Abstract:
BACKGROUND:Ten to fifteen percent of awake patients develop neurological deficits secondary to cerebral hypoperfusion after carotid artery cross-clamping. The reversal of such deficits by increasing the inspired oxygen fraction (Fio(2)) has been demonstrated, and regional cerebral oxygenation (rSO(2)) has been shown to improve during carotid cross-clamping in awake patients by increasing Fio(2). Paradoxical improvements in cerebral blood flow during carotid endarterectomy (CEA) at the time of cross-clamping and normalization of post-cross-clamp electroencephalographic abnormalities have been induced by hypocapnia. We performed this study to determine the influence of Fio(2) and end-tidal carbon dioxide (Petco(2)) on rSO(2) in patients undergoing CEA with general anesthesia during carotid cross-clamping. METHODS:Twenty patients were recruited. Ten underwent elective shunting. Patients received standardized general anesthesia. rSO(2) was measured using the INVOS 5100B monitor (Somanetics Corporation, Troy, MI). After carotid cross-clamping, Fio(2) and minute ventilation were sequentially adjusted: 1) Fio(2) 30%, Petco(2) 30-35 mm Hg; 2) Fio(2) 100%, Petco(2) 30-35 mm Hg; and 3) Fio(2) 100%, Petco(2) 40-45 mm Hg. At each point, rSO(2) was recorded from both operative and nonoperative sides, and arterial blood gas analysis was performed. RESULTS:Results from shunted and unshunted patients were analyzed separately. Increasing Fio(2): Administration of 100% oxygen while maintaining Petco(2) in the range 30-35 mm Hg in unshunted patients resulted in an 8% increase (P = 0.008) in rSO(2) on the operative side and a 6% increase (P = 0.011) on the nonoperative side compared with an Fio(2) of 30%. In shunted patients, administration of 100% oxygen while maintaining the Petco(2) in the range 30-35 mm Hg resulted in a 4% increase in rSO(2) on both the operative side (P = 0.008) and the nonoperative side (P = 0.011) compared with an Fio(2) of 30%. Increasing Petco(2): In unshunted patients, there was a 6% (P = 0.008) increase in rSO(2) on the operative side and a 5% increase (P = 0.024) on the nonoperative side at Petco(2) 40-45 mm Hg compared with Petco(2) 30-35 mm Hg maintaining Fio(2) at 100%. In shunted patients, there was a 3% increase (P = 0.018) in rSO(2) on the operative side and a 4% increase (P = 0.007) on the nonoperative side at Petco(2) 40-45 mm Hg compared with Petco(2) 30-35 mm Hg maintaining Fio(2) at 100%. CONCLUSION:rSO(2) is reliably improved during carotid cross-clamping by increasing Fio(2) in patients undergoing CEA with general anesthesia. Additional improvement in rSO(2) may be gained by increasing Petco(2).
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Picton P,Chambers J,Shanks A,Dorje Pdoi
10.1213/ANE.0b013e3181c5f160subject
Has Abstractpub_date
2010-02-01 00:00:00pages
581-7issue
2eissn
0003-2999issn
1526-7598pii
ANE.0b013e3181c5f160journal_volume
110pub_type
杂志文章abstract::Nicardipine is used in the treatment of premature labor. There are no previous reports in the anesthesia literature of serious side effects associated with this drug. We report a case of pulmonary edema induced by nicardipine therapy for tocolysis in a pregnant 27-yr-old patient admitted to our hospital for preterm la...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000135182.79774.A0
更新日期:2004-09-01 00:00:00
abstract:UNLABELLED:Apparently large plasma volumes derived by indocyanine green (PV-ICG) have been determined in the initial period after induction of anesthesia. We tested the hypothesis that possible overestimation of PV-ICG occurs shortly after anesthetic induction. Anesthesia was induced in 13 patients with fentanyl bolus ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000084361.12884.d1
更新日期:2003-11-01 00:00:00
abstract::The low solubility of sevoflurane in blood suggests that this agent should enter and leave the body more rapidly than isoflurane. However, the closeness of sevoflurane and isoflurane tissue/blood partition coefficients suggests that the rates of equilibration with and elimination from tissues should be similar. We tes...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199103000-00007
更新日期:1991-03-01 00:00:00
abstract::The purpose of this article is to provide a summary of the Enhanced Recovery After Cesarean delivery (ERAC) protocol written by a Society for Obstetric Anesthesia and Perinatology (SOAP) committee and approved by the SOAP Board of Directors in May 2019. The goal of the consensus statement is to provide both practical ...
journal_title:Anesthesia and analgesia
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200003000-00005
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:The efficiency of red blood cell collection during cell salvage is dictated by multiple variables, including suction pressure. In this study, we attempted to determine the influence of suction pressure on the efficiency of cell salvage and to identify methods for minimizing the impact of suction on salvaged ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000255208.96685.2e
更新日期:2007-03-01 00:00:00
abstract::We present the case of a 50-year-old man who suffered a crush injury to his right lower extremity in 2002 and received 191 spinal anesthetics to date with no identifiable neurologic complications by physical examination or imaging. He has undergone >300 operations at our institution related to recurrent infection and ...
journal_title:Anesthesia and analgesia
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doi:10.1213/ANE.0b013e3182a9664a
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abstract::Ocular microtremor (OMT) is a fine physiologic tremor of the eye related to neuronal activity in the reticular formation of the brainstem. The frequency of OMT is suppressed by propofol and sevoflurane and predicts the response to command at emergence from anesthesia. Previous studies have relied on post hoc computer ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/01.ANE.0000133145.98702.C0
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Mounting evidence from animal studies shows that anesthetic exposure in early life leads to apoptosis in the developing nervous system. This loss of neurons has functional consequences in adulthood. Clinical retrospective reviews have suggested that multiple anesthetic exposures in early childhood are associ...
journal_title:Anesthesia and analgesia
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doi:10.1213/ANE.0b013e31826d37c5
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-07-01 00:00:00
abstract::This study was designed to evaluate effects of enalaprilat, an angiotensin-converting enzyme inhibitor, on hemodynamic and hormonal responses during surgery at endotracheal intubation, incision, and limb-tourniquet inflation. Thirty patients undergoing limb procedures with general anesthesia (N2O/narcotic technique) a...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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abstract:UNLABELLED:There is concern that the environment in which consent for anesthesia research is sought may be coercive. We therefore designed this study to determine the factors that parents consider in consenting to their child's participation in clinical anesthesia research. The study sample consisted of 246 parents who...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199801000-00010
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199504000-00008
更新日期:1995-04-01 00:00:00
abstract::The purpose of this study was to compare the psychological effects of ketamine and thiopental anesthesia. In a double-blind comparison, 20 normal female volunteers were given 2.5 mg/kg ketamine intravenously and 20 were given 5.0 mg/kg thiopental intravenously. Subjects were assessed with a variety of objective and su...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
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更新日期:2004-08-01 00:00:00
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pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181ee8092
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journal_title:Anesthesia and analgesia
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pub_type: 历史文章,杂志文章,评审
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更新日期:2012-12-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199006000-00013
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journal_title:Anesthesia and analgesia
pub_type: 历史文章,杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182a6d31b
更新日期:2013-11-01 00:00:00
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pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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