EEG and bispectral analysis during inhalational anesthesia in children

Bispectral index (BIS) is a parameter of the depth of anesthesia, but the use of it in children remains discussable. The study was carried out to compare EEG and BIS considering the age of patients during anesthesia with halotane, sevoflurane and consequent combination of sevoflurane and isoflurane. 60 children 3 to 17 years of age, who underwent urological surgeries, were divided into 3 groups (20 patients in each): 1st--halothane group, 2nd--sevoflurane group and 3rd--consequent combination of sevodlurane and isoflurane group. The oxygen: nitrous oxide 1:1 mixture was used in all the mentioned groups. EEG recording (6 channel computerised encephalograph) and BIS monitoring (XP version) was carried out through the whole duration of anesthesia. In the 1st group the gradual reduction of main rhythm was registered on EEG, with slow activity and restoration during awakening. The BIS index values changed from 95-98 to 39-47 with rise to 77-85 during awakening. In the 2nd and 3rd group where sevoflurane was used for anesthesia induction sharpened alpha rhythms, amplitude enlargement and rhythm synchronization were registered on EEG. BIS values changed from 96-99 to 13-38. During the maintenance of anesthesia in the 2nd group BIS values were 30-40 and 72-77 during awakening. In the stage of isoflurane anesthesia in the 3rd group EEG pattern changed towards the rhythm synchronization and slow oscillations in all the leads. The BIS index was 30-39 during maintenance and 70-76 during awakening. The parameters of EEG and BIS in all the investigated groups were proportional to the clinical stage and depth of anesthesia. Based on the clinical data and its comparison to EEG and BIS values it is determined that BIS index can be used for monitoring depth of anesthesia in children.     

Intracranial pressure changes during xenon anesthesia in neurosurgical patients without intracranial hypertention

Xenon assures rapid awakening and stable hemodynamics, it also has some neuroprotective effect. This is the reason why it may become an anesthetic of choice in neurosurgery. Still there is little and controversial data on its impact upon ICP. This is the first study of xenon effect upon intracranial pressure, cerebral perfusion pressure and cerebrovascular reactivity during xenon anesthesia in neurosurgical patients without intracranial hypertension. We report a slight increase in intracranial and a slight decrease in cerebral perfusion pressure during xenon anesthesia and show that cerebrovascular reactivity is preserved. Thus we conclude that xenon anesthesia is safe for neurosurgical patients without intracranial hypertension.     

The early postanesthetic period in children

Forty-one children aged 4 to 15 years, who had been operated on for varicocele and hernias at various sites, were examined. Central hemodynamics, and the level of sedation and pain were assessed. Studies were performed in 2 groups of patients: 1) those who received anesthesia with ketamine in combination with propofol and 2) those who had inhalational-mask anesthesia using phtorotan in combination with nitrous oxide. They indicated that the patients more promptly emerged from phtorotan anesthesia; however, they require preventive analgesia.     

Prevention of hemodynamic disorders during anesthesia in middle-aged and elderly patients with essential hypertension. Components of anesthesia. II

Hemodynamic parameters were evaluated during various stages of anesthesia in two groups of patients aged 60-85 years with mild essential hypertension. In group 1, routine preoperative treatment with hypotensive drugs was carried out and in group 2 differentiated preoperative treatment with calcium antagonists was carried out with consideration for a hemodynamic type. Group I patients were operated on under traditional neuroleptic analgesia (NLA), group 2 under NLA with 40% lower drug doses than in group 1 and with addition of calcium antagonists. To patients with hypo- and eukinetic hemodynamics, nifedipine was injected (bolus injection) in a dose of 14.2 micrograms/kg before induction and then was infused in a dose of 6.0-14.2 micrograms/kg/min. Patients with hyperkinetic hemodynamics were injected verapamil in a dose of 70-140 micrograms/kg (bolus injection) and then the same dose every hour of the operation. Differentiated use of calcium antagonists during anesthesia helped transform the hyper- and hypokinetic types of hemodynamics into a more rational eukinetic type, which was associated with a decrease of MVO2. Calcium antagonists, exerting analgesic, automatic stabilizing, and antihypoxic effects, prevented the hyperdynamic reactions complicating NLA in 30% cases and precluded complications of concomitant ischemic diseases, which were observed in 40% of group 1 patients.     

Xenon: anesthesia for the 21st century

Xenon is a naturally occurring, gaseous element that comprises 0.000008% of air, or 0.05 parts per million. It was discovered by Ramsey and Travers in 1898. Xenon is found on the Periodic Table in group 0, which is the group commonly referred to as the noble or inert gases. It is obtained by fractionally distilling liquefied air. Xenon has been studied sporadically within the discipline of anesthesia as a replacement for nitrous oxide. Because it is a naturally occurring element, xenon is not a pollutant. It is not an occupationally hazardous gas. It is neither teratogenic nor fetotoxic, as is nitrous oxide; it does not contribute to the depletion of stratospheric ozone, as do chlorofluorocarbons and nitrous oxide. Xenon does not contribute to global warming and the greenhouse effect, as does nitrous oxide. Xenon provides excellent anesthesia and analgesia at its minimum alveolar concentration, 71%, as well as excellent analgesia at "subanesthetic" concentrations. Xenon also provides excellent cardiovascular and hemodynamic stability and offers both rapid induction and emergence. Because of the relatively high cost of xenon, a low-flow, closed-system technique is needed to be most cost effective.     

Status of central hemodynamics in elderly patients with different types of anesthesia during laparoscopic operations for colon cancer

Comparative analysis of central hemodynamics changes in 54 elderly patients with colon cancer during laparoscopic interventions. Physical status - ASA II-III. Were used 3 methods of anesthesia maintenance. In the 1-st group applied total intravenous anesthesia (TIVA) with myoplegia and ALV in the 2nd group surgical intervention was performed under the co-epidural anesthesia with intravenous potentiation with myoplegia and ALV; the 3rd group operations were performed under combination of epidural anesthesia with sevorane potentiation with myoplegia and ALV. The best results were obtained in groups with combined types of anaesthesia - epidural anesthesia with intravenous potentiation with myoplegia and ALV and epidural anesthesia with sevorane potentiation with myoplegia and ALV.     

Electroencephalogram,informational saturation of electroencephalogram,and bispectral index during xenon anesthesia for laparoscopic operations

The depth of xenon anesthesia was never evaluated by modern methods of EEG monitoring, and hence, we studied changes in EEG, INEEG, and BIS during different stages of xenon narcosis and evaluated the possibility of using these values as criteria of xenon anesthesia adequacy. The study was carried out in 60 patients during laparoscopic operations on abdominal organs. The patients were divided into 2 groups receiving different gas anesthetics (xenon or nitric oxide). The results indicate that xenon monoanesthesia caused dose-dependent changes in the native and treated EEG; xenon is a good inhalation anesthetic providing adequate anesthesia for little traumatic operations even in case of mononarcosis; INEEG and BIS monitoring during xenon anesthesia allows an objective evaluation of its depth.     

Diastolic dysfunction--predictor of cardiac remodeling in arterial hypertension in young males

For the study of the state of central hemodynamics and diastolic function of the left and right ventricle in formation of arterial hypertension (AH) with method of computer polyrheocardiography 76 males of mean age of 35.1 +/- 3.2 years were examined. The first group included 26 cases with high normal BP (systolic BP (SBP) 130-139 mm Hg, diastolic (DBP) 85-89 mm Hg--prehypertension, the second group was consisted of 30 cases with essential AH 1 stage (SBP 140-159 mm Hg, DBP 90-99 mm Hg), who did not receive antihypertensive therapy. The control group was consisted of 20 practically health young males. As a result of performed study at early stages of AH there were revealed lop-sided changes both of central hemodynamics and a diastolic function of both ventricles, which progressively increase along with elevation of AH stage. Diastolic dysfunction of left and right ventricle appears at the prehypertension stage and stage 1 arterial hypertension and precedes heart remodeling.     

Central hemodynamics, gas exchange, and gas oxygen-transporting function in combined anesthesia using xenon during operations under extracorporeal circulation

The advantages of xenon include its good hemodynamic profile and possible cardioprotective properties. The investigation was undertaken to study central hemodynamics, lung gas exchange, and blood oxygen-transporting function in xenon anesthesia in patients operated on under extracorporeal circulation (EC). Fifteen patients aged 41-69 years operated on for coronary heart disease were examined. The severity of the patients' baseline status corresponded to NYHA functional classes I to IV. The duration of an operation was 251 +/- 10 min; that of EC was 97 +/- 5 min; aortic ligation lasted 59 +/- 3 min. After induction of anesthesia with propofol via concentration-regulated infusion (CRI) and with fentanyl, delivery of xenon was initiated at concentrations of 47 +/- 1 to 52.5 +/- 1%, which was mixed with oxygen. Propofol CRI was used during EC. After the latter, xenon was inhaled at concentrations of 47.7 +/- 1 to 53.3 +/- 1%. The mean arterial pressure (BP(mean)), heart rate (HR), and cardiac index (CI) remained unchanged during xenon anesthesia in the preperfusion period. After EC during xenon anesthesia, CI significantly rose with a moderate increase in HR without inotropic support. BP(mean) was moderately, but statistically significantly decreased. Prior to and following EC, there were no changes in the values of blood oxygen-transporting function.     

The efficacy of combined general anesthesia with electroacupuncture analgesia in abdominal surgery in patients with concurrent massive obesity

Combined anesthesia and electroacupuncture analgesia (EAA) were performed in 48 obese patients. Control group (50 patients) was subject to surgery under combined anesthesia with drugs for neuroleptanalgesia, calipsol and nitrous oxide. Stability of hemodynamics, glycemia level, esophagus and skin temperature gradient, minute diuresis during EAA, as well as absence of respiratory depression and postoperative adaptation mechanisms inhibition have been observed. EAA made it possible to do without narcotic analgesics and drugs for neuroleptanalgesia during surgery in obese patients and promoted early activation of patients in the postanesthesia period, normalization of lung ventilation and lower incidence of postoperative complications.     

The influence of nitrous oxide and remifentanil on cerebral hemodynamics in conscious human volunteers

Remifentanil is increasingly used in the context of anesthesia, e.g., in patients presenting for MRI examinations, not only as an analgesic but also to replace nitrous oxide. Therefore, a comparative analysis of the effects of commonly used doses of remifentanil and of nitrous oxide on cerebral hemodynamics is warranted. The present study used contrast-enhanced magnetic resonance (MR) perfusion measurement to compare the effects of nitrous oxide (N(2)O/O(2) = 50%; n = 9) and remifentanil (0.1 microg/kg/min; n = 10) on regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), and regional mean transit time (rMTT) in spontaneously breathing human volunteers. Remifentanil increased rCBF above all in basal ganglia, whereas in supratentorial gray matter the increase in rCBF was equal or even more pronounced when using nitrous oxide. In contrast, nitrous oxide produced a greater increase in rCBV in gray-matter regions than did remifentanil. In summary, nitrous oxide increased rCBV in all gray-matter regions more than did remifentanil. However, the increase in rCBF, especially in basal ganglia, was typically less pronounced than during infusion of remifentanil.     

Intrarenal hemodynamics and blood pressure in hypertensive patients with renal artery anomalies

AIM: To determine characteristics of a clinical course, 24-h profile of arterial pressure (AP), of renal hemodynamics, involvement of target organs in patients with arterial hypertension (AH) of the third degree and anomalies of renal arteries. MATERIAL AND METHODS: 24-h monitoring of AP, echocardiography, measurement of microalbuminuria, renal hemodynamic were made in 15 patients (9 female, 6 male) having resistant AH of the third degree and different anomalies of renal arteries (mean age 45.3 +/- 1.9 years). The control group consisted of patients with essential AH stage III (mean age 45.3 +/- 1.8 years). The groups were comparable by sex, age, duration of AH. RESULTS: The patients of the study group had a significantly lower pulsatility index in the renal artery and interlobular level and resistance index at the segmental and interlobular level of the RA on the side of the anomaly. There was a significantly higher minimal diastolic blood flow velocity in the segmental level of RA on the side of the anomaly. Renal scintigraphy revealed a decreased index of radiopharmaceutical accumulation. A positive correlation was found between the pulsatility index, resistance at a segment RA level and variability, an increase of morning diastolic blood pressure. The groups had significant differences neither by 24-h AP indices nor by severity of target organ lesion. CONCLUSION: Patients with RA anomalies have specific renal hemodynamics determining renal hypoperfusion on the side of the anomaly which may be involved in development of resistance to hypotensive therapy.     

脑电双频指数监测下全身麻醉用于合并高血压老年患者的临床观察

目的观察在脑电双频指数(BIS)监测下实施全身麻醉对合并高血压老年患者血流动力学和麻醉恢复的影响。方法 80例择期行腹腔镜下胆囊切除手术的老年高血压患者,随机分为BIS组和对照组,BIS组依据BIS监测值调整麻醉深度,对照组患者根据麻醉医生经验调整麻醉深度。记录两组患者麻醉期间血压和心率的变化以及麻醉恢复情况。结果在气管插管后1min,BIS组患者收缩压、舒张压和心率均低于对照组,差异均有统计学意义(t分别=-3.26、-3.41、-4.25,P均<0.05);BIS组患者麻醉恢复时间为(18.60±6.08)min,对照组为(26.22±7.37)min,两者比较,差异有统计学意义(t=-8.47,P<0.05)。结论 BIS监测使老年高血压患者全身麻醉期间血压和心率波动小,麻醉恢复快,并发症少。     

The clinical importance of studying disorders in the rheological properties of the blood in hypertension patients

Altogether 118 patients with stages I-III essential hypertension were examined for hemodynamics and rheologic blood properties: total viscosity, deformability, aggregation, form and mechanical resistance of red blood cells, plasma osmolality, hematocrit, and red blood cell count. The data obtained indicate that in patients suffering from essential hypertension, there occur consistent abnormalities of hemorheology, correlating with the disease stage and some hemodynamic parameters. Early changes in red blood cell deformability and their discospheric transformation turned out to be the most specific in patients with essential hypertension. Red blood cell aggregation and hydrodynamic deaggregation underwent alterations mainly in complicated disease patterns.     

A comparative analysis of haemodynamics and oxygen transport during xenon and nitrous oxide anaesthesia in endoscopic surgery in gynaecology

A comparative analysis of haemodynamics and blood gases has been performed in patients during either low-flow anaesthesia with xenon and nitrous oxide and high-flow nitrous oxide anaesthesia. Ninety five patients scheduled for endoscopic surgery were included and divided into three groups: a combined low-flow anaesthesia (30 women), a low-flow nitrous oxide anaesthesia (30 women) and a high-flow nitrous oxide anaesthesia using a semi-closed circuit (35 women). The study has shown a stimulating effect of xenon on haemodynamics during carboxyperitoneum and Trendelenburg position, a better oxygen transport performance and a lower consumption of opioids in this group. Those favourable changes enable the optimization of the oxygen transport in endoscopic surgery in gynaecology, and reduce the contraindications to endoscopic surgery.     

The magnetotherapy of hypertension patients

A study was made of the influence of the constant MKM2-1 magnets on patients suffering from essential hypertension. Continuous action of the magnetic field, created by such magnets, on the patients with stage II essential hypertension was noted to result in a decrease of arterial pressure without the occurrence of any side effects and in a simultaneous reduction of the scope of drug administration. Apart from that fact, magnetotherapy was discovered to produce a beneficial effect on the central hemodynamics and microcirculation. The use of the MKM2-1 magnets may be regarded as a feasible method of the treatment of essential hypertension patients at any medical institution.     

全麻联合硬膜外麻醉在高血压患者腹腔镜胆囊切除术中的应用分析

目的探讨全麻联合硬膜外麻醉在高血压患者腹腔镜胆囊切除术中的价值。方法将内江市第二人民医院行腹腔镜胆囊切除术的45例高血压患者,随机分成实验组25例和对照组20例,实验组给予全麻联合硬膜外麻醉麻醉,对照组给予单纯全麻,比较两组全麻前、气管插管后、气腹建立后及苏醒拔管后血流动力学指标收缩压(SBP)、舒张压(DBP)及心率(HR);比较两组全麻药物用量及麻醉恢复时间。结果实验组气管插管后、气腹建立后及苏醒拔管后血流动力学指标SBP、DBP及HR明显低于对照组,差异具有统计学意义(P<0.05);实验组全麻药物用量明显较对照组少,实验组麻醉自主呼吸恢复时间较对照组提前,差异均具有统计学意义(P<0.05)。结论全麻复合硬膜外麻醉用于高血压患者施行腹腔镜胆囊切除术,能明显减轻应激反应,维持血流动力学的稳定,减少全麻用药量,麻醉后苏醒快。     

Continuous infusion of alfentanil for maintenance of anesthesia: comparison with halothane anesthesia

This study compares anesthetic maintenance, hemodynamic stability, and speed of recovery obtained with inhalational halothane versus intravenous alfentanil anesthesia administered continuously. In two groups of patients, anesthesia was induced with sodium thiopental, maintained with 70% nitrous oxide in 30% oxygen, and either halothane (n = 10) or a continuous infusion of alfentanil (n = 10). The administration of the allocated anesthetic was adjusted according to strict predefined criteria of inadequate anesthesia. After endotracheal intubation, hemodynamics (heart rate, systolic and diastolic pressure) changed less in the alfentanil group (P less than .01). Overall hemodynamic stability was the same in both groups. In neither group was there recall of intraoperative events. Recovery was assessed by the time from cessation of nitrous oxide administration to return of spontaneous ventilation, response to simple command, extubation, orientation, and discharge from the recovery area. The time taken to respond to simple command was significantly shorter in the alfentanil group (P less than .05), but other indices of recovery were similar.     

Comparative evaluation of the action of altiazem PP-180 taken at different time of the day by patients with stage-II hypertension

AIM: To study time-dependent effects of altiazem PP-180 and its influence on circadian pattern of hemodynamics in patients with essential hypertension stage II in its administration in 8.00, 14.00 and 22.00. MATERIAL AND METHODS: 30 patients with essential hypertension stage II (mean age 63.3 years) were divided into 3 groups 10 patients each by time of altiazem intake: 8.00, 14.00 or 22.00. Altiazem was given in a single daily dose 180 mg for 10 days. Before and after the treatment, a circadian profile of arterial pressure according to Korotkov was determined, 24-h monitoring of arterial pressure was made (AP-monitor Astrakard, Russia) and echo-CG measurements of hemodynamics were made (Toshiba, Japan). Tetrapolar chest rheography was also performed. RESULTS: More potent hypotensive effect of altiazem was observed in its administration in 8.00 and 22.00, less potent in 14.00. Negative chronotropic and positive inotropic effects occurred in its morning intake. These effects are less prominent in the evening and minimal if taken in 14.00. Normalization of circadian hemodynamic rhythms was registered in altiazem intake only in the morning. CONCLUSION: Altiazem PP-180 produces time-related hemodynamic effects.     

Intraoperative blood loss during acetabuloplastic in children under traditional and combined neuroaxial anesthesia

In this study included 61 patients aged 3-8 years, undergoing Solter operation. Patients were randomized into 3 groups: 1st group-operative interventions were performed under traditional endotracheal anesthesia; 2nd group - under combined spinal anesthesia; 3rd group - combined epidural anesthesia and 4th group - combined spinal-epidural anesthesia. In comparison with the traditional anesthesia, intraoperative blood loss was significantly lower in the 2nd group by 36.8%, in the 3rd group by 31% and in the 4th group 34.5%. The volume and speed of intraoperational blood loss is not very dependent on the type of neuroaxial blockade.