thiopental and Strabismus

Day case surgery has become a widely accepted practice for many ophthalmological procedures including strabismus surgery. Prompt recovery from anesthesia and minimal postoperative morbidity are especially requested to the anesthesiologists to deal with the high day case surgery burden. The purpose of this study was to compare two anesthesia techniques, halothane/thiopental anesthesia and propofol anesthesia, for patients undergoing monocular strabismus surgery. We studied the level of postoperative consciousness, nausea and vomiting, ocular pain, starting oral intake and activity in 43 patients, ranging from 7 to 41 years of age. A scoring system was used to assess these parameters in the first postoperative 48 h. Although there was not a significant difference in the level of ocular pain, the propofol group had less morbidity in terms of having a better level of consciousness and appetite, less nausea and vomiting and enhanced activity than the halothane/thiopental group. We conclude that propofol anesthesia has significant advantages over halothane/thiopental anesthesia on an outpatient basis for strabismus surgery.

Topics: Adolescent; Adult; Anesthesia Recovery Period; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Follow-Up Studies; Halothane; Humans; Monitoring, Intraoperative; Propofol; Strabismus; Thiopental; Treatment Outcome

Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery.. Children (3-16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg x m(-2) i.v.; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg x kg(-1) i.v. All children received prophylactic atropine 0.02 mg x kg(-1) and alfentanil. Nitrous oxide was omitted.. Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thiopentone-isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number-needed-to-treat was 5.5 (95% CI 2.9-46). Propofol was not different from thiopentone-isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number-needed-to-harm was 3.9 (95% CI 2.6-8).. Thiopental-isoflurane-air/O2-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.

Topics: Adolescent; Alfentanil; Analgesics, Opioid; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Antiemetics; Atropine; Child; Child, Preschool; Confidence Intervals; Elective Surgical Procedures; Hospitalization; Humans; Incidence; Injections, Intravenous; Isoflurane; Lidocaine; Mydriatics; Ondansetron; Postoperative Complications; Propofol; Reflex, Oculocardiac; Risk Factors; Strabismus; Thiopental; Vomiting

Previous studies have indicated that propofol anaesthesia may reduce the incidence of postoperative nausea and vomiting after strabismus surgery in children. This study was designed to investigate the incidence of vomiting after strabismus surgery at two different levels of propofol anaesthesia compared to thiopental/isoflurane anaesthesia.. Ninety ASA class I or II children, aged 5-14 yrs were randomly assigned to one of three groups: Group T/I (n = 30) induction with 5 mg kg-1 of thiopental and maintenance with isoflurane, group P5 (n = 31) induction with propofol 2 mg kg-1, maintenance with propofol infusion 5 mg kg-1 h-1 or group P10 (n = 29) induction with propofol 2 mg kg-1, maintenance with propofol 10 mg kg-1 h-1. All received glycopyrrolate, vecuronium, fentanyl and controlled ventilation with O2/N2O 30/70. Ketorolac i.v. was given to prevent postoperative pain. If additional analgesia was needed, ibuprofen/acetaminophen or buprenorphine was given according to clinical need.. There were no differences between study groups with respect to age, weight, history of previous anaesthesia or emesis after previous anaesthesia, duration of anaesthesia, surgery or sleep after anaesthesia, or number of muscles operated. The incidence of vomiting was 37%, 29% and 28% in groups T/I, P5 and P10, respectively. There were no statistically significant differences between the three groups in the incidence of vomiting. The median age of patients who vomited was 7.5 (range 5.0-13.7) yrs while the median age of the patients who did not vomit was 9.1 (range 5.0-14.0) yrs (P < 0.01).. In the present study, propofol anaesthesia compared to thiopental/isoflurane anaesthesia did not reduce the incidence of vomiting following strabismus surgery in children.

Topics: Adolescent; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Child, Preschool; Female; Humans; Isoflurane; Male; Postoperative Complications; Propofol; Strabismus; Thiopental; Vomiting

Propofol anaesthesia may reduce postoperative emesis. The purpose of this study was to compare the incidence of emesis after propofol anaesthesia with and without nitrous oxide, compared with thiopentone and halothane anaesthesia, in hospital and up to 24 hr postoperatively, in outpatient paediatric patients after strabismus surgery. Seventy-five ASA class I or II, unpremedicated patients, aged 2-12 yr were randomly assigned to one of three groups: Thiopentone, 6.0 mg.kg-1 i.v. induction followed by halothane and N2O/O2 for maintenance (T/H); propofol for induction, followed by propofol and oxygen for maintenance (P/O2); and propofol for i.v. induction, followed by propofol infusion and N2O/O2 for maintenance (P/N2O). All received vecuronium, controlled ventilation, and acetaminophen pr. Morphine was given as needed for postoperative analgesia. There were no differences in age, weight, number of eye muscles operated upon, duration of anaesthesia or surgery. The P/N2O group (255 +/- 80 micrograms.kg-1 x min-1) received less propofol than the P/O2 group (344 +/- 60 micrograms.kg-1 x min-1) (P < or = 0.0001) and had shorter extubation (P < 0.001) and recovery (P < 0.01) times. Emesis in the hospital, in both the P/N2O (4.0%) and P/O2 group (4.0%) was less than in the T/H group (32%) (P < 0.01). Antiemetics were required in four patients in the T/H group (16.0%). Overall emesis after surgery was not different among the groups: T/H (48%), P/O2 (28%) and P/N2O (42%). The use of propofol anaesthesia with and without N2O decreased only early emesis. This supports the concept of a short-acting, specific antiemetic effect of propofol.

Topics: Ambulatory Surgical Procedures; Anesthesia Recovery Period; Anesthesia, Inhalation; Anesthesia, Intravenous; Child; Child, Preschool; Female; Halothane; Humans; Incidence; Length of Stay; Male; Mental Recall; Metoclopramide; Nitrous Oxide; Postoperative Complications; Propofol; Strabismus; Thiopental; Vomiting

Forty-four children, ASA physical status I or II, aged 1.5-14 years and admitted for strabismus surgery, were studied. The study compared the postoperative condition after two different anesthesia methods. All children were premedicated with midazolam rectally, received glycopyrrolate i.v. and were then randomised to one of two anesthetic methods: 1) induction with thiopental, maintenance with halothane or 2) induction with propofol supplemented with fentanyl, maintenance with propofol infusion. In both groups, tracheal intubation was performed after vecuronium i.v. and the children were ventilated manually. Peroperatively, patients receiving propofol/fentanyl had more episodes of bradycardia (P less than 0.001). Times to spontaneous breathing and extubation were shorter in the propofol/fentanyl group (P less than 0.05) and there was also a lesser degree of sedation during the first 2 h postoperatively (P less than 0.01). Fewer children in the propofol/fentanyl group vomited postoperatively (P less than 0.05). The apprehension score was higher in the propofol/fentanyl group compared to the thiopental/halothane group (P less than 0.05). We conclude that children undergoing strabismus surgery anesthetized with propofol/fentanyl had more episodes of peroperative bradycardia, a lower incidence of postoperative vomiting and a shorter recovery time, and were more apprehensive during the initial postoperative period than children anesthetized with thiopental/halothane.

Topics: Adolescent; Anesthesia Recovery Period; Anesthesia, Inhalation; Anesthesia, Intravenous; Child; Child, Preschool; Female; Fentanyl; Halothane; Humans; Infant; Male; Propofol; Strabismus; Thiopental; Vomiting

Propofol was assessed for eye surgery in 20 children. ASA group I or II, 2-14 year-old, randomly assigned to 2 equal groups. Premedication, analgesia and muscle paralysis were similar in both groups. Group P patients were given an induction dose of 4 mg.kg-1 propofol, followed by an infusion of 15 mg.kg-1.h-1 for the first half hour, and then 10 mg.kg-1.h-1 to maintain anaesthesia. Group C patients were given 10 mg.kg-1 thiopentone for induction and halothane for maintenance. The quality of anaesthesia was assessed by monitoring adverse effects, heart rate, blood pressure, the length of anaesthesia, the delay of the first spontaneous breath and eye opening, and extubation. Intraocular pressure was measured before and 3 min after intubation, and 5 min after extubation. The quality of anaesthetic induction and maintenance were very similar in both groups. Pain occurred more frequently at the injection site with propofol (p less than 0.01). Children in group P recovered more quickly, and extubation was possible much earlier in this group (p less than 0.05). However, restlessness was significantly more frequent in group P (n = 9) than in group C (n = 1) (p less than 0.01). Systolic, diastolic blood pressure and heart rate were significantly lower in group P (p less than 0.05; 0.001; 0.001 respectively). No significant decrease in intraocular pressure in both groups was observed. The use of propofol for eye surgery in children is acceptable, despite some restlessness during recovery.

Topics: Adolescent; Anesthesia Recovery Period; Anesthesia, General; Blood Pressure; Child; Child, Preschool; Clinical Protocols; Female; Halothane; Heart Rate; Humans; Intraocular Pressure; Male; Propofol; Strabismus; Thiopental

Strabismus surgery in children is associated with side-effects, intraoperative oculocardiac reflexes in relation with muscular tractions and postoperative vomiting. Studies with propofol anaesthesia in this surgery have shown a lower incidence of these side-effects. So, a prospective study compared these incidences with propofol (P) versus thiopental/halothane (T+H) anaesthesia. Propofol appears to be efficient in reducing postoperative vomiting but might be associated with more frequent OCR.

Topics: Adolescent; Bradycardia; Child; Child, Preschool; Halothane; Humans; Infant; Postoperative Complications; Propofol; Prospective Studies; Reflex, Oculocardiac; Strabismus; Thiopental; Vomiting

Topics: Anesthesia, General; Blepharoptosis; Child; Child, Preschool; Female; Halothane; Humans; Infant; Male; Myoglobin; Ophthalmoplegia; Strabismus; Succinylcholine; Thiopental

There is no clinical test to detect a blockade. Under Anesthesia it is possible to discover a suspected blockade, so this test is quite helpful. Even in small babies this test can be applied in order to dected a pseudoparalysis of the external recti. We decide to operate after evaluation of the clinical facts and the findings under anesthesia according to the Zato test. We especially observe the positions of the eyes during normal breathing and the position under deep anesthesia.

Topics: Anesthesia; Anesthesia, Inhalation; Atropine; Eye Movements; Halothane; Humans; Infant; Nitrous Oxide; Strabismus; Succinylcholine; Thiopental

All physicians performing surgery while the patient is under general anesthesia must be aware of the existence of idiopathic malignant hyperthermia. A young adult had a malignant hyperthermic reaction despite four prior uneventful administrations of general anesthetics. To my knowledge, this is the first report of a patient who survived following a hyperthermic reaction, having sustained considerable residual brain damage. There is a great need for continuous body-temperature monitoring during general anesthesia.

Topics: Adolescent; Anesthesia, Inhalation; Brain Damage, Chronic; Chlorides; Heart Arrest; Humans; Male; Malignant Hyperthermia; Methoxyflurane; Sodium; Strabismus; Succinylcholine; Tachycardia; Thiopental

Topics: Anesthesia; Anesthesia, General; Cataract Extraction; Child; Humans; Hydrophthalmos; Infant; Lidocaine; Ophthalmology; Strabismus; Surgical Procedures, Operative; Thiopental; Trichloroethylene