thiopental and Blood-Loss--Surgical

To evaluate the impact of general anesthesia (GA) versus spinal anesthesia (SpA) on intraoperative and postoperative outcome in patients undergoing radical retropubic prostatectomy.. Seventy-two consecutive patients with clinically localized prostate cancer were randomized into group 1 (GA: 34 patients) or group 2 (L2-L3 or L3-L4 SpA: 38 patients) and underwent radical retropubic prostatectomy. The intraoperative and postoperative anesthetic and surgical variables were evaluated.. The mean +/- SEM operative time was not significantly different between the two groups (P = 0.43). The overall blood loss was less in group 2 (P = 0.04). The mean +/- SEM postoperative time in the postoperative holding area was significantly shorter after SpA than after GA (P <0.0001). The perioperative pain outcome in the postoperative holding area was significantly better for group 2 than for group 1 (P = 0.0017), but postoperative pain on day 1 was not significantly different between the two groups. The postoperative sedation score was significantly less in group 2 than in group 1 (P <0.0001). On day 1, first flatus passed in a significantly larger number of patients in group 2 (P <0.0001), and the overall gait was greater for group 2 patients (P = 0.02).. These results suggest that SpA allows good muscle relaxation and a successful surgical outcome in patients undergoing radical retropubic prostatectomy with pelvic lymphadenectomy for clinically localized prostate cancer. Moreover, SpA results in less intraoperative blood loss, less postoperative pain, and a faster postoperative recovery than GA.

Topics: Adenocarcinoma; Aged; Anesthesia Recovery Period; Anesthesia, General; Anesthesia, Spinal; Blood Loss, Surgical; Bupivacaine; Fentanyl; Humans; Hypnotics and Sedatives; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Patient Acceptance of Health Care; Preanesthetic Medication; Propofol; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Thiopental; Vecuronium Bromide

To compare evacuation under systemic analgesia (fentanyl and midazolam) in a treatment room (ward group) with evacuation under general anaesthesia in theatre.. A prospective randomised clinical trial.. A tertiary medical centre serving a black urban population.. One hundred and forty-two patients with uncomplicated incomplete abortions.. Randomisation into two groups, those for evacuation under systemic analgesia and those for evacuation under general anaesthesia.. Both groups were compared in terms of safety, efficacy, acceptability, blood consumption and time delay between admission and evacuation.. Significantly less blood was used in the ward group (37 units for 13 patients) than in the theatre group (65 units for 24 patients) (P < 0.03). Significantly less time was taken between admission and evacuation in the ward group (median 7 hours 15 minutes) than in the theatre group (median 12 hours 38 minutes) (P < 0.0003). Evacuation under fentanyl and midazolam was safe, effective and acceptable for the majority of patients compared with evacuation under general anaesthesia.. Patients with uncomplicated incomplete abortions (uterine size equivalent to a pregnancy of 14 weeks' duration or less) can undergo evacuation safely and effectively under fentanyl and midazolam and have a significantly smaller chance of requiring a blood transfusion.

Topics: Abortion, Incomplete; Adult; Anesthesia, General; Anesthesia, Intravenous; Blood Loss, Surgical; Blood Transfusion; Dilatation and Curettage; Female; Fentanyl; Hospital Units; Humans; Midazolam; Operating Rooms; Patient Satisfaction; Pregnancy; Prospective Studies; Succinylcholine; Thiopental; Time Factors

We report a case of ischaemic optic neuropathy which occurred after prolonged spine surgery in the prone position in an obese, diabetic patient.. The patient was a 44-yr-old, 123 kg, 183 cm man for decompressive laminectomy and instrumented fusion of the lumbar spine. Anaesthesia was induced with thiopentone, fentanyl and succinylcholine and maintained with nitrous oxide, oxygen, isoflurane and a fentanyl infusion. He was positioned prone on the Relton-Hall frame and had an uneventful intraoperative course. Estimated blood loss was 3,000 ml. He was taken to the surgical intensive care unit (SICU) and the trachea was extubated 3.5 hr later. He had no pulmonary or haemodynamic problems and went to a regular nursing floor in the morning. He was discharged home on postoperative day #5. He telephoned his surgeon on postoperative day #7 to say that his vision had been blurry since surgery. His visual acuity was decreased, and on examination, he had a bilateral papillary defect, optic swelling and a splinter haemorrhage in the right eye. Magnetic resonance imaging (MRI) scan of the head and orbits detected no other abnormality. Based on this examination, he was felt to have bilateral ischaemic optic neuropathy and treated conservatively. By postoperative day #47, his visual acuity was greatly improved and near normal. Careful review of possible contributing factors suggests that the cause of the ischaemic optic neuropathy was venous engorgement.. This patient developed ischaemic optic neuropathy from a prolonged interval in the prone position of the Relton-Hall frame, which may be related to venous engorgement.

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Loss, Surgical; Diabetes Mellitus, Type 1; Fentanyl; Hemorrhage; Humans; Immobilization; Isoflurane; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Neuromuscular Depolarizing Agents; Nitrous Oxide; Obesity; Optic Nerve; Optic Neuropathy, Ischemic; Oxygen; Papilledema; Prone Position; Spinal Fusion; Spinal Stenosis; Succinylcholine; Thiopental; Time Factors; Vascular Diseases; Veins; Visual Acuity

To evaluate the influence of acute isovolemic hemodilution on the dose-response and time course of action of vecuronium, we studied 60 adult patients with and without hemodilution during surgery. The patients with hemodilution underwent major elective plastic surgery with an anticipated surgical loss of more than 600 mL. Anesthesia was induced with thiopental 4-6 mg/kg and fentanyl 2-4 microg/kg i.v. and was maintained with 60% nitrous oxide in oxygen. Further increments of thiopental 2 mg/kg or fentanyl 2 microg/kg were given as required. Acute isovolemic hemodilution in the hemodilution group was induced by drainage of venous blood and an i.v. infusion of lactated Ringer's solution and 6% dextran, during which hematocrit and hemoglobin decreased from 45.7% to 26.2% and from 148.5 g/L to 90.2 g/L, respectively. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s, and the percent depression of T1 response was used as the study parameter. The dose-response relationships of vecuronium in the two groups were determined by using the cumulative dose-response technique. The results showed that during hemodilution, the dose-response curve of vecuronium was shifted to the left in a parallel fashion, and the potency of vecuronium was increased. There were significant differences in the 50%, 90%, and 95% effective doses between the two groups. After the i.v. administration of vecuronium 80 microg/kg, vecuronium-induced neuromuscular block was significantly longer in the patients with hemodilution than in the control patients. The duration of peak effect, clinical duration, recovery index, and total duration in the hemodilution patients were significantly different from those in the control patients. We conclude that hemodilution induces significant changes in the pharmacodynamics of vecuronium.. We found that patients with hemodilution were 20% more sensitive to vecuronium and had a longer duration of action after the administration of the same dose than the controls. This should be taken into account when vecuronium is used as a muscle relaxant during acute hemodilution.

Topics: Adolescent; Adult; Anesthesia Recovery Period; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Loss, Surgical; Blood Volume; Dextrans; Dose-Response Relationship, Drug; Drainage; Elective Surgical Procedures; Electric Stimulation; Evaluation Studies as Topic; Female; Fentanyl; Hematocrit; Hemodilution; Hemoglobins; Humans; Isotonic Solutions; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Oxygen; Plasma Substitutes; Plastic Surgery Procedures; Ringer's Lactate; Thiopental; Time Factors; Vecuronium Bromide; Wrist

To evaluate the effect of gender on the pharmacokinetics of vecuronium, we studied 30 patients (15 male and 15 female) undergoing elective plastic surgery with anticipated surgical blood loss of <300 mL under general anesthesia. General anesthesia was induced with thiopental 4-6 mg/kg and fentanyl 2-4 microg/kg and was maintained with 60% nitrous oxide in oxygen and an end-tidal concentration of 1.5%-2% enflurane. After a 2-min infusion of vecuronium 100 microg/kg, a modified fluorometric assay was used to determine the plasma concentrations of vecuronium for 5 h. The results showed that, compared with women, the plasma concentrations of vecuronium in men were significantly lower during the first 20 min and that the disposition kinetics of vecuronium can be best described mathematically by a three-compartment open model in the two groups. The volume of the central compartment and the volume of distribution at steady state were 39.6 +/- 8.6 and 164.8 +/- 29.3 mL/kg, respectively, in women. These values increased significantly to 54.4 +/- 14.4 and 201.4 +/- 75.8 mL/kg in men (P < 0.05). When the data were calculated on the basis of ideal body weight, the volume of distribution of vecuronium was also different between men and women (P < 0.05. The half-lives of fast distribution and distribution, the elimination half-life, mean residual time, area under the plasma-concentration curve, and plasma clearance were not different between the two groups. We conclude that the pharmacokinetics of vecuronium are significantly different between genders and that and men have the greater volume of distribution of vecuronium.. The authors found that, compared with women, men had lower plasma concentrations of vecuronium after the i.v. administration of vecuronium and a larger volume of distribution of vecuronium. The pharmacokinetic differences may be related to the differences in the sensitivity to vecuronium between genders.

Topics: Adolescent; Adult; Anesthetics, Inhalation; Anesthetics, Intravenous; Area Under Curve; Blood Loss, Surgical; Body Weight; Elective Surgical Procedures; Enflurane; Female; Fentanyl; Half-Life; Humans; Injections, Intravenous; Male; Metabolic Clearance Rate; Models, Chemical; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Plastic Surgery Procedures; Sex Characteristics; Thiopental; Time Factors; Vecuronium Bromide