Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1993
Comparative StudySerum inorganic fluoride levels in mildly obese patients during and after sevoflurane anesthesia.
Serum inorganic fluoride levels in obese versus control patients were compared during and after sevoflurane anesthesia. Mean serum inorganic fluoride levels in the obese group increased more rapidly and were significantly higher than in the control group at each sampling time (P < 0.01). ⋯ Peak serum fluoride level in the obese patients was 51.7 +/- 2.5 mumol/L and exceeded 50 mumol/L for nearly 2 h. Our study showed that serum fluoride concentrations between mildly obese and nonobese patients differed during and after sevoflurane anesthesia.
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Anesthesia and analgesia · Nov 1993
Reliability of a new generation transesophageal Doppler device for cardiac output monitoring.
A new generation continuous-wave transesophageal Doppler (TED) device for cardiac output (CO) monitoring (Accucom 2, Datascope), which displays aortic blood flow velocity in real time, was evaluated by 140 simultaneous comparisons with thermodilution (TD) in 16 patients early after coronary artery bypass surgery. The aim was to determine whether this technologic advancement improves the accuracy of COTED assessment. Absolute COTED values showed a considerable scatter as compared to COTD [COTED = 1.77 + 0.75. ⋯ The agreement between delta COTD and delta COTED improved (P < 0.05) when the aortic diameter changes induced by changes in mean arterial pressure were considered [delta COTEDMAPC = 1.10 + 0.95.delta COTD (%), r = 0.87, n = 124]. Compared with previous results, the reliability of the second generation device to monitor relative CO changes was considerably improved. Provided that the aortic blood flow velocity signal was stable and free from any disturbances, the second generation TED device may be regarded acceptable for CO trend monitoring in sedated, paralyzed patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialPreliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B).
Remifentanil is a newly synthesized 4-anilido-piperidine with an ester side chain susceptible to esterase metabolism. We evaluated the safety, analgesic efficacy, and pharmacokinetics of remifentanil in 48 male volunteers. Volunteers were randomized to receive increasing doses of remifentanil, alfentanil, or placebo. ⋯ Remifentanil had a small volume of distribution of 0.39 (SD, +/- 0.25) L/kg (alfentanil, 0.52 +/- 2 L/kg), with a rapid distribution phase of 0.94 (SD, +/- 0.57) min and an extremely short elimination half-life of 9.5 (SD, +/- 4) min compared with an elimination half-life of alfentanil of 58 (SD, +/- 7.6) min. The t1/2 ke0 (half-time for equilibration between plasma and the effect compartment) of remifentanil for analgesia was calculated as 1.3 min. Thus, remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short-lasting pharmacokinetics, which is likely to make it a very useful opioid for clinical practice.