Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Clinical TrialClonidine in pediatric caudal anesthesia.
Extradural clonidine produces analgesia in adults. To assess its efficacy in children, we randomized 45 pediatric patients aged 1-7 yr presenting for a subumbilical surgery into three groups of 15 each. After halothane and N2O/O2 induction, and with a double-blind protocol, caudal anesthesia was performed with 1 mL/kg of 0.25% bupivacaine. ⋯ More patients in the CG (n = 7) than in the EG (n = 1) and BG (n = 2) required no postoperative analgesia; P < 0.05. No differences were found among the groups for the minimal respiratory rate and minimal Spo2 values in the postoperative phase, and there were no differences among the groups for heart rate and systolic arterial pressure during the 3 h after caudal anesthesia. We conclude that the duration of postoperative analgesia with caudal bupivacaine was significantly increased by the addition of 1 microgram/kg of clonidine.
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Clinical TrialQuantifying the interaction of rocuronium (Org 9426) with etomidate, fentanyl, midazolam, propofol, thiopental, and isoflurane using closed-loop feedback control of rocuronium infusion.
The present study was designed to evaluate the interactions of rocuronium with etomidate, fentanyl, midazolam, propofol, thiopental, and isoflurane using closed-loop feedback control of infusion of rocuronium. Sixty patients were randomly assigned to one of six sequences where anesthesia was maintained with etomidate, fentanyl, midazolam, propofol, or thiopental and nitrous oxide, or with isoflurane and nitrous oxide. The possible interaction of rocuronium with the anesthetics was quantified by determining the asymptotic steady-state rate of infusion (Iss) of rocuronium necessary to produce a constant 90% neuromuscular block. ⋯ Iss values calculated per lean body mass were 0.64 +/- 0.22, 0.60 +/- 0.15, 0.61 +/- 0.21, 0.67 +/- 0.31, 0.63 +/- 0.15, and 0.39 +/- 0.17 mg.kg-1.h-1 in the etomidate, fentanyl, midazolam, propofol, thiopental, and isoflurane groups, respectively. The isoflurane group had a lower steady-state rate of infusion of rocuronium than the other five groups (P < 0.05). Compared to intravenous anesthetics, etomidate, fentanyl, midazolam, propofol, or thiopental, isoflurane reduced the infusion requirement of rocuronium by 35%-40%.
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialThe laryngeal mask airway in pediatric patients: factors affecting ease of use during insertion and emergence.
Use of the laryngeal mask airway (LMA) permits the maintenance of a patent airway with successful insertion rates of the LMA on the first attempt varying between 67%-92% in children. The recommended insertion technique involves deflation of the mask using a syringe, and application of a lubricant jelly. In a randomized study of 122 children, we compared the time to complete LMA insertion, the number of attempts before successful placement, and the occurrence of laryngospasm and Spo2 < 90% during insertion using the standard deflated method and an alternative method of insertion with the LMA cuff partially inflated. ⋯ Insertion of the LMA partially inflated required significantly less time (16 vs 23 s, P < 0.05), and was associated with a higher success rate on first attempts (85.5% vs 96.7%, P < 0.05). In those who did not receive morphine, 2% lidocaine topical solution decreased the incidence of coughing on emergence (10.3% vs 36.4%). The ease of insertion of the LMA in children was improved by partial inflation of the cuff and in addition, 2% lidocaine topical solution was as beneficial as morphine in reducing coughing on emergence.
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Anesthesia and analgesia · Apr 1994
Comparative StudyStructure-selective anesthetic action of steroids: anesthetic potency and effects on lipid and protein.
Alphaxalone was a clinically used steroid anesthetic. Its analog delta 16-alphaxalone is nonanesthetic. The only difference between the two is the presence of a double bond at the hydrophobic end of the delta 16-alphaxalone molecule. ⋯ These values translate into 3.5 mmol/L for alphaxalone and 0.15 mol/L for delta 16-alphaxalone, when expressed by the concentration in the peptide. The change from alpha-helix to beta-sheet is accompanied by dehydration of the surface of poly(L-lysine). The steroids decreased the phase-transition temperature of DPPC membrane.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Clinical TrialVisual estimation of train-of-four responses at the orbicularis oculi and posttetanic count at the adductor pollicis during intense neuromuscular block.
Posttetanic count (PTC) predicts the time to return of train-of-four (TOF) responses at the adductor pollicis (AP) muscle. The duration of neuromuscular block at the orbicularis oculi (OO) is shorter than at the AP. The aim of this study was to assess whether TOF at the OO can predict, as accurately as PTC does, the time to return of TOF at the AP. ⋯ Times from injection to the first response to PTC (PTC1), to the reappearance of the first response of TOF at the OO (T1OO), and to the reappearance of the first response of TOF at the AP (T1AP) were recorded. After pancuronium and atracurium, PTC1 and T1OO recovered before T1AP (P < 0.001). In all patients, PTC1 recovered earlier than T1OO (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)