Cardiopulmonary effects of rebreathing and nonrebreathing systems during halothane anesthesia in the cat

Cardiopulmonary variables were measured in 3 groups of halothane-oxygen anesthetized cats. The groups, each containing 6 animals, were treated similarly except for maintenance anesthetic systems, and system variation was the basis for comparison. Groups were maintained, using a pediatric circle CO2 absorption system with an O2 flow of 0.5 L/minute, an Ayre's T-piece system with an O2 flow of 3 L/minute, and an adult circle CO2 absorption system with an O2 flow of 0.5 L/minute. Anesthesia was induced by mask, endotracheal intubation was done, and end-expired halothane was maintained at 1.4%. Measurements of cardiopulmonary variables were reported at 30-minute intervals for 135 minutes, the first measurements being made 15 minutes after induction. Control data were similar for all groups. Measured variables were not statistically or clinically different among groups, and change from control within groups was related to halothane anesthesia. The 3 systems produced similar cardiovascular and respiratory effects. Consequently, none of the systems proved superior to the other 2 on the basis of measured variables. Halothane anesthesia produced cardiopulmonary changes comparable to changes reported in other species anesthetized and maintained by similar techniques.     

Cause of hypotension during spinal anesthesia--the relation between the level of anesthesia and the hypotension

A retrospective study was conducted on the cause of hypotension during spinal anesthesia and also on the relation between the level of anesthesia and the hypotension. Two hundred twenty three patients who had received spinal anesthesia for gynecological surgery were divided into two groups. Group I consisted of 87 patients with a significant decrease in blood pressure, while group II consisted of 136 patients with no significant decrease in blood pressure. First, the age, dosage of spinal anesthesia, amount of preoperative transfusion, and level of spinal anesthesia were reviewed and compared between the group I and II. Next, all the patients were classified by the level of spinal anesthesia, and the degree of decrease in blood pressure and the frequency of a significant decrease in blood pressure were examined by each level of spinal anesthesia. Only the level of spinal anesthesia was found to differ significantly between the group I and II. The degree of hypotension was greater at higher levels of spinal anesthesia. More than 50% of the patients with T5 or higher levels of anesthesia had a significant decrease in blood pressure. We conclude that the cause of the significant decrease in blood pressure during high spinal anesthesia is in most part due to the blockade of the cardiac sympathetic nerve.     

Glucose turnover in the post-absorptive rat and the effects of halothane anaesthesia

1. Rates and rate coefficients of glucose utilization and replacement in post-absorptive rats, either conscious or under halothane anaesthesia, were determined in a thermoneutral environment by using [5-3H]- and [U-14C]glucose. Label was not injected into rats under halothane until about 0.5h after anaesthesia was initiated. 2. Comparison with the results for 24h-starved rats in the preceding paper [Heath et al. (1977) Biochem. J. 162, 643-651] showed that insulin concentrations were considerably higher but rate coefficients for glucose utilization were little altered in post-absorptive rats. Sensitivity to insulin was thus considerably increased by a 24h period of starvation in the rat. 3. Fractional recycling of glucose carbon in post-absorptive rats was under one-half of that in starved rats, reflecting the larger contribution of liver glycogenolysis to glucose production in the former. 4. In post-absorptive rats halothane decreased the mean rate of glucose utilization by about 17%. This decrease was associated with an increase in mean plasma insulin concentration, showing that halothane decreased sensitivity to insulin. 5. Recycling was slightly increased by halothane, indicating that the contribution of liver glycogen to the total glucogenic rate was decreased, probably because liver glycogen concentration were about 40% lower throughout the rate determinations in halothane. 6. Comparison of our results with earlier work shows that during and shortly after induction of halothane anaesthesia glucose turnover must have been greatly increased whereas from about 0.5h after induction it was decreased.     

Incremental bolus versus a continuous infusion of propofol for deep sedation/general anesthesia during dentoalveolar surgery

PURPOSE: This article compared the use of the traditional incremental bolus technique with the continuous infusion technique for the administration of propofol for deep sedation/general anesthesia. PATIENTS AND METHODS: Patients were sedated with midazolam and fentanyl and then had maintenance of an anesthetic state achieved with propofol administered by either of the two techniques. Data were collected to evaluate the overall surgical/anesthetic procedure, movement of the patient, and his or her hemodynamic status. RESULTS: Both groups received a mean maintenance dose of propofol exceeding 6 mg/kg/hr. However, the patients in the continuous infusion group received a statistically greater maintenance dose (continuous infusion + supplemental vs incremental bolus). All patients were maintained in a deep sedation/general anesthetic state. Respiratory and blood pressure values were comparable in both groups. However, the continuous infusion group showed improved hemodynamic stability manifested as fewer fluctuations in heart rate. Visual analog scale (VAS) questionnaires completed by the surgeon and surgical assistant reported less patient movement and improved surgical/anesthetic conditions with the continuous infusion technique. Recovery of the two groups was comparable. CONCLUSION: This study, although finding advantages in the continuous infusion technique, showed satisfactory conditions associated with both techniques.     

Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter

Protective immunity against infection with Mycobacterium tuberculosis is imparted by T cells rather than antibodies, but B cells can play a role as antigen-presenting cells and in granuloma formation. We re-evaluated the role of B cells in the course of tuberculous infection in mu-chain knock-out (Ig-) mice. Surprisingly, the organs of M. tuberculosis-infected Ig- mice were found to have three- to eight-fold elevated counts of viable bacilli compared with normal littermates at 3-6 weeks post-infection. Splenic interferon-gamma responses to whole antigen were unimpaired, whilst proliferation to certain mycobacterial peptides was found to be diminished. However, bacille Calmette-Guérin (BCG) vaccination significantly reduced the infection in Ig- mice. The mechanisms by which B cells can influence primary tuberculous infection need further study.     

Prevention of hypotension during spinal anaesthesia for caesarean section: ephedrine infusion versus fluid preload

We compared the efficacy of prophylactic ephedrine infusion over fluid preloading in prevention of maternal hypotension during spinal anaesthesia for Caesarean section. Forty-six women undergoing elective Caesarean section at term were allocated randomly to receive either intravenous fluid preloading with Hartmann's solution 20 ml.kg-1 (fluid group) or prophylactic intravenous ephedrine 0.25 mg.kg-1 (ephedrine group). Moderate hypotension was defined as > or = 20% reduction in systolic blood pressure and severe hypotension as > or = 30% reduction in systolic blood pressure. Maternal uterine circulation was measured using Doppler ultrasound in 11 parturients before and after spinal anaesthesia. There was a lower incidence of severe hypotension in the ephedrine group compared with the fluid group (35% vs. 65%, p = 0.04), although the incidence of moderate hypotension was similar. Mean umbilical venous pH was higher in the ephedrine group than in the fluid group (7.33 vs. 7.29, p = 0.02) and the number of patients shivering was lower in the ephedrine group (2 vs. 9, p = 0.02). No difference was found between pre- and postspinal uterine artery pulsatility indices in either group. We conclude that prophylactic ephedrine infusion alone is at least as good as fluid preload alone in combating the hypotension associated with spinal anaesthesia for Caesarean section.     

Arrhythmias during halothane anaesthesia II: the influence of atropine

The effect of i.v. atropine premedication on cardiac rhythm was studied in healthy adult patients during thiopental-N2O/O2-halothane anesthesia without intubation. A higher incidnece of arrhythmias was seen in younger patients in close relation to administration of atropine, but the overall incidence during anesthesia was identical in atropine groups and the control groups. The most common arrhythmias were supraventricular ectopies. None of the ECG irregularities led to serious arrhythmias. No consistent changes in blood pressure were observed as the result of arrhythmias or changes in heart rate. It is concluded that atropine should be reserved for situations where severe bradycardia and hypotension occur, or can be expected to occur, and not given automatically, since cardioacceleration which is inherent in its action may be injurious to patients with limited cardiac reserve.     

The effects of sevoflurane, isoflurane, halothane, and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans

A rapid increase in isoflurane or desflurane concentration induces tachycardia and hypertension and increases-plasma catecholamine concentration. Little information is available as to whether sevoflurane, halothane, and enflurane induce similar responses during anesthesia induction via mask. Fifty ASA physical status I patients, aged 20-40 yr, and scheduled for elective minor surgery, received one of four volatile anesthetics: sevoflurane, isoflurane, halothane, or enflurane. Anesthesia was induced with thiamylal, followed by inhalation of 0.9 minimum alveolar anesthetic concentration (MAC) of the anesthetic in 100% oxygen via mask. The inspired concentration of anesthetic was increased by 0.9 MAC every 5 min to a maximum of 2.7 MAC. Heart rate (HR) and systolic blood pressure (SBP) were measured before and every minute for 15 min during anesthetic inhalation. In the sevoflurane and isoflurane groups, venous blood samples were drawn to determine the concentrations of plasma epinephrine and norepinephrine 3 min after each increase in anesthetic concentration. Sustained increments in HR were observed after increases in inspired isoflurane concentration to 1.8 MAC and 2.7 MAC (peak changes of 15 +/- 3 and 17 +/- 3 bpm, respectively). Isoflurane also increased SBP transiently after the inspired concentration was increased to 2.7 MAC (peak change of 10 +/- 4 mm Hg). Enflurane increased HR after the inspired concentration was increased to 2.7 MAC (peak change of 9 +/- 2 bpm). In contrast, changes in sevoflurane and halothane concentrations did not induce hyperdynamic responses. Plasma norepinephrine concentration in the isoflurane group was significantly higher than that in the sevoflurane group during 2.7 MAC (P = 0.022). We propose that there is a direct relationship between airway irritation of the anesthetic and immediate cardiovascular change during an inhaled induction of anesthesia.     

Rocuronium versus succinylcholine: are they equally effective during rapid-sequence induction of anesthesia?

Characteristics of karyotypes were analyzed in de novo acute myeloid leukemia (AML) with trilineage myelodysplasia (AML/TMDS) at initial diagnosis and compared with myelodysplastic syndrome (MDS) cases that had evolved to AML (MDS/AML). Abnormal karyotypes were seen in 11 of 19 patients with AML/TMDS and 13 of 16 MDS/AML cases. Trisomy 8 was observed in 3 AML/TMDS cases as a sole anomaly and was also present in 3 MDS/AML cases but not as a sole finding. Although MDS/AML frequently displayed monosomies or long-arm deletions of chromosome 5, 7 and 9, only one case exhibited long-arm deletion (of chromosome 7) in AML/TMDS. Two or more chromosome aberrations were found in some cases in both groups. These findings suggest that AML/TMDS had passed through several preleukemic stages at diagnosis, as has been well documented in MDS and MDS/AML. Additionally, clonal evolution may have already occurred in AML/TMDS, as MDS transformed to AML is associated with clonal evolution.     

Protective effects of halothane but not isoflurane against global ischaemic injury in the isolated working rat heart

The effects of equi-anaesthetic concentrations of halothane (HAL) and isoflurane (ISO) on myocardial performance, perfusion, oxygenation and lactate release were studied before, during and after a low-flow, global ischaemic insult in isolated, paced rat left heart preparations. An antegrade perfusion technique was used, where left atrial pressure (LAP) and mean aortic pressure (MAP) could be altered independently of each other. Aortic flow, coronary flow (CF) and PO2 in venous coronary effluent were continuously recorded and stroke volume, myocardial oxygen consumption (MVO2) and myocardial oxygen extraction as well as lactate release were calculated. The hearts were exposed for at least ten minutes to the perfusate without (control, n = 10) or with HAL (n = 10) or ISO (n = 10) at a MAP of 80 mmHg (10.4 kPa) and a LAP of 7.5 mmHg (1.0 kPa). After baseline measurements, MAP was reduced to 25 mmHg (3,2 kPa) for a total of nine minutes. Thereafter MAP was increased to 80 mmHg (10.4 kPa) for another nine minute period. During the whole experimental procedure, LAP was maintained at 7.5 mmHg (1.0 kPa) and heart rate at 325 beats per minute. In the pre-ischaemic control period, MVO2 was lower with HAL compared to ISO (P < 0.05) and control (P < 0.05). Stroke volume was also lower with HAL compared to control (P < 0.05). During hypoperfusion, lactate release was twice as high in the control group (P < 0.01) and with ISO (P < 0.01) compared to HAL.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spaced-trials reward magnitude effects in the rat: Single versus multiple food pellets.

Trained 56 male Charles River hooded rats in a runway with either small- or large-reward magnitude. Both small and large rewards were presented in single- or multiple-pellet form. 1 training trial was given each day for 120 days. Early in training, the large-reward Ss ran faster than those receiving small reward, and the effect was more pronounced in the multiple-pellet condition. Later in training, the small-reward Ss equaled the performance of Ss receiving large reward and even ran somewhat faster in the run section of the alley. The typical extinction effect of greater persistence for small-reward Ss was observed, but only in the goal section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebral protection by intermittent reperfusion during temporary focal ischemia in the rat

Temporary arterial occlusion has been routinely used as an adjunct in intracranial aneurysm surgery. This has commonly been performed using a protocol of multiple short periods of occlusion alternating with periods of restoration of normal circulation. Recently, the logical basis of this method has come under scrutiny. There is extensive experimental evidence to suggest that repetitive, brief periods of global ischemia may cause more severe cerebral injury than an equivalent single period of global ischemia. Only recently has this issue begun to be addressed with regard to focal ischemia. Hence, despite the common use of temporary clipping, little experimental data are available regarding the ischemic consequences of temporary arterial occlusion with periods of reperfusion versus uninterrupted temporary occlusion. To investigate this issue, a protocol of occlusion/reperfusion that simulates the temporal profile that occurs during surgery was performed in a rat model of focal ischemia. Sixteen anesthetized Sprague-Dawley rats were divided into two groups. The animals in Group I underwent 60 minutes of uninterrupted middle cerebral artery occlusion and the animals in Group II were subjected to six separate 10-minute occlusion periods with 5 minutes of reperfusion between occlusions. Histopathological analysis was performed 72 hours postischemia. Group I had significantly increased mean infarction volumes (50.0 +/- 12.1 mm3) compared to Group II (8.7 +/- 3.1 mm3) (p = 0.008). Injuries in Group I occurred in both the cortex and striatum, whereas Group II showed only striatal injuries. Furthermore, the extent of the injuries in Group II was less severe, characterized by ischemic neuronal injury rather than frank infarction. The results indicate that intermittent reperfusion is neuroprotective during temporary focal ischemia and support the hypothesis that intermittent reperfusion is beneficial if temporary clipping is required during aneurysm repair.     

Stress and dexfenfluramine: effects on the immune response and energy balance in the rat

The effects of stress, dexfenfluramine (d-Fen), and a combination of both were investigated on ingestive behavior, body weight, and the humoral immune response in the rat. Three-hundred and 84 male Sprague-Dawley rats were split into four groups of 96 animals. In a balanced design, each group was submitted or not to repeated intense stress for 20 consecutive days. Animals were also treated with 5 mg/kg/day d-Fen (IP, 1 ml/kg) or an equal volume of placebo (saline) for 28 days. The humoral immune response of rats to sheep red blood cells (50% solution, 1 ml IP at day 0) was assessed from the antibody titer on days 4, 8, 12, 16, 20, and 28. Antibodies were assayed by direct hemagglutination and by the Coombs' test. Plasma corticosterone was also measured on days 0 and 12. The effects of stress and d-Fen on ingestive behavior and body weight were consistent with previously published results. In addition, rats treated with d-Fen had a significantly reduced body weight (-20 g) 5 weeks after the end of the treatment, whereas the loss in body weight induced by stress had totally disappeared. Stress did not decrease animals' immune response despite a massive corticosterone secretion on day 0, with a marked response lasting for at least 12 days. d-Fen reduced the corticosterone levels determined on day 12. Antibody production was slightly but significantly reduced in rats receiving d-Fen.(ABSTRACT TRUNCATED AT 250 WORDS)     

Breathing patterns in infants and children under halothane anesthesia: effect of dose and CO2

We studied the amplitude, timing, and shape of the airflow waveform at the mouth of spontaneously breathing children under two sets of conditions: 1) in 30 children aged 9 wk-4.5 yr at 2, 1, and 0% inspired halothane concentration and 2) in 22 children aged 5 mo-7 yr during hyperoxic CO2 rebreathing while recovering from anesthesia. Compared with control values, the relative changes in breath parameters at 1 and 2% halothane were, respectively, as follows: total cycle time -19 and -31%, tidal volume (VT) -30 and -44%, minute ventilation -11 and -17%, and VT/inspiratory time (TI) -16 and -20%. Parameters of timing and breath shape did not change except for the significant but small increase in TI/total cycle time (by 6 and 8%, respectively). With CO2 rebreathing, parameters reflecting inspiratory drive increased significantly in all patients as shown by the slopes of the regressions of these parameters against end-tidal PCO2. Mean slopes expressed in %control value per millimeter of mercury CO2 were 12.1 for minute ventilation, 8.3 for VT, and 10.67 for VT/TI. Parameters reflecting the timing and breath shape remained essentially unchanged. Our results suggest that, in children under halothane anesthesia, the amplitude, timing, and shape of the breathing pattern are controlled independently. In particular, the amplitude and timing of the breath may vary widely without any significant change in the shape.     

Cholinergic vasoconstrictor effects in the rabbit eye: vasomotor effects of pentobarbital anesthesia

Oculomotor nerve stimulation causes vasoconstriction in the anterior uvea, which is due partly to a muscarinic mechanism and partly to a non-sympathetic aminergic mechanism. The labelled microsphere method was used to analyze the effect of pentobarbital anesthesia on the resting cholinergic vasomotor tone in the anterior uvea and to determine the relationship between stimulation frequency and vasomotor response. An attempt was made also to ascertain whether the aminergic part of the vasoconstriction is caused by release of 5-hydroxytryptamine or norepinephrine. Induction of pentobarbital anesthesia caused a marked vasodilation in the iris and the ciliary processes and a subsequent muscarinic blockade had no effect on the blood flow. A similar result was obtained in the optic nerve. In the choroid plexus, heart muscle, pineal body and coecum, pentobarbital anesthesia caused vasodilation and a subsequent muscarinic blockade caused vasoconstriction. In the brain pentobarbital anesthesia caused a marked reduction in the blood flow of the grey matter and a moderate reduction in the white matter. After a muscarinic blockade there was some increase in the blood flow of the grey matter. Stimulation of the oculomotor nerve caused near maximum vasomotor responses at 10-20 Hz; maximum effect on the pupil size was obtained at 40-50 Hz. Depletion of 5-hydroxytryptamine with fenfluramine did not prevent the aminergic part of the vasoconstriction and a marked vasoconstriction was also observed after pretreatment with reserpine. The results indicate the pentobarbital anesthesia abolishes most of the spontaneous cholinergic vasoconstrictor tone of the anterior uvea and that the aminergic part of the oculomotor nerve induced vasoconstriction is caused by the stimulation of phentolamine-sensitive receptors by a mechanism probably not involving release of norepinephrine or 5-hydroxytryptamine.