Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1991
Biography Historical ArticleThe development of academic anesthesiology at the Roswell Park Memorial Institute: James O. Elam, MD, and Elwyn S. Brown, MD.
In the early 1950s, Drs. James Elam and Elwyn Brown were recruited to establish the department of anesthesiology at the Roswell Park Memorial Institute. ⋯ Their work on carbon dioxide elimination led to a redesigning of the soda lime canisters that is still in clinical use. By popularizing mouth-to-mouth rescue breathing, these two anesthesiologists changed the manner in which emergency aid was given and won international acclaim.
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Anesthesia and analgesia · Apr 1991
Potentiation of atracurium neuromuscular blockade by enflurane: time-course of effect.
This study was designed to determine the time required for potentiation of atracurium neuromuscular blockade after the introduction of enflurane. Ten ASA physical status I and II adults anesthetized with thiopental, nitrous oxide, and alfentanil were given 0.4 mg/kg atracurium besylate. The force of contraction of the adductor pollicis muscle in response to train-of-four stimulation of the ulnar nerve was recorded. ⋯ During the first 30 min, no significant decrease in plasma levels occurred; but at 45 min, concentrations were only 67% +/- 8% of their initial value (P less than 0.01) and 48% +/- 2% at 120 min (P less than 0.01). This suggests that the interaction between enflurane and atracurium is time-dependent. Clinically, the interaction between atracurium and enflurane is negligible during procedures of less than 45 min.
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Anesthesia and analgesia · Apr 1991
One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography.
Interscalene brachial plexus anesthesia for shoulder surgery routinely includes sensory anesthesia of the fourth and fifth cervical nerves. The authors reasoned that some degree of diaphragm paralysis should result from interscalene blocks that produce surgical C3-C5 sensory anesthesia. In this investigation, ultrasonography was used to study the incidence of ipsilateral hemidiaphragmatic paresis during routine interscalene block, as it is a practical, sensitive, and low-risk method for diagnosing hemidiaphragmatic function without radiation exposure. ⋯ Changes from normal to paradoxical motion of the ipsilateral hemidiaphragm were seen in all 13 patients during sniff and Mueller maneuvers within 5 min (in 11 of 13 patients at 2 min). Diaphragmatic motion returned to normal in 10 of 11 patients between 3 and 4 h after injection and in the remaining patient by the fifth hour after injection. Diaphragmatic paresis appears to be an inevitable consequence of interscalene brachial plexus block when providing anesthesia sufficient for shoulder surgery.
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Anesthesia and analgesia · Apr 1991
Comparative StudyBenefits of a glucose-containing priming solution for cardiopulmonary bypass.
Benefits from the use of glucose-containing intravenous and priming solutions during coronary artery bypass operation have not been documented, but an increased risk of postoperative neurologic deficit by hyperglycemia has been suggested. To determine benefits, 107 patients undergoing coronary artery bypass operation were managed identically except that one group (n = 54) received 5% dextrose in lactated Ringer's solution (D5LR) as the sole intravenous and priming solution during operation and a second group (n = 53) received the same solution without glucose (LR). During cardiopulmonary bypass, the D5LR group required significantly less additional crystalloid to maintain safe oxygenator levels and flow (1.8 +/- 3.3 vs 15.8 +/- 20.9 mL.kg-1.h-1) and produced more urine (3.5 +/- 3.2 vs 1.2 +/- 1.4 mL.kg-1.h-1). ⋯ Five days after operation, the D5LR group weighed less than preoperatively (-0.8 +/- 2.6 kg), whereas the LR group gained weight (+1.0 +/- 2.8 kg). We conclude that use of glucose-containing solutions during coronary artery bypass operation benefits patients by decreasing perioperative fluid requirements and postoperative fluid retention. Because embolism is the cause of most postoperative neurologic deficits, any increased risk by hyperglycemia is small.
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Anesthesia and analgesia · Apr 1991
Computerized continuous infusion of intravenous anesthetic drugs during pediatric cardiac surgery.
We evaluated the efficacy of a computer-assisted continuous infusion device (CACI) using a two-drug infusion of midazolam and sufentanil as an anesthetic technique during pediatric cardiac surgery. Seventeen pediatric patients were anesthetized with CACI using age-appropriate pharmacokinetic models for administering sufentanil and midazolam. Predicted CACI plasma concentrations were correlated with assayed plasma drug concentrations at eight predefined intervals. ⋯ We found that plasma levels predicted by CACI provided a reasonable approximation of measured plasma concentrations for both drugs. The median absolute prediction error for sufentanil during cardiopulmonary bypass was compared with measurements made off of cardiopulmonary bypass (both pre and post cardiopulmonary bypass) and were 49% and 32%, respectively, and for midazolam 44% and 32%, respectively. We conclude that (a) current kinetic models provide a reasonable estimate of plasma drug concentrations, and (b) the ease of administration and targeted plasma level provided by the CACI system is an alternative to inhalation anesthesia using calibrated vaporizers.