EEG-changes during general anaesthesia with enflurane (Efrane) in comparison with ether

The effects of enflurane (efrane) and ether on the cerebral functions were studied by EEG on two similar groups of adult patients. For basic comparison a depth of anaesthesia was chosen which permitted abdominal surgery without the need to administer muscular relaxants. At this level of anaesthesia the typical EEG-changes of paroxysmal type which have been described with enflurane were seen only occasionally. If, however, the depth of anaesthesia was further increased, such EEG-changes indicating increased cerebral excitability were seen more often under enflurane and also appeared under ether anaesthesia. No seizure activity was recorded.     

The beginnings of anesthesia

In the nineteenth century, introduction of the first inhaled general anaesthetic (Long, 1842) induced a further search for new types of anaesthesia: carbon dioxide, petroleum ether, derivatives of ethylene, acetone, methyl dichloride, and the study of a new technique-hypnosis. Only chloroform, ether, nitrous oxide were used. Towards the end of the century, ether became the mainstay of inhaled anaesthetics. The other routes of administering anaesthetics (rectal, venous, spinal, local) appeared around 1860.     

Propofol, isoflurane and neuroleptanesthesia. Ophthalmic surgery in geriatric patients

Ophthalmic surgeons require anaesthesia to ensure that the patient is completely relaxed for microsurgical operations and that the intraocular pressure is reduced. These conditions must be maintained throughout the operation. In addition to these requirements, the anaesthetist mostly deals with elderly patients with multiple diseases. Although earlier studies have shown which general or local anaesthesia is preferred for which patients and operations, studies on which general anaesthesia technique is ideal to fulfil these requirements are still lacking. The aim of this study was to show which technique causes the least stress for a geriatric patient undergoing an ophthalmic operation, propofol/fentanyl anaesthesia, isoflurane anaesthesia or neuroleptanaesthesia. PATIENTS AND METHODS. Sixty patients aged 60 years and above were included in this study. After being randomly allocated to either propofol/fentanyl (continuous propofol infusion), isoflurane or neuroleptanaesthesia, they underwent ophthalmic surgery. Intraoperative complications (cardiocirculatory changes) and surgical conditions were recorded. After the operation, patient vigilance and post-operative pain reactions (nominal pain score) were assessed over 8 h by means of simple reaction tests and the Juhl index. Within the first 2 h after surgery, cardiocirculatory changes were also documented and arterial blood gases measured. RESULTS. The treatment groups did not differ with respect to general biometric data, preoperative risk or operations carried out. Intraoperative cardiocirculatory changes and the resulting therapy (positive inotropic drugs, volume replacement fluids) were similar in all groups. The surgical conditions were equally good in all groups. Apart from a lower rate pressure product in the first 60 min after propofol/fentanyl anaesthesia, there were no postoperative differences in cardiocirculatory parameters or blood gases. After isoflurane anaesthesia the time until the patients were able to give their names and perform the finger-nose test properly was longer than that after neurolept-anaesthesia or propofol anaesthesia. After propofol anaesthesia the patients could perform simple tests earlier and were more alert over the whole monitoring period than after isoflurane or neuroleptanaesthesia. On the other hand, the patients in the neuroleptanaesthesia group had fewer pain complaints than those in the two groups compared. DISCUSSION. None of the anaesthesia techniques used in this study showed an intraoperative advantage. This is not surprising since all anaesthetics, with the exception of ketamine, reduce intraocular pressure. The prerequisite, however, is careful monitoring of anaesthesia in elderly patients in order to avoid cardiocirculatory changes, mild hyperventilation and coughing and pressing at the end of the operation. Until this point in time no change in the depth of anaesthesia is allowed. Therefore, it seems on the whole that there are benefits from propofol-fentanyl anaesthesia because of the fact that in comparison with the rather techniques, elderly patients become alert again faster. However, sufficient postoperative pain therapy is necessary to free the patients of pain to the same degree as with neuroleptanaesthesia. In most cases peripherally acting analgesic substances with no interference with vigilance are sufficient.     

Natural variation within the principal arginine-specific protease gene, prpR1, of Porphyromonas gingivalis

Patients who were treated for fractures of the limbs were assigned to 1 of 2 groups for the management of postoperative pain. In Group 1 (postoperative patient-controlled analgesia group), 46 patients were given postoperative continuous epidural anaesthesia in combination with narcotic analgesics and this was regulated by the patient using a device. The 46 patients in Group 2 (control group) received suppositories or intramuscular injections of narcotic analgesics on their request. Patients in Group 1 needed suppositories and intramuscular injection of narcotic analgesics less often than those in Group 2, and had more satisfactory pain relief according to the visual analogue scale for pain assessment made on the first, second and third postoperative day. The time spent by nurses for pain management in Group 1 was less than that in Group 2. It appears that this patient-controlled method, combined with postoperative continuous epidural anaesthesia, is a safe, effective and efficient method for the management of postoperative pain.     

Recurrence of inguinal hernia: ambulatory surgery under local anesthesia

In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.     

Appendectomy under local anaesthesia following conscious pain mapping with microlaparoscopy

The appendix is an under-appreciated source of chronic pelvic pain. Laparoscopic evaluation of the appendix is limited without intra-operative patient feedback on the presence and absence of pain. New techniques using local anaesthesia with conscious sedation have enabled us to perform operative laparoscopic surgery while the patient is awake. We report the first two cases of microlaparoscopic appendectomies performed under local anaesthesia with conscious sedation following diagnosis obtained during conscious pain mapping.     

Will MCP-1 and RANTES take center stage in inflammatory diseases including asthma?

There were analyzed the conditions under which the basal glycemia and/or glucose tolerance curve is not contaminated by stress induced changes in glycide metabolism. When the basal glycemia was monitored, blood was sampled to heparinized capillaries from retrobulbar plexus under the light ether anaesthesia or by decapitation without narcosis. The animal represented the control for itself. No differences was found in basal glycemia under the two mentioned blood sampling. In the second series of experiments glycemia was monitored in the time schedule which is used in glucose tolerance test, i.e., blood sampling was performed 30, 60, 120 and 180 min after the first sampling from retrobulbar plexus either under light ether anaesthesia (in 14 h starvated rats or in rats with free access to diet) or under Nembutal anaesthesia (in 14 h starvated rats). No differences were found in glycemia when two types of narcosis is compared. No signs of augmentation were detected. In the last series when blood sampling was taken in two sec intervals, time dependent augmentation of stress glucose elevation was found. The augmentation was more expressed in the rats with free access to diet than in starvated animals.     

Pre-emptive analgesia using local anaesthesia: a study in bilaterally symmetrical surgery

Two studies were carried out in patients undergoing bilaterally symmetrical lower third molar surgery under general anaesthesia. In the first study observations were carried out in 40 patients, using McGill pain questionnaires and visual analogue scales (VAS), to assess the variation in pain intensity between the two sides in each individual on the morning after surgery. The within-patient variation in pain intensity indicated that a sample size exceeding 30 was required to show a difference of more than 10 mm on the VAS and achieve a power of 90% at the 5% level of significance. The second study was carried out to determine if local anaesthesia administered before rather than after tooth removal rendered any benefit. Each of the 38 patients acted as their own control; one side was allocated randomly to receive the local anaesthetic before operation and the other side after operation. The difference in pain between the pretreated and post-treated sides in each individual was assessed using a McGill pain questionnaire on the morning after surgery in addition to two VAS (one for each operation side) after operation, at 6 h, 1 and 6 days after surgery. There were no significant differences in pain at any time using any of the above methods.     

Sub-Tenon's anaesthesia: an efficient and safe technique

AIM: To evaluate sub-Tenon's anaesthesia as an alternative to peribulbar anaesthesia. METHODS: 109 consecutive patients listed for various eye operations (including cataract, trabeculectomy, and vitrectomy) under peribulbar anaesthesia were operated on under sub-Tenon's anaesthesia instead. After topical anaesthesia a buttonhole was fashioned through the conjunctiva and Tenon's capsule 10 mm posterior to the limbus. 1.5 ml of lignocaine 2% was then delivered to the posterior sub-Tenon's space using a blunt cannula. The surgical procedure was performed immediately after the completion of the anaesthetic procedure. Chemosis, conjunctival haemorrhage, degree of akinesia, and pain scoring were analysed. RESULTS: There were no anaesthesia related complications. The administration of the block was painless for 99.1% of the patients. In all, 97.3% reported no pain during surgery. There was no akinesia when assessed just after the completion of the block and akinesia was limited when assessed after surgery. Chemosis and conjunctival haemorrhage were frequent but caused no intraoperative problems. CONCLUSION: Sub-Tenon's anaesthesia is an efficient and safe anaesthetic technique. It is a good alternative to peribulbar anaesthesia.     

Patterns of osteoarthritis of the hip

Measurements of the rate of rise of left ventricular blood pressure (dP/dt) have been made in conscious and anaesthetised ponies. Concurrent measurements of heart rate, mean arterial pressure and left ventricular pressure were also made in order to assess their relationship to values of dP/dt. Thiopentone-halothane and thiopentone-ether anaesthesia reduced the maximal rate of rise of intraventricular pressure (dP/dt max) from conscious control levels. After correcting for variations in the loading conditions of the ventricle, the depressant effect of halothane was still apparent, but the action of ether was not. It was concluded that the negative inotropic effect of halothane in the pony was greater than that of ether, possibly because a compensatory sympathoadrenal stimulation occurred during ether but not during halothane anaesthesia.     

Rectal indomethacin potentiates spinal morphine analgesia after caesarean delivery

This double-blind, randomized study was designed to evaluate the use of indomethacin (Indocid, MSD) following caesarean delivery performed under spinal anaesthesia. Thirty ASA I-II women presenting for elective caesarean were recruited. Spinal anaesthesia was performed in a standard manner using hyperbaric bupivacaine, fentanyl and morphine. At the completion of surgery, subjects were administered two rectal suppositories, followed by 12-hourly suppositories for six doses (three days). The study group received 100 mg indomethacin suppositories and controls were given placebo (Anusol). Data collected included Visual Analog Scale (VAS) pain scores at rest and with movement, VAS scores for nausea and itch, and analgesic use. Demographic data were similar in the two groups. Median time to first analgesia (TTFA) was nine hours in the control group v. 39.5 hours in the indomethacin group (P < 0.003). Additional analgesic requests throughout the postoperative period were less in women who received indomethacin: 4 v 11 (P < 0.001). Women who received indomethacin had significantly less pain on the first postoperative day, especially on movement: mean VAS 1.4 v 5.1 (P < 0.00001). There were no reported adverse neonatal or maternal effects from the use of indomethacin. Rectal indomethacin use following caesarean delivery leads to significantly improved pain relief compared with placebo. The combination of spinal morphine and rectal indomethacin leads to high-quality postoperative analgesia.     

Use of the Vibrio harveyi toxicity test for evaluating mixture interactions of nitrobenzene and dinitrobenzene

Trauma during wartime has been the scourge of the ages. Conventional anesthesia with ether has been available since 1846 when it was demonstrated in Boston by a dentist named William Morton. Subsequently, ether was used during the Mexican-American War in 1847, and chloroform was used during the Crimean War from 1854 to 1856. Nurse anesthetists have made substantial contributions to care of the war-injured by initiating acute airway management and resuscitation efforts and by the administration of anesthesia care for critically injured war casualties undergoing surgical procedures. They have further contributed to goodwill in war-torn areas by providing anesthesia care to many civilian children and adults living in these areas of conflict. The evolution of nurse anesthesia contributions to the treatment of traumatized war casualties is the central focus of this article.     

Laparoscopic cholecystectomy: evaluation of intraoperative complications with respect to 2 different kinds of anesthesia

Two anaesthetic managements for elective laparoscopic cholecystectomy were compared in 64 patients in order to investigate some perioperative complications: 1) bowel distension during surgery. 2) recovery from anaesthesia. 3) post-surgery incidence of emesis and pain. In addition, the quality of postoperative peristalsis as well as the time of dimissal were recorded. Group I (n = 30) was treated with NLA in N2O-O2 and Group II (n = 34) received propofol plus fentanyl in air-O2. Bowel distension, evaluated by surgeon at 15 min intervals throughout the operation was similar in both the groups as well as postoperative peristalsis recuperation. During the first 12 hours after laparoscopy no differences were found at any times of observation in the incidence or severity of emesis and pain between the two different anaesthesia patients. In subjects which were given propofol the psychomotor recovery was more rapid than after NLA, particularly during the first 6 hours after surgery. The patients were discharged between 36-48 hours following the operation independently from anaesthetic management. It is concluded that both the anaesthetic techniques provide similar intra/postoperative conditions, except the early recovery that is more rapid for the propofol patients. The overall frequency of emesis and pain was rather high in both the groups, suggesting a routine medication with analgesics and antiemetics.     

The analgesic efficacy of tenoxicam versus placebo in day case laparoscopy: a randomised parallel double-blind trial

The analgesic efficacy and duration of action of tenoxicam, an injectable non-steroidal analgesic with a long elimination half-life, were studied in day case laparoscopy in a double-blind randomised prospective parallel placebo-controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. Outcome measures were time to first analgesia, pain levels at 2, 4 and 24 h plus postoperative analgesic consumption in hospital and at home. The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20 mg intravenously immediately pre-operatively cannot be recommended for day case surgery on the basis of this study.     

Influence of dose and timing of administration of morphine on postoperative pain and analgesic requirements

In a randomized, double-blind study, we have investigated the effect of dose and timing of administration of morphine on postoperative pain and analgesic requirements in 60 patients undergoing hysterectomy, with or without salpingo-oophorectomy. Patients were allocated randomly to one of three groups: during standardized general anaesthesia, group post received morphine 0.15 mg kg-1 i.v. at peritoneal closure after hysterectomy; group pre-low received morphine 0.15 mg kg-1 on induction of anaesthesia; and group pre-high received morphine 0.3 mg kg-1 on induction of anaesthesia. Median postoperative morphine consumption (first 24 h) from a PCA system was 68 mg (group post), 56 mg (group pre-low) and 43 mg (group pre-high), and total perioperative morphine consumption (induction of anaesthesia to end of 24 h after surgery) was 77 mg (group post), 65 mg (group pre-low) and 63 mg (group pre-high). Pain scores (at rest and on movement) were similar in the three groups. A large dose of morphine 0.3 mg kg-1 i.v. on induction of anaesthesia significantly reduced postoperative PCA morphine requirements compared with the smaller dose (0.15 mg kg-1) administered at induction or peritoneal closure, in patients undergoing hysterectomy, with or without salpingo-oophorectomy.     

The Military Medical Academy--the national property of Russia

Article by the Chief of the Academy has been based on its history of 200 years. One of the oldest establishments of medical education has played a great role in the development of the national and world medicine. Among the Academy graduates of highest merit was N. I. Pirogov, a famous surgeon, who marked a new age in the medical science and education and introduced important innovations in the casualty treatment on the battlefield. He was the first to apply ether anaesthesia and plaster bandage and to have women taking care of the wounded on the theater of operations. Academy graduates S. P. Botkin, G. F. Lang and F. I. Komarov had founded their own schools of therapy. E. N. Pavlovski? developed a study on the focus nativeness of infection and parasite disease process. Every year the Academy scientists implement more than 150 research projects for the government, ministries and different agencies, defend up to 75 theses on 30 specialties, conduct more than 20 national and international conferences, symposiums and meetings. For the last 35 years the Academy has been training medical doctors, scientists and healthcare specialists for 35 countries in Europe, Asia, Africa and Latin America.     

Value of sedative premedication in female sterilization via minilaparotomy: a prospective study of two local anaesthesia regimen

A prospective study of two local anaesthesia regimen for female sterilization is presented. A total of 1,077 female clients were sterilized via minilaparotomy under local anaesthesia (ML/LA) as outpatients. The clients underwent pre-operative screening and received pre-operative and continuing counselling. The first 257 of these clients were sedated with an intramuscular injection of pethidine after atropine premedication (pre-sedated group). The other clients (non-sedated group) were premedicated with atropine alone, without sedation. For the pre-sedated group, the mean volume of one percent lignocaine used was 18.3 (S.D. 2.2) ml, the mean length of surgical incision was 2.8 (S.D. 0.5) cm, and the mean duration of surgical was 15.8 (S.D. 5.3) minutes; 8.2% of these clients reported that they felt much pain. In comparison, 7.7% of the non-sedated group clients reported much pain following a mean of 17.7 ml of one percent lignocaine (S.D. 2.7) through an incision of mean length 2.5 (S.D. 0.5) cm for surgery lasting a mean of 14.5 (S.D. 4.5) minutes. Clients who were pre-medicated with pethidine were more likely to have multiple post-operative complaints, especially dizziness, faintness, headache, nausea and vomiting. This study found no significant difference in the clinical performance of female sterilization by minilaparotomy, duration of operation, length of incision, amount of local anaesthesia required or perception of pain between clients who were premedicated with intramuscular pethidine and those who were not.     

Radip induction of ether anaesthesia and controlled maintenacne by a combination of intravenous and inhalation administration without the risk of explosion

The induction and maintenance of anaesthesia with ether using a combined intravenous infusion and a constant low inspired concentration are discribed. Predictions from a mathematical model were checked against animal experiments. Anaesthesia occurred within 5 min. The mehtod obviates the need for explosive mixtures.     

Changes in mediobasal hypothalamic dopamine and GABA release: a possible mechanism underlying taurine-induced prolactin secretion

BACKGROUND: In the last years the interest for Informed Consent (IC) in anaesthesia has been growing and it has been debated on the adequate explanations in order to obtain a consent. The purpose of the present study was to assess patients' desire for information about anaesthesia. METHODS: In this prospective study a form has been given to consecutive patients waiting for surgical operation in general surgery or ear nose throat surgery and able to read and write, to inform them about the necessity of General Anaesthesia (GA); they were asked to complete a questionnaire concerning their desire for information about the following six items concerning anaesthesia: "the duration of anaesthesia"; "what type of pain will I have when I come round, and what pain-killers will I be given"; "details on the various types of anaesthesia, how and where will I be anaesthetized"; "what are the most common complications of general anaesthesia"; "where and how will I come round from general anaesthesia"; "what is artificial respiration in general anaesthesia". RESULTS: 107 patients participated in the study, 24 of whom were undergoing surgery for malignant cancer and 83 for benign non-oncological diseases. More than two-thirds of patients expressed their wish to receive information, and the trend of desire to know was inversely related to age (p < 0.05). There was no significant statistical difference in the desire to know according either to sex or to the kind of disease (benign or malignant). The demand for information about pain was particularly high (85%), also in the older group of patients. The results and the difficulties for obtaining IC are debated. CONCLUSIONS: The growth of patients' desire for information about anaesthesia is an aspect of the evolving doctor-patient relationship in Italy. Efforts should be directed at improving reciprocal communication.     

The use of patient-controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomised controlled clinical trial

OBJECTIVE: To compare the use of topical anaesthesia and transcutaneous electronic nerve stimulation (TENS) as means of reducing the discomfort of inferior dental block injections. METHODS: One hundred adult dental patients received 2% lignocaine with 1:80,000 adrenaline for long buccal and inferior dental block anaesthesia. The long buccal injections were given first with no prior mucosal preparation. Patients received inferior dental blocks after one of the following mucosal preparations: (1) no pretreatment; (2) a 2 min application of 20% benzocaine topical anaesthetic; (3) application of patient-controlled TENS at the injection site. Patients scored injection discomfort after each administration on a 100 mm visual analogue scale. RESULTS: The discomfort of the long buccal injection did not differ between the three groups of patients (F2,97 = 1.0). There were significant differences in the pain scores for the inferior dental block injections (F2,97 = 5.3; p < 0.01). Injection discomfort following TENS was less than that following no pretreatment (p < 0.01) and after topical anaesthetic application (p < 0.05). The use of topical anaesthesia did not produce a significant change in injection discomfort compared with no pretreatment. CONCLUSION: The use of TENS reduces injection discomfort during inferior dental block anaesthesia.