Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1991
Randomized Controlled Trial Comparative Study Clinical TrialEffects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery.
To examine the interaction of epidural anesthesia, coagulation status, and outcome after lower extremity revascularization, 80 patients with atherosclerotic vascular disease were prospectively randomized to receive general anesthesia combined with postoperative epidural analgesia (GEN-EPI) or general anesthesia with on-demand narcotic analgesia (GEN). Demographics did not differ between groups except that the GEN-EPI group had a higher incidence of diabetes mellitus and of previous myocardial infarction. Coagulation status was monitored using thromboelastography. ⋯ The rates of cardiovascular, infectious, and overall postoperative complications, as well as duration of intensive care unit stay, were significantly reduced in the GEN-EPI group. Stepwise logistic regression demonstrated that the only significant predictors of postoperative cardiovascular complications were preoperative congestive heart failure and general anesthesia without epidural analgesia. We conclude that in patients with atherosclerotic vascular disease undergoing arterial reconstructive surgery (a) thromboelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and (b) epidural anesthesia and analgesia is associated with beneficial effects on coagulation status and postoperative outcome compared with intermittent on-demand opioid analgesia.
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Anesthesia and analgesia · Dec 1991
Randomized Controlled Trial Comparative Study Clinical TrialPlasma inorganic fluoride concentrations during and after prolonged (greater than 24 h) isoflurane sedation: effect on renal function.
We studied the effect of prolonged sedation (greater than 24 h) with isoflurane on plasma inorganic fluoride concentrations and renal function in 60 critically ill patients allocated randomly to receive either isoflurane or midazolam for sedation. In the isoflurane group, plasma fluoride increased from a mean concentration of 3.1 mumol/L to 20.0 mumol/L at the end of sedation, continued to increase to a peak of 25.3 mumol/L 16 h later, and then decreased exponentially (t1/2 = 111 h) to reach normal levels by the fifth day. ⋯ Serum and urinary electrolytes, urine osmolality, and creatinine clearance during and after sedation were similar in the two groups. Isoflurane sedation was associated with an increase in plasma fluoride concentration without any clinical deterioration of renal function.