Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 1992
Comparative StudyA comparison of the effects of propofol and nitrous oxide on the electroencephalogram in epileptic patients during conscious sedation for dental procedures.
The influence of sedative doses of propofol or nitrous oxide on the electroencephalogram was studied in 11 mentally handicapped patients with treated epilepsy undergoing dental procedures. At one session, propofol was titrated to achieve conscious sedation. The mean (+/- SD) dose requirements were 5.5 +/- 1.1 mg.kg-1.h-1. ⋯ The electroencephalogram did not change in nine patients, whereas in two patients epileptic activity decreased. There were no clinical epileptoid or other adverse manifestations during any treatment or up to 48 h thereafter. The results of the present study suggest that propofol or nitrous oxide can be administered in subanesthetic doses for conscious sedation in mentally handicapped patients with treated epilepsy.
-
Anesthesia and analgesia · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the anesthetic requirement for tolerance of laryngeal mask airway and endotracheal tube.
We tested the hypothesis that the laryngeal mask airway (LMA) is tolerated at lighter levels of anesthesia than an endotracheal tube (ET). We studied 20 unpremedicated, nonsmoking ASA physical status I or II patients aged 18-40 yr whose surgery lasted > 1 h. Subjects were randomly assigned to receive either an ET or LMA. ⋯ The patient was observed for signs of reaction to the presence of the LMA or ET. The mean (range) end-tidal isoflurane concentrations for reaction to ET and LMA were 0.55% (0.4-0.7) and 0.35% (0.2-0.51), respectively (P < 0.001). These data confirm the original hypothesis of the study.
-
Anesthesia and analgesia · Nov 1992
Comparative Study Clinical Trial Controlled Clinical TrialComparison among intrathecal fentanyl, meperidine, and sufentanil for labor analgesia.
This study compared the analgesic efficacy of intermittent injections of intrathecal fentanyl (10 micrograms), meperidine (10 mg), or sufentanil (5 micrograms) administered to 65 parturients during the first stage of labor. The groups did not differ in onset or duration of effective analgesia. The meperidine group, however, had significantly lower pain scores once cervical dilation progressed beyond 6 cm. ⋯ All neonates had a 5-min Apgar score of 7 or more. We conclude that intermittent intrathecal injections of fentanyl, meperidine, or sufentanil can provide adequate first-stage labor analgesia. Meperidine appears to provide more reliable analgesia as the first stage of labor progresses.
-
Anesthesia and analgesia · Nov 1992
Comparative StudyA comparison of methods for the detection of myocardial ischemia during noncardiac surgery: automated ST-segment analysis systems, electrocardiography, and transesophageal echocardiography.
Clinicians often fail to detect intraoperative ischemic electrocardiographic (ECG) changes when viewing oscilloscopes. Automated ST-segment monitors promise to increase the detection of such ECG changes. We investigated the capacity of two commercially available ST-segment monitors to detect intraoperative myocardial ischemia in patients at high risk for developing intraoperative myocardial ischemia during vascular and other noncardiac procedures. ⋯ Comparison of the printed ECG with TEE revealed that ST-segment changes in the printed ECG, as analyzed by a cardiologist, were 25% sensitive and 62% specific for the detection of TEE-diagnosed myocardial ischemia. When T-wave inversions were added to ST-segment depression as a criterion for the diagnosis of myocardial ischemia by the printed ECG, the sensitivity of ECG for the detection of intraoperative myocardial ischemia, as determined by TEE, was 40% and specificity was 58%. Twenty-three of the 44 patients were simultaneously monitored in leads I, II, and V5 with an automated Marquette ST-segment monitor.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Nov 1992
Effects of sodium L-lactate and sodium racemic lactate on intraoperative acid-base status.
Lactated Ringer's solution is frequently used to avoid metabolic acidosis during fluid resuscitation. The standard lactated Ringer's solution contains racemic lactate, an equal mixture of the D- and L-stereoisomers. We investigated whether sodium L-lactate or sodium racemic lactate (DL-lactate) is more effective for increasing buffering capacity in body fluids. ⋯ Although differences occurred among the three groups in blood concentrations of L-lactate, D-lactate, and the L-lactate/pyruvate ratio, no differences occurred between the two lactate groups in either bicarbonate ion concentration or base excess. The amount of buffering capacity increased significantly in both lactate groups, compared with preinfusion levels, and was more than the values in the nonlactated Ringer's solution group. We conclude that sodium racemic lactate is metabolized at nearly the same rate as that of sodium L-lactate.