Anesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of brachial and radial arterial pressure monitoring in patients undergoing coronary artery bypass surgery.
The pressure in either the radial (n = 88) or proximal brachial artery (n = 82) was compared with aortic pressure before and after cardiopulmonary bypass (CPB) in patients receiving coronary artery bypass grafts. Radial artery pressures were measured via 20-G 5-cm long catheters, brachial artery pressures via 20-G 12.7-cm catheters, and aortic pressures were measured via a luer port in the aortic perfusion cannula. Transducers were connected via 122-cm long tubing. ⋯ The prebypass brachial correlation (r) with aortic for systolic, diastolic, and mean were 0.90, 0.98, and 0.98; respective radial correlations with aortic were 0.78, 0.97, and 0.95. Postbypass brachial systolic, diastolic, and mean correlations were 0.91, 0.97, and 0.98; radial were 0.50, 0.93, and 0.83. Brachial artery pressures were more accurate and reliable than radial artery pressures.
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The effect of three different depths of enflurane anesthesia (1.0, 1.4, and 1.8 MAC) upon laryngeal and respiratory responses to tracheal instillation of distilled water in nine female patients in whom a double-cuffed endotracheal tube had been inserted was investigated. The laryngeal responses were monitored by measuring the pressure in the saline-filled cuff positioned within the larynx, and the respiratory responses were monitored by measuring ventilatory flow and tracheal airway pressure. Increases in laryngeal cuff pressure in response to tracheal irritation were 19.7 +/- 4.5 cmH2O (mean +/- SD) at 1.0 MAC, 13.9 +/- 3.6 cmH2O at 1.4 MAC, and 7.6 +/- 1.8 cmH2O at 1.8 MAC, respectively (P less than 0.01 for anesthetic dose). ⋯ At 1.4 and 1.8 MAC, the same stimulation caused only apnea and constriction of the larynx in the majority of patients. These results indicate that changes in depth of anesthesia can modify the laryngeal and respiratory responses to tracheal irritation. The close association of laryngeal and respiratory responses may be an integral part of the defensive reflex synergism.
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Randomized Controlled Trial Clinical Trial
Transdermal scopolamine reduces nausea and vomiting after outpatient laparoscopy.
The authors evaluated the effect of transdermal scopolamine on the incidence of postoperative nausea, retching, and vomiting after outpatient laparoscopy in a double-blind, placebo-controlled study. A Band-Aid-like patch containing either scopolamine or placebo was placed behind the ear the night before surgery. Anesthesia was induced with fentanyl (0.5-2 micrograms/kg iv), thiopental (3-5 mg/kg iv), and succinylcholine (1-1.5 mg/kg iv) and maintained with isoflurane (0.2-2%) and nitrous oxide (60%) in oxygen. ⋯ Patients in the scopolamine group were also discharged from the hospital sooner (4 +/- 1.3 vs. 4.5 +/- 1.5 h; P = 0.0487). Side effects were more frequent among those patients treated with the scopolamine patch (91% vs. 45%; P less than 0.05) but were not troublesome. The authors conclude that transdermal scopolamine is a safe and effective antiemetic for outpatients undergoing laparoscopy.