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Anesthesia and Analgesia for Donkeys, Mules and Foals
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Tomas Williams, Michele Barletta
Induction of general anesthesia can be achieved by the use of IV injectable agents, such as ketamine/diazepam (1–3 mg/kg and 0.05–0.1 mg/kg, respectively) and propofol (2 mg/kg to effect), or inhalant anesthetics. Isoflurane or sevoflurane can be delivered via face mask or nasotracheal tube (which can be placed without sedative drugs or with minimal sedation if necessary).
Anesthetic Agents and Surgery during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
No epidemiologic investigations of the frequency of human birth defects and the use of methoxyflurane or isoflurane during the first trimester are published. Halogenated anesthetic agents were reported to cause a variety of malformations in animal studies at doses many times those used in humans (Friedman, 1988).
Anesthetic Management of the Neonate with Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Early anesthetic regimens for neonatal surgery consisted of a modified “Liverpool technique”: a neuromuscular blocker, pancuronium, nitrous oxide, and oxygen. Robinson and Gregory demonstrated a high-dose narcotic anesthetic was safe in preterm infants with doses of fentanyl in the 30 to 50 mcg/kg range (21). However, due to the uniqueness of neonatal physiology and pharmacology, the patients were anesthetized for a period well after surgery. Subsequently, Yaster demonstrated doses of 10 to 12 mcg/kg provided adequate anesthesia for neonates for 75 to 90 minutes (22). The benefits of fentanyl anesthesia for neonates were confirmed by Anand and Hickey, who demonstrated that surgical stress and the metabolic response to it could be blunted by its intraoperative use (23, 24). Over time, clinical research demonstrated that a combination of inhalational agents, such as isoflurane and sevoflurane, could be safely and effectively used for neonatal surgery, even in premature neonates. Evaluation of minimum alveolar concentration (MAC), the parameter for measuring potency of anesthetic gases, for isoflurane is lower in preterm neonates compared to full-term neonates, but the MAC for sevoflurane is the same (25, 26) (Figures 21.2 and 21.3). A typical anesthetic regimen now consists of a combination of fentanyl, sevoflurane or isoflurane, and a muscle relaxant.
SREKA-targeted liposomes for highly metastatic breast cancer therapy
Published in Drug Delivery, 2023
Balázs Vári, Levente Dókus, Adina Borbély, Anikó Gaál, Diána Vári-Mező, Ivan Ranđelović, Anna Sólyom-Tisza, Zoltán Varga, Norbert Szoboszlai, Gábor Mező, József Tóvári
Biodistribution studies were carried out in our murine orthotopic breast cancer allograft model. Tumor-bearing mice were treated with an equal amount of daunomycin (3 mg/kg) intraperitoneally, either encapsulated by liposomes or in a free form. Ninety-six hours after treatment, mice were euthanized using isoflurane (Baxter, Budapest, Hungary) at a concentration of 5% as suggested in the drug’s guidelines. Isoflurane exposure was continued until one minute after breathing stopped. Primary tumor, lung, heart, liver, spleen, and kidney were removed and snap-frozen in isopentane (Sigma-Aldrich, St. Louis, Missouri, USA). Organs and primary tumors were pooled based on treatment groups. Tissue samples were weighed accurately and homogenized in sterile distilled water (30%, wt/vol) with gentleMACS™ Dissociator (Miltenyi Biotec, Bergisch Gladbach, Germany). Homogenates were centrifuged at 500 × g for 5 min at RT. After gentle resuspension with a pipette, 200 µL was transferred into LoBind® tubes, and the leftover was frozen for further analysis. The precipitation of the proteins and the extraction of daunomycin from the different tissue homogenates were performed as described earlier. HPLC-MS/MS analysis (see section HPLC-MS/MS analysis for cellular uptake, blood stability, and biodistribution studies) was performed to detect the level of daunomycin.
Analgesic efficacy of ultrasound-guided PECS II and transeversus thoracic plane blocks compared to serratus anterior plane block for modified radical mastectomy: A randomized prospective study
Published in Egyptian Journal of Anaesthesia, 2023
Alshaimaa Soliman Alasrag, Amira Mahfouz Elkeblawy, Mohammed Mohye Eldin Abo Elyazid, Hoda Alsaid Ahmed Ezz
On arrival at the preoperative area, a peripheral intravenous (IV) line was inserted, and all patients received midazolam (0.03 mg/kg) IV. On entering operating room (OR), the routine monitoring was applied including noninvasive blood pressure (NIBP), pulse oximetry, ECG, while, temperature probe and end tidal capnography were applied after endotracheal intubation. Intravenous induction of anesthesia was achieved with propofol 2 mg/kg , fentanyl 1 µg/kg, atracuruim 0.5 mg/kg and then endotracheal tube was inserted. Isoflurane 1.5% in 50% oxygen and air was used to maintain anesthesia and atracurium 0.1 mg/kg was administered as a bolus dose when needed. After endotracheal intubation the regional technique was performed according to group allocation by the same anesthesiologist who played no further role in the study. Fentanyl 0.5 µg/kg as a IV bolus was given If there was an increase in heart rate (HR) and/or mean arterial blood pressure (MAP) of more than 20% above baseline, and the number of patients who needed intraoperative fentanyl was recorded. At the end of surgery, isoflurane was turned off and muscle relaxant was reversed with neostigmine 0.05 mg/kg IV and atropine 0.01 mg/kg IV. Paracetamol (15 mg/kg IV infusion) was administered after extubation and then every 6 hours.
Outcomes of children with life-threatening status asthmaticus requiring isoflurane therapy and extracorporeal life support
Published in Journal of Asthma, 2023
Sneha Kolli, Cydney Opolka, Adrianna Westbrook, Scott Gillespie, Carrie Mason, Brittany Truitt, Pradip Kamat, Anne Fitzpatrick, Jocelyn R. Grunwell
This is a retrospective cohort study of children under 18 years of age admitted to the Children’s Healthcare of Atlanta Egleston or Scottish Rite campus PICUs with life-threatening asthma between March 2009–May 2020. Children were identified with asthma or reactive airway disease on the problem and diagnosis lists from the electronic medical record (eMR). The eMR was independently reviewed for each child to confirm that the child was admitted to the PICU for asthma or reactive airway disease. We further identified children who received isoflurane and/or ECLS by reviewing the medication administration record, respiratory flow sheet, lines and drains flow sheet, procedure notes, and physician notes in the eMR. The Egleston PICU is a 36-bed academic unit affiliated with Emory University School of Medicine; the Scottish Rite PICU is a 56-bed private unit. The inpatient rehabilitation unit for the Children’s Healthcare of Atlanta system is located within the Scottish Rite hospital. Both campuses are able to perform mechanical ventilation with isoflurane for life-threatening asthma. ECLS is only offered in the Egleston PICU.