Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialCombined inotropic effects of amrinone and epinephrine after cardiopulmonary bypass in humans.
Amrinone, a phosphodiesterase inhibitor, and epinephrine, an alpha- and beta-adrenergic receptor agonist, are inotropic drugs used during cardiac surgery to reverse myocardial depression after cardiopulmonary bypass. However, these drugs have not been compared separately, or in combination, in this patient population. We hypothesized that the combination might have complementary actions in improving myocardial function. ⋯ These data indicate that amrinone and epinephrine effectively increase myocardial performance during cardiac surgery. Right ventricular function especially was improved with amrinone and the combination of amrinone and epinephrine. The combined effects of amrinone and epinephrine may be useful in patients recovering from the ischemia and reperfusion injury resulting from coronary artery bypass grafting.
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Anesthesia and analgesia · Oct 1993
ReviewCocaine abuse in the parturient and effects on the fetus and neonate.
The growing use of cocaine among pregnant women and women of childbearing age has become an issue of great concern to physicians. Cocaine abuse among parturients is associated with multi-target organ involvement, including the cardiovascular, respiratory, neurologic, and hematologic systems. ⋯ Although a history of premature rupture of membranes, smoking, alcohol use, syphilis serology, and use of other illicit drugs suggests cocaine abuse, the single most important predictor is the absence of prenatal care. The intraoperative anesthetic management should take into consideration the different effects of cocaine on the mother, the fetus, and the neonate.
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Anesthesia and analgesia · Oct 1993
Multicenter Study Clinical TrialEffects on recovery when isoflurane is used to supplement propofol-nitrous oxide anesthesia.
During propofol-nitrous oxide (N2O) anesthesia, volatile anesthetics are frequently administered to treat signs of inadequate anesthesia and to decrease the possibility of intraoperative awareness. Because the clinical effects of this combination have not been examined rigorously, we used data from the 1989-90 Phase IV clinical trial with propofol to evaluate recovery from propofol-N2O anesthesia with and without supplementation with isoflurane. In this study involving 15,806 patients at 1722 institutions, propofol was administered for induction and maintenance of anesthesia with N2O for procedures lasting less than 60 min. ⋯ Adjunctive use of isoflurane prolonged the time to awakening and to becoming oriented, but discharge times were similar for the two groups. The incidence of postoperative nausea, vomiting, recall, and excitement did not differ between the two groups. We conclude that the addition of isoflurane to a propofol-N2O anesthetic does not alter recovery from anesthesia.
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Anesthesia and analgesia · Oct 1993
Randomized Controlled Trial Clinical TrialThe orbicularis oculi and the adductor pollicis muscles as monitors of atracurium block of laryngeal muscles.
The aim of this study was to determine whether atracurium-induced neuromuscular block at the laryngeal adductor muscles could be predicted by visual inspection of either adductor pollicis or orbicularis oculi responses. Twenty-one ASA Class I or II patients were anesthetized with propofol (2-2.5 mg/kg) and fentanyl (2-5 micrograms/kg). Tracheal intubation was performed without neuromuscular blocking drugs. ⋯ In patients receiving atracurium 0.5 mg/kg, laryngeal and orbicularis oculi responses were abolished faster (mean +/- SD: 132 +/- 80 and 146 +/- 58 s, respectively) than the adductor pollicis muscle (243 +/- 55 s; P < 0.05). There was a significant correlation (r = 0.94; P < 0.001) between neuromuscular block onset time at the laryngeal adductor and orbicularis oculi muscles but not between laryngeal and thumb muscles. The authors conclude that, after injection of atracurium, laryngeal adductor and orbicularis oculi blocks have similar intensities and time courses.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Oct 1993
Comparative StudyComparison of bedside coagulation monitoring tests with standard laboratory tests in patients after cardiac surgery.
We compared portable bedside tests of whole blood coagulation with standard laboratory plasma coagulation tests to assess the accuracy and precision of the bedside tests in a clinical setting (postcardiac surgery). The Ciba Corning 512 Coagulation Monitor (Ciba Corning Diagnostics Corp., Medfield, MA) and the Hemochron 801 (International Technidyne Corp., Edison, NJ) were tested. One hundred forty-one patients who underwent cardiac surgery requiring cardiopulmonary bypass were evaluated upon arrival in the intensive care unit. ⋯ The difference between Hemochron TT and Hemochron HNTT correlated weakly, but significantly, with laboratory aPTT ratio (r = 0.52, P < 0.001). The slope of the regression line indicated that a TT-HNTT difference > 30 s correlated with an aPTT > 1.5 x control. We conclude that, in the postoperative cardiac surgical patient, PT was both accurate and precise in two commercially available tests, but aPTT was not.(ABSTRACT TRUNCATED AT 250 WORDS)