Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialProspective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery.
We examined the response to the laryngeal mask (LM) compared to the endotracheal tube (ETT) in patients undergoing ambulatory anesthesia. The differences in management by the anesthesiologists for these two airways were also examined. Peripheral orthopedic procedures were studied in 44 outpatients randomized to receive a LM or ETT, and either spontaneous or controlled ventilation. ⋯ The ETT was associated with greater hemodynamic response not only to airway placement (P < 0.05), but also to surgical incision (P < 0.05) and airway removal (P < 0.05). Spontaneous or controlled ventilation favored neither airway, although the ETT was associated with increased work of inspiration with controlled ventilation (P < 0.05). Anesthesiologists tended to elect smaller tidal volumes, faster ventilation rates, and lower anesthetic concentrations for patients with the LM (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Oct 1994
Randomized Controlled Trial Clinical TrialEffect of injection rate on sensory level and duration of hypobaric bupivacaine spinal anesthesia for total hip arthroplasty.
We prospectively studied 18 male patients undergoing total hip arthroplasty in the lateral decubitus position to determine the effect of injection rate on sensory level and duration of 0.3% hypobaric bupivacaine spinal anesthesia. Patients were randomized into one of two groups according to rate of injection. Dural puncture was performed in the midline at the L3-4 interspace with a 22-gauge needle, with the patient in the lateral decubitus position (operative side uppermost). ⋯ Fast rate of injection also resulted in a higher maximum sensory level on both nondependent and dependent sides compared to the slow rate of injection (mean difference four segments). The specific gravity of the local anesthetic solution was significantly less than that of patient cerebrospinal fluid (CSF), indicating that 0.3% bupivacaine is hypobaric. We conclude that fast injection of 0.3% bupivacaine at room temperature results in a higher maximum sensory level than slow injection.
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Anesthesia and analgesia · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of tracheal extubation in patients deeply anesthetized with desflurane or isoflurane.
A randomized, single-blind study design was used to compare desflurane with isoflurane in 31 adults undergoing intraocular surgery to determine whether the lower blood:gas partition coefficient of desflurane would result in a more rapid emergence after endotracheal extubation of deeply anesthetized patients. A standardized general anesthetic technique was used, consisting of sufentanil, 0.25 microgram/kg, and propofol, 1.5 mg/kg, followed by either isoflurane (n = 15) or desflurane (n = 16) in an air/oxygen mixture. After the operation and reversal of residual neuromuscular block, spontaneous ventilation was reestablished and the patients' tracheas were extubated at equianesthetic concentrations of desflurane and isoflurane (i.e., approximately 1.4 times the minimum alveolar anesthetic concentration [MAC]). ⋯ Use of desflurane (versus isoflurane) was not associated with an increased incidence of coughing or airway irritation during the emergence period. However, use of desflurane did not significantly reduce the duration of the postanesthesia care unit (PACU) stay or alter later recovery events compared to isoflurane. In conclusion, the more rapid emergence would favor the use of desflurane when tracheal extubation during deep anesthesia is required.
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Anesthesia and analgesia · Oct 1994
Comparative Study Clinical Trial Controlled Clinical TrialDetermination of the distance between the laryngoscope blade and the upper incisors during direct laryngoscopy: comparisons of a curved, an angulated straight, and two straight blades.
We compared visibility and dental complications from a variety of blades during tracheal intubation. Ninety-eight patients who received tracheal intubation were enrolled. They were divided into two groups: Study 1 (n = 50) and Study 2 (n = 48). ⋯ Two patients sustained a fracture of the central incisor and subluxation of the central incisor, respectively, during laryngoscopy in which a Wisconsin blade was used. The average incidence of dental injury was 1/191. The Belscope blade may contribute to a reduced likelihood of upper dental injuries during laryngoscopy.
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Anesthesia and analgesia · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialBlood transfusion with autologous and leukocyte-depleted or standard allogeneic red blood cells and the immune response to open heart surgery.
Allogeneic blood transfusions have been associated with impaired outcome in surgical patients. This effect may be mediated by leukocytes. Animal experiments have shown that at least some of the effect can be modified by removal of leukocytes from transfused blood. ⋯ Three of the 12 patients in the allogeneic leukocyte-containing red blood transfusion group became human lymphocyte antigen (HLA) alloimmunized. No infections or other complications occurred in any patients. We conclude that HLA alloimmunization was the only effect that could be modified by use of autologous blood.