Diazepam-ketamine anaesthesia for open heart surgery a “micro-mini” drip administration technique

Hatano, Shigeru; Keane, D. M.; Boggs, Roy E.; El-Naggar, Moustafa; Sadove, Max S.

doi:10.1007/bf03006748

Cited by 27 publications

(10 citation statements)

References 13 publications

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“…The advantages of the microdrip technique with ketamine, as described by Hatano,et al,22 provide for a greater degree of control over dosage and less total drug is administered. It is suggested that the incidence of emergence phenomena may be related to the total dose of ketamine employed per unit of ti me.…”

Section: Discussionmentioning

confidence: 99%

Continuous ketamine infusion for one- lung anaesthesia

Weinreich

Silvay

Lumb

1980

Canad. Anaesth. Soc. J.

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The mechanism which normally affects distribution of blood flow through unventilated areas of the lung is hypoxic pulmonary vasoconstriction; this acts to divert the blood to well ventilated alveoli, resulting in a better ratio of ventilation to perfusion.Several reports have focused attention on the reduction or abolition of this reflex in the unventilated lung by most of the volatile anaesthetic agents used in clinical practice. This response was not abolished by the intravenous anaesthetic agents.One hundred and ten patients undergoing elective pulmonary resection were studied to evaluate the effect of a continuous infusion of ketamine during one-lung anaesthesia, by observing the changes in Pao~aS a reflection of shunt. Ketamine was chosen as the intravenous agent for its positive inotropic and chronotropic action. Additionally, by providing both analgesia and hypnosis, we were able to admininster inspired oxygen concentrations of 50-100 per cent without concern that the patient might have recall for events during operatior,We have demonstrated that in all cases a Pao2 in excess of 9.31 kPa (70 ton-) was achieved with ketamine and Flo~ 1.0 as well as an increase in shunt fraction from 25.9 per cent (Ftoz0.5) to 36.0 per cent (Flo~ 1.0).We feel that ketamine provides a satisfactory alternative to the volatile agents for one-lung anaesthesia in patients where relative hypoxaemia might be unacceptable during operation.ONE LONe VENTILATION with a high inspired oxygen fraction, a volatile anaesthetic agent and a muscle relaxant is commonly used for endobronchial anaesthesia, despite the fact that this technique has been associated with significant arterial hypoxaemia (Pao2 less than 9.33 kPa (70 torr)) in 15-25 per cent of cases. '-3 This figure agrees with our own review of 100 cases of pulmonary resection for carcinoma anaesthetized with halothane and Flo2 1.0 during one-lung anaesthesia, where the Pao2 was less than 9.33 kPa (70 torr) in 20 per cent. The main factors contributing to this arterial hypoxaemia are: (1) Excessive pulmonary shunting in the unventilated, non-dependent lung. 4-6 (2) The development of atelectatic areas in the ventilated dependent lung, secondary to a reduction in functional residual capacity and increase in airway closure, leading to a relative mismatching of ventilation and blood flow with an increase in venous admixture. 6-8 (3) A reduction in cardiac output due to anaesthetic agents, 9-It mechanical ventilation, 6,~:'~3 and manipulations during operation.The major cause of hypoxaemia during onelung anaesthesia is persistence of blood flow through the unventilated lung. Hypoxic pulmoAvron I. Weinreich, M.D., Associate Clinical Professor;

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Section: Discussionmentioning

confidence: 99%

Continuous ketamine infusion for one- lung anaesthesia

Weinreich

Silvay

Lumb

1980

Canad. Anaesth. Soc. J.

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“…Como a cetamina preserva a freqüência cardíaca e a pressão atrial direita através de seus efeitos sobre o sistema nervoso simpático, foi usada para indução anestésica em pacientes com tamponamento cardíaco, pericardite restritiva e com doença cardíaca congênita com propensão a desvio do fluxo sangüíneo da direita para a esquerda 45 . A combinação da cetamina com diazepam ou midazolam é usada em infusão contínua para promover anestesia em pacientes com doença valvar ou isquemia miocárdica 46 . Nas crianças, as reações psicomiméticas ocorrem com menor intensidade e freqüência que nos adultos 47 e a cetamina foi usada para radioterapia, estudos radiológicos, tratamentos dentários 48 e cateterismo cardíaco.…”

Section: Cetamina -Aspectos Farmacológicosunclassified

“…Since ketamine preserves heart rate and right atrial pressure through its effects on sympathetic nervous system, it has been used for anesthetic induction in patients with cardiac tamponade, restrictive pericarditis and congenital heart disease with proneness for right to left blood flow bypass 45 . The association of ketamine and diazepam or midazolam is used in continuous infusion to induce anesthesia in patients with valve or ischemic myocardial disease 46 . Psychomimetic reactions in children are less intense and frequent as compared to adults 47 and ketamine has been used for radiotherapy, radiological evaluations, dental treatments 48 and heart catheterization.…”

Section: Ketamine -Pharmacological Aspectsmentioning

confidence: 99%

Cetamina e analgesia preemptiva

Oliveira¹,

Sakata²,

Issy³

et al. 2004

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:, pioneiro em usar o termo "analgesia preemptiva", observou redução das alterações centrais quando opióides e anestésicos locais foram administrados isoladamente ou associados antes da incisão cirúrgica, havendo diminuição da intensidade da dor pós-operatória. Os estudos mostram que a anestesia geral promove diminuição da transmissão de impulsos dolorosos periféricos para o sistema nervoso central, porém não é capaz de inibi-los totalmente 3 . Assim, os estímulos nociceptivos provocam sensibilização central, que são responsáveis por aumento da intensidade da dor e do consumo de analgésicos no período pós-operatório. A intensidade da dor pós-operatória depende não somente da incisão cirúrgica, mas também de fatores como: tipo e duração da cirurgia, extensão e natureza da lesão tecidual, atividade farmacológica do agente escolhido, analgesia adicional intra e pós-operatória 4,5 . A analgesia preemptiva visa bloquear ou reduzir a sensibilização central e a dor patológica, diferente da dor fisiológica por ser excessiva em intensidade e induzida por estímulos não dolorosos 6,7 . Recentemente, Kissin 8 relatou que, para uma abordagem analgésica preemptiva correta, é fundamental a verificação da eficácia analgésica de um tratamento e sua duração no período pós-operatório inicial. Por isso, talvez inúmeros estudos tenham falhado em demonstrar efeito preemptivo. Algumas definições de analgesia preemptiva são usadas por diferentes autores, dificultando a avaliação e a comparação de resultados. A analgesia preemptiva é definida de diferentes maneiras: 1-aquela realizada antes do estímulo cirúrgi-co; 2-a que evita a sensibilização central provocada pela incisão cirúrgica; 3-a que evita o estabelecimento de sensibilização central pela incisão cirúrgica e pelo processo inflamatório pós-operatório. A primeira definição pode levar a uma conclusão falsa, pois a analgesia deve ser suficiente para bloquear os impulsos aferentes e não ser, simplesmente, administrada antes da incisão. O segundo conceito expressa a analgesia preemptiva de modo restrito, considerando os fenômenos nociceptivos CETAMINA -ASPECTOS FARMACOLÓGICOSA cetamina, 2-(o-clorofenil)-2-(metilamino)-cicloexanona, foi sintetizada em 1963 por Stevens, sendo usada pela primeira vez em humanos, em 1965, por Corssen e Domino. Essa fenciclidina lipossolúvel possui peso molecular de 238 daltons e pKa de 7,5 9-13 . Pode ser usada clinicamente na forma racêmica ou como isômero levo-rotatório (S+ cetamina). AS(+) cetamina é considerada 3 a 4 vezes mais potente que o isômero dextro-rotatório (R-cetamina) para alívio da dor e em doses equianalgésicas, produz menos alterações psíqui-cas e agitação que as formas racêmica e dextro-rotatória [14][15][16][17][18][19][20][21] . A S(+) cetamina é 2 vezes mais potente que a forma racêmica para prevenir a sensibilização central da medula espinhal 22 . A biodisponibilidade desse agente é de 93% 23 e sua meia-vida plasmática de 186 minutos 24 . Por ser altamente lipossolúvel, apresenta grande volume de distribu...

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“…Moreover, no long-term comparative studies have been conducted and the effects of hypothermic or sufficiently sedated, the dogs were anesthetized with thiamylal sodium (10 mg/kg). Each dog was then intubated with an endotracheal tube, and inhalation anesthesia using a mixture of oxygen and isoflurane, and intravenous anesthesia using 0.1% ketamine micro-mini drip administration technique [7,14,22] were started. While performing thoracotomy, 0.2 mg/kg of suxamethonium chloride (a muscle relaxant) was administered intravenously as necessary under the management of controlled respiration [14].…”

Section: Animalsmentioning

confidence: 99%

A Comparative Study between Hypothermic and Normothermic Cardiopulmonary Bypass in Open Heart Surgery in Dogs. Effects on Systemic Hemodynamics.

Shibazaki

Matsui²,

Shiroshita

et al. 1999

The Journal of Veterinary Medical Science

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ABSTRACT. Open heart surgery was performed on two groups of dogs under extracorporeal circulation with or without hypothermia to investigate hemodynamic changes during extracorporeal circulation. During hypothermic cardiopulmonary bypass (CPB), arterial O 2 tension and postoperative blood pressure were favorably maintained, indicating that hypothermic extracorporeal circulation can be performed for a long period of time. On the other hand, during normothermic CPB, the average surgical duration was significantly shorter, and marked shifts in the concentrations of various enzymes were suppressed. However, due to reductions in arterial O 2 tension, the length of cardiac arrest time was restricted, demonstrating that this method is suitable for performing extracorporeal circulation for CPB of relatively short duration. If circulation circuitry can be improved, such as through the development of a surpassing oxygenator, normothermic CPB would incur less stress on the body, thus making it preferential to hypothermic CPB in most cases.-KEY WORDS: canine, extracorporeal circulation, hypothermia, normothermia.J. Vet. Med. Sci. 61(4): 331-336, 1999 normothermic CPB in humans have yet to be fully clarified. The present study investigate the effect of extracorporeal circulation using an artificial heart-lung machine with or without hypothermia on pathophysiology of dogs (in particular, hemodynamics). MATERIALS AND METHODS Animals:Fourteen clinically healthy male beagles were examined. All dogs were cared for in accordance with the experimental animal guidelines of Tokyo University of Agriculture and Technology. The animals were randomly divided into two groups. Group H (hypothermic CPB, age 2.2 ± 1.2 years (mean ± standard error), weight 10.0 ± 0.8 kg, n=7), in which their body temperature was reduced to 24-26°C, and Group N (normothermic CPB, age 2.0 ± 0.4 years, weight 10.4 ± 0.3kg, n=7), in which their body temperature was maintained at 36°C. To obtain clinically useful data, open heart surgery was performed assuming that the dogs would live for at least one month after surgery.Surgical technique and cardiopulmonary bypass system: Dilation and remodeling of the right ventricular outflow tract of all dogs was performed using a patch graft technique as if they had pulmonary stenosis. The artificial heart-lung machine (NAPS-III, Fig. 1) [18,19,21] that was used in the present study consists of three two-roller pumps, a membrane oxygenator, a heat exchanger, and a circuit. Before starting extracorporeal circulation, the machine was primed with lactated Ringer solution, 5% glucose, 7% sodium bicarbonate, and 20% mannitol, without using whole blood. The dogs were pretreated with atropine sulfate (0.04 mg/kg) and acepromazine maleate (0.4 mg/kg), and whenCurrent techniques in open heart surgery in humans involve establishing extracorporeal circulation using an artificial heart-lung machine. In this method, the artificial heart-lung machine performs systemic respiration and circulation so that the heart can be temporarily sto...

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Diazepam-ketamine anaesthesia for open heart surgery a “micro-mini” drip administration technique

Cited by 27 publications

References 13 publications

Continuous ketamine infusion for one- lung anaesthesia

Continuous ketamine infusion for one- lung anaesthesia

Cetamina e analgesia preemptiva

A Comparative Study between Hypothermic and Normothermic Cardiopulmonary Bypass in Open Heart Surgery in Dogs. Effects on Systemic Hemodynamics.

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