We examined changes in the cardiorespiratory system of small children during surgical correction of strabismus with a laryngeal mask airway and spontaneous respiration with sevoflurane or halothane inhaled anesthesia. Fifty-one children, 1–7 yr old, having outpatient strabismus correction were randomized to sevoflurane (S) or halothane (H) in 66% nitrous oxide at 1.3 minimum alveolar concentration. Children breathed spontaneously through a laryngeal mask airway and were not pretreated with anticholinergics. The oculocardiac reflex (OCR), defined as a 20% decrease in heart rate (HR) from baseline, dysrhythmias, or sinoatrial arrest concomitant with ocular muscle traction occurred less frequently with sevoflurane than with halothane (S 38%, H79%, P = 0.009). The baseline HR was higher with sevoflurane (S 114 ± 13 bpm, H 101 ± 15 bpm, P = 0.002). The lowest HR occurred with halothane (S 95 ± 22 bpm, H 73 ± 19 bpm, P = 0.001). The incidence of dysrhythmias was higher in the halothane group (S 4%, H 42%, P = 0.004). Reductions in minute ventilation and PETCO2 accompanied OCRs. Airway irritability was present with halothane only (S 0, H 3). Eleven children, of whom the majority had received halothane, required measures to correct SpO2 < 95% or PETCO2 > 60 mm Hg during maintenance anesthesia (S 11%, H 32%). Sevoflurane may be a more suitable anesthetic than halothane for operations involving traction on the ocular muscles with spontaneous respiration in children because of reduced incidence of OCR, airway irritability, and ventilatory disturbances. Implications Some children experience a sudden slowing of the heart and impaired breathing when the surgeon pulls on the eye muscles during squint operations under anesthesia. Sevoflurane, a recently developed anesthetic vapor, may reduce this problem when compared with the established vapor halothane.
Alfentanil by continuous intravenous infusion and isoflurane have been compared as anaesthetic agents for outpatient arthroscopy. In 42 patients, divided at random into two groups, anaesthesia was induced with methohexitone and vecuronium bromide, and, after intubation, maintained with nitrous oxide 66% in oxygen combined with alfentanil or isoflurane. Alfentanil was given before intubation (1 mg), as a loading dose before starting surgery (50 μg kg ‐1 ) and by a continuous infusion at a rate of 1 μg kg ‐1 min ‐1 . Isoflurane was given in a concentration of 0.9% as a maintenance dose. Awakening from anaesthesia was morc rapid with alfentanil than with isoflurane. Recovery tests were applied in the recovery room. Both anarsrhetic techniques provided satisfactory anaesthesia and rapid recovery. All patients but one were content with the anaesthesia. The patients who received isoflurane scored better in the recovery tests in the first 3 h, but after 3 h there was no difference between the groups. The alfentanil group showed a higher incidence of nausea and/or vomiting: 45% compared to 14% in the isoflurane group.
Exaggerated inflammation and oxidative stress are involved in the pathogenesis of Complex Regional Pain Syndrome (CRPS). However, studies assessing markers for oxidative stress in CRPS patients are limited. In this study, markers for lipid peroxidation (malondialdehyde and F2-isoprostanes) and DNA damage (8-hydroxy-2-deoxyguanosine) were measured in nine patients (mean age 50.1 ± 17.1 years) with short term CRPS-1 (median 3 months) and nine age and sex matched healthy volunteers (mean age 49.3 ± 16.8 years) to assess and compare the level of oxidative stress. No differences were found in plasma between CRPS patients and healthy volunteers for malondialdehyde (5.2 ± 0.9 µmol/L vs. 5.4 ± 0.5 µmol/L) F2-isoprostanes (83.9 ± 18.7 pg/mL vs. 80.5 ± 12.3 pg/mL) and 8-hydroxy-2-deoxyguanosine (92.6 ± 25.5 pmol/L vs. 86.9 ± 19.0 pmol/L). Likewise, in urine, no differences were observed between CRPS patients and healthy volunteers for F2-isoprostanes (117 ng/mmol, IQR 54.5–124.3 vs. 85 ng/mmol, IQR 55.5–110) and 8-hydroxy-2-deoxyguanosine (1.4 ± 0.7 nmol/mmol vs. 1.4 ± 0.5 nmol/mmol). Our data show no elevation of systemic markers of oxidative stress in CRPS patients compared to matched healthy volunteers. Future research should focus on local sampling methods of oxidative stress with adequate patient selection based on CRPS phenotype and lifestyle.
Evaluation of (a) the incidence of phantom limb pain after a lower limb amputation, (b) the influence of either general or epidural anaesthesia on the incidence, and (c) the different kinds of therapies applied.Retrospective.Department of Anaesthesiology, Academic Hospital, Vrije Universiteit, Amsterdam, the Netherlands.All 45 patients who had undergone a lower limb amputation in the period 1985-1994, and whose amputation had taken place at least 6 months earlier received a questionnaire. The level of the phantom limb pain was measured using a Visual Analogue Scale.33 Patients returned the questionnaire. 85% suffered from phantom limb pain; 20 patients were still suffering at the time of replying to the questionnaire. The pain sensation was mostly characterized as "cramping'. The physicians told 42% of the patients that nothing could be done to relieve the pain. Other patients were given all different kinds of therapies. The type of anaesthesia, general or regional anaesthesia, did not influence the incidence of phantom limb pain.After lower limb amputations there was a high incidence of long lasting phantom limb pain. Therapy showed a large variability and a considerable failure rate. Further research into prevention and treatment of phantom pain is urgently needed.
