Anesthesiology
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Randomized Controlled Trial Clinical Trial
Dose comparison of remifentanil and alfentanil for loss of consciousness.
This study evaluated the efficacy and safety of remifentanil, a potent mu agonist opioid with a rapid onset and offset of effect, as a sole induction agent for loss of consciousness (LOC) and compared it with alfentanil. ⋯ Remifentanil is 15 times more potent than alfentanil, based on the ED50 to achieve loss of response to a verbal command and 20 times more potent than alfentanil based on the EC50. Neither opioid is suitable as a sole induction agent.
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Randomized Controlled Trial Clinical Trial
Twenty-four-hour pharmacokinetics of rectal acetaminophen in children: an old drug with new recommendations.
Rectal acetaminophen is often administered during operation to provide supplemental analgesia or antipyresis in children. Recent studies examining current dose guidelines are limited by short sampling times. The authors extended the drug sampling period to more clearly define acetaminophen pharmacokinetics in children having surgery. ⋯ The current recommended rectal acetaminophen dose of 10-15 mg/kg yields peak serum concentrations less than the antipyretic serum concentration of 10-20 microg/ml. Based on the observed kinetics, the authors recommend that the initial dose should be approximately 40 mg/kg.
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Randomized Controlled Trial Clinical Trial
Oral clonidine premedication does not alter the efficacy of simulated intravenous test dose containing low dose epinephrine in awake volunteers.
Clonidine premedication modifies the hemodynamic responses to sympathomimetics. The present study was designed to test whether clonidine altered the response to a small intravenous dose of epinephrine, such as that which might be used in an epidural test dose. ⋯ Oral clonidine does not alter the efficacy of epinephrine-containing test doses used for detecting intravascular injection.
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Propofol and fentanyl infusion rates should be varied according to the patient's responsiveness to stimulation to maintain satisfactory anesthetic and operative conditions. However, somatic and autonomic responses to various noxious stimuli have not been investigated systematically for intravenous propofol and fentanyl anesthesia. ⋯ The authors successfully defined the propofol concentration required for various stimuli. Tracheal intubation was the strongest stimulus. The absence of somatic reactions for propofol does not guarantee hemodynamic stability without fentanyl. Propofol with fentanyl was able to suppress motor and hemodynamic reactions to various noxious stimuli.
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Randomized Controlled Trial Clinical Trial
Dose-range effects of clonidine added to lidocaine for brachial plexus block.
Although addition of clonidine to local anesthetics can prolong pain relief after peripheral nerve block, a dose-range effect has not been determined. ⋯ This study suggests that a small dose of clonidine enhances the quality of the peripheral blocks from lidocaine and limits the classical alpha2-agonist side effects to sedation.