Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialSynergism between atracurium and mivacurium compared with that between vecuronium and mivacurium.
Synergism exists between some combinations of nondepolarizing muscle relaxants. To test the possibility of synergism between mivacurium and atracurium or vecuronium, 60 children anesthetized with propofol-alfentanil-N2O-O2 were randomized to one of five groups. Three groups of 10 patients each received an ED50 dose of a parent drug atracurium (A), vecuronium (V), or mivacurium (M), respectively, and two other groups of 15 patients each received a single-dose combination of atracurium with mivacurium (cAM) or vecuronium with mivacurium (cVM). ⋯ Maximum NMB established by combinations averaged 6.15 +/- 0.21 probits (87.5% NMB). The onset of maximum NMB for mivacurium was significantly faster compared to that for atracurium or for vecuronium (2.8 +/- 0.3 vs 5.7 +/- 0.4 or 4.0 +/- 0.3 min, respectively; P = 0.0001). Our results indicate that both drug combinations are synergistic even though only vecuronium is markedly different in its molecular structure from mivacurium.
-
Anesthesia and analgesia · Nov 1994
Randomized Controlled Trial Clinical TrialThe effect of low-dose bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography.
We performed a prospective, randomized, double-blind study to determine the effect of bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography in 120 patients who underwent extensive gastrointestinal or genitourinary surgery. The patients were randomized into four groups, 30 patients per group: Group I = epidural fentanyl (EF), 10 micrograms/mL in saline; Group II = EF with 0.1% bupivacaine; Group III = EF with 0.15% bupivacaine; and Group IV = EF with 0.2% bupivacaine. Pain relief was evaluated by a visual analog scale (VAS), both at rest and during coughing, and by a visual rating scale (VRS). ⋯ The VAS, VRS, sedation scores, changes in postoperative FVCs, and the incidence of side effects were not statistically different among the four groups. The 24-h total volumes of infusion in the four groups (146 +/- 40 mL, 140 +/- 38 mL, 142 +/- 40 mL, 124 +/- 21 mL, respectively) were not statistically different from each other. There were no significant differences in the TEG values [reaction time (R), coagulation time (K), angle (alpha), and maximum amplitude (mA)] among the four groups at anytime nor was there any difference between the baseline, PARR, and 24-h TEG values within any group.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialCost comparison: a desflurane- versus a propofol-based general anesthetic technique.
The purpose of this study was to compare the cost of a desflurane-based with a propofol-based general anesthetic technique. Fifty ambulatory orthopedic surgery patients were randomly assigned to one of two groups. Premedication and induction of anesthesia were standardized in both groups. ⋯ In conclusion, maintenance general anesthesia with our desflurane technique was considerably less expensive than with our propofol technique. PACU stay was not increased using desflurane as opposed to propofol in our study. Desflurane offers a cost effective alternative to propofol for ambulatory general anesthesia.
-
Anesthesia and analgesia · Nov 1994
Plasma inorganic fluoride and intracircuit degradation product concentrations in long-duration, low-flow sevoflurane anesthesia.
Plasma inorganic fluoride (F-) concentrations in long-duration, low-flow sevoflurane anesthesia were studied to assess effects on renal and hepatic function. The intracircuit concentration of degradation product generated by reaction between sevoflurane and CO2 absorbant was also determined. Ten patients undergoing prolonged surgery of 10 h or longer received sevoflurane anesthesia at 1 L/min. ⋯ Its individual maximum concentrations were 13.6-35.1 ppm (24.3 +/- 2.4 ppm). Postanesthesia clinical laboratory tests showed no renal impairment and only mild hepatic dysfunction that was not associated with anesthesia. Hyperfluorinemia and minute quantities of compound A were detected following long-duration, low-flow sevoflurane anesthesia.
-
The swallowing reflex is depressed by anesthetics. During recovery from anesthesia the rapid return of laryngeal and upper airway reflexes is important to protect the lower airway from aspiration. This study measures the recovery of the swallowing reflex after propofol anesthesia. ⋯ The EMGi was significantly decreased over the first 12 min and returned to control at 21 min. Propofol depresses the swallowing reflex, but complete recovery is rapid. This study suggests that the oral intake could be allowed early after recovery from anesthesia when propofol is used as the sole anesthetic.