Anesthesiology
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Biography Historical Article
Henry Ruth: pioneer of modern anesthesiology.
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Pulmonary aspiration of gastric contents during the perioperative period may be associated with postoperative mortality or pulmonary morbidity. Recent determination of the incidence of perioperative pulmonary aspiration and evaluation of factors related to clinical outcomes is lacking. ⋯ This study suggests that patients with clinically apparent aspiration who do not develop symptoms within 2 h are unlikely to have respiratory sequelae.
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Midazolam is being selected increasingly for use in patients with cardiovascular compromise. Although clinical doses of midazolam have minimal effects on cardiac function, the influence of midazolam (and other benzodiazepine sedatives) on cardiac arrhythmogenesis has yet to be elucidated fully. ⋯ This study has demonstrated that midazolam infusion results in either no effect (with clinical plasma midazolam concentrations) or flumazenil-reversible suppression (with supraclinical concentrations) of halothane-epinephrine arrhythmogenesis.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized, double-blind evaluation of ketorolac tromethamine for postoperative analgesia in ambulatory surgery patients.
Given the trend toward early discharge of patients after surgery and the inherent adverse effects of opioid analgesics, we compared a new nonsteroidal antiinflammatory drug, ketorolac tromethamine, given intravenously (iv) and then orally, with two commonly prescribed opioid analgesics in ambulatory patients for up to 1 week after surgery. ⋯ Ketorolac, when used in an iv and then oral sequence, is a safe and effective analgesic in the ambulatory surgery setting. It has a slower onset than fentanyl, but causes fewer side effects than C+A.
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Volatile anesthetics depress global left ventricular function by altering intracellular calcium (Ca2+) homeostasis at several sites within the myocyte. Although extracellular Ca2+ partially reverses the negative inotropic effects of volatile anesthetics, the actions of extracellular Ca2+ on anesthetic-induced diastolic dysfunction are unexplored. This investigation examined and compared the direct effects of extracellular Ca2+ on left ventricular systolic and diastolic function in conscious and anesthetized dogs. ⋯ Although CaCl2 produced positive inotropic effects in both the conscious and anesthetized states, CaCl2 did not alter diastolic function in conscious dogs. In contrast, CaCl2 reversed halothane- and isoflurane-induced negative lusitropic actions. The results of the present investigation suggest that improvement of left ventricular performance by CaCl2 during volatile anesthesia may be related to actions in diastole as well as systole.