Background: Ropivacaine is a new amide local anesthetics, having therapeutic properties similar to those of bupivacaine but less cardiovascular toxicity and motor blockade. The aim of this study was to evaluate the effects of ropivacaine used in stellate ganglion block (SGB) compared with those of lidocaine or bupivacaine. Methods: This prospective and crossover study performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB, in the paratracheal approach using 8 ml of 1% lidocaine, 0.2% bupivacaine, and 0.2% ropivacaine respectively without any orders. Onset time and action duration of Horner's syndrome were observed after each SGB. Results: Onset time of ropivacaine was the middle of the three agents; earlier lidocaine and slower bupivacaine. Lidocaine ($3.0{\pm}1.9$ min), bupivacaine ($4.1{\pm}2.9$ min) and ropivacaine ($3.3{\pm}1.3$ min). But there were no significant differences; Action duration of Horner's syndrome of ropivacaine (223.6?105.2 min) was longer than lidocaine ($134.6{\pm}77.3$ min) and shorter than bupivacaine ($241.2{\pm}115.8$ min). There were significant differences in the action duration of each local anesthetics (P<0.05). There was no critical side effects and temporary foreign body sensation was the most common side effect. Conclusions: We conclude that ropivacaine is a good alternative in SGB instead of lidocaine or bupivacaine. Ropivacaine is a long acting local anesthetic similar to those of bupivacaine with wide margin of safety. However, optimal concentration and volume of ropivacaine in SGB should be studied.
The author has experienced 50 cases of vocal nodules and polyps in our department for 3 years from May 1974 to April 1977. These nodules were removed out with laryngeal forcep under indirect laryngoscopy and maximum phonation time and timbre of the voice were analyzed before and after operation. Very shortened phonation time of the patient with vocal nodule has returned to normal range (Male : 30 seconds, Female: 20 seconds) and the voice timbre has recovered to almost normal voice postoperatively. The author has made a brief literature review.
Kim, Mi-Seon;Seo, Kwang-Suk;Kim, Hyun-Jeong;Han, Hyo-Jo;Shin, Teo-Jeon;Chang, Ju-Hea
Journal of The Korean Dental Society of Anesthesiology
/
v.11
no.2
/
pp.146-152
/
2011
Background: Elderly patients with progressive dementia including Alzheimer's disease (AD) are more and more often scheduled to undergo general anesthesia for various pathologies including dental problem. But, there is high risk of deterioration of underlying mental diseases and other co-morbidities. So it is important to implement preventive strategies and take adequate measures to minimize negative perioperative events in these patients. Methods: We reviewed the 17 cases of 11 patients with AD who underwent ambulatory general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 68 (57-81) years. All of them were diagnosed with AD and some had hypertsnsion, bronchiectasis, urinary incontinence. For anesthesia induction, 3 cases (1 patient) was needed physical restraint, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (11 cases), propofol (3 cases) and sevoflurane (3 cases). All patients received nasotracheal intubation without difficulties. Mean total anesthetic time was 3 hour 44 min ${\pm}$ 60 min and staying time at PACU was 83 ${\pm}$ 34 min. All the patients except one who showed hypertension discharged without any complication. There was no death or long term hospitalization because of severe complications. Conclusions: If general anesthesia is needed, pertinent diagnostic tests and workup about other medical problems, and appropriate anesthetic planning are essential for safety.
Background: Inappropriate use of intravenous and inhaled anesthetics may be dangerous in infants undergoing facial cleft surgeries. This study primarily aimed to compare the effect of infraorbital nerve block on sevoflurane requirement in infants undergoing cheiloplasty. Intraoperative opioid consumption, hemodynamics, blood glucose levels, extubation time, and delirium were also compared. Methods: This prospective, randomized, double-blinded study was conducted in 34 infants undergoing cheiloplasty under general anesthesia. After induction, group A received bilateral infraorbital nerve block with 0.5 mL of 0.5% bupivacaine and group B 0.5 mL saline. An increase in heart rate or blood pressure > 20% was managed by increasing sevoflurane by 2-2.5%, followed by fentanyl 0.5 ㎍/kg bolus. The chi-square test and independent-sample t-test were used where applicable. Results: Demographics, duration of surgery, and intravenous fluids used were comparable between the groups. Compared to group A, patients in group B had significantly higher consumption of fentanyl (14.2 ± 4.4 ㎍ vs. 22.1 ± 6.2 ㎍) and sevoflurane (14.2 ± 4.8 mL vs. 26.8 ± 15.6 mL). Intraoperative hemodynamic parameters were significantly lower in group A, the number of times increases in hemodynamic parameters occurred, and fentanyl supplemental bolus was required remained significantly lower in group A than in group B. Intraoperative glycemic levels remained higher in group B, and the extubation time was significantly shorter in group A than in group B (4.40 ± 1.60 min vs. 9.2 ± 2.18 min). Group A had a lesser occurrence of postoperative delirium. Conclusion: Supplemental infraorbital block in infants undergoing cheiloplasty under general anesthesia resulted in significantly decreased anesthetic requirements and optimal hemodynamic and glycemic levels with faster extubation and lesser delirium.
This study reports the clinical use of two sevoflurane-based anesthetic techniques in dogs undergoing craniectomy. Twenty-one animals undergoing elective rostrotentorial or transfrontal craniectomy for brain tumor excision, anesthetized with sevoflurane, were enrolled in this retrospective, observational study. Anesthetic records were allocated to two groups: Sevo-Op (sevoflurane and short acting opioid infusion): 8 dogs and Sevo-Dex (sevoflurane and dexmedetomidine infusion): 13 dogs. Average mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10-70) vs. 19.63 (10-25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.
Kim, Young-Suk;Kim, Myung-Jin;Lee, Soo-Jin;Lee, Jae-Il;Jun, Moo-Hyung;Park, Chang-Sik;Kim, Myung-Cheol
Journal of Veterinary Clinics
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v.24
no.3
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pp.300-304
/
2007
The purpose of this study was to determine the anesthetic effects of tiletamine-zolazepam (TZ) alone and azaperone plus tiletamine-zolazepam in growing pigs, and to compare the various physiological parameters in both treatments. Cross experiment was accomplished at 2-week interval. Group 1 (TZ group): six pigs ($31.4{\pm}4.83$ kg) received 4.4 mg/kg of TZ alone. Group 2 (ATZ group); the same six pigs ($43.6{\pm}4.31$ kg) received 4.4 mg/kg of TZ twenty minutes after receiving 2 mg/kg of azaperone. All of the anesthetic drugs were injected into the trapezius muscles. The pigs were fasted for 24 hours before the experiments. Induction and recovery values were determined. Heart rate, respiratory rate, rectal temperature, $pO_2,\;pCO_2$ and pH were determined before administration and 5, 25, 45, 65 and 85 minutes after administration. Induction time of ATZ group was more rapid than that of TZ group (p<0.01). During recovery, sternal recumbency time, standing time and walking time of ATZ group were longer than those of TZ group (p<0.01). Heart rate, respiratory rate, $pO_2,\;pCO_2$, and pH did not show especial differences between the two groups. However, rectal temperature was significantly different between the TZ and ATZ group (p<0.05). As a result, ATZ group had a faster induction and a longer duration of anesthesia than TZ group did. Thus, it was concluded that ATZ combination could be usefully used for chemical restraint in pigs.
In order to investigate the influences of Panax ginseng (white ginseng and red ginseng) on the anesthetic effect and toxic effect of alcohol, experimental studies .had been carried out with albino rabbits, mongolian dogs and mice. The anesthetic effect of alcohol was observed by measuring the induction time, .anesthetic time, recovery time and duration from the beginning of induction to , the recovery of anesthesia (total time), respectively. and toxic effect ($LD_{50}$) of alcohol was measured. In addition to these experiments, al cohol concentration in .blood, blood sugar level, serum transaminase (GOT and GPT) activities and serum alkaline phosphatase activity were measured. Also in order to study the clinical effect of alcohol in healthy students, code .substitution, response time and muscle coordination were tested. The results were obtained as follows. 1. In the rabbits and mongolian Jags, the induction time of anesthesia by the administration of alcohol was delayed by the pretreatment of ginseng but recovery time and total time of anestksia were markedly shortend. 2. The bleed alcohol concentration was decreased by the pretreatment of ginseng , but not affected in mongolian dogs. 3. The blood sugar level, serum transaminase (GOT and GPT) activities and alkaline phoshatase activity in rabbits and dogs induced by the administration of alcohol were affected by the Pretreatment of ginseng. Because those were included within normal ranges, the differnces have no remarkable significance. 4. Liver alcohol dehydrogenase activity of rabbit was increased by the treatment of ginseng, especially it was markedly increased by the treatment of red ginseng 5. The average lethal dose of alcohol to mice was increased by the pretreatment. of ginseng, especially it was markedly increased by the pretreatment of red .ginseng. 6. In the clinical experiments, the blood alcohol concentration induced by alcohol administration was not affected by the pretreatment of ginseng whereas the bleed sugar level was increased. Blood alcohol concentration and bleed sugar level were measured after three hours alcohol administration. 7. The response time of healthy students administered with alcohol was markedly shortened by the pretreatment of ginseng but the experiments on the code substitution and muscle coordination were not affected.
This study was performed to evaluate anesthetic and cardiovascular effects of xylazine/fentanyl/azaperone and medetomidine/midazolam as preanesthetics and their combinations with antagonists in halothane-anesthetized dogs. Eight clinically healthy dogs($4.54{\pm}2.16kg$) were used at the interval of more than 14 days between experiments in turn for propionyl promazine(PP 0.3mg/kg, IM), xylazine/fentanyl/azaperone(XFA 2mg/kg, 0.0137mg/kg, 0.11mg/kg, IM), medetomidine/midazolam(MM 0.02mg/kg, 0.3mg/kg, IM), combination of XFA and their antagonists (yohimbine 0.05mg/kg, naloxon 0.0005mg/kg, IV) and combination of MM and their antagonist(atipamezole 0.08mg/kg IM). The sedation induction times in XFA($2.56{\pm}1.01min$) and MM($5.44{\pm}2.07min$) groups were significantly better than that of PP group($10.75{\pm}2.38min$)(p < 0.05). The thiopental sodium dose required for tracheal intubation in XFA($2.38{\pm}3.38mg/kg$) and MM($3.91{\pm}3.47mg/kg$) groups were significantly less than that of PP group($12.57{\pm}2.13mg/kg$)(p < 0.05). All time indices expressing the recovery(pedal reflex recurrence time, extubation time, arousal time, standing time and walking time) were significantly shorter in the combination groups of XFA or MM with their antagonists than in PP, XFA and MM groups(p < 0.05). The suppressions of cardiovascular function of XFA and MM were more than that of PP. Heart rate and cardiac output were recovered by the antagonists of XFA and MM, but mean arterial pressure were not recovered by the antagonists. PP induced apnea in 4 out of 8 dogs, but XFA in none and MM in one. The present study suggested that for rapid sedation, prevention of apnea after intubation and rapid recovery after halothane cessation, combinations of xylazine/fentanyl/azaperone or medetomidine/midazolam with their antagonists are recommendable as preanesthetic method in gas anesthetised dogs with normal cardiovascular function.
It is important to identify the most suitable anesthetic agent that has minimal side effects to be able to control and perform surgeries on bears. In this study, we examined and compared the induction and recovery times as well as the physiological changes occurring during anesthesia induced by medetomidine-zolazepam/tiletamine (MZT) and xylazine-zolazepam/tiletamine (XZT) at general anesthesia for laparoscopic salpingectomy in 326 female Asiatic black bears. The body temperature, heart rate, respiratory rate, and levels of PaO2 and EtCO2 were the physiological changes measured during surgical procedures in female bears after anesthesia. In addition, the levels of pO2, pCO2, and sO2 were measured using a portable blood gas analyzer. To induce recovery from anesthesia, bears anesthetized with MZT were intravenously administered atipamezole and bears anesthetized with XZT were intravenously administered yohimbine. The combination MZT, at dosages of 0.019 ± 0.001 mg/kg for medetomidine and 1.4 ± 0.1 mg/kg for ZT, or the combination XZT, at dosages of 2.0 ± 0.1 mg/kg for xylazine and 3.0 ± 0.1 mg/kg for ZT, proved to be reliable and effective in anesthetizing Asiatic black bears for a 40-min handling period for routine clinical procedures. The average anesthesia induction times were 16.5 ± 0.95 min for the bears in the MZT group and 12.0 ± 0.44 min for those in the XZT group. A significant difference was noted between the two drugs (P < 0.001) in terms of the average anesthesia induction time. The anesthesia induction time was shorter for bears with lower body weights than those with higher body weights (P < 0.05). The recovery time of MZT was significantly faster than that of XZT (11.3 ± 0.45 min vs. 18.5 ± 0.83 min) (P < .001). The bears anesthetized with MZT exhibited lower cardiopulmonary suppression than those anesthetized with XZT (P < 0.05). The body temperatures and EtCO2 of bears in the M ZT group were significantly lower than those in the XZT group as time progressed after anesthesia (P < 0.05). The average pO2 before the bears were supplied with oxygen was 64.8 ± 3.7 mmHg, but it increased to 211.5 ± 42.5 mmHg afterwards (P < 0.001). In conclusion, our results indicate that bears anesthetized with MZT have longer anesthesia induction time, shorter recovery time, slower heart and respiratory rates, and lower body temperatures and EtCO2 than those anesthetized with XZT. These findings suggest that XZT is preferable to MZT, warranting further research on its uses and clinical responses in bears.
The effects of 5 different drugs (amphetamine, caffeine, serotonin, sod. salicylate and pentazocine) on the duration of action of two barbiturates (thiopental and pentobarbital) and an intravenous anesthetic (propanidid) were determined in rats. Duration of action was determined by the time elapsing between loss and return of the righting reflexes. All drugs were injected intraperitoneally except propanidid which was administered by the intravenous route. Preliminary experiments indicated that at a dose of 40 mg/kg either of the two barbiturates or propanidid produced loss of the righting reflexes without death. At this dose, however, the duration of action of propanidid was extremely short. However, this dose was selected for subsequent studies. 1. At the dose employed amphetamine shortened the sleeping time of three compounds. 2. Caffeine and theophylline shortened the sleeping time of thiopental and prolonged the duration of action of pentobarbital. 3. Serotonin had no effect on duration of action of the barbiturates but prolonged the sleeping time produced by propanidid. 4. Sod. salicylate significantly prolonged the sleeping time of the barbiturates whereas pentazocine exhibited this effect only in relation to thiopental.
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