Anesthesiology
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Comparative Study Clinical Trial
The pharmacology of sevoflurane in infants and children.
Sevoflurane is a new volatile anesthetic with physical properties that should make it suitable for anesthesia (MAC of sevoflurane on oxygen alone and in 60% nitrous oxide, (MAC) of sevoflurane in oxygen alone and in 60% nitrous oxide, the hemodynamic, induction and emergence responses to sevoflurane and the metabolism to inorganic fluoride were studied in 90 ASA physical status 1 or 2 neonates, infants, and children. ⋯ We conclude that sevoflurane appears to be a suitable anesthetic agent for use in neonates, infants and children undergoing < or = 1 h of anesthesia.
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Case Reports Comparative Study
A clinical grading scale to predict malignant hyperthermia susceptibility.
The diagnosis of an acute malignant hyperthermia reaction by clinical criteria can be difficult because of the nonspecific nature and variable incidence of many of the clinical signs and laboratory findings. Development of a standardized means for estimating the qualitative likelihood of malignant hyperthermia in a given patient without the use of specialized diagnostic testing would be useful for patient management and would promote research into improved means for diagnosing this disease. ⋯ The malignant hyperthermia clinical grading scale is recommended for use as an aid to the objective definition of this disease. It use may improve malignant hyperthermia research by allowing comparisons among well-defined groups of patients. This clinical grading system provides a new and comprehensive clinical case definition for the malignant hyperthermia syndrome.
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Clinical Trial Controlled Clinical Trial
Minimum alveolar concentration of isoflurane for tracheal extubation in deeply anesthetized children.
The end-tidal anesthetic gas concentration required to prevent the anesthetized patient from coughing or moving during or immediately after tracheal extubation is not known. ⋯ In 50% of anesthetized children age 4-9 yr tracheal extubation may be accomplished without coughing or moving at 1.27% end-tidal isoflurane concentration.
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Normal thermoregulatory function is believed to be modulated by thermosensitive neurons in the preoptic region of the anterior hypothalamus and other sites within the central nervous system including the spinal cord. Previous evidence has demonstrated modulation of segmental spinal cord thermoregulatory mechanisms from more rostral central nervous system sites. The ability of the volatile anesthetics to disrupt normal thermoregulatory function and produce shivering-like activity during emergence is well documented. The purpose of the current investigation was to examine the action purpose of the current investigation was to examine the action of the volatile anesthetics halothane, isoflurane, and enflurane on thermoregulatory responses produced at the preoptic region and spinal cord. ⋯ The ability of preoptic region heating and cooling to modulate postanesthetic shivering implies that while thermoregulatory pathways remain intact, volatile anesthetics produce an imprecision in the control of thermoregulatory responses at the level of the anterior hypothalamus. Attenuation of shivering-like responses generated at spinal cord levels in pontine-transected cats implies a significant blunting action of thermoregulatory response mechanisms at the level of the spinal cord or lower brain stem.
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Randomized Controlled Trial Comparative Study Clinical Trial
Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers.
Direct laryngoscopy frequently is modified in patients with known or suspected cervical spine injury. The goals of this study were to measure the degrees of head extension required to expose the arytenoid cartilages and glottis if neck flexion were not possible and to determine whether in-line stabilization maneuvers alter the amount of head extension. ⋯ Head immobilization reduced head extension necessary for laryngoscopy. If head extension is construed to be potentially dangerous in patients with cervical spine injuries, head immobilization without traction might be the preferable stabilization technique.