Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 1994
Pulse oximetry monitoring can change routine oxygen supplementation practices in the postanesthesia care unit.
Routine use of supplemental oxygen (O2) in the postanesthesia care unit (PACU) traditionally has been used to minimize the incidence of hypoxemia. However, with the advent of continuous noninvasive monitoring by pulse oximetry, is routine administration of O2 necessary? We hypothesized that administering O2 as needed, based on pulse oximetry data, would effect considerable cost savings without compromising patient care. Five hundred adult (> or = 18 yr) patients breathing room air when arriving in the PACU were enrolled in the study. ⋯ Cost savings to the 307 patients in one study not receiving O2 was $31,928 if it had been billed separately from the PACU global charge. The annualized figure for patients in our hospital (approximately 10,000 cases) would be an additional $623,272. Inasmuch as pulse oximetry monitoring is now standard in the PACU, perhaps it is time to apply the objective data it supplies, thereby creating cost savings while maintaining patient care standards.
-
Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of patient controlled epidural analgesia with sufentanil by the lumbar versus thoracic route after thoracotomy.
To compare the efficacy of patient-controlled lumbar and thoracic epidural sufentanil, 22 patients scheduled for elective thoracotomy were assigned randomly to receive sufentanil via either a lumbar or a thoracic epidural catheter. For 24 h postoperatively, the patients received analgesia only by patient-controlled epidural sufentanil. There were no significant differences in the visual analog scale (VAS) for pain between the two groups at 8 and 24 h postoperatively. ⋯ The forced vital capacity (FVC) measured at 24 h (as a percentage of baseline FVC) showed no significant difference between the lumbar and thoracic groups (44.7 +/- 3.8 and 41.7 +/- 5.5; P = 0.68). The total sufentanil used by the lumbar and thoracic groups was not significantly different (196 +/- 25.2 micrograms and 157 +/- 28.6 micrograms; P = 0.32). We conclude that there is no clinical advantage of thoracic over lumbar epidural sufentanil in the thoracotomy patient with respect to quality of analgesia, amount of sufentanil used, severity of side effects, or postoperative pulmonary function.
-
Anesthesia and analgesia · Feb 1994
The degradation, absorption, and solubility of volatile anesthetics in soda lime depend on water content.
Absorption of anesthetic into soda lime may delay induction of anesthesia and degradation by soda lime may produce toxic products. We determined whether the moisture content of soda lime influences the mechanisms underlying absorption (saturable uptake), degradation, and solubility (nonsaturable uptake). We placed liquid anesthetic (sevoflurane, isoflurane, halothane, enflurane, or desflurane) in 581-mL equilibration flasks containing soda lime of various water contents (0%-15.1% H2O) and sampled the vapor concentrations repeatedly for 24-35 h. ⋯ We also found that soda lime in absorbers may dry from H2O contents of 15% to 4%-8.5% in routine clinical use. Our observations suggest that during induction of anesthesia a portion of the delivered anesthetic may be lost to the soda lime, rather than delivered to the patient. In addition, the potential for production of toxic products may be increased when volatile anesthetics are used with dry soda lime.
-
Anesthesia and analgesia · Feb 1994
Blood volume redistribution during cross-clamping of the descending aorta.
We tested the hypothesis that occlusion of the descending aorta is associated with blood volume redistribution resulting in a relative hypervolemia in organs and tissues proximal to the level of occlusion. The study was performed on splenectomized dogs anesthetized with pentobarbital. Whole body scintigraphy with a Sophy DSX rectangular large field of view gamma-camera equipped with a high resolution collimator was used; Tc99m was used to label plasma albumin. ⋯ The aortic cross-clamping at diaphragmatic level was associated with significant increases in the gamma-emission in all organs and tissues above the level of aortic occlusion by 8%-38%. Thus, the present study supports the hypothesis by demonstrating that cross-clamping of the aorta at diaphragmatic level is associated with an increase in blood volume in the organs and tissues proximal to the level of cross-clamping. Such an increase might represent the mechanism for well-documented increases in preload and blood flow above aortic occlusion, resulting in an additional (in addition to an increase in afterload) burden to the heart.