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*

Enflurane* ; Metabolism* ; Methoxyflurane* ; Panax*

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*

BACKGROUND: To evaluate the effects of thoracic epidural anesthesia, with or without bilateral vagotomy, epinephrine-induced arrhythmias were studied in 31 rabbits anesthetized with 1 MAC enflurane. METHODS: Logdose protocol was used for the infusion of epinephrine; its arrhythmic dose being defined as the smallest infusion rate produced four or more continuous or intermittent arrhythmias within 15 seconds. RESULTS: The values (geometric mean) of arrhythmic doses and the plasma concentration of epinephrine during arrhythmia were as follows: 10.21 g.kg 1.min 1 and 83.16 ng/ml in epidural control group; 118.90 g.kg 1.min 1 and 677.76 ng/ml in epidural lidocaine group (p<0.05); 6.34 g.kg-1.min 1 and 96.42 ng/ml in intravenous lidocaine group; 8.65 g.kg 1.min-1 and 44.64 ng/ml in vagotomized-epidural control group; and 12.03 g.kg 1.min 1 and 95.35 ng/ml in vagotomized- epidural lidocaine group. CONCLUSIONS: The data suggest that thoracic epidural anesthesia raises the threshold for enflurane- epinephrine arrhythmias in rabbits and that this effect is eliminated by bilateral vagotomy.
Anesthesia, Epidural* ; Arrhythmias, Cardiac* ; Enflurane ; Epinephrine ; Lidocaine ; Plasma ; Rabbits* ; Vagotomy*

BACKGROUND: The bispectral index (BIS) has been designed to objectively measure the degree of sedation and hypnosis for anesthesia. Although it has been well-known that BIS correlates highly with the concentration of inhalation anesthetics, it is not clear whether analgesic potency expressed as MAC is comparable to hypnotic potency described as BIS50 in inhaled anesthetics. This study was conducted to examine the degree of correspondence by correlating the changes of BIS according to the different MAC of commonly used inhalation anesthetics. METHODS: One hundred ASA class 1 or 2 patients, scheduled for laparoscopic knee surgery were included. Patients were equally divided into 4 groups (n = 25 each) according to the inhalational agent enflurane, isoflurane, desflurane, or sevoflurane. Anesthetic depth for each individual agent was controlled to 2.0, 1.75, 1.5, 1.25, 1.0, 0.75 and 0.5 MAC, respectively. After equilibration for each concentration, BIS values were measured three times at 30 second intervals and an average was obtained. In addition, MAC values for each agent were measured when the bispectral index showed 50. RESULTS: The concentrations of inhaled agents vs. BIS showed high negative correlations (enflurane; -0.91, isoflurane; -0.94, desflurane; -0.84, and sevoflurane; -0.86). BIS50 for each agent was enflurane, 0.93 (1.6 vol%); isoflurane, 0.71 (0.9 vol%); desflurane, 0.95 (5.7 vol%); and sevoflurane, 0.84 MAC (1.7 vol%). Isoflurane-BIS50 showed a significant difference to the others (P<0.05). CONCLUSIONS: We concluded that the MAC of inhalation anesthetics showed poor correlation with BIS, suggesting a difference between the hypnotic and analgesic potency of individual inhaled anesthetic agents.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation* ; Enflurane ; Humans ; Hypnosis ; Inhalation* ; Isoflurane ; Knee

BACKGROUND: This study was performed to evaluate whether the degree of hypotension influences blood loss during spinal surgery. METHOD: Fifty patients undergoing only one level spinal fusion were assigned to one of three groups. In group 1 (n = 14), the systolic blood pressure (SBP) was maintained at 100 120 mmHg with enflurane. In groups 2 (n = 18) and 3 (n = 18), the SBP were maintained at 80 100 and 60 80 mmHg, respectively. Hydralazine and esmolol were used in the hypotensive groups. RESULTS: Blood losses during operation in groups 2 (554 +/- 287 ml) and 3 (456 +/- 162 ml) were significantly lower than in group 1 (1141 +/- 690 ml) (P < 0.05), although there was no significant difference between groups 2 and 3. The percentage of patients receiving transfusions during the operation in groups 1 and 2 were 57.1 and 5.6%, respectively. CONCLUSIONS: The results show that a moderate reduction in SBP (80 - 100 mmHg) reduces blood loss by more than half in comparison to a mild reduction in SBP (100 - 120 mmHg). However, a severe reduction in SBP (60 - 80 mmHg) does not increase the reduction in blood loss in comparison to moderate hypotension.
Blood Pressure ; Enflurane ; Humans ; Hydralazine ; Hypotension* ; Spinal Fusion

To evaluate the depth of enflurane anesthesia, spectrum analysis of rat EEG was used. Bipolar EEG was recorded through one lead form rat scalp during inhalation with 1,2,3 and 4% of enflurane, and analysed to produce the spectrum from which the density of each band(delta 1-3.25Hz, theta 3.5-7.75Hz, alpha 8-12.75Hz, beta2 18-20.75Hz, and beta3 21-31.75Hz)and total density, and medican power frequency were calculated. Differences among the EEG patterns, which were represented by F values through discriminant analysis of those 8 variables, in each level of anesthesia were significant among all concentrations except between 1% and 2% enflurane administration. The results suggest that the discriminat anlysis for the EEG parameters derived from power spectrum analysis can apply to determine the level of enflurane anesthesia.
Anesthesia ; Anesthetics* ; Animals ; Electroencephalography* ; Enflurane* ; Inhalation ; Rats* ; Scalp ; Spectrum Analysis*

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

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