Anesthesiology
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Randomized Controlled Trial Clinical Trial
Monitoring of heparin-induced anticoagulation with kaolin-activated clotting time in cardiac surgical patients treated with aprotinin.
High-dose aprotinin appears to enhance the anticoagulant effects of heparin, as documented by increases in the activated clotting times (ACTs) during cardiopulmonary bypass; hence, some authorities have advocated reducing the dose of heparin in patients treated with aprotinin. An in vitro study by our group suggested that the increase of the ACT in the presence of aprotinin and heparin may be due to the use of celite as surface activator. We compared celite and kaolin as surface activators for the measurement of the ACT in cardiac surgical patients treated with aprotinin and in patients given no aprotinin. ⋯ The latter also was used for measurement of the blood heparin concentration. The ACTs of blood without heparin did not differ between aprotinin and control patients. During anticoagulation with heparin and cardiopulmonary bypass, the average C-ACTs were 784 +/- 301 s (aprotinin) and 496 +/- 120 s (control) (P < .001); the K-ACTs were 502 +/- 131 s (aprotinin) and 458 +/- 101 s (control) (P > .05); the HR-ACTs were 406 +/- 87 s (aprotinin) and 423 +/- 82 s (control) (P > .05), which was consistently less than C-ACT and K-ACT.(ABSTRACT TRUNCATED AT 250 WORDS)
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Meta Analysis Comparative Study
Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis.
Fracture of the hip typically occurs in older women. These patients usually have serious accompanying chronic illnesses. There is a difference of opinion as to the choice of regional versus general anesthesia for surgery in these patients. ⋯ By probability difference, mortality was a non-significant 2.7 percentage points less following regional anesthesia. By odds ratio effect measure, death was 1.5 times more likely following general anesthesia, but the lower bound of the 95% confidence interval was close to 1. Meta-analysis does not allow a conclusion that important differences in mortality exist between regional and general anesthesia for traumatic hip fracture surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy.
Administration of large doses of fentanyl is a popular method to provide postoperative analgesia after thoracotomy. It is however unclear whether epidural lumbar (L) or epidural thoracic (T) administration of fentanyl confers any major advantage over intravenous (iv) infusion. Using a randomized prospective study design, we compared the potential benefits of L, T, and iv fentanyl administration after thoracotomy in 50 patients. ⋯ There was no difference between the groups in overall quality of analgesia at rest and after coughing, quantity of fentanyl delivered (L = 1.15 +/- 0.38, T = 1.22 +/- 0.23, iv = 1.27 +/- 0.3 micrograms.kg-1.h-1), incidence of pruritus needing treatment (L = 2, T = 1, iv = 0 patients), need to decrease fentanyl infusion rate because of side effects (L = 2, T = 2, iv = 4 patients), importance of pulmonary infiltrates, or arterial blood gas values. One patient (L group) needed naloxone (0.04 mg iv). Intravenous patients were more frequently nauseated (P = .009) and needed boluses of fentanyl more often (L = 3 +/- 9, iv = 6 +/- 12, T = 4 +/- 8; P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Morphine and hydromorphone epidural analgesia. A prospective, randomized comparison.
Because evidence from uncontrolled, unblinded studies suggested fewer side effects from epidural hydromorphone than from epidural morphine, we employed a randomized, blinded study design to compare the side effects of lumbar epidural morphine and hydromorphone in 55 adult, non-obstetric patients undergoing major surgical procedures. A bolus dose of epidural study drug was given at least 1 h prior to the conclusion of surgery, followed by a continuous infusion of the same drug for two postoperative days. Infusions were titrated to patient comfort. ⋯ Prevalence of pruritus, however, differed significantly on postoperative day 1, with moderate to severe pruritus reported by 44.4% of patients in the morphine group versus 11.5% in the hydromorphone group (P < .01). On post-operative day 2, reports of pruritus by patients receiving morphine remained higher than those among the hydromorphone-treated subjects, although this difference was no longer statistically significant (32% vs. 16.7%, P = .18). We conclude that lumbar epidural morphine and hydromorphone afford comparable analgesia, but the occurrence of moderate to severe pruritus on the first postoperative day is reduced by the use of hydromorphone.
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Sevoflurane, a new inhalational anesthetic agent has been shown to produce degradation products upon interaction with CO2 absorbants. Quantification of these sevoflurane degradation products during low-flow or closed circuit anesthesia in patients has not been well evaluated. The production of sevoflurane degradation products was evaluated using a low-flow anesthetic technique in patients receiving sevoflurane anesthesia in excess of 3 h. ⋯ Mean maximum inhalation concentration of compound A using baralyme was 20.28 +/- 8.6 ppm (mean +/- SEM) compared to 8.16 +/- 2.67 ppm obtained with soda lime, a difference that did not reach statistical significance. A single patient achieved a maximal concentration of 60.78 ppm during low-flow anesthesia with baralyme. Exhalation concentrations of compound A were less than inhalation concentrations, suggesting patient uptake.(ABSTRACT TRUNCATED AT 250 WORDS)