Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1986
The dorsomedian connective tissue band in the lumbar epidural space of humans: an anatomical study using epiduroscopy in autopsy cases.
An anatomical study of the lumbar epidural space in 48 autopsy subjects was made using a method of endoscopy developed by the author called epiduroscopy. In every case there was a dorsal connective tissue band in the midline of the epidural space between the dura mater and the flaval ligaments. The appearance of the band varied from strands of connective tissue to a complete membrane. This connection fixed the dura mater to the flaval ligaments and also narrowed the epidural space in the midline.
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Anesthesia and analgesia · Jul 1986
Randomized Controlled Trial Clinical TrialPrevention of silent aspiration due to leaks around cuffs of endotracheal tubes.
Significant aspiration may occur around correctly inflated high volume, low pressure endotracheal tube cuffs. The prevention of silent aspiration due to leaks around cuffs of endotracheal tubes was investigated during general anesthesia for hip replacement in 47 patients. The patients were randomly assigned to one of three groups, in which one of three endotracheal tubes of different designs were used for intubation. ⋯ At termination of the operation, the trachea below the cuff was inspected with a fiberoptic bronchoscope. Aspiration was found in 12.5% with the Rüsch tube, in 31.2% with the Mallinckrodt tube, and in 0% with the NL tube. Our results show that silent aspiration is still a problem with standard endotracheal tubes, but that it may be minimized by use of appropriate tubes, cuffs, and control of cuff inflation.
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Anesthesia and analgesia · Jul 1986
Electrical and mechanical train-of-four responses during depolarizing and nondepolarizing neuromuscular blockade.
Simultaneous measurements of train-of-four (TOF) responses by integrated electromyography (IEMG) and twitch force were compared for atracurium, vecuronium, and succinylcholine in 30 subjects during nitrous oxide-fentanyl anesthesia. Determinations of TOF were made during neuromuscular blockade (NMB) onset and recovery. Scattergrams and least squares regression lines were plotted, and z-tests for parallel slope and common intercept were used to compare lines. ⋯ This finding is important for interpretation of IEMG when used for clinical monitoring. Comparison of data for depolarizing NMB shows more complex relationships. Integrated electromyography is found to be convenient and reliable for monitoring nondepolarizing NMB.
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Anesthesia and analgesia · Jul 1986
Intrathecal morphine and heroin in humans: six-hour drug levels in spinal fluid and plasma.
Lumbar spinal fluid and plasma concentrations of morphine were measured by radioimmunoassay after intrathecal administration of 1 mg of morphine (n = 13) or heroin (n = 10). Plasma levels of morphine were measured regardless of 'whether heroin or morphine was injected intrathecally, because of the rapid biotransformation of heroin to morphine in plasma. Significant drug concentrations appeared in plasma after intrathecal heroin (peak concentration 47.8 +/- 9.0 nmol/L, time to peak concentration 10 +/- 2.4 min); after intrathecal morphine plasma drug concentrations were significantly lower (8.1 +/- 1.0 nmol/L; P less than 0.002) and significantly later (216 +/- 39 min; P less than 0.002). Elimination half-life of heroin from spinal fluid (43 +/- 5 min) was significantly shorter than for morphine (73 +/- 5 min; P less than 0.02).