Seeing the wood for the trees: Insights into reducing inhalational agent consumption.

2021 ◽  
Author(s):  
R Ross Kennedy
Keyword(s):  
Inhalational Agent

'Green-gional' anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change

2020 ◽  
Vol 45 (9) ◽  
pp. 744-745
Author(s):  
Mausam Kuvadia ◽  
Cynthia Eden Cummis ◽  
Gregory Liguori ◽  
Christopher L Wu
Keyword(s):  
Climate Change ◽  
Global Warming ◽  
Greenhouse Gas Emissions ◽  
Greenhouse Gas ◽  
Regional Anesthesia ◽  
Real Life ◽  
General Anesthetic ◽  
Gas Emissions ◽  
Inhalational Agent ◽  
Potential Benefits

Volatile halogenated gases and nitrous oxide used as part of a balanced general anesthetic may contribute to global warming. By avoiding volatile inhalational agent use, regional anesthesia may reduce greenhouse gas emissions and help prevent global warming. We present a theoretical calculation of the potential benefits and a real-life example of how much regional anesthesia may reduce greenhouse gas emissions.

scholarly journals The Contrasting Effects of Enflurane on Transplacental Exchange after Methohexitone and Ketamine Induction of Anaesthesia for Caesarean Section

1978 ◽  
Vol 6 (3) ◽  
pp. 239-242 ◽  
Author(s):  
J. W. Downing ◽  
P. J. C. Houlton ◽  
J. G. Brock-Utne ◽  
R. J. R. Buley
Keyword(s):  
Caesarean Section ◽  
Beneficial Effect ◽  
General Anaesthesia ◽  
Elective Caesarean Section ◽  
Volatile Agent ◽  
Inhalational Agent ◽  
Induction Of Anaesthesia ◽  
Uterine Relaxation

Supplementation of general anaesthesia with enflurane 0.6% before delivery of the foetus by elective Caesarean section, produced contrasting effects after methohexitone and ketamine administration. Enflurane, an inhalational agent causing vasodilation and uterine relaxation, enhanced maternal to foetal transplacental exchange following methohexitone induction of narcosis. This beneficial effect of the volatile agent was not seen after ketamine, a vasoconstrictor drug which stimulates myometrial contraction.

scholarly journals A STUDY OF INCIDENCE OF AWARENESS IN GENERAL ANESTHESIA WITH INHALATIONAL AGENT (HALOTHANE)

2014 ◽  
Vol 03 (03) ◽  
pp. 775-783
Author(s):  
Sreeraghu G.M ◽  
Hemanth Kumar ◽  
Sreeharsha S ◽  
Dwideep Chandra
Keyword(s):  
General Anesthesia ◽  
Inhalational Agent

scholarly journals A comparative study between intraoperativelow-dose ketamine and dexmedetomidine, as an anaesthetic adjuvant in lumbar spine instrumentation surgery for the post-operative analgesic requirement

2017 ◽  
Vol 04 (02) ◽  
pp. 091-098 ◽  
Author(s):  
Ranadhir Mitra ◽  
Hemanshu Prabhakar ◽  
Girija Rath ◽  
Parmod Bithal ◽  
Ankur Khandelwal
Keyword(s):  
Lumbar Spine ◽  
Hospital Stay ◽  
Spinal Instrumentation ◽  
Visual Analog Scale Score ◽  
Analgesic Requirement ◽  
Comparable Group ◽  
Treatment Regimens ◽  
Spine Instrumentation ◽  
Inhalational Agent ◽  
Group D

Abstract Background: Spinal instrumentation and fusion surgery presents the anaesthesiologist with multiple issues like intraoperative blood loss, hemodynamic changes, prolonged surgery etc, but the most probing aspect is analgesia. While both ketamine and dexmedetomidine as adjuvants have shown to decrease intraoperative anaesthetics and post operative analgesic consumption but there are no comparative studies. The primary aim of this study was comparison of post-operative analgesic requirements for 1st 24 hours after surgery when either of the drugs was used as adjuvants. Methods: Adult patients aged 18-60 years, of either sex, and ASA status I or II scheduled for elective lumbar spine instrumentation (of 2 or more spinal levels) surgery were enrolled for the study. Patients were randomised into one of the 3 treatment regimens ketamine/group K (0.5mg/kg bolus followed by 250 mcg/kg/h infusion), dexmedetomidine/ group D (0.5mcg/kg bolus followed by 0.5 mcg/kg/h infusion) or the placebo/ group S (saline/placebo). The study drugs were started after turning the patient prone. Data were recorded for intraoperative hemodynamics, anesthetic consumption (inhalational agent and opioids), emergence through RAS scale (Riker sedation agitation scale), PCA (patient controlled analgesia)-fentanyl use and VAS (visual analog scale) score in the 1st 24 hours after surgery. Appropriate statistical analysis was done. Results: A total of 42 patients (14 in each group) were enrolled. The total PCA fentanyl consumed in first 24 hours of surgery was maximum with the group-S (1366.6±382.6 mcg) in compared with group- D (1035.4±391.8 mcg) and group- K (1164.9±503.6 mcg) (P=0.13). The post extubation RAS score was lower in group-K (3.7±0.6) when compared with group-D (4±0.4) and group-S (4.5±0.9) (P=.009). Total intraoperative sevoflurane and fentanyl consumption showed no difference (P=0.19 and P=0.28). VAS score at rest was higher at baseline with group-S (P=0.009). The ICU stay was comparable (group-D: 1.4±0.5 d, group-K: 1.5±0.5 d, group-S: 1.9±0.5 d) among the groups. Hospital stay was also comparable (P=0.09). Conclusion: In patients undergoing lumbar instrumentation surgery, opioid consumption, VAS scores, PCA pump bad demands, inhalational agent consumption, hospital stay were comparable when either ketamine or dexmedetomidine was used as intraoperative anesthetic adjuvants.

scholarly journals Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support?

Hearts ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 213-223
Author(s):  
Tara A. Lenk ◽  
Carlos E. Guerra-Londono ◽  
Thomas E. Graul ◽  
Marc A. Murinson ◽  
Prabhdeep K. Hehar ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Surgery ◽  
Propensity Score ◽  
Regression Models ◽  
Independent Predictor ◽  
Care Hospital ◽  
Elective Cardiac Surgery ◽  
Logistic Regression Models ◽  
Adjusted Analysis ◽  
Inhalational Agent

Background and Aims: We hypothesized that maintaining a patient on moderate–high doses of potent inhalational agent for greater than 30 min during the post-bypass period would be an independent predictor of initiation and usage of either inotropic and/or vasopressor infusions. Setting and Design: This study is a retrospective design and approved by the institutional review board. The setting was a single-center, academic tertiary care hospital in Detroit, Michigan. Materials and Methods: Three-hundred, ninety-seven elective cardiac surgery patients were identified for chart review. Electronic medical records were reviewed to collect demographics and perioperative data. Statistics used include a propensity score regression adjusted analysis utilizing logistic regression models and a multivariable model. Results: A propensity score regression adjusted analysis was performed and then applied in both univariate and multivariate logistic regression models with a p value of <0.05 reaching statistical significance. Fifty-six percent of the participants had an exposure of greater than 30 min of a minimum alveolar concentration of isoflurane greater than 0.5 (ETISO ≥ 0.5MAC, 30 min) in the post-bypass period. After adjusting for propensity score, this was found to be a significant predictor of inotrope and/or vasoconstrictor use post-bypass (OR 2.49, 95% CI 1.15–5.38, p = 0.021). In the multivariate model, pulmonary hypertension (OR 5.9; 95% CI 1.33–26.28; p = 0.02), Euroscore II (2.73; 95% CI 1.35–5.5; p = 0.005), and cardiopulmonary bypass hours (OR 1.86; 95% CI 1.02–3.4; p = 0.042) emerged as significant. Conclusions: This study showed that an ETISO ≥ 0.5MAC, 30 min exposure during the immediate post-bypass period during elective cardiac surgery was an independent predictor of a patient being started on inotrope or vasoconstrictor infusions. Further research should consider a prospective design and examine depth of anesthesia during the post-bypass period.

scholarly journals Volatile Agents to Avoid Ventilating Asthmatics

2003 ◽  
Vol 31 (2) ◽  
pp. 208-210 ◽  
Author(s):  
G. Baigel
Keyword(s):  
Mechanical Ventilation ◽  
Tracheal Intubation ◽  
Medical Treatment ◽  
Severe Asthma ◽  
Initial Response ◽  
Acute Severe Asthma ◽  
Inhalational Agent ◽  
The Face ◽  
Spontaneously Breathing ◽  
Volatile Agents

The management of six awake, spontaneously breathing patients with acute severe asthma who responded to a subanesthetic dose of an inhalational agent is described. All of these patients were on maximal medical treatment, the next intervention likely to be tracheal intubation and mechanical ventilation in the face of further deterioration. All six patients initially responded dramatically, although one required mechanical ventilation after initial response.

scholarly journals Central anticholinergic syndrome following general anaesthesia: prevention and treatment with galantamine

2018 ◽  
Vol 10 (1) ◽  
pp. 43-48
Author(s):  
M. S. Danilov ◽  
K. M. Lebedinskii ◽  
I. S. Kurapeev
Keyword(s):  
General Anaesthesia ◽  
Treatment Effectiveness ◽  
Anticholinergic Syndrome ◽  
Group Iii ◽  
Central Anticholinergic Syndrome ◽  
Group I ◽  
First Choice ◽  
Inhalational Agent ◽  
German Speaking ◽  
Group Ii

Prolonged emergence, excitation and shivering after general anaesthesia are well-known, though only in German-speaking countries they are considered to be forms of single central anticholinergic syndrome (CAS), while in others this term is not associated with general anaesthesia. In Russia the problem is augmented with lack of physostigmine — the first choice for CAS in Germany. We present our analysis of implementing galantamine instead of physostigmine for CAS prevention and management while administering this drug for decurarization. 130 patients undergoing general anaesthesia were divided into three groups depending on decurarization — group I (n = 54) without decurarization, in group II (n = 29) we used galantamine, in group III (n = 47) — neostigmine. In all the groups we assessed CAS incidence and its galantamine treatment effectiveness. Diagnostic criteria for CAS comatose form was unconsciousness 5 min later reaching inhalational agent zero end-expiratory concentration. Using the criteria we found CAS incidence in group I was 26,9%, in group II there were no cases of the syndrome, in group III the incidence was 14,9%. Thus, galantamine 0,3–0,4 mg · kg–1 (max 0,78 mg · kg–1) IV not only prevents CAS but is also effective in its treatment.

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