may result in pharmacokinetic alterations in affected patients. The purpose of this study was to investigate the pharmacokinetics of sufentanil in chronic renal failure patients undergoing kidney transplantation. Ten male patients were studied. Following induction of anaesthesia each patient received sufentanil 2.0 micrograms.kg-1 IV with subsequent serial plasma sampling for drug measurement from one to 360 minutes. A biexponential equation provided the best fit of the sufentanil concentration data with mean +/- SEM distribution (alpha) and elimination (beta) half-lives of 2.9 +/- 1.3 and 176 +/- 87 minutes, respectively. The mean Vc and Vd beta values were 0.15 +/- 0.05 L.kg-1 and 0.85 +/- 0.16 L.kg-1, respectively; plasma drug clearance was 11.5 +/- 3.7 ml.kg-1.min-1. Mean values for K10, K12 and K21 were 0.15 +/- 0.06.min-1, 0.4 +/- 0.14.min-1 and 0.1 +/- 0.04.min-1, respectively. With the exception of Vd beta, these pharmacokinetic values are similar to those reported in previous studies in general surgical, elderly and burn patients. The Vd beta values observed in this study may have resulted from alterations in drug distribution or elimination following revascularization of the implanted kidneys. Nevertheless, it appears that modification of sufentanil doses is unnecessary in chronic renal failure patients undergoing renal transplantation.
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PMID:Pharmacokinetics of sufentanil in patients undergoing renal transplantation. 252 91

Twenty consecutive patients with chronic renal failure (CRF) and 20 control patients received subarachnoid anaesthesia with 3 ml of 0.75% bupivacaine plain for surgery in the lower abdomen. Sensory analgesia (onset) developed significantly more rapidly in the CRF patients: maximum segmental level of pin-prick analgesia was reached in an average of 21 min in the CRF patients and in 35 min in the control patients. An observed tendency to acidosis and a possible reduced intrathecal space in the uraemic patients may account for the more rapid blockade. The mean spread of the sensory block in CRF patients (T4) was two segments higher than that in the control patients, but because of marked inter-individual variation this difference cannot be considered clinically important. Three CRF patients and two control patients had insufficient analgesia for surgery. In the CRF patients, both sensory and motor blockades were of shorter duration than in the control patients. The incidence of complaints of nausea and backache was similar in the groups. One control patient had a headache.
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PMID:Subarachnoid anaesthesia with 0.75% bupivacaine in patients with chronic renal failure. 370 97

Thrombectomy of a graft in ambulatory patients can be performed simply under local anesthesia, avoiding admission to hospital of patients with shunts. The technique is applicable to two types of shunt: arterio-arterial shunts for lower limb arteriopathy and arteriovenous shunts of a dialysis for chronic renal failure. The advantages are twofold: dissection of a subcutaneous graft is avoided and the patient can either immediately reinstitute activity if arteritic or dialysis for renal failure. The method is effective if the thrombus is of accidental origin, failures resulting from proximal or distal stenosis, their evaluation being possible during thrombectomy.
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PMID:[Ambulatory thrombectomy of a graft. Transcutaneous clamping]. 374 25

The effect of chronic renal failure (RF) on the pharmacokinetics of morphine was studied in nine patients with end-stage RF, aged 58 +/- 8 yr (SD), and in seven control patients, aged 58 +/- 15 yr, undergoing peripheral surgery under general anesthesia. All patients received 0.2 mg X kg-1 as an intravenous bolus injection. Blood samples were collected over a 36 h period, and plasma concentrations were measured using a specific radioimmunoassay method. Unchanged morphine could be identified for only 12 h in all patients. The mean plasma concentrations of unchanged morphine were similar in the two groups, except in the first sample (5 min) where it was higher (P less than 0.05) in RF group. Patients with RF had a significantly smaller (P less than 0.05) central compartment (0.3 +/- 0.2 l X kg-1 versus 0.8 +/- 0.4 l X kg-1) than in the controls. Volume of distribution at steady state was also significantly (P less than 0.05) decreased in RF patients (2.8 +/- 1.0 l X kg-1) versus 3.7 +/- 1.2 l X kg-1 in the normal patients. The total apparent volume of distribution, the elimination half-life, and the plasma clearance were similar in the two groups. Identical peak levels of morphine metabolites were observed in the two groups, but plasma concentration of morphine metabolites was undetectable after 12 h in the control group and remained at a high level of 82 +/- 49 ng X ml-1 at 24 h and 83 +/- 57 ng X ml-1 at 36 h in RF patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Morphine pharmacokinetics in renal failure. 382 90

Among 606 patients on maintenance dialysis in the same unit, 111 (18.3%) underwent various surgical procedures. 14 additional patients on dialysis in other units were included in this group. A total of 138 surgical procedures were performed in these 125 patients, of which 112 were on hemodialysis. In 57 patients, surgery was warranted by a complication directly related to the chronic renal failure. In 81 patients, surgery was indicated because of an associated condition, a complication resulting from therapy, or a coincidental surgical affection. After these 138 procedures, 27 post-operative complications (19,6 %) and 15 deaths (10,86 %) were reported. The mean age for deceased patients is 66 years. These findings show that surgical morbidity and mortality, even after major procedures, are not prohibitive in patients on dialysis, if certain measures are taken during dialysis, anesthesia, surgery, and post-operative care. These measures are reviewed in the study.
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PMID:[Surgery in patients with chronic renal failure on maintenance dialysis (author's transl)]. 627 27

Secondary hyperparathyroidism is a recognized complication which develops in patients on hemodialysis for chronic renal failure. Parathyroidectomy may be required in patients with severe renal osteodystrophy, intractable pruritus, soft tissue and vascular calcifications or neuromuscular abnormalities. Three different operations have been employed in the treatment of patients with secondary hyperparathyroidism: total parathyroidectomy, radical subtotal (3 1/2 gland) parathyroidectomy and total parathyroidectomy with heterotopic autotransplantation. The last technique has been the procedure of choice in our group because the parathyroid mass is effectively reduced, and the results are comparable to those obtained with other techniques. Furthermore, the complication of graft dependent hyperparathyroidism, should it develop, can be managed by excising a portion of the transplanted tissue under local anesthesia.
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PMID:Surgical treatment of secondary hyperparathyroidism. 635 46

Two hundred and seventy patients underwent anaesthesia for 280 renal transplants between October 1977 and October 1982. Their medical records were studied retrospectively. These patients were representative of the end-stage chronic renal failure population, with the usual high incidence of cardiovascular and biochemical abnormalities. Most received general anaesthesia, with an intravenous barbiturate, muscle relaxant, narcotic and volatile supplement sequence being the most common. There were no intra-operative deaths. One postoperative death was felt to be influenced by the anaesthetic management. Four patients had life-threatening cardiac complications and a further four required postoperative respiratory support, three for delayed recovery of neuromuscular function and one for "recurarisation". Less serious complications were considerably more common. General anaesthesia utilising suxamethonium and tubocurarine as the relaxants and halothane as the volatile supplement is least likely to result in complications. Changes to this anaesthetic sequence are likely with the introduction of new agents.
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PMID:Anaesthesia for renal transplantation--5 years' experience. 635 50

Forty-three patients with chronic renal failure and secondary hyperparathyroidism underwent parathyroidectomy; 20 of the 43 underwent subtotal parathyroidectomy (Group A) and 23 patients underwent total parathyroidectomy and parathyroid autotransplant in the forearm (Group B). Postoperative clinical improvement was similar in both groups. In the immediate postoperative period eight patients in Group A who had severe bone changes and 21 patients in Group B needed supplemental calcium administration. The grafted tissues in all cases functioned well; reimplantation of the cryopreserved parathyroid tissues was unnecessary. One case in each group showed a recurrence. One patient in Group A was submitted to reexploration of the neck with a lateral approach. The other patient in Group B underwent excisions of the transplanted parathyroid tissues on three separate occasions under local anesthesia. The second operation was definitely easier and safer to manage after a total parathyroidectomy with autotransplantation to the forearm.
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PMID:Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure. 673 23


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