Peribulbar anaesthesia for strabismus surgery

BACKGROUND: Strabismus surgery is underwent with general anaesthesia since it's a paediatric surgery in the majority of cases. The aim of our study is to analyse the safety and tolerance of peribulbar anaesthesia for strabismus surgery. PATIENTS AND METHODS: sixty two patients underwent strabismus surgery with a peribulbar anaesthesia. All patients had premedication the evening before and two hours bef6re the surgery. All patients were examined to evaluate the efficacy and the safety of such anaesthesia. RESULTS: The main age was 31,5 years. Forty patients were female and twenty two were male. None had report pain. Three patients report just incomfort during surgery. Orthoptic results were acceptable. CONCLUSION: Peribulbar anaesthesia has shown to be an effective alternative for general anaesthesia for strabismus surgery in an attempt to reduce the morbidity and mortality. It take importance particularly in patients of high-risk characteristics and in monocular surgery.     

Anaesthesia for patients with cardiac disease. Intraoperative management

The risks of anaesthesia and surgery may be very much higher for patients with cardiac disease than for healthy patients. Now that the chief risk factors are known, efforts to identify and correct cardiovascular perturbations during anaesthesia in patients with these factors are likely to be rewarded by lower morbidity and mortality. Extensive cardiovascular monitoring techniques widely used in anaesthesia for cardiac surgery are applicable in patients with cardiac disease undergoing non-cardiac surgery.     

Clearance and action of insulin during general or epidural anaesthesia

Surgery performed under general anaesthesia induces impaired glucose tolerance together with comparatively low levels of insulin. This contrasts with the normal glucose tolerance and normal insulin levels found in patients operated upon under epidural anaesthesia. The aim of this study was to investigate insulin clearance and insulin action during surgery. Sixteen non-diabetic patients admitted for elective inguinal herniorrhaphy were operated under general anaesthesia (thiopentone, N(2)O/O(2) (2 1 ), fentanyl, pancuronium bromide) or after high epidural blockade with mepivacaine. The clearance and hypoglycemic action of insulin were determined after a 2.5 min infusion of a physiologic dose of insulin. All patients were studied the day before operation and during surgery. The hypoglycemic action of insulin, expressed as % decrement from the pre-test blood glucose level, was unchanged during epidural anaesthesia but reduced during general anaesthesia (22.4 +/- 1.8% pre-operatively vs 7.5 +/- 1.3% intra-operatively, p < 0.01). The insulin resistance during general anaesthesia was associated with a decreased clearance of insulin (20.3 +/- 0.8 ml min(-1) kg(-1) pre-operatively vs 12.7 +/- 1.1 ml min(-1) kg(-1) intra-operatively, p < 0.01), whereas insulin clearance was normal during epidural anaesthesia. It is concluded that general anaesthesia, but not epidural anaesthesia, induces a reduction in both clearance and hypoglycemic action of insulin.     

Influence of anaesthesia on blood loss in transurethral prostatectomy

In this study operative blood loss was measured in 177 transurethral prostatectomies performed over a six-year period in one hospital by the author. A comparison was made relative to type of anaesthesia used i.e. general inhalation versus spinal anaesthesia. The two groups were similar in age and physical condition. Their prostates were almost the same size and there was negligible difference in the rate of resection between the two groups. Mean loss and median loss in 113 patients given general anaesthesia were 66.6 and 29.9 ml. In 64 patients who had spinal anaesthesia these losses were 35.6 and 22.2 ml respectively. The findings are in agreement with two of the three previous studies devoted to the relationship between operative blood loss during transurethral prostatectomy and the type of anaesthesia used.     

神经阻滞麻醉控制耵聍取出时的疼痛

目的：探讨神经阻滞麻醉控制耵聍取出的方法及疗效。方法：54例确诊为耵聍栓塞患者在耳颞神经、迷走神经阻滞麻醉下取出耵聍。结果：有效地控制耵聍取出时的疼痛,减轻患者的痛苦。结论：神经阻滞麻醉控制耵聍取出的方法简便,操作易掌握,疗效肯定。     

等比重罗哌卡因腰-硬联合麻醉782例临床分析

目的总结等比重0·5%罗哌卡因腰-硬联合麻醉的临床应用,探讨其用于下腹以下手术的可行性。方法782例下腹以下手术的患者,麻醉前大量扩容,采用腰-硬联合麻醉技术,等比重0·5%罗哌卡因腰麻后硬膜外置管,必要时硬膜外推注2%利多卡因以补充麻醉不足。观察麻醉效果及不良反应。结果腰麻起效快,麻醉效果好,大部分不需追加2%利多卡因。腰麻后血压、心率下降,以及腰穿产生放射性异感,产科多于其他科。结论等比重0·5%罗哌卡因腰-硬联合麻醉可用于下腹以下手术麻醉。     

Assessing introduction of spinal anaesthesia for obstetric procedures.

To assess the impact of introducing spinal anaesthesia for obstetric operative procedures on use of general anaesthesia and quality of regional anaesthesia in a unit with an established epidural service a retrospective analysis of routinely collected data on method of anaesthesia, efficacy, and complications was carried out. Data were collected from 1988 to 1991 on 1670 obstetric patients requiring an operative procedure. The introduction of spinal anaesthesia in 1989 significantly reduced the proportion of operative procedures performed under general anaesthesia, from 60% (234/390) in 1988 to 30% (124/414) in 1991. The decrease was most pronounced for manual removal of the placenta (88%, 48/55 v 9%, 3/34) and emergency caesarean section (67%, 129/193) v 38%, 87/229). Epidural anaesthesia decreased in use most significantly for elective caesarean section (65%, 77/118 v 3% 3/113; x2=139, p<0.0001). The incidence of severe pain and need for conversion to general anaesthesia was significantly less with spinal anaesthesia (0%, 0/207 v 3%, 5/156; p<0.05). Hypotension was not a problem, and the incidence of headache after spinal anaesthetic decreased over the period studied. Introducing spinal anaesthesia therefore reduced the need for general anaesthesia and improved the quality of regional anaesthesia.     

Epidural anaesthesia and urinary dysfunction: the risks in total hip replacement.

Epidural anaesthesia in total hip replacement is an established and safe practice. It may be used alone or in combination with general anaesthesia for analgesia. Urethral catheterization in the perioperative period is known to greatly increase the complication of deep sepsis following total hip replacement. We assessed the effect on the incidence of urinary catheterization of using bupivocaine epidural anaesthesia in addition to general anaesthesia in total hip replacement. A prospective study was made of 113 total hip replacements. The incidence of catheterization in male patients who received an epidural was 67% compared to only 12% who had no epidural [P = 0.001]. In women the corresponding rates were 30% and 23%. We conclude that in men the use of supplementary epidural anaesthesia with bupivocaine is associated with a worrying increased need for urinary catheterization. This must be balanced against the claimed benefits of this form of anaesthesia.     

Focus on the various techniques of anaesthesia in ophthalmologic surgery

Ophthalmologic surgery is not a vital one. It mostly concerns patients in extreme ages: children and old people. The risk of anaesthesia mainly depends on the health conditions of the patient. General anaesthesia through use of intravenous drugs alters the balance of the endocrine and sympathetic systems. Tracheal airway intubation constitutes an added constraint and stress especially for the vascular system. Retrobulbar anaesthesia is not devoid of risks: ptosis, diplopic, orbit haematoma, lesion of the optic nerve, eye perforation, vascular occlusion, intra arterial injection, neurologic and cardiovascular toxic effects of local anaesthetics, are all ever present risk Topical anaesthesia with its various variants (single topic or associated with intracameral injection, subconjunctival, circumferential perilimbal, subtenon) represents an interesting alternative for it is simple, less toxic and harless. In our experience, this method is indicated in surgery of eye's anterior segment. We find it safe, efficacisious and economical. Regional anaesthesia is preferred to general anaesthesia especially in the surgery of dacryocystitis and ptosis. General anaesthesia in stell indicated in case of children.     

布比卡因脊麻和硬膜外阻滞用于剖宫产麻醉的临床观察

目的:观察布比卡因硬膜外麻醉和布比卡因重比重腰麻用于剖宫产手术的麻醉效果,以及对患者和胎儿的影响。方法:选择行择期剖宫产手术患者80例,随机分为硬膜外阻滞组和蛛网膜下隙阻滞组,每组40例。监测并记录患者麻醉前、硬膜外或蛛网膜下隙给药后各时点SBP、DBP、MAP、HR、SpO2的变化。记录硬膜外或蛛网膜下隙给药后药物起效时间和维持时间,评价两组患者肌松效果,记录两组患者术中牵拉反应、新生儿Apgar氏评分以及麻醉并发症。结果:SB组药物起效时间较EB组显著缩短(P<0.01)。EB组患者给药后10～30min患者MAP有明显下降(P<0.05),而给药后60～180min MAP水平与给药前相比无明显变化(P>0.05);SB组患者给药后3～10min患者MAP较给药前有显著下降(P<0.05),但给药后30～180min患者MAP与给药前相比无明显变化(P>0.05)。SB组肌松效果明显较EB组好(P<0.01),两组新生儿Apgar氏评分比较差异无显著性(P>0.05)。EB组患者术中有牵拉反应,而且术后出现腰背部疼痛;SB组并未出现此类症状。结论:针对剖宫产手术采用布比卡因重比重蛛网膜下隙阻滞是一种有效的麻醉方法。     

Short preoperative health assessment proposed by the Health Council not useful in clinical practice]

OBJECTIVE: To evaluate the value of the short questionnaire drawn up by the Dutch Health Council for the classification of patients to an ASA class (a 5-point scale according to the American Society of Anesthesiologists, on which the patient's preoperative physical condition can be scored) and to propose an anaesthesia care plan for surgery patients aged between 16 to 40 years old. DESIGN: Observational. METHODS: From June 1999 through to May 2000, all 2090 preoperative patients aged 16 to 40 years at the academic hospital of Utrecht, the Netherlands, were asked to complete the Dutch Health Council's short questionnaire. In addition, the usual extensive preoperative health assessment was carried out on these patients. Of the 379 (18%) who were found by the short questionnaire to be 'healthy', 100 were selected. A panel of 10 anaesthesiologists was asked to preoperatively evaluate these 100 patients twice: once using the short questionnaire and once using the usual extensive health evaluation. The primary outcome was the percentage of patients who could be classified to an ASA class and for whom an anaesthesia care plan could be drawn up. The secondary outcome was the information judged by the anaesthesiologists to be either 'redundant' or 'missing' when drawing up an anaesthesia care plan. RESULTS: Using the short questionnaire, 63% of the patients could not be assigned to an ASA class, compared to 22% with the extensive health evaluation (p < 0.0001). On the basis of the information obtained with the short questionnaire, it was not possible to draw up an anaesthesia care plan for any of the patients, while the extensive health evaluation enabled an anaesthesia care plan to be drawn up for 65% of the patients (95% CI: 62-68%). Using the missing information deemed 'necessary', recommendations were made for the minimum scope of a preoperative health assessment for use in patients aged 16 to 40 years old. CONCLUSION: The short questionnaire as proposed by the Dutch Health Council was not found to be useful in practice.     

Anaesthesia for hip fracture: a survey of Scottish practice

A postal survey of all senior anaesthetists with routine commitment to an acute trauma list in 13 Scottish hospitals was conducted to delineate contemporary anaesthetic practice for hip fracture surgery. Almost equal use of general and regional anaesthesia was reported, however the techniques used for general anaesthesia were different from those described in previous literature in this group. The recently released Scottish Intercollegiate Guidelines Network (SIGN) guidelines for the management of elderly people with fractured hip state that seniority of anaesthetist is important for improved outcome but there is no difference between either general or regional anaesthesia. However these conclusions relate to techniques and drugs which are now rarely used during general anaesthesia for hip fracture surgery. Further work to assess the impact of new techniques and agents on outcome for this group of patients may be required.     

脑电双频指数在老年患者静脉全身麻醉中应用的临床观察

目的评价脑电双频指数（BIS）监测对老年患者静脉全身麻醉用药及苏醒质量的影响。方法需静脉全身麻醉手术老年患者60例随机均分为BIS组（Ⅰ组）和对照组（Ⅱ组）,两组患者均采用丙泊酚联合瑞芬太尼双通道靶控输注。记录术中麻醉药用量、呼之睁眼时间、气管拔管时间、随意运动恢复时间、定向力恢复时间及术中知晓发生率。结果Ⅰ组丙泊酚用量显著少于Ⅱ组（P〈0.05）,而且其呼之睁眼时间、拔管时间、随意运动恢复时间、定向力恢复时间均明显短于Ⅱ组（P〈0.05）。两组均无术中知晓发生。结论 BIS监测可减少老年患者全凭静脉麻醉丙泊酚用量并改善麻醉苏醒质量。     

Retrobulbar anesthesia during keratolplasty

AIM: A restrospective study was carried in order to evaluate the efficacy and safety of retrobulbar anaesthesia during keratoplasty. METHODS: Of 250 consecutive keratoplasty, 30 (12%) were performed under retrobulbar anaesthesia. Patients received a mean volume of 12 ml, composed of etidocaine (2/3), bupicaine (1/3) and hyaluronidase. Ocular compression duration was at least 20 minutes. RESULTS: Surgery was found painless by 90% of patients. Akinesia was complete in 80% of cases. CONCLUSION: Theses results demonstrate that retrobulbar anaesthesia may be recommended to this type of surgery.     

Prospective study of liver function following repeat halothane and enflurane

In a prospective study of liver function following repeat anaesthesia, patients who received repeat halothane had a higher frequency of abnormal liver enzyme results than a similar group who received repeat enflurane. Obesity and short intervals between administrations increased the likelihood of abnormal liver enzyme activity in the halothane group. Enflurane would seem to be the volatile agent of choice for repeat anaesthesia in such circumstances.     

空气供气循环紧闭麻醉环路氧浓度变化规律研究

目的 探讨空气循环紧闭麻醉呼吸环路内氧浓度变化规律.方法 ASA Ⅰ～Ⅱ级腹部择期手术患者和健康志愿者各20例,根据供气的不同,将手术患者和志愿者相应地分为纯氧对照组和空气实验组,每组各10例 以空气替代纯氧供应,每分钟记录一次氧浓度,手术患者环路内最低浓度不低于25%,低于25%直到最低耐受氧浓度段试验采用健康志愿者.结果 手术组和志愿者组在空气供气下氧浓度随时间延长逐渐下降,与对照组相比,有显著的统计学差异（P≤0.01）.手术实验组氧浓度与时间呈正相关（r=0.9999,t=894.381,P≤0.01）,直线回归方程是y=-3.0695x＋84.40 志愿者实验组氧浓度与时间也呈正相关（r=0.9899,t=28.001,P≤0.01）,直线回归方程是y=-3.0967x＋41.447.结论 空气循环紧闭麻醉呼吸环路内氧浓度随时间延长而降低,且氧浓度与时间的变化呈直线相关.     

异丙酚用于无痛人工流产术的临床观察

目的:探讨异丙酚静脉麻醉应用于人工流产术的镇痛效果。方法:随机分为三组,异丙酚组350例,静脉全麻,剂量为2mg/kg,必要时可追加30～50mg;利多卡因组180例,局麻,剂量为5～6ml;对照组300例,不使用任何镇痛药。结果:异丙酚静脉麻醉应用于人工流产术无痛率为100.00%,无人工流产综合征发生;利多卡因组可不同程度地减轻疼痛,无痛率为14.44%;对照组无痛率为2.33%,三组间有显著性差异(P<0.01)。结论:异丙酚用于无痛人工流产术是一种安全有效的静脉麻醉药,值得进一步推广应用。     

Postoperative vomiting

INTRODUCTION: Nausea and vomiting following general anaesthesia are among the most frequent adverse reactions causing complications, the relief of which is an absolute demand. 5-HT3 receptor antagonists, such as ondansetron, belonging to the latest class of antiemetics were launched more than a decade ago. PATIENTS/METHODS: Efficacy and tolerability of ondansetron injection in prevention of postoperative nausea and vomiting were investigated in a prospective, randomised, double-blind, placebo controlled, three-armed clinical study in 148 patients undergoing laparoscopic cholecystectomy. Moreover the authors also investigated the effect of timing of dosing, i.e. whether the administration of antiemetic drug before starting anaesthesia has any advantage comparing its use at the end of operation. RESULTS: While using a standard surgical and anaesthesia method vomiting after laparoscopic cholecystectomy occurred in a frequency of 44.7% of the patients in the placebo group, whereas the figures decreased significantly after administration of 4 mg ondansetron at the end (28.9%) or before (25.5%) anaesthesia. Inclusively the frequency of severe cases decreased from 19.2% of control group up to 8.9% and 4.3% in the active groups, respectively. CONCLUSIONS: Intravenous administration of 4 mg ondansetron effectively reduces vomiting occurring in more than 40% of patients after laparoscopic cholecystectomy, especially the frequency of severe cases, and mainly if administered before operation. The preparation is safe; no clinical or laboratory adverse reactions, complications have been observed in the studied patients.     

应用EnCor麻醉模式防止乳腺肿块微创切除术创腔出血的研究

目的 探讨应用EnCor麻醉模式防止乳腺肿块微创切除术创腔出血的价值.方法 乳腺肿块患者618例,随机分为两组.对照组（Ⅰ组）真空辅助病变切除后单纯压迫止血.研究组（Ⅱ组）病变切除后在EnCor麻醉模式下向创腔注射血凝酶＋肾上腺素盐水止血.术后观察患者创腔出血情况.结果 Ⅰ组患者306例,术后发生创腔出血并发症115例（38.3%）.Ⅱ组患者312例,术后发生创腔出血并发症19例（6.2%）.Ⅰ组患者创腔出血并发症的发生率显著高于Ⅱ组（χ^2=144.31,P＜0.001）.结论 术中在EnCor麻醉模式下向创腔内注射血凝酶＋肾上腺素盐水,可有效防止真空辅助乳腺肿块切除术后乳腺血肿.     

异丙酚用于10890例无痛人工流产术临床观察

目的:观察异丙酚静脉麻醉下人工流产术镇痛效果及安全程度。方法:将13504例要求人工流产的健康孕妇按志愿分为两组,异丙酚麻醉组10890例、对照组2614例,比较两组孕妇疼痛情况及其他指标,如人工流产综合征、呼吸循环系统的影响、宫口紧张度、术中出血、手术时间等。结果:异丙酚静脉麻醉用于人工流产术镇痛效果非常满意,两组间人工流产综合征发生率有显著性差异,异丙酚麻醉组明显优于对照组;其他各并发症两组间无显著性差异。结论:异丙酚静脉麻醉下人工流产术镇痛效果非常满意,并能使人工流产综合征发生率降低,而不增加人工流产术其他并发症的发生率,值得临床推广应用。