Anesthesiology
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Comparative Study
Effect of Bay K 8644 on the magnitude of isoflurane and halothane contracture of skeletal muscle from patients susceptible to malignant hyperthermia.
Isoflurane has a lesser ability than halothane to induce contracture in malignant hyperthermia (MH) muscle in vitro. This does not necessarily imply that isoflurane is not as potent an MH trigger as halothane in vivo. A hypothesis was tested that in vitro treatment with Bay K 8644, an activator of both the dihydropyridine receptors as well as the sodium channels of the T-tubules, potentiates isoflurane-induced MH-susceptible skeletal muscle contracture. ⋯ Bay K 8644 did not induce muscle contracture on its own but consistently enhanced both the 0.5 MAC isoflurane and halothane to the same maximal isometric tension (1.09 +/- 0.35 g and 1.11 +/- 0.37 g, respectively). Such an effect was not observed in the MH-nonsusceptible group. Under the conditions of this in vitro study, 0.5 MAC isoflurane appears to be as potent as halothane in inducing muscle contracture in skeletal muscle bundles from individuals susceptible to MH.
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Clinical studies have reported that body core temperature decreases during prolonged surgery and anesthesia. Although this finding has been attributed primarily to increased heat loss resulting from exposure of body cavities and infusion of cold solutions, it is generally recognized that anesthesia interferes with the thermoregulatory system. The present study examined the effects of mild narcosis induced by 30% N2O on shivering thermogenesis and cutaneous thermoregulatory vasoconstriction in humans, during exposure in a much more intense peripheral thermal stimulus than the ones often used in clinical studies. ⋯ No significant difference was observed in cutaneous thermoregulatory vasoconstriction between the two experimental conditions, as indicated by the Tsk-gr values. The estimated Tes threshold for shivering (estimated from the O2 consumption vs. delta Tes regression) was reduced by 0.95 +/- 0.26 (SE) degrees C during the immersion phase and by 0.39 +/- 0.05 (SE) degrees C during the rewarming phase in the N2O condition compared to the control conditions. Although the thermosensitivity (gain) of shivering appeared preserved during the immersion phase, it was reduced during the N2O rewarming phase.(ABSTRACT TRUNCATED AT 400 WORDS)
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The effects of propofol, etomidate, midazolam, and fentanyl on motor evoked responses to transcranial stimulation (tc-MERs) were studied in five healthy human volunteers. Each subject, in four separate sessions, received intravenous bolus doses of propofol 2 mg.kg-1, etomidate 0.3 mg.kg-1, midazolam 0.05 mg.kg-1, and fentanyl 3 micrograms.kg-1. Electrical tc-MERs (tce-MERs) were elicited with anodal stimuli of 500-700 V. ⋯ Etomidate caused significant but transient depression of tc-MER amplitude. However, there was considerable intersubject variability. Latency did not change significantly after any drug.(ABSTRACT TRUNCATED AT 250 WORDS)
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Human error is believed to contribute to the majority of negative anesthesia outcomes. Because retrospective analysis of critical incidents has several shortcomings and prospective studies are limited by the low frequency of critical incidents, an anesthesia simulator was used to evaluate the management of simulated emergency situations by ten anesthesia residents, ten faculty anesthesiologists, and ten anesthesiologists in private practice in order to identify specific patterns of errors in diagnosis and treatment. The simulator is a computer program that presents the patient, monitors, and management choices in a graphical display on an IBM or compatible personal computer. ⋯ Fixation errors or failure to revise a plan in the presence of inconsistent cues were made by 63% of subjects. The subjects that gathered more information during simulated anaphylaxis made the correct diagnosis more often and made fewer treatment errors. The time since the last ACLS training was found to be an important predictor of correct management of simulated cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)
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Editorial Comment
Improving anesthesiologists' performance by simulating reality.