Enflurane* ; Metabolism* ; Methoxyflurane* ; Panax*

We chose enflurane as the primary anesthetic agent for the surgical removal of a pheochromocytoma (23 year old male) with the satisfactory results. A review of the literature on the anesthetic management of pheochromocytoma discloses no general agreement regarding choice of an anesthetic agent. Almost all agents have at some time been both praised and rejected. It would suggest that selection of an anesthetic agent is not as important as the adequate management of that agent.
Anesthesia* ; Enflurane* ; Pheochromocytoma*

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of low-flow anesthesia with a semi-closed circle anesthesia system in infants. METHODS: Twenty, ASA physical status 1 or 2, infants were randomly assigned into two groups: high-flow anesthesia (HFA) or low-flow anesthesia (LFA). An identical semi-closed Dr ger circle anesthesia system (Cato) was used to all patients. Initial fresh gas flow (FGF) was N2O 1.5 L/min and O2 1.5 L/min in both groups. This FGF of 3 L/min was maintained in the HFA group. After 10 min of HFA, the FGF was reduced to 500 ml/min (N2O 250 ml/min and O2 250 ml/min) in the LFA group. RESULTS: Hypoxic or hypercarbic gas concentrations were not observed in all patients. Enflurane consumption during LFA was about 1/3 of that during HFA (6.8 +/- 1.3 ml vs. 19.5 +/- 5.8 ml). The mean highest esophageal temperature was similar in both groups. The mean highest inspiratory gas and soda lime temperatures were significantly higher in the LFA group than in the HFA group. CONCLUSIONS: Low-flow anesthesia in a circle system with a fresh gas flow of N2O 250 ml/min and O2 250 ml/min could be performed safely and economically for infants.
Anesthesia* ; Enflurane* ; Humans ; Infant*

Plasma inorganic fluoride concentrations were measured in adult patients without hepatic or renal disease following sevoflurane-N2O anesthesia (n=7) or enflurane-N2O anesthesia (n=6). The anesthetic dosage of sevoflurane and enflurane was 6.48+/-2,15%-hour and 6.57+/-2.05%-hour, respectively. The mean peak plasma inorganic fluoride concentration in the sevoflurane group was 19.5+/-13.4 umol/L 1hour after anesthesia, which decreased to preanesthetic levels 24 hours after anesthesia. In the enflurane group the values were 13.2+/-5.8 umol/L at the end of anesthesia and decreased, but remained, still twice as high as the preanesthetic level 24 hours after anesthesia. The relationship of plasma inorganic fluoride concentration and anesthetic dosage was more pronounced in the sevoflurane group (r=0.68, slope=4.2) than in the enflurane group (r=0.39, slope=1.2). In conclusian, sevoflurane-N2O anesthesia results in similar subnephrotoxic levels of plasma inorganic fluoride as enflurane-N2O. anesthesia, and although the fluoride concentration had a better correlation to anesthetic dosage in the sevoflurane group than in the enflurane group, its excretion was faster in the sevoflurane group than in the enflurane group.
Adult ; Anesthesia* ; Enflurane ; Fluorides* ; Humans ; Plasma*

To investigate the changes in renal function during the halothane, enflurane and thalamonal anesthesia and elective surgery, the authors measured urine flow rate, creatinine clearance(Ccr, GFR), excreted amounts of sodium, potassium and chloride ions, fractional excretion of sodium (FeNa), free water clearnace (C H2O) at preanesthesia (control), 20 minute after the induction of anesthesia, during operation (3 times), 1 hour after surgery, respectively, and obtained the results as follows: 1) Changes in renal function was not significant after the induction of anesthesia compared to preanesthesia in halothane, enflurane and thalamonal anesthesia. 2) Renal function decreased signifi-cantly during the operation under anesthesia with halothane or enfiurane. 3) There was a tendency of renal function to be decreased compared to preanesthesia in the 1st postoperative day in patients anesthetized with halothane or enflurane, but tendency of it to be increased in thalamonal anesthesia. Therefore, it is suggested that thalamonal anesthesia is a good choice in patients with renal dysfunc-tion.
Anesthesia* ; Creatinine ; Enflurane* ; Halothane* ; Humans ; Ions ; Kidney ; Potassium ; Sodium ; Water

Pheochromocytoma is a functioning tumor occurring in the chromaffin tissue and catecholamines from the tumor cell lead to the symptoms such as hypertension, palpitation and headache. Among the problems arising in the anesthetic management, the excessive secretion of catecholamines by the induction of anesthesia and the tumor mass manipulation causes a hypertensive crisis and the arrhythmia. Also, after the removal of the tumor mass, it must be remembered that a profound hyptension may follow due to abrupt lowering of catecholamine level. We experienced two cases of anesthetic management of pheochromcytoma using enflurane. In one case of sufficient preoperative management, it was performed uneventfully without symptoms such as hypertensive crisis and arrhythmia during the anesthetic management. But, in the other case with insufficient preoperative management, the patient was unstable due to hypertnesive crisis, premature contractions of the ventricle and tachyarrhythmia during the anesthetic management.
Anesthesia ; Arrhythmias, Cardiac ; Catecholamines ; Enflurane* ; Headache ; Humans ; Hypertension ; Pheochromocytoma* ; Tachycardia

BACKGROUND: We examined the use of DFA-Detrended fluctuation analysis-of heart rate variability during general anesthesia in order to assess the depth of anesthesia. METHODS: In this study, we observed changes in alpha1, the short range scaling exponent, in alpha2, the long range scaling exponent, and in the alpha2/alpha 1 ratio during enflurane anesthesia. We monitored 7 stages during general anesthesia, i.e., 1) preoperation (awake state), 2) during induction, 3) after induction, 4) during maintenance, 5) before extubation, 6) after extubation, and 7) postoperation (Next day). RESULTS: The alpha 2/alpha 1 ratio increased during the induction and extubation state compared to preoperation (awake state). This may be related to increased sympathetic activity due to stimulation of the autonomic nervous system. In the postoperation (awakened state), the ratio returned to the preoperation value (awake state). These results are similar to low frequency (LF), high frequency (HF) and LF/HF ratio values which reflect activity of autonomic nervous system. CONCLUSIONS: Detrended fluctuation analysis parameters, especially the alpha 2/alpha 1 ratio, would be used for monitoring the depth of anesthesia. Also these parameters are useful indexes with the LF/HF ratio for the evaluation of sympathetic activity during general anesthesia.
Anesthesia* ; Anesthesia, General ; Autonomic Nervous System ; Enflurane ; Heart Rate

BACKGROUND: There are many factors including the operation site, duration of anesthesia, preoperative liver function and hepatitis, which cause postoperative hepatic dysfunction. The purpose of this study is to evaluate postoperative liver function with respect to a history of alcohol intake. METHODS: Seventy-five patients were divided into 2 groups:44 patients without alcohol intake (non-alcohol group), 31 patients with alcohol intake (alcohol group). All patients were anesthetized with about 1.5 vol% of enflurane combined with 50% nitrous oxide and 50% oxygen. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) were measured before anesthesia, 1, 3 and 7 days after surgery in both groups, respectively. Postoperative AST and ALT values were compared to preoperative values within each group, and were also compared between groups. RESULTS: In the alcohol group, postoperative AST and ALT values were significantly higher than preoperative values (P < 0.05). In addition, postoperative ALT values significantly increased in the 1st and 7th day over the upper normal limit of ALT (P < 0.05). In the non-alcohol group, postoperative AST and ALT values increased over preoperative values, but those levels were within the normal limits of AST and ALT. CONCLUSIONS: The data suggest that when surgery can reduce hepatic blood flow, patients with a history of alcohol ingestion may have a risk of raised liver-derived enzyme in the first seven postoperative days.
Anesthesia* ; Eating* ; Enflurane* ; Gastrectomy* ; Hepatitis ; Humans ; Liver ; Nitrous Oxide ; Oxygen

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.
Anesthesia* ; Ear ; Ear, Middle* ; Enflurane ; Halothane ; Humans ; Tympanic Membrane

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.
Anesthesia* ; Ear ; Ear, Middle* ; Enflurane ; Halothane ; Humans ; Tympanic Membrane