Anesthesiology
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Comparative Study
Continuous noninvasive finger blood pressure during controlled hypotension. A comparison with intraarterial pressure.
The Finapres is a noninvasive monitor that continuously displays the arterial waveform, pulse rate, and systolic, mean, and diastolic blood pressure. We determined its bias (mean prediction error) and precision (mean absolute error), relative to directly measured radial arterial blood pressure, in 16 otherwise healthy patients undergoing spinal fusion surgery under hypotensive anesthetic techniques. Data were recorded during three contiguous epochs: 20 min of normotension; 30 min following the initiation of hypotension; 20 min of hypotension. ⋯ The Finapres closely tracked changes in blood pressure, even in the presence of a large bias. In most patients, the Finapres is a useful continuous noninvasive blood pressure monitor. Periodic calibration of the Finapres by the difference between Finapres and oscillometrically determined mean arterial pressure is recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy.
This study compared epidural and intravenous fentanyl infusions for pain relief for the first 20 h after thoracotomy, in order to examine whether an thoracic epidural fentanyl infusion offers clinical advantage over an intravenous infusion. Forty patients were assigned randomly to receive either fentanyl epidurally and saline intravenously or fentanyl intravenously and saline epidurally in a double-blind fashion. ⋯ Respiratory function was better preserved and the incidence of nausea and sedation was less in the epidural group than in the intravenous group. In conclusion there appears to be a clinical advantage to the epidural infusion over the intravenous infusion of fentanyl for analgesia after thoracotomy.
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Randomized Controlled Trial Clinical Trial
Efficacy of therapeutic suggestions for improved postoperative recovery presented during general anesthesia.
There have been claims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery. This study evaluated the effectiveness of such therapeutic suggestions under double-blind and randomized conditions. A tape recording predicting a smooth recovery during a short postoperative stay without pain, nausea, or vomiting was played during anesthesia to about half the patients (N = 109), while the remaining, control patients were played a blank tape instead (N = 100). ⋯ There were no meaningful, significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls. These negative results were not likely to be due to insensitivity of the assessments of recovery, as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery. Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of desflurane and isoflurane in patients undergoing coronary artery surgery.
Animal studies indicate that desflurane and isoflurane have similar hemodynamic effects when administered in equipotent anesthetic concentrations. The authors compared desflurane and isoflurane, used as primary anesthetics for patients undergoing elective coronary artery bypass surgery whose left ventricular ejection fractions were greater than 0.34. After induction of anesthesia with thiopental (dose 180 +/- 45 mg [mean +/- standard deviation]) and fentanyl, 10 micrograms.kg-1, either desflurane or isoflurane was administered to maintain systolic blood pressure within 70-120% of, and heart rates less than 120% of, the patients' average preoperative values. ⋯ Systolic arterial pressure was also significantly greater in the isoflurane group 1 min after intubation, during skin preparation, and 1 min after sternotomy. Otherwise, the hemodynamic effects of these volatile agents were similar. There were no differences between groups in the incidence of ECG changes indicative of myocardial ischemia prior to cardiopulmonary bypass, perioperative myocardial infarction, or perioperative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
An evaluation of anesthesiologists' present checkout methods and the validity of the FDA checklist.
The United States Food and Drug Administration (FDA) published the Anesthesia Apparatus Checkout Recommendations (checklist) in order to improve the methods anesthesiologists use to check out anesthesia equipment. Whereas no published study of current checkout methods had been performed since the introduction of the FDA checklist, we compared anesthesiologists' current anesthesia equipment pre-use checkout methods with anesthesiologists' use of the FDA checklist. One hundred and eighty-eight anesthesiologists were tested to compare the number of prearranged anesthesia machine faults that could be detected with 1) their own checkout methods and 2) the FDA checklist. ⋯ For only one fault, malfunction of the oxygen/nitrous oxide ratio protection system, was there a statistically significant improvement (P less than 0.01) with the use of the FDA checklist. Anesthesiologists in residency training detected more faults (average 2.46/8, 30.8%) than did anesthesiologists who primarily practiced direct patient care (1.98/8, 23.9%) (P less than 0.01). Our data indicate that the mere introduction of the FDA checklist did not improve the ability of anesthesiologists to detect anesthesia machine faults.