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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Modern anesthesiology differs widely from what it was 40-50 years ago, not only because of what anesthesiology now involves in the operating room, but also because anesthesiology has expanded its horizons and activities above and beyond the provision of surgical anesthesia. These changes and the identity of modern anesthesiology are, however, but poorly understood, if understood at all, by the majority of laity and physicians alike. ⋯ The problem of public identity of our specialty includes the historically correct, but, contemporaneously, all too often misleading name of our specialty. It is suggested that it is appropriate, at this time, to at least consider the potential advantages of changing the name of our specialty to, say, metesthesiology and metesthesiologist, to indicate that while, today, our specialty continues to involve operative anesthesia, it extends above and beyond to include a wide variety of professional activities outside the operating room richly rewarding to patient and practitioner alike.
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The LMA is a useful airway device for most adult and pediatric patients. It is easy and atraumatic to insert, with minimal somatic and autonomic responses from the patient. ⋯ In addition, the LMA facilitates blind and fiberoptic techniques of intubation, but its role in the emergency scenario has yet to be established. The preliminary experience gained with this device in Europe and Australasia suggests that it may also transform contemporary anesthetic practice in the United States.
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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.