Thesis (Ph. D.) - University of California, Los Angeles, 1959. / "Literature cited": leaves 200-209.

Thesis (doctoral)--University of Turku. / Includes reprints of 8 papers on which thesis is based.

Thesis (M.P.H.)--University of Hong Kong, 2005.

Anesthetics are provided to millions of patients every year in the United States mostly by anesthesiologists. However, there is a lack of literature or documentation on how anesthetics are administered by various anesthesia providers. In order to have a better understanding on the pattern, we performed retrospective chart review on anesthetic practice for surgical atrial septal defect repair procedures performed in Boston Children's Hospital. Our collected data included: premedication, anesthesia induction methods, anesthesia maintenance methods, choice of vasoactive agents, analgesics, and intravenous accesses, extubation in the operating room, postoperative sedation, and choice of antiemetics and postoperative nausea and vomiting. In addition, the studied patients were divided into two groups based on the institutional initiation of the Fast-track protocol: before and after the implementation of the Fast-track protocol (the Non-fast-track group and the Fast-track group). Some results fell under expectation; for example, in the Non-fast-track group, all patients who were induced intravenously were older than 10 years old, and received propofol for induction, which is the most popular choice of intravenous induction drug. The Fast-track group showed a similar trend; 80% of all intravenously induced patients were 10 years or older and induced with propofol. Also, in both groups, anesthesia was maintained with the combination of IV and volatile anesthetics. An anticipated change in practice pattern was seen in the Fast-track group for the choice of analgesics and postoperative sedation for non-extubated patients; acetaminophen was introduced as an adjunct to other analgesics, and propofol infusion was introduced as a standard drug of postoperative sedation for non-extubated patients, both of which are part of the Fast-track protocol. Interestingly, however, overall intraoperative opioid doses did not show any change. The variation in the choice of intravenous access showed difference before and after the Fast-track implementation; in the Non-fast-track group, extra jugular vein was accessed as the most popular choice, whereas in the Fast-track group, central venous line was the most popular choice. Also, the incidence of postoperative nausea and vomiting was notably lower in patients who were not given anti-emetics after the Fast-track protocol implementation. This calls for a need for a future research on what part of the Fast-track protocol could have resulted this improvement without intraoperative administration of regular anti-emetics. Overall, our results provide future directions for researches on anesthetic practice that may help improve patient safety and efficiency beyond the practice in Boston Children's Hospital.

Orientador: Stelio Pacca Loureiro Luna / Resumo: A anestesia epidural empregando-se anestésicos locais normalmente produz anestesia apenas da região retro umbilical. O trabalho investiga e compara o uso da lidocaína isolada ou associada ao butorfanol ou à quetamina, em anestesia epidural lombo-sacra de cães, no seu aspecto cardiorrespiratório e analgésico. Todos os animais foram tranquilizados com 0,1 mg/kg de acepromazina IV. Na primeira fase, seis cães adultos, foram anestesiados, em três ocasiões distintas, em ordem aleatória, com: 5 mg/kg lidocaína 2% com vasoconstritor (GAL); 1 mg/kg de quetamina (GAQ) e 0,1 mg/kg de butorfanol (GAB), nestes dois últimos complementando-se o volume de 1 ml/4 kg com lidocaína 2% com vasoconstritor. Foram avaliados: freqüência cardíaca, pressão arterial sistólica, freqüência respiratória, concentração expirada de CO2, volume minuto e corrente e temperatura retal. Ainda observou-se período de latência, duração do bloqueio, região bloqueada, duração da cirurgia e grau de miorrelaxamento. Na segunda fase, dezoito cadelas foram divididas em três grupos de mesmo número, anestesiadas com os mesmos protocolos anestésicos da primeira fase (GCL, GCQ, GCB) e submetidas à ovariosalpingohisterectomia. Para análise estatística dos dados paramétricos foram utilizadas a análise de variância, seguida do teste de Student-Newman-Keuls, para comparação entre momentos. Para comparação entre grupos, foi utilizado o teste T. Para as variáveis não paramétricas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to compare the cardiorespiratory effects and duration of lumbosacral epidural anaesthesia produced by lidocaine alone or combined with ketamine or butorphanol in dogs submitted or not to ovariohysterectomy. In the first stage, six mixed breed adult dogs (mean weight 14,0 ± 3,1 kg) were used in three different occasions: lidocaine 2% with adrenaline - 5 mg/kg (GAL), ketamine - 1 mg/kg (GAQ) or butorphanol - 0,1 mg/kg (GAB). In groups GAQ and GAB, the total volume of 1 ml/4 kg was completed with lidocaine. Heart heat, sistolic arterial blood pressure, respiratory rate, expired CO2, tidal and minute volume and rectal temperature were measured 15 minutes after pre-medication and every 30 minutes after epidural anesthesia until 120 minutes. The time to loss the interdigital reflex, duration and region of block were observed. In the second stage, eighteen mixed breed female dogs (mean weight 13,4 ± 3,5 kg) were divided in three groups(GCQ, GCB and GCL), anaesthetised as before and submitted to ovariohysterectomy. All animals were sedated with acepromazine 0,1 mg/kg IV. Data were analysed using ANOVA, followed by Student-Newman-Keuls test or Kruskal-Wallis and Friedman tests as appropriate. The rectal temperature reduced in all groups. Muscle relaxation was better in the GCQ and GCB groups than the in GCL group. Anaesthesia was not sufficient for ovariohysterectomy in animals treated with lidocaine and general anaesthesia... (Complete abstract click electronic access below) / Mestre

Orientador: Maria Cristina Volpato, Francisco Carlos Groppo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-20T03:44:20Z (GMT). No. of bitstreams: 1 Caldas_CristinaSaragiotto_M.pdf: 985125 bytes, checksum: b1fed0990a0c2cfad07e069fd573fcc8 (MD5) Previous issue date: 2012 / Resumo: Este estudo teve como objetivo avaliar a eficácia anestésica de duas formulações de mepivacaína encapsulada em lipossomas (uni e multilamelar) com concentração lipídica 8 mM, comparando-as com solução de mepivacaína com epinefrina em três modelos: bloqueio do nervo infraorbital (BNIO), bloqueio do nervo alveolar inferior (BNAI) e infiltração subcutânea em ferida cirúrgica (ISFC), em ratos. Em cada experimento os animais receberam injeção de uma das seguintes formulações: mepivacaína 2% associada à epinefrina 1:100.000 (Mepi-Epi), mepivacaína 3% lipossomal unilamelar (Mepi-LUV) e mepivacaína 3% lipossomal multilamelar (Mepi-MLV) e os respectivos controles: solução de NaCl 0,9%, suspensão lipossomal unilamelar e suspensão lipossomal multilamelar sem anestésico. Para o BNIO (30 ratos) e BNAI (51 ratos) os animais foram divididos em 3 grupos, e receberam uma das formulações contendo mepivacaína no lado direito e a respectiva formulação controle no lado esquerdo, sendo respectivamente 0,1 mL no BNIO e 0,2 mL no BNAI. A s o N oram avaliados dura ão e sucesso da anestesia no l bio su erior, por pinçamento. Após o NA oram avaliados latência, dura ão e sucesso da anestesia ul ar or estímulo el trico. Para a ISFC, 48 ratos foram divididos em 6 grupos, sendo submetidos a estímulo inflamatório na pata traseira direita (incisão e sutura). Após 24h os animais que apresentaram hipernocicepção (diminuição de pelo menos 20% na sensibilidade à pressão - analgesímetro de von Frey) receberam injeção de 0,1 mL de uma das formulações, contendo mepivacaína ou controle, ao lado da ferida cirúrgica. A anestesia local foi avaliada com analgesímetro de von Frey a cada 10 minutos. Os resultados foram submetidos aos testes Log-Rank, Tukey, Kruskal-Wallis, Student-Newman-Keuls (alfa=5%). Nos três modelos estudados, a solu ão de Me i-Epi promoveu maior sucesso e duração da anestesia (p<0,05), enquanto as formulações lipossomais não diferiram entre si (p>0,05). Para o experimento do BNAI, não foram observadas diferenças entre as formulações (p>0,05) para latência da anestesia. Conclui-se que a encapsulação em lipossomas uni ou multilamelares foi menos eficaz do que a epinefrina em aumentar a eficácia anestésica da mepivacaína em todos os modelos estudados / Abstract: The aim of this study was to evaluate the anesthetic efficacy of two liposomal (unilamelar and multilamelar, 8mM lipid concentration) mepivacaine formulations compared to mepivacaine with epinephrine in three models: infraorbital nerve block (IONB), inferior alveolar nerve block (IANB) and subcutaneous infiltration in surgical wound (SISW) in rats. In each model animals received one of the following formulations: 2% mepivacaine with 1:100,000 epinephrine, (Mepi-Epi), liposomal unilamelar 3% mepivacaína (Mepi-LUV), liposomal multilamelar 3% mepivacaína (Mepi-MLV), and the respective controls: 0.9% NaCl solution, and liposomal unilamelar and liposomal multilamelar suspensions without the local anesthetic. For IONB (n= 30) and IANB (n= 51) the animals were divided into 3 groups, which received one of the formulations containing mepivacaine in the right side and the respective control formulation in the left side; 0.1 mL and 0.2mL were respectively injected for IONB and IANB. After IONB the success and duration of anesthesia was evaluated by upper lip pinching.After IANB the onset, duration and success of pulpal anesthesia were evaluated by electric stimulus. For SISW experiment the 48 rats were divided into 6 groups and submitted to an inflammatory stimulus in the right hind paw (incision and suture). After 24 h the animals that presented hypernociception (at least 20% decrease in the baseline response to force - von Frey anesthesiometer) received a 0.1mL injection of one of mepivacaíne or control formulations at the side of the surgical wound. Local anesthesia was evaluated each 10 min with von Frey anesthesiometer. Data were submitted to Log-Rank, Tukey, Kruskal-Wallis and Student-Newman-Keuls tests (alpha=5%). Mepi-Epi provided higher success and duration of anesthesia (p<0.05) in the three studied models; no difference was observed between the liposomal formulations (p>0.05). No differences in the anesthesia onset were observed among formulations for IANB (p>0.05). It is concluded that the encapsulation in unilamelar and multilamelar liposomes was less effective than epinephrine to improve mepivacaine anesthetic efficacy in all studied models / Mestrado / Farmacologia, Anestesiologia e Terapeutica / Mestre em Odontologia

The principle aim of this study was to isolate a chemical for the "safe anaesthesia" of abalone under commercial farming conditions. "Safe anaesthesia" implied that the anaesthetic had no immediate detrimental or long term sublethal effect on the abalone, that it was safe for the farmer, the consumer and the environment. Four chemicals, magnesium sulphate (MgS0₄), ethylenediamine tetra-acetic acid (EDTA), 2-phenoxyethanol and procaine hydrochloride were shown to effectively inhibit the in vitro contraction of isolated tarsal muscle of Haliotis midae. This identified them as potential anaesthetics for abalone. Since abalone, like any other aquaculture species, would be subject to frequent size-sorting during the grow-out period, size related dosage tables were developed for the four chemicals at a temperature of 18⁰C. Dosage tables were also developed for benzocaine and carbon dioxide (C0₂), Three size classes (5-15, 20-50 and 60-90 mm shell length (SL)) of abalone were considered. Only three of the six chemicals, viz. MgS0₄, 2-phenoxyethanol and CO₂, met the criteria of an effective abalone anaesthetic in that they effected rapid and mortality-free anaesthesia. The other three chemicals caused mortalities and were considered to be unsuitable for commercial scale anaesthesia. Temperature related dosage tables were then developed for MgS0₄ and CO₂, MgS0₄ concentrations and CO₂ flow rates for effective anaesthesia in abalone were found to be inversely related to temperature. The three size classes of H. midae were intermittently exposed to MgS0₄ and 2-phenoxyethanol anaesthesia for an eight month period to determine the effect of the anaesthetics on growth rate. Because of an increased resistance to the efficacy of 2-phenoxyethanol and high monthly mortalities it was concluded that this chemical was unsafe and unsuitable for commercial use. MgS0₄, on the other hand, had no effect on growth of abalone and no significant effect on the rate of mortality. MgS0₄ also had no measurable effect on H. midae muscle ultrastructure and, by implication had no effect on flesh texture. The use of MgS0₄ as an anaesthetic would, therefore, not affect marketability. Moreover, no magnesium residues were found in H. midae muscle tissue after short term or intermittent long term exposure to MgS0₄ anaesthesia. It was found that the three size classes of H. midae used in this study could be safely exposed to the recommended MgS0₄ concentrations for up to 40 minutes without any mortalities. This is more than adequate for routine farming procedures. Medium size abalone (20-50 mm SL) were also safely exposed to 14 g.100 ml⁻¹ MgS0₄ for up to 6 hours without any mortalities. The results have shown that MgS0₄ was undoubtedly the best chemical that was evaluated for anaesthesia of H. midae in this study. It fulfils the requirements set forth by the U.S.A. Food and Drug Administration (FDA) in that it is safe for the abalone, the farmer, the consumer and the environment.

Following the successful synthesis of 2:3-Benzo-l,l-dimethyl-l-silacyelohex-2-ene and its 4-bromo derivative, attempts were made to prepare further derivatives. The syntheses of 2:3-Benzo-4-cyano-l,l-dimethyl-l-silacyclohex-2-ene and 2:3-Benzo-4-hydroxy-l,l-dimethyl-l-silacyclohex-2-ene were attempted via substitution reactions under various conditions. Attempts to prepare the 4-cyano compound were in vain, while the 4-hydroxy compound was readily prepared, on the strength of infrared analyses. The 4-hydroxy compound, however, presented a problem in characterization, as attempts to produce several derivatives of the compound were unsuccessful. Attempts were also made to improve the methods of synthesis and the yields of various intermediate compounds. / Pharmaceutical Sciences, Faculty of / Graduate

Magister Scientiae Dentium - MSc(Dent) / This study was designed to evaluate the efficacy and safety of intranasal sufentanil/midazolam [S/M] and ketamine/madazolam [K/M] for sedation and analgesia in preschool children that require dental surgery [extractions]. Fifty children [ASA 1] aged 5 – 7 years, requiring six or more dental extractions under general anaesthesia, were allocated to two groups of 25 children to receive either ketamine 5 mg/kg or sufentanil 20μg intranasally, 20 minutes before induction of surgery in this randomised double-blind study. All the children in both groups in addition concurrently received nasal midazolam 0,3 mg/kg. For induction of anaesthesia, sevoflurane in nitrous oxide and oxygen, was used. S/M was accepted significantly better as a nasal pre-medication [p<0.05]. Both groups were equally sedated and a smooth mask induction of anaesthesia was experienced in the majority of children. Recovery of children in both groups were similar; 82% of the S/M group were fully recovered 120 minutes post-operatively versus 80% in the K/M group [p>0,05]. Effective postoperative analgesia for multiple extractions was provided. For pain evaluation, children were divided into two groups, a non-responder group where all pain values over time were more than 40 and a responder group where pain values were equal to, or less than 40. Seventy two percent of children in the S/M group were responders as to fifty two percent in the K/M group [p>0,05]. No adverse respiratory, cardiovascular or other effects were recorded. This study showed that intranasal administration of sufentanil /midazolam or ketamine/midazolam, provides safe and effective sedation and analgesia in children aged 5–7 years undergoing multiple dental extractions.

This thesis covered the fast track assessment of the referred dental patient for conscious sedation in a day clinic. The assessment took in consideration patient information, medical history, anatomical observations, treatment required, phobic aspects and patient expectations.