Anesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
Awakening propofol concentration with and without blood-effect site equilibration after short-term and long-term administration of propofol and fentanyl anesthesia.
The propofol awakening concentration can vary. However, the effect site awakening propofol concentration will be a fixed value. The purpose of this study was to determine the awakening propofol concentrations obtained from infusion Schede using abrupt discontinuation of propofol (half-maximal effective concentration [EC50]) or a descending decrease in concentration to allow blood-effect site equilibration (EC50eq). ⋯ The EC50eq was independent of propofol infusion length, compared with the EC50. Thus the potential for hysteresis during emergence from propofol anesthesia was confirmed.
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Comparative Study Clinical Trial
The relation between the platelet-activated clotting test (HemoSTATUS) and blood loss after cardiopulmonary bypass.
Platelet dysfunction is one of several major causes of bleeding after cardiopulmonary bypass. A timely, simple, point-of-care determinant of platelet function recently became available for clinical use. Adding platelet-activating factor to conventional activated clotting time methods (platelet-activated clotting test [PACT]) produces rapid results (<15 min) and may yield a measure of platelet responsiveness and whole-blood procoagulant activity. ⋯ The PT correlated with blood loss and transfusion requirements and was superior to PACT, aPTT, and platelet count for predicting excessive blood loss after cardiopulmonary bypass.
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Comparative Study Clinical Trial
The pharmacokinetics and steady state pharmacodynamics of mivacurium in children.
The authors previously showed that children require larger infusion rates of mivacurium than adults to maintain target twitch depression. Here, they determined whether there are differences between children and adults in mivacurium's pharmacokinetic and pharmacodynamic properties. ⋯ Clearance of mivacurium's potent isomers is larger in younger patients, consistent with the larger mivacurium infusion requirement in children than in adults reported previously.
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Comparative Study Clinical Trial
Correlation of regional cerebral blood flow with ischemic electroencephalographic changes during sevoflurane-nitrous oxide anesthesia for carotid endarterectomy.
Carotid endarterectomy necessitates temporary unilateral carotid artery occlusion. Critical regional cerebral blood flow (rCBF) has been defined as the rCBF below which electroencephalographic (EEG) changes of ischemia occur. This study determined the rCBF50, the rCBF value at which 50% of patients will not demonstrate EEG evidence of cerebral ischemia with carotid cross-clamping. ⋯ The rCBF50 of 0.6-1.2% sevoflurane in 50% N2O, as determined using logistic regression analysis, is 11.5 +/- 1.4 ml 100 g(-1) x min(-1). Further, in patients anesthetized in this manner, ischemic EEG changes due to carotid occlusion were accurately and rapidly detected.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The concordance of intraoperative left ventricular wall-motion abnormalities and electrocardiographic S-T segment changes: association with outcome after coronary revascularization. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.
Transesophageal echocardiography (TEE) and Holter electrocardiography (ECG) are used to detect intraoperative ischemia during coronary artery bypass graft surgery (CABG). Concordance of these modalities and sensitivity as indicators of adverse perioperative cardiac outcomes are poorly defined. The authors tried to determine whether routine use of Holter ECG and TEE in patients with CABGs has clinical value in identifying those patients in whom myocardial infarction (MI) is likely to develop. ⋯ Wall-motion abnormalities detected by TEE are more common than S-T segment changes detected by ECG, and concordance between the two modalities is low. One half of patients with MI had preceding ECG or TEE ischemia. Logistic regression revealed that TEE is twice as predictive as ECG in identifying patients who have MI.