Anesthesiology
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Randomized Controlled Trial Clinical Trial
Dose-response pharmacology of intrathecal morphine in human volunteers.
Intrathecal morphine sulfate (ITMS) administration was introduced into clinical practice in 1979. Inadequate information exists delineating ITMS respiratory effects in the dosage range most frequently employed today. This study evaluated 0.2, 0.4, and 0.6 mg ITMS in male volunteers. ⋯ ITMS produced dose-related analgesia and respiratory depression in nonsurgical healthy, young, adult male volunteers. Respiratory depression was significant after 0.2 or 0.4 mg and profound and prolonged after 0.6 mg. No clinical signs or symptoms, including respiratory rate, reliably indicated hypoxemia. Pulse oximetry reliably detected hypoxemia after ITMS, and supplemental nasal oxygen (2 L/min) effectively corrected this hypoxemia.
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Comment Letter Biography Historical Article
Henry Ruth, T. Drysdale Buchanan, and history of anesthesia.
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Clinical Trial
Pupillary assessment of sensory block level during combined epidural/general anesthesia.
Currently, no reliable method exists to determine the level of sensory block during combined epidural/general anesthesia. However, the pupil dilates markedly in response to noxious electrical stimulation during general anesthesia. Presumably, sensory block produced by epidural anesthesia decreases or obliterates this autonomic response. Accordingly, we tested the hypothesis that pupillary dilation in response to noxious stimulation would predict the level of sensory block achieved during combined epidural/general anesthesia. ⋯ We conclude that dilation of the pupil in response to electrical stimulation is an accurate test of the sensory block level during combined epidural/general anesthesia.
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Comparative Study Clinical Trial
Intraoperative transesophageal echocardiography for the detection of cardiac preload changes induced by transfusion and phlebotomy in pediatric patients.
Intraoperative blood volume changes are difficult to monitor in pediatric patients. The authors tested the hypothesis that transesophageal echocardiography would identify changes in cardiac filling resulting from manipulations of blood volume. ⋯ Transesophageal echocardiography is a potentially useful monitor of cardiac filling changes in pediatric patients.