A study of 800 patients ranging in age from seven to one hundred years was conducted in the development of an anesthetic technique which combines the desirable qualities of a neuroleptic agent with the requirements of an outpatient oral surgical anesthetic. These requirements included rapidity of onset, effectiveness of action, ease of controlling duration, and rapid postoperative recovery.
Patients who were cleared medically for outpatient procedures were given Innovar 1.5 cc/150 lb of body weight, atropine 0.4 mg, and fentanyl 1.0 cc/150 lb of body weight as an initial dose within 30-45 seconds in a D5W drip by means of a 21 gauge scalp vein needle. On cases lasting over 30 minutes, morphine sulfate 5 mg/150 lb of body weight was given initially instead of the fentanyl and repeated in four minutes.
The patient's level of sedation was measured by an "observer's scale." Doses of fentanyl 1 cc/150 lb of body weight were repeated at one minute intervals until the patient's level of sedation was adequate. Twenty mg doses of methohexital sodium were then administered at 30 second intervals until the patient displayed a minimal lid reflex, delayed response to voice commands, and intercostal breathing approximately equal to abdominal breathing. All patients breathed room air during the procedure and almost all patients received a local anesthetic. The total amount of medications used seemed to depend on a combination of the patient's physical status, drug history, and the complexity of the surgical procedure.
With this technique 95 percent of the patients became ambulatory within 10 minutes following surgery and could be discharged in the care of a responsible adult.
Ten volunteer prisoner patients were used to monitor the effect of the drugs on blood gas values of the radial artery. All ten patients exhibited a PaO2 of 60 mm Hg or above at the point of deepest sedation. Electrocardiogram tracings on all ten volunteers were within normal limits. The effect of the anesthetic on the means of their blood pressure and pulse rate was minimal. The mean of their tidal volumes at the end of the surgical procedure was 25 percent below normal values.
A review of the complications in the series of 800 patients includes six patients who experienced depressed respirations requiring treatment with levallorphan or doxapram. Three patients developed postoperative hypotension. No emesis occurred in any patient either during or after the procedure and only six patients experienced nausea. None developed a laryngospasm nor a board chest.
The procedures varied in length from five minutes to 4 1/2 hours. Ninety-six percent of the patients rated preoperatively for affect experienced adequate sedation from the initial premedication. Zero percent were overdosed and the four percent who were inadequately sedated after the initial premedication were all drug abusers.
Because of the subnormal PaO2 values obtained in the blood gas study it is recommended that all patients patients receive 100 percent nasal oxygen during the surgical procedure. Because of the potency of the drugs and the complications which may develop, it is also recommended patients receive 100 percent nasal oxygen during the surgical procedure. Because of the potency of the drugs and the complications which may develop, it is also recommended that these agents should be used only by those individuals who have had adequate training in general anesthesia.
Henry W. Elliott
Bernard C. Byrd
Lawrence D. Day
Master of Science (MS)
Year Degree Awarded
Date (Title Page)
Library of Congress/MESH Subject Headings
Loma Linda University Libraries
This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.
Haerich, Fredric D., "An Anesthetic Technique Utilizing Innovar, Fentanyl, and Methohexital Sodium for Outpatient Oral Surgery" (1971). Loma Linda University Electronic Theses, Dissertations & Projects. 1854.
Loma Linda University Electronic Theses and Dissertations
Loma Linda University. Del E. Webb Memorial Library. University Archives