Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1993
Clinical TrialProlonged administration of isoflurane to pediatric patients during mechanical ventilation.
We undertook a prospective study of the effectiveness and potential toxicities of isoflurane sedation in pediatric patients undergoing mechanical ventilation who required large doses of opioids for sedation were considered eligible. Ten patients (ages 3 wk to 19 yr) received continuous isoflurane sedation for a mean duration of 131 minimum alveolar concentration (MAC)-hours (range 13-497 MAC-hours). The mean peak inorganic fluoride (F-) concentration was 11.0 microM, and the highest F- concentration was 26.1 microM after 441 MAC-hours. ⋯ Five patients demonstrated an abstinence syndrome which consisted of nonpurposeful movements and extreme agitation. All of these patients had received at least 70 MAC-hours of isoflurane. Our experience indicates that isoflurane can effectively provide sedation to pediatric patients for prolonged periods without significant adverse effects on cardiovascular, hepatic, or renal function.
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Anesthesia and analgesia · Mar 1993
Editorial Comment Comparative StudyConstant versus optimal plasma concentrations.
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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
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.