Greater Incidence of Delirium during Recovery from Sevoflurane Anesthesia in Preschool Boys 

1997 ◽  
Vol 87 (6) ◽  
pp. 1298-1300 ◽  
Author(s):  
Jun Aono ◽  
Wasa Ueda ◽  
Kikyo Mamiya ◽  
Eri Takimoto ◽  
Masanobu Manabe
Keyword(s):  
Age Groups ◽  
Older Children ◽  
Caudal Block ◽  
Physical Status ◽  
Early Recovery ◽  
Sevoflurane Group ◽  
Preschool Boys ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background In the authors' clinical experience, preschool children are more likely to show delirium after sevoflurane than are older children. Methods Sixty-three preschool boys aged 3-5 yr (classified as American Society of Anesthesiologists [ASA] physical status I), and 53 school-age boys aged 6-10 yr (ASA physical status I) who underwent minor urologic surgery were randomly assigned to receive either halothane or sevoflurane, thus creating four groups: preschool-halothane (n = 32), preschool-sevoflurane (n = 31), school-halothane (n = 27), and school-sevoflurane (n = 26). Anesthesia was induced by inhalation of halothane or sevoflurane in oxygen and was maintained at 1 minimum alveolar concentration of each agent throughout surgery. For intra- and postoperative analgesia, caudal block with 0.5-1.0 ml/kg 0.25% plain bupivacaine and topical infiltration with 3-5 ml 1% lidocaine were provided for all patients. Recovery characteristics and incidence of delirium on emergence were compared among the four groups. Results Two patients in the preschool-halothane group, one in the preschool-sevoflurane group, and one in the school-halothane group were excluded from the comparison because of insufficient analgesia or agitation before induction. In both age groups, the time to emergence from sevoflurane was significantly faster (about 3 min) than from halothane. The incidence of delirium during recovery in the preschool-sevoflurane group (40%) was significantly greater than that in the other groups (preschool-halothane, 10%; school-halothane, 15.4%; school-sevoflurane, 11.5%). Conclusion Sevoflurane provided quicker emergence and early recovery compared with halothane, but the incidence of delirium was greater in preschool boys after sevoflurane.

Comparative Hemodynamic Depression of Sevoflurane versus Halothane in Infants 

1997 ◽  
Vol 87 (4) ◽  
pp. 795-800 ◽  
Author(s):  
Eric Wodey ◽  
Patrick Pladys ◽  
Catherine Copin ◽  
Marie Madeleine Lucas ◽  
Andre Chaumont ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Index ◽  
Elective Surgery ◽  
Physical Status ◽  
Inhalation Induction ◽  
Cardiovascular Side Effects ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background The cardiovascular side effects of volatile anesthetics are one of the chief causes of postoperative complications in children, and infants seem to be at the greatest risk for this. This study compared cardiovascular changes at equipotent concentrations of sevoflurane and halothane in infants. Methods Thirty infants classified as American Society of Anesthesiologists physical status I or II who required elective surgery were randomized to receive either halothane or sevoflurane for inhalation induction. Cardiovascular and echocardiographic data were recorded in both groups at baseline and at end-tidal concentrations of 1 and 1.5 minimum alveolar concentration (MAC). Results Sevoflurane did not alter heart rate or cardiac index at all concentrations compared with awake values. Sevoflurane significantly decreased blood pressure and systemic vascular resistance compared with awake values at all concentrations. Shortening fraction and rate-corrected velocity of circumferential fiber shortening decreased at 1.5 but not at 1 MAC. Myocardial contractility assessed by stress-velocity index and stress-shortening index decreased significantly at all concentrations, but did not fall into the abnormal range at any concentration. Halothane caused a greater decrease in heart rate, shortening fraction, stress-shortening index, velocity of circumferential fiber shortening, stress-velocity index, and cardiac index at all concentrations than did sevoflurane. Conclusion Sevoflurane causes a lesser decrease in cardiac output than does halothane in infants.

Dilution of Spinal Lidocaine Does Not Alter the Incidence of Transient Neurologic Symptoms 

1999 ◽  
Vol 90 (2) ◽  
pp. 445-450 ◽  
Author(s):  
Julia E. Pollock ◽  
Spencer S. Liu ◽  
Joseph M. Neal ◽  
Carol A. Stephenson
Keyword(s):  
Postoperative Complications ◽  
Knee Arthroscopy ◽  
Physical Status ◽  
Double Blind ◽  
Neurologic Symptoms ◽  
The Third ◽  
Ambulatory Patients ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background Although it has been suggested that the dilution of 5% hyperbaric lidocaine before injection for spinal anesthesia may decrease the incidence of transient neurologic symptoms, previous studies have not noted a decreased incidence between 5% and 2% lidocaine. The aim of the current study was to determine whether the incidence of transient neurologic symptoms could be altered by further diluting spinal lidocaine from 2.0% to 0.5%. Methods One hundred nine patients with American Society of Anesthesiologists physical status 1 or 2 undergoing outpatient knee arthroscopy were randomized in a double-blind fashion to receive 50 mg hyperbaric spinal lidocaine as a 2.0%, 1.0%, or 0.5% concentration. On the third postoperative day, patients were contacted by a blinded investigator and questioned regarding the incidence of postoperative complications, including transient neurologic symptoms, defined as pain or dysthesia in one or both buttocks or legs occurring within 24 h of surgery. Results The incidence of transient neurologic symptoms did not differ among patients receiving 2.0% (incidence of 15.8%), 1.0% (incidence of 22.2%), and 0.5% (incidence of 17.1%) lidocaine (P = 0.756). Conclusions For ambulatory patients undergoing arthroscopy, the incidence of transient neurologic symptoms is not reduced by decreasing spinal lidocaine concentrations from 2.0% to 1.0% or 0.5%. The incidences of transient neurologic symptoms with the 0.5%, 1.0%, and 2.0% solutions are similar to previously reported incidences for 5.0% lidocaine, suggesting that dilution of lidocaine from 5.0% to 0.5% does not change the incidence of these symptoms.

scholarly journals Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy

2017 ◽  
Vol 135 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Luis Antônio Borges ◽  
Plínio da Cunha Leal ◽  
Ed Carlos Rey Moura ◽  
Rioko Kimiko Sakata
Keyword(s):  
Adverse Effects ◽  
Pain Intensity ◽  
Hospital Discharge ◽  
Primary Objective ◽  
Spinal Block ◽  
Early Recovery ◽  
Local Infiltration ◽  
Randomized Clinical Study ◽  
American Society ◽  
American Society Of Anesthesiologists

ABSTRACT BACKGROUND AND OBJECTIVES: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION: ClinicalTrials.gov NCT02839538.

scholarly journals Epidural Anaesthesia Saved A Patient With Multiple Co-Morbid Condition

KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 729-730
Author(s):  
Rahena Khatun ◽  
Md Zulfikar Ali
Keyword(s):  
Epidural Anaesthesia ◽  
Postoperative Recovery ◽  
Morbid Condition ◽  
Physical Status ◽  
Uncontrolled Diabetes ◽  
Life Saving ◽  
Diabetic Gangrene ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Morbid Conditions

Epidural anaesthesia has been routinely used for many years and widely accepted as an effective mathod of pain relief . The procedure is commonly performed as a sole anaesthesic or in combination with spinal or general anaesthesia. In our case Md. Alauddin, 59 years old male was admitted in KYAMCH with complaints of diabetic gangrene of right foot with features of septicemia and he has a long history uncontrolled diabetes mellitus and hypertension leading to developed ischemia heart disease and CRF. After proper evaluation patient's physical status was graded as ASA (American society of Anesthesiologists) class-IV, and selected for above knee amputation of right lower limb but patient was unfit for anesthesia due to his co morbid conditions. As a life saving procedure the operation was done under epidural anesthesia and per- operative and postoperative recovery was uneventful.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 729-730

scholarly journals Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

2021 ◽  
Author(s):  
Charlene Xian Wen Kwa ◽  
Jiaqian Cui ◽  
Daniel Yan Zheng Lim ◽  
Yilin Eileen Sim ◽  
Yuhe Ke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Outcomes ◽  
Real World ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Clinical Factors ◽  
Physical Status ◽  
Asa Score ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe American Society of Anesthesiologists Physical Status Classification (ASA) score is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA scoring among healthcare providers. However, there is a paucity of concordance studies using real-world data, as well as studies of clinical factors or patient outcomes associated with discordant scoring. The study aims to assess real-world ASA score concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. MethodsThis retrospective cohort study was conducted in a tertiary academic medical center on 46284 consecutive patients undergoing elective surgery between January 2017 and December 2019. ASA scores entered by surgeons and anesthesiologists, patient demographics, and post-operative outcomes were collected. We assessed the concordance of preoperative ASA scoring between surgeons and anesthesiologists, clinical factors associated with score discordance, the impact of score discordance on clinically important outcomes, and the discriminative ability of the two scores for 30-day mortality, 1-year mortality, and intensive care unit (ICU) admission. Statistical tests used included Cohen’s weighted 𝜅 score, chi-square test, t-test, unadjusted odds ratios and logistic regression models. ResultsThe ASA score showed moderate concordance (weighted Cohen’s 𝜅 0.53) between surgeons and anesthesiologists. 15098 patients (32.6%) had discordant scores, of which 11985 (79.4%) were scored lower by surgeons. We found significant associations between discordant scores and anesthesiologist-assessed comorbidities, patient age and race. Patients with discordant scores had a higher risk of 30-day mortality (odds ratio 2.00, 95% confidence interval [CI] = 1.52-2.62, p<0.0001), 1-year mortality (odds ratio 1.53, 95% CI = 1.38-1.69, p < 0.0001), and ICU admission >24 hours (odds ratio 1.69, 95% CI = 1.47-1.94, p< 0.0001), and stratified analyses showed a trend towards higher risk when the surgeons’ ASA score was lower. ConclusionsThere is moderate concordance between surgeons and anesthesiologists in assigning the ASA classification. Discordant ASA scores are associated with adverse patient outcomes. Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.

Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor

2017 ◽  
Vol 127 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Jessica L. Booth ◽  
Vernon H. Ross ◽  
Kenneth E. Nelson ◽  
Lynnette Harris ◽  
James C. Eisenach ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Local Anesthetic ◽  
Primary Outcome ◽  
A Priori ◽  
Regulatory Compliance ◽  
Epidural Bupivacaine ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Labor Epidural ◽  
To Receive

Abstract Background The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. Methods A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Results Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). Conclusions The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

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