Anesthesia and analgesia
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This study was designed to quantify the rate of mental recovery in elderly and young patients after general anesthesia for intraabdominal surgery (cholecystectomy). Forty patients (25-83 yr) were given four tests assessing neuropsychological function once preoperatively and on five occasions postoperatively. Two of the four neuropsychological tests showed impairment in scores in the elderly patients on the first postoperative day (Symbol Digit Modalities Test, P less than 0.004; The Trail Making Test, P less than 0.03). ⋯ The changes that did occur in these tests on the first postoperative day reverted to baseline levels thereafter. There were no significant changes in the remaining two tests, the Mini Mental State Test or the Digit Span Test, at any time in either group. We conclude that postoperative mental deterioration is no greater in elderly than in young patients.
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Anesthesia and analgesia · Sep 1990
Modulation of pain-related somatosensory evoked potentials by general anesthesia.
The aim of the present study was to assess if late somatosensory evoked cerebral potentials (SEPs) in response to painful electrical stimuli are a sensitive indicator for analgesic treatment during general anesthesia. For this purpose, a pain model developed for the quantification of drug-induced analgesia in awake volunteers was used in 10 patients scheduled for elective abdominal hysterectomy. Before induction of anesthesia, stimuli were adjusted to two and three times the pain threshold for each individual. ⋯ However, AEP components remained suppressed with increased auditory stimulus intensity. Addition of fentanyl (HF) suppressed SEP amplitudes and stimulus-induced hemodynamic responses. Our results suggest that late SEPs in response to painful stimuli change with different analgesic levels.
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Anesthesia and analgesia · Sep 1990
Hepatocellular integrity in swine after prolonged desflurane (I-653) and isoflurane anesthesia: evaluation of plasma alanine aminotransferase activity.
Desflurane, formerly known as I-653 (CF2H-O-CFH-CF3), is a new inhalation anesthetic derived by fluorine substitution for the alpha-ethyl chlorine of isoflurane (CF2H-O-CClH-CF3). The lower solubility and increased stability of desflurane provided by the C-F bond lessen biotransformation to potentially hepatotoxic metabolites. Repeated administration of desflurane to rats, with or without induced hepatic enzymes, does not result in evidence of hepatic injury. ⋯ Plasma alanine aminotransferase activities remained in the normal range, and were not significantly greater over baseline values in samples drawn immediately after, 4 h after, or 3-8 days after (mean +/- SD, 6.1 +/- 2.1) the administration of either anesthetic was discontinued after the first study with either desflurane or isoflurane. Five additional pigs were given a mean total dose of 9.7 MAC-hours of desflurane or isoflurane in conjunction with succinylcholine, N2O, fentanyl, naloxone, atracurium, thiopental, edrophonium, and atropine. No changes in plasma alanine aminotransferase activity were detected in blood samples drawn at termination of the anesthesia, 24 h later, and 4-7 days later (mean +/- SD, 5.8 +/- 1.3).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Sep 1990
Doxacurium and mivacurium do not trigger malignant hyperthermia in susceptible swine.
The role of succinylcholine in the precipitation of malignant hyperthermia (MH) necessitates the testing of new neuromuscular relaxants for their ability to trigger MH in MH-susceptible swine before general human use. We tested doxacurium and mivacurium, two new nondepolarizing bis-benzylisoquinolinium neuromuscular relaxants, at ED95 and at four times ED95 doses in swine previously documented to be MH-susceptible. ⋯ Muscle biopsy specimens taken before administration of the relaxant confirmed that all animals had increased sensitivity to halothane, caffeine, or both. Thus, we conclude that doxacurium and mivacurium are not triggering agents of malignant hyperthermia in MH-susceptible swine.
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Anesthesia and analgesia · Sep 1990
Historical ArticleThe Wood Library-Museum's 1858 edition of John Snow's On chloroform and other anaesthetics.
The original 1858 edition of John Snow's On Chloroform and Other Anaesthetics, from which came the Wood Library-Museum of Anesthesiology reprints in 1971 and 1989, was donated to the Wood Library-Museum by Ralph Waters of Madison, Wisconsin, in 1967. The book contains a message of appreciation to Waters, dated October 1937, with the signatures of J. Blomfield, Charles King, and R. ⋯ George's Hospital, London, where John Snow had worked. It was this copy that they presented to Waters, and that was delivered to Waters by hand when Waters' resident, Ivan Taylor, returned from Oxford to Madison. Blomfield's ownership of the book, in addition to his position as president of the Association of Anaesthetists of Great Britain and Ireland, explains why the inscription is in his handwriting.