Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1994
Randomized Controlled Trial Clinical TrialPrevention of endotracheal tube-induced coughing during emergence from general anesthesia.
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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 TrialClonidine decreases the dose of thiamylal required to induce anesthesia in children.
Clonidine is a useful drug to give preoperatively because it produces anxiolysis, sedation, and hemodynamic stability, and reduces intravenous and volatile anesthetic requirements. Several premedicants, including midazolam and diazepam, have been shown to reduce the induction dose of intravenous anesthetics, such as thiopental, ketamine, or propofol. A randomized, double-blind controlled study was conducted to evaluate the effect of premedication with oral clonidine on thiamylal requirement for the induction of anesthesia and on associated hemodynamic changes in children. ⋯ The induction dose of thiamylal (mean +/- SD) was 5.4 +/- 0.9, 4.5 +/- 1.1, and 3.4 +/- 0.9 mg/kg for patients receiving placebo, clonidine 2 micrograms/kg, and clonidine 4 micrograms/kg, respectively (P < 0.05). Systolic BP decreased by 6.8%, 5.6%, and 6.6% and HR increased by 5.7%, 4.8%, and 4.1% after administration of thiamylal in the control (placebo) group and the clonidine 2 micrograms/kg and clonidine 4 micrograms/kg groups, respectively (P > 0.05). Premedication with oral clonidine reduced the dose of intravenous thiamylal required for the induction of anesthesia in children.
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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.