Anesthesiology
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In human skeletal muscles, the phosphodiesterase-III inhibitor enoximone induces in vitro contracture development, and it has been suggested that enoximone could trigger malignant hyperthermia (MH). In this study, the in vitro and in vivo effects of enoximone in MH-normal (MHN) and MH-susceptible (MHS) swine were investigated. ⋯ The cumulative enoximone doses used in this study were 30- to 50-fold higher than therapeutic doses in humans. Enoximone does not trigger MH in genetically determined swine. However, enoximone might be useful for in vitro diagnosis of MH.
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Randomized Controlled Trial Clinical Trial
The effects of hydration on core temperature in pediatric surgical patients.
Reduced vascular volume might influence body temperature by diverting heat flow from peripheral tissues to the central organs. We therefore tested the hypothesis that mild hypovolemia helps to prevent intraoperative hypothermia in pediatric patients. ⋯ Conservative fluid management, which decreased body weight by only 1%, prevented reduction in core body temperature, presumably by reducing dissipation of metabolic heat from the core thermal compartment to peripheral tissues.
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Randomized Controlled Trial Clinical Trial
Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery.
The need for increasing operating room efficiency has led to various initiatives, one of which is the elimination of mandatory admission to the phase I recovery area postoperatively, also referred to as fast tracking of ambulatory surgery patients. This Institutional Review Board-approved study was conducted to evaluate the effect of Bispectral Index (BIS) monitoring on the ability of patients to successfully bypass the phase I recovery area following gynecologic laparoscopy during general anesthesia. ⋯ With a standardized anesthetic regimen and a strict discharge scoring system, BIS monitoring does not have a significant effect on the ability to fast track outpatients.
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Comparative Study Clinical Trial
Local anesthetic requirements are greater in dystocia than in normal labor.
Dystocia is characterized by abnormal progress of labor and is a common contemporary indication for cesarean delivery in the United States. There has been considerable controversy as to whether epidural analgesia causes dysfunctional labor leading to cesarean delivery for dystocia. The minimum local analgesic concentration (MLAC) is a clinical model used to determine the relative potencies of local anesthetics in the first stage of labor. In this article, the authors report a prospective study determining the MLAC of bupivacaine in early labor of parturients who eventually delivered either vaginally or via cesarean section. ⋯ These data suggest that an increased local anesthetic requirement for epidural labor analgesia is associated with more intense pain related to dystocia. Women in early, clinically normal labor but who later develop dystocia require more local anesthetic and, by inference, are experiencing more severe pain than women who deliver vaginally. This association should be considered when studying the relation between the method of labor analgesia and the course of labor.
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Comparative Study
Nerve stimulators used for peripheral nerve blocks vary in their electrical characteristics.
Nerve stimulation with a low-intensity electrical current has become a vital part of the performance of peripheral nerve blockade. The purpose of this study was to compare the accuracy and characteristics of peripheral nerve stimulators used in clinical practice in the United States. ⋯ Nerve stimulators used for regional anesthesia vary greatly in accuracy of current output and in manufacturer-selected electrical characteristics (e.g., current duration, stimulating frequency, maximum voltage output).