Guide-wire assisted arterial cannulation?a complication

Anesthesia & Analgesia, 1982

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction-sized dose (0.25 mg/kg) of midazolam in A.S.A. class I or I 1 surgical patients (N = 11) sedated with morphine and N20-02 were compared in a double-blind fashion with a similar group of patients (N = 9) receiving thiopental (4.0 mg/kg). Consistent with earlier studies, patients given thiopental experienced downward trends from base line in mean arterial pressure, stroke volume, cardiac output, and heart rate; mean right atrial pressure increased slightly, whereas systemic vascular resistance did not change. Induction of anesthesia with midazolam was associated with more gradual and less pronounced hernodynamic alteration; the only significant changes from base line were decreases in mean arterial pressure 5 and 10 minutes after injection. When the two groups were compared, no significant differences were found. Midazolam is, then, as acceptable for induction of anesthesia as thiopental from a hemodynamic point of view in A.S.A. class I and II patients.

Irish Veterinary Journal

Background: A prospective, randomized, placebo-controlled, blinded clinical study was conducted to determine whether a single dose of midazolam affects the cardiovascular response to surgical manipulation of the ovaries during elective ovariohysterectomy. Thirty-nine client-owned dogs undergoing elective ovariohysterectomy were recruited. After scoring cage demeanour, dogs were premedicated with acepromazine (0.03 mg kg-1) and pethidine (3 mg kg-1) intramuscularly into the quadriceps muscle and 20 min later sedation was scored. Anaesthesia was induced with propofol intravenously (IV) to effect. The study treatment (group M: midazolam (0.25 mg kg-1); or group P: placebo (Hartmann's solution) (0.125 ml kg-1)) was administered IV before the intra-operative manipulation of the first ovary. Anaesthesia was maintained with isoflurane in oxygen. Morphine (0.3 mg kg-1 IV) was administered prior to the start of surgery. The vaporizer setting was adjusted according to the depth of anaesthesia. If an end-tidal isoflurane concentration (FE'Iso) above 1.6% was required additional analgesia was provided with fentanyl (2 μg kg-1). Dogs received meloxicam (0.2 mg kg-1 IV) at the end of procedure. Heart rate, mean arterial blood pressure, respiratory rate and end-tidal partial pressure of carbon dioxide as well as FE'Iso were recorded and analysed. Results: A statistical significant difference between groups was detected in FE'Iso, with group M requiring a significantly lower FE'Iso than group P (14.3%) after administration of midazolam. No differences between groups was shown for percentage change in heart rate and mean arterial blood pressure, or end-tidal carbon dioxide and requirement for mechanical ventilation, or rescue analgesia. There was no statistically significant difference in the incidence of complications in group M and P. Group M received significantly more succinylated gelatin solution pre-administration of midazolam than group P, but no differences in fluid administration post-administration of the study treatment (midazolam/placebo) were detected. No statistical significant difference was demonstrated for the use of anticholinergic agents, dobutamine or noradrenaline. Conclusion: No significant effect on cardiovascular parameters could be observed with administration of midazolam, but a modest (14.3%) isoflurane-sparing effect was detected.

Journal of …, 1981

An optimalized technique for chronic venous and arterial cannulation of rodents that permits repeated blood collections in unstressed, freely moving animals is presented. The indwelling catheter can also be used for chronic and/or acute drug administration in rats or other small laboratory animals, as well as for the recording of blood pressure and heart rate. The attachment device of minimal size is easily fixed on the head of the animals, allowing the additional implantation of a chronic cannula for intracerebral injections. No residual effects on the resting levels of plasma catecholamines (CA) were present 24-hr after surgery and anesthesia for implanting the cannula. No variations of plasma CA concentrations were observed at the different times of day examined or as a consequence of withdrawal of subsequent blood samples. Training the animals to be handled prevented the increase in plasma prolactin levels produced by decapitation; training had no influence on the decapitation-induced rises in plasma CA concentrations.

2003

Critical Care 2003, 7(Suppl 2):P001 (DOI 10.1186/cc1890)

Journal of Neuroscience Methods, 1985

A chronic arterial and venous cannulation method appropriate for pharmacokinetics studies in freely moving rats is described. Two catheters were implanted: one in the abdominal aorta, the other in the inferior vena cava. Passing subcutaneously, the catheters then emerged at the nape of the neck and were sealed by heating. In most cases (70%), 2-3 weeks after surgery, there were no problems of catheter patency. Twenty-four hours after surgery, all the animals were in good health as attested by normal behaviour and physiological parameters. Plasma corticosterone levels (544_+219 ng/ml/ determined at various times after an i.v. injection of saline, though 2.4-fold lower than in restrained rats (1 330+ 292 ng/ml), were, however, indicative of a moderate stress. From a differential analysis of the factors involved in the relatively elevated circulating corticosterone as compared to basal levels, it is concluded that a prolonged postoperative period (7 days) and maintaining of the animals in metabolic cages are necessary conditions to obtain a minimal state of stress with this technique.

Anaesthesia, 1983

Midazolum given ora1l.v ihe night before and on the morning of operation had a distinct subjective pre-operative redative @kct ar compurd Mirh placebo. Patients receiving midazolam a1.w experienred less apprehension and exritetnent hq/brr surgery, hut in relation 10 qualify ofsleep, rhe difference between the two groups wus not .statistically .significant. Antidiuretic hormone ( A D H ) concrnfrations were determined just before induction o j anaesthesiu and were significantly lower in the mi~liizolutn group (2.14 pgjrnl, SD 0.96) than in the placebo group (3.07 pglml, S D I .73). Our results show that midarolcirn is ri useful sedative anxiolytic oral premedicant, which appears to prevent initiation of a .stress reucrion before induction of anae.rthe,pia.

Saudi Journal of Anaesthesia, 2014

With ever increasing number of pre and peri-operative patients presenting for surgery with co-morbid endocrine disorders, the challenges for the anesthesiologists have grown manifold. Apart from caring for the impact of surgical pathology on endocrine functions, anesthesiologist also confronts endocrine disorders and manages their possible implications during anesthesia procedures. [1,2] DIFFERENT YET SOME COMMON BASE Though on the surface, there does not seem to be any similarity between endocrinology and anesthesiology specialties if one explores them in chthonic depth, a lot of common ground can be observed. Endocrine anesthesia (EA), an amalgam of these two medical sciences, is fast becoming a distinct specialty on its own and the present editorial aims to focus on these. ENDOCRINOLOGICAL CHALLENGES IN ANESTHESIOLOGY Anesthesia for endocrine surgery is different from that for routine procedures. Peri-operative neurotransmitter and hormonal secretion occurring with a deranged endocrinal milieu in the background can be highly variable and unpredictable. This may have a direct impact on the morbidity and mortality. In both non-endocrine and endocrine surgery, the role of pituitary, thyroid, parathyroid, pancreas, adrenal, and various other hormone releasing tissues and organs can have a direct impact on the surgical outcome. [3-7] Endocrine complications are more likely to occur in routine daily anesthesia practice in patients presenting with endocrinopathy, but may occur in all. It is therefore mandatory that an anesthesiologist should be thoroughly well-versed with all endocrine pathologies and complications, which can be encountered during surgical practice so as to "suspect," "prevent," "diagnose," and "manage" them in a timely and appropriate Access this article online Quick Response Code:

Canadian Journal of Anaesthesia, 1994

A randomized, double-blind study was undertaken to determine the dose requirements, recovery characteristics, and pharmacokinetic variables of midazolam given by continuous infusion for sedation in patients following abdominal aortic surgery. Thirty subjects, 50-75 yr, scheduled to undergo aortic reconstructive surgery, entered the study. Following a nitrous oxide-isoflurane-opioid anaesthetic technique, patients were randomly allocated to receive one of three loading doses (0.03, 0.06 or 0.1 rag" kg -I) and initial infusion rates (0.5, LO or L5 #g" kg -I" min -1) of midazolam, corresponding to groups low (L), moderate (M) and high (H). The infusion of midazolam was adjusted to maintain sedation levels of "3, 4 or 5," which permitted eye opening in response to either verbal command or a light shoulder tap, using a seven-point scale ranging from "0" (awake, agitated) to "6" (asleep, non-responsive). Ad-ditionally, morphine was given in increments of 2.0 mg iv prn for analgesia. On the morning after surgery, midazolam was d~continued, and the tracheas were extubated when patients were awake. Blood samples were taken during, and at increasing intervals for 48 hr following discontinuation of the infusion, and analyzed by gas chromatography. The desired level of sedation was maintained during more than 94% of the infusion period in all three groups, with a maximum of three dose adjustments per patient, for treatment which lasted 16.3 -t-0.6 hr. There was, however, an increase in both the infusion rates and mean plasma concentrations from Group L to Group H (P < 0.05), which corresponded to an inverse relationship of morphine requirements during the period of sedation (P < 0.05, Group H vs Group L). Optimal midazolam infusion rates and resulting plasma concentrations at the times the infusions were discontinued (in parentheses) were as follows - . Times to awakening were longer in Group H: 3.1 • 3.4 hr, than in Group L' L1 • 0.8 h, P < 0.05. Pharmacokinetic variables were found to be dose-independent over the range of infusion rates. Mean values were tt/2 [J = 4.4 • L5 hr, provides a stable level of sedation, when administered in conjunction with intermittent iv morphine following AAS. This sedation technique, which costs $L65 • 0.73 hr -t (SCan), is associated with rapid recovery and minimal side effects. Cette dtude randomisde et d double vise d d dterminer les doses, le caractdristiques du rdveil et les variables pharmacocinktiques du midazolam administrd en perfusion continue apr~s une chirurgie aortique abdominale. Trente sujets ftgds de 50 d 75 arts programmds pour une chirurgie reconstructive de l'aorte font CAN J ANAESTH 1994 / 41:9 / pp782-93

Journal of the South African Veterinary Association, 2001

Midazolam was administered intravenously to 8 bitches in a randomised, placebocontrolled clinical trial before propofol induction of surgical anaesthesia. Anaesthesia was maintained with isoflurane-in-oxygen during surgical endoscopic examination of the uterus and ovariohysterectomy. Clenbuterol was administered at the start of surgery to improve uterine muscle relaxation, and to facilitate endoscopic examination of the uterus. Ventilation was controlled. Induction of anaesthesia with propofol to obtain loss of the pedal reflex resulted in a statistically significant (P < 0.05) decrease in minute volume and arterial oxygen partial pressure in the midazolam group. Apnoea also occurred in 50 % of dogs in the midazolam group. The dose for propofol in the midazolam group was 7.4 mg/kg compared to 9.5 mg/kg in the control. Minute volume was significantly (P < 0.05) higher in both groups during isoflurane maintenance, compared to the value after incremental propofol to obtain loss of the pedal reflex. Propofol induction resulted in a 25-26 % reduction in the mean arterial blood pressure in both groups, and the administration of clenbuterol at the start of surgery resulted in a transient, but statistically significant (P < 0.05), decrease in mean arterial blood pressure in the midazolam group during isoflurane anaesthesia. It is concluded that intravenous midazolam premedication did not adversely affect cardiovascular function during propofol induction, but intra-operative clenbuterol during isoflurane maintenance of anaesthesia may result in transient hypotension. Midazolam premedication may increase adverse respiratory effects when administered before propofol induction of anaesthesia.

Upsala Journal of Medical Sciences, 1990

The aim o f the study was t o evaluate the e f f e c t o f a l i d o c a i n e-p r i l o c a i n e cream (EMLA cream, A s t r a l i n r e l i e v i n g p a i n d u r i n g a r t e r i a l cannulation. The study had a random, double-blind, placebo-controlled design and i n c l u d e d a l t o g e t h e r 90 p a t i e n t s. A l l t h e p a t i e n t s were premedicated with an o p i o i d