Anesthesiology
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Randomized Controlled Trial Clinical Trial
Thermoregulatory thresholds during epidural and spinal anesthesia.
There are significant physiologic differences between spinal and epidural anesthesia. Consequently, these two types of regional anesthesia may influence thermoregulatory processing differently. Accordingly, in volunteers and in patients, we tested the null hypothesis that the core-temperature thresholds triggering thermoregulatory sweating, vasoconstriction, and shivering are similar during epidural and spinal anesthesia. ⋯ Comparable sweating, vasoconstriction, and shivering thresholds during epidural and spinal anesthesia suggest that thermoregulatory processing is similar during each type of regional anesthesia. However, thermoregulatory control was impaired during regional anesthesia, as indicated by the significantly enlarged inter-threshold and sweating-to-shivering ranges.
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Randomized Controlled Trial Clinical Trial
The electroencephalogram does not predict depth of isoflurane anesthesia.
The power spectrum of the electroencephalogram (EEG) may be analyzed to provide quantitative measures of EEG activity (e.g., spectral edge, which defines the highest EEG frequency at which significant activity is found). The current study tested the hypothesis that spectral edge and similar measures distinguish different functional depths of anesthesia in humans. ⋯ We conclude that our EEG measures do not predict depth of anesthesia as defined by the response to surgical incision, the response to verbal command or the development of memory.
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Randomized Controlled Trial Clinical Trial
Effect of flumazenil on recovery after midazolam and propofol sedation.
Flumazenil, a benzodiazepine antagonist, reverses midazolam-induced sedation and amnesia. We designed a double-blind study to evaluate the effects of flumazenil on patient outcome when flumazenil was used to reverse large or small doses of midazolam as part of standardized monitored anesthesia care. ⋯ Early recovery after breast biopsy procedures with midazolam sedation and flumazenil reversal is similar to recovery after propofol sedation. However, the beneficial effects of flumazenil were apparent only during the first 60 min after the procedure and resedation after discharge is an important consideration in the outpatient setting.
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Randomized Controlled Trial Clinical Trial
Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination.
Rocuronium is a new nondepolarizing neuromuscular blocking agent with a rapid onset but with intermediate duration of action. Mivacurium, on the other hand, is a new short-acting nondepolarizing neuromuscular relaxant, but of slower onset of action. The current study was undertaken to characterize the interaction between rocuronium and mivacurium. ⋯ The interaction between rocuronium and mivacurium was found to be synergistic.
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Clinical Trial Controlled Clinical Trial
Long-duration, low-flow sevoflurane anesthesia using two carbon dioxide absorbents. Quantification of degradation products in the circuit.
Sevoflurane reacts with soda lime, generating degradation products. The concentrations of sevoflurane degradation products in a low-flow circuit have been reported for anesthesia times of less than 5 h. In this study, sevoflurane degradation products generated during low-flow anesthesia exceeding 10 h were examined. ⋯ The degradation products detected were at low concentrations in long-duration, low-flow anesthesia with sevoflurane. Baralyme produced higher concentrations of degradation products than soda lime.