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To compare operating conditions, intraoperative adverse events, recovery profiles, postoperative adverse effects, patient satisfaction, and costs of small-dose lidocaine spinal anesthesia with those of general anesthesia using fentanyl and propofol for elderly outpatient prostate biopsy.Prospective, randomized, blind study.Outpatient anesthesia unit at a municipal hospital.80 ASA physical status I and II patients, aged 65 to 80 years, scheduled for outpatient prostate biopsy.Patients were assigned to receive either spinal anesthesia with 10 mg of hyperbaric 1% lidocaine (L group, n=40) or anesthetic induction with fentanyl 1 microg.kg-1 IV and 1.0 mg.kg-1 propofol injected at 90 mg.kg-1.h-1, followed by continuous infusion at 6 mg.kg-1.h-1 (F/P group, n=40).Both anesthetic techniques provided acceptable operating conditions for the surgeon. However, a significantly higher frequency of intraoperative hypotension was found in the F/P group than in the L group (P0.05). Time to home readiness was shorter in the F/P group (P0.05). Both techniques had no major postoperative adverse effects and resulted in a high rate of patient satisfaction. Total costs were significantly lower in the L group than in the F/P group (P0.01).Spinal anesthesia with 10 mg of hyperbaric 1% lidocaine may be a more suitable alternative to general anesthesia with fentanyl and propofol for ambulatory elderly prostate biopsy in terms of safety and costs.

We wished to compare the effectiveness of intravenous-based (IV) and epidural-based (EPI) techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. Effectiveness was compared in terms of reduction of postoperative pain and adverse events, and achieving a high level of patient satisfaction.Thirty American Society of Anesthesiologists (ASA) physical status I-II patients aged more than 65 years, scheduled for laparoscopic cholecystectomy, were enrolled in this study. The patients in the IV group (n = 15) received modified neurolept anesthesia with droperidol 0.2 mgxkg(-1) and pentazocine 0.15-0.3 mgxkg(-1) (maximum dose of 1.0 mgxkg(-1)) and 60% nitrous oxide in oxygen, followed by postoperative intravenous infusion of 20 microgxml(-1) buprenorphine, provided with a patient-controlled analgesia pump programmed to deliver a bolus of 0.5 ml with a lockout interval of 15 min and a background infusion of 0.5 mlxh(-1). The patients in the EPI group (n = 15) had combined epidural analgesia and general anesthesia with sevoflurane and 60% nitrous oxide in oxygen, followed by the epidural infusion of a 0.125% bupivacaine and 5 microg x ml(-1) buprenorphine mixture by means of an on-demand analgesic system (bolus of 2 ml, lockout interval of 60 min, and background infusion of 2 mlxh(-1)).The quality of postoperative analgesia was similar in the two groups. The incidences of intraoperative hypotension and bradycardia and postoperative hypotension were significantly lower in the IV group than in the EPI group (P0.05). A significantly higher level of patient satisfaction was found in the IV group compared with that in the EPI group (P0.05). The major contributor to dissatisfaction in the EPI group was anxiety or discomfort associated with the epidural procedures.Modified neurolept anesthesia with pentazocine and postoperative i.v. analgesia with buprenorphine were superior to epidural-based techniques, in terms of hemodynamic stability and patient satisfaction, in elderly patients undergoing laparoscopic cholecystectomy.

Migration of a foreign body into the nasal cavity accidentally occurred in three children aged 2 yr. All procedures for removal were performed under general anesthesia. Two patients underwent slow anesthetic induction with sevoflurane and their tracheas were intubated under spontaneous breathing without neuromuscular blocking agents. One patient underwent rapid sequence induction with cricoid pressure to prevent aspiration. Anesthetic courses of the three patients were stable, and the foreign bodies were successfully removed without any complications. Since a nasal foreign body can cause occurrence of its aspiration into the trachea due to crying or reduction of muscle tone, special attention should be paid for safe management of the airway and/or anesthesia throughout the procedure.

Blood or plasma glucose concentration can be measured accurately and rapidly. However, after a glucose challenge metabolism may modify glucose kinetics, so that glucose has not been used as an indicator for dilution volumetry. To test the hypothesis that the initial distribution volume of glucose (IDVG) reflects cardiac output rather than glucose metabolism in the critically ill, the relationship between IDVG and thermodilution cardiac output was evaluated at 27 points in 13 non-surgical, critically ill patients without congestive heart failure. The IDVG was calculated from incremental plasma glucose concentrations using a one compartment model. Correlations were obtained between the IDVG and cardiac output (r = 0.89, n = 27, P < 0.001), and between the incremental plasma glucose concentrations three minutes after the injection and the IDVG (r = 0.94, n = 27, P < 0.001). No difference was found between the IDVG with or without continuous insulin infusions. The results indicate that the IDVG reflects cardiac output rather than glucose metabolism in patients without congestive heart failure.

Although a reduced dose of propofol combined with remifentanil is often used in anesthesia for electroconvulsive therapy (ECT), there have been few studies in which the optimal technique for injection of remifentanil was examined in detail. The aim of this study was to evaluate the effects of single and divided injection of remifentanil combined with propofol on seizure duration and hemodynamic responses during ECT. Twenty-six ASA I–II patients were enrolled in this study and received a total of 78 ECTs. Each patient received propofol 1.2 mg/kg (group P), remifentanil 1 μg/kg followed by propofol 0.5 mg/kg (group R1), and remifentanil 1 μg/kg followed by propofol 0.5 mg/kg and thereafter remifentanil 2 μg/kg (group R2). Succinylcholine 1 mg/kg was used for muscle paralysis after loss of consciousness. Although mean motor seizure durations were significantly longer in groups R1 and R2 than in group P (P

A 61-year-old woman underwent microlaryngeal surgery for a vocal cord polyp. Anesthesia was induced with propofol, and vecuronium was given after loss of consciousness. The trachea was intubated smoothly with a Portex tracheal tube with a 6.0 mm in inner diameter and the cuff was inflated to the minimal occlusion volume. Anesthesia was maintained with O2-air-sevoflurane. The surgical procedure was completed without any troubles. Immediately after tracheal extubation, she developed dyspnea with stridor. As marked laryngeal edema was found by direct vision with the aide of a laryngoscope, reintubation was performed and methylprednisolone was administered intravenously. She was extubated on the next day, after confirmation of the tracheal tube cuff leak following the reduction in the cuff pressure. At this time, fiberoptic bronchoscopy revealed that the laryngeal edema had disappeared. For the past history, she had taken amlodipine for 10 years and candesertan for 2 months, and had often experienced dyspnea. It should be kept in mind that preoperative antihypertensive medications might have an impact on occurrence of perioperative laryngeal edema.

Opinions differ as to what is more appropriate anesthetic technique for elderly patients undergoing ambulatory surgery. The objective of this study is to compare the efficacy and safety of spinal anesthesia with small-dose lidocaine and those of propofol general anesthesia in elderly patients undergoing ambulatory prostate biopsy.Eighty ASA physical status I x II patients aged older than 65 year were randomized to receive either spinal anesthesia with 1% hyperbaric lidocaine 1 ml (10 mg) (group L) or general anesthesia with 1.0 mg x kg(-1) of propofol injected at 180 mg x kg(-1) x hr(-1) followed by continuous infusion at 8 mg x kg(-1) x hr(-1) (group P).Significantly higher incidences of intraoperative hypotension and respiratory depression were found in the group P compared with the group L (P0.05). There were no major postoperative side effects, including transient neurologic symptoms and delirious sate, in either group. Both anesthetic techniques resulted in a high rate of patient satisfaction. Total perioperative costs were significantly lower in the group L compared with the group P (P0.01).Spinal anesthesia with 10 mg of hyperbaric 1% lidocaine may be more preferable to propofol anesthesia in elderly patiens undergoing ambulatory prostate biopsy, with respect to safety and costs.

The purpose of the study was to evaluate the role of insulin in glucose kinetics after glucose administration using an insulinogenic index to indicate the magnitude of insulin response. The initial distribution volume of glucose (IDV-G) was calculated with a one-compartment model from repeated measurements of plasma glucose concentration three to seven minutes after administration of 100 mg · kg−1 glucose. The IDV-G was compared with the insulin response and the thermodilution assessments of cardiac output, measured simultaneously both before and after induced haemorrhage (30 ml · kg−1 over 30 min) in 12 adult mongrel dogs. The plasma insulin concentration was measured during the procedure and insulinogenic indices were calculated. There was no correlation between the IDV-G and insulinogenic indices, but there was a correlation between the IDV-G and thermodilution cardiac output before and after induced haemorrhage (r = 0.85, n = 24, P < 0.001). We conclude that the initial distribution volume of glucose is an indication of cardiac output in normo- and hypovolaemic dogs. Modification of glucose kinetics by the insulin response to glycaemic stimuli was negligible in that short period of time.