Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Preanesthetic cimetidine and metoclopramide for acid aspiration prophylaxis in elective surgery.
The effect of preanesthetic cimetidine and metoclopramide on gastric contents in inpatients undergoing elective surgery was studied. One hundred and fifty patients were allocated randomly into six groups with 25 patients in each group. Patients in Group 1 served as control. ⋯ Cimetidine and metoclopramide favorably modified the risk factors in all the experimental groups. This study demonstrated that the three groups receiving cimetidine in the morning (Groups 3, 5, and 6) had significantly greater mean gastric pH than the other groups. Gastric volumes were significantly less in all experimental groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of the study was to establish whether there exists a relationship between blood methadone concentration and analgesic response and the intrasubject and intersubject variability in this relationship. Sixteen general surgical (upper abdominal) and orthopedic (spinal fusion) patients were administered methadone (20 mg, iv) as part of the general anesthetic and supplementary methadone doses (usually 5 mg, iv) in the recovery ward until postoperative pain was controlled effectively. The criteria established for the administration of supplementary methadone doses were the co-existence of 1) spontaneous reporting of significant pain by the patient; 2) an unstimulated respiratory rate of greater than 10 breaths/min, and 3) no significant depression of the level of consciousness. ⋯ Serial blood samples were collected for the estimation of blood methadone concentration following all doses. The methadone concentration in the blood sample collected immediately prior to a supplementary dose was termed the minimum effective concentration (MEC [methadone]). The mean (+/- SD) coefficient of variation in MEC (methadone) for the 16 patients was 21 +/- 10% (range: 7-38%), while the mean MEC for methadone was 57.9 +/- 15.2 ng/ml (range: 34.5-80.3 ng/ml) in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Major traumatic injury frequently causes hemodynamic instability that necessitates reducing the usual dose of anesthetic given for surgery. Nevertheless, a lower dose may be sufficient to provide anesthesia because of conditions present in trauma victims that are known to reduce anesthetic requirement (hypotension, hypothermia, and acute alcohol intoxication). To determine the incidence and patient perception of recall of surgery, 51 patients were interviewed after surgery for major trauma. ⋯ Of the six patients in this group who recalled surgery (43%), two considered this awareness their worst hospital experience. No condition known to reduce anesthetic requirement did so reliably enough that recall of surgery did not occur when the anesthetic dose had to be reduced because of major trauma. The authors conclude that the incidence of recall of surgery in victims of major trauma is considerable, and that reducing the dose of anesthetic increases this incidence, despite the presence of conditions known to reduce anesthetic requirement.