Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialUse of ketorolac and fentanyl during outpatient gynecologic surgery.
In healthy outpatients undergoing minor gynecologic surgery, the analgesic efficacy of ketorolac was compared to fentanyl and to a combination of the two analgesics. One hundred and nine patients were randomly selected to receive fentanyl 50-100 micrograms, ketorolac 30-60 mg, or a combination of fentanyl 50-100 micrograms and ketorolac 30-60 mg, intravenously (IV). Anesthesia was induced with midazolam 2 mg IV and propofol 1 mg/kg, IV, and maintained with propofol, 50-160 micrograms.kg-1.min-1, IV, and nitrous oxide 67% in oxygen via a face mask. ⋯ Although there were no significant differences in intraoperative mean arterial pressure, heart rate, and oxygen saturation of hemoglobin values among the three treatment groups, the ketorolac group manifested significantly more rapid respiratory rates throughout the procedure compared with the fentanyl and combination groups. Recovery times, postoperative side effects, and pain scores, as well as postoperative analgesic and antiemetic requirements, were similar in all three treatment groups. However, the ketorolac group reported significantly higher pain scores in the early postoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Aug 1993
Randomized Controlled Trial Clinical TrialIntravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients.
The effects of intravenously administered lidocaine on cough suppression in elderly patients over the age of 60 yr during tracheal intubation under general anesthesia were evaluated in two studies. In the first study, 100 patients received a placebo of either 0.5, 1.0, 1.5, or 2.0 mg/kg lidocaine intravenously 1 min before tracheal intubation. All visible coughs were classified as coughing. ⋯ The incidence of coughing decreased significantly (P < 0.01) when 2 mg/kg lidocaine was injected intravenously between 1 min and 3 min before attempting intubation. The cough reflex was almost entirely suppressed by plasma concentrations of lidocaine in excess of 4 micrograms/mL. The results suggest that intravenous administration of lidocaine is effective in suppressing the cough reflex during tracheal intubation in elderly patients under general anesthesia, but that relatively high plasma concentrations of lidocaine may be required for suppression of coughing.
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Anesthesia and analgesia · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialA clinical comparison of bronchial cuff pressures in three different designs of left double-lumen tubes.
This study compared the bronchial cuff pressures and volumes required by three different designs of disposable left double-lumen tubes during clinical one-lung ventilation in 48 patients having right thoracotomies. Mallinckrodt, Rusch, and Sheridan design tubes (n = 16 for each) were studied in a randomized fashion using Fr# 35, 37, 39, and 41 sizes (n = 12 for each size). ⋯ Intraoperatively, the Sheridan design required significantly higher mean bronchial cuff pressures: [27.9 cm H2O +/- 17 cm H2O (SD)] than either the Mallinckrodt [17.6 cm H2O +/- 8.5 cm H2O (P = 0.012)] or Rusch [14.1 cm H2O +/- 8.6 cm H2O (P = 0.010)] to achieve one-lung isolation. During prolonged one-lung ventilation, the potential for trauma to the bronchus may be reduced with a Mallinckrodt or Rusch design of left double-lumen tube.
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Malignant hyperthermia (MH) is triggered by many anesthetics. This study investigates the epidemiology of MH, its association with various drugs, and mortality rates. Five hundred three cases of MH were reported. ⋯ Previous uneventful anesthesia (20.9%) and absence of positive family history (75.9%) were common. Case fatality rates have decreased with time to 10% since 1985. This decline is partly and independently due to dantrolene therapy, as well as to better vigilance and awareness on the part of the anesthetic community.