Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1993
Comparative StudyComplications and fiberoptic assessment of size 1 laryngeal mask airway.
In pediatric practice, complications due to the laryngeal mask airway (LMA) have been studied with size 2 LMA, but not with size 1 LMA. We, therefore, compared prospectively the complications induced by LMA size 1 and 2 in 141 children aged 21 days to 11 yr. Intraoperative and lowest SpO2 values after removal of LMA were recorded. ⋯ The number of attempts, complications, intraoperative SpO2, and lowest SpO2 values were similar when using size 1 and size 2 LMA. Fiberoptic examination of size 1 LMA showed a high incidence of impinging of the epiglottis in the LMA bars without airway obstruction. In conclusion, there was no difference in the complication rate between the two pediatric sizes of LMA when used in pediatric patients.
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Anesthesia and analgesia · Mar 1993
Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax.
Supraclavicular nerve blocks are technically easy to perform, but may be associated with pneumothorax. The objective of this study is to define the parasagittal anatomy important to our modified technique of supraclavicular nerve block designed to decrease the incidence of pneumothorax and to determine whether this technique is anatomically sound. Two cadaver specimens were studied. ⋯ MR imaging showed that in no instance using our modified technique was the lung contacted by the simulated needle before entering either the subclavian artery or contacting the brachial plexus. Our technique has been used in more than 110 patients without pneumothorax. The combination of our cadaver and magnetic resonance data suggests that our plumb-bob technique of supraclavicular nerve block is anatomically sound and may minimize the development of pneumothorax during supraclavicular block.
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Anesthesia and analgesia · Mar 1993
Randomized Controlled Trial Comparative Study Clinical TrialInduction of anesthesia with sevoflurane, nitrous oxide, and oxygen: a comparison of spontaneous ventilation and vital capacity rapid inhalation induction (VCRII) techniques.
In this study, the vital capacity rapid inhalation induction of anesthesia (VCRII) technique and the conventional spontaneous inhalation induction technique, each using 4.5% sevoflurane in nitrous oxide and oxygen, were compared. The VSRII group (n = 32) and conventional group (n = 32) were each tested on unpremedicated volunteers. ⋯ Each of the two techniques was found acceptable by most of the volunteers studied (more than 80%). However, sevoflurane is best used with the VCRII technique because VCRII resulted in fewer excitement movements that could lead to severe complications and pronounced excitement.
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Anesthesia and analgesia · Mar 1993
Selective application of cardiopulmonary resuscitation improves survival rates.
This study is a retrospective review of all patients who died without cardiopulmonary resuscitation (CPR) or who sustained a sudden cardiopulmonary arrest in the hospital and received CPR during a 2-yr period at a large medical center. Based on a review of Current Procedural Terminology codes, patients were classified into one of the ten disease categories: multiple medical problems, acute disease, procedure-related, congenital disease, neoplasm, metastatic neoplasm, trauma, burn, acquired immunodeficiency syndrome, and dementia. A total of 1206 patient deaths without a CPR effort were identified. ⋯ The other groups had survival rates comparable to the mean. Patients 70 yr of age and older were less likely to receive CPR than those younger than 70 (P < 0.0001). However, if they did receive CPR, they were just as likely to survive to discharge from the hospital as the younger patients (P = 0.3404).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1993
Preprogrammed infusion of alfentanil to constant arterial plasma concentration.
A variable rate infusion regimen, designed to rapidly achieve and maintain a target arterial concentration (CT) of 100 micrograms. L-1 of alfentanil, was developed using the method of Plasma Drug Efflux. This method uses a series of clearance values (Ep), calculated as the ratio of instantaneous infusion rate/arterial plasma drug concentration normalized to lean body mass (LBM), at various sampling times during a suboptimal infusion regimen. ⋯ The calculated infusion-rate-versus-time profile to produce CT was obtained from the product Ep x CT for each time point and was transferred to the read-only memory of a computerized infusion pump. This new variable infusion profile was used in four patients, and the process was repeated in three further groups of 5, 8, and 12 patients using infusion profiles calculated from the previous group. Each set of concentration data was assessed by calculating the performance error (PE), the median performance error (MDPE), i.e., bias, and the median absolute value of PE (MDAPE), i.e., inaccuracy.(ABSTRACT TRUNCATED AT 250 WORDS)