Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1994
Comparative Study"Do not resuscitate" (DNR) orders in the perioperative period--a comparison of the perspectives of anesthesiologists, internists, and surgeons.
The purpose of this descriptive study is to compare and contrast the experience, perceptions, and opinions of practicing anesthesiologists, internists, and surgeons regarding "do not resuscitate" (DNR) orders in the perioperative period. A questionnaire was mailed to 600 internists and 600 surgeons. Responses from these two groups were analyzed and compared with the results of a previously reported survey of 420 anesthesiologists. ⋯ All groups were more likely to require DNR suspension for elective than for palliative cases. The majority of all groups concurred that physician responsibility for defining DNR status in the perioperative period should be shared by the anesthesiologist, surgeon, and primary care physician and not prescribed by hospital policy. The manner in which a DNR order is perceived in the perioperative period varies considerably among specialties and warrants further discussion among these groups.
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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)
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Anesthesia and analgesia · Apr 1994
Comparative StudyRheologic effects of plasma substitutes used for preoperative hemodilution.
This study was designed to compare the influence of various plasma substitutes, administered for preoperative hemodilution, on blood rheology. We studied 40 patients, ASA grade I, who underwent elective facial reconstructive surgery and received 4% albumin (n = 10), 3.5% dextran 40 (n = 10), gelatin (n = 10), or hydroxyethyl starch (HES) (n = 10). Ten patients, undergoing the same surgical procedure without hemodilution, were chosen as controls. ⋯ In contrast, at a low shear rate and at 40% corrected hematocrit, the blood viscosity decreased in the albumin (15.9 +/- 1.9 to 13.1 +/- 2.1 mPa.s; P < 0.01) and the dextran 40 (16.9 +/- 2.9 to 12.8 +/- 2.5 mPa.s; P < 0.01) groups and was unchanged in the gelatin and the HES groups. Erythrocyte aggregation (measured with primary aggregation time) was markedly decreased in the albumin (3.27 +/- 1.74 to 7.03 +/- 2.95 s; P < 0.01) and in the dextran 40 (2.72 +/- 0.58 to 6.24 +/- 2.55 s; P < 0.001) groups, unchanged with HES, and increased with gelatin (2.41 +/- 0.90 to 1.55 +/- 0.33 s). These findings suggest that albumin and dextran 40 may be the plasma substitutes of choice for preoperative hemodilution when this technique aims to improve rheologic conditions.
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We sought to determine the effectiveness of a magnet placed over the thyroid cartilage in the neck to guide an endotracheal tube into the trachea. Forty patients aged 18 to 60 yr with normal airway anatomy (ASA grade I) who required general anesthesia with an endotracheal tube and paralysis for their surgery were chosen and informed consents were obtained. The tip of the epiglottis was exposed with a No. 3 MacIntosh laryngoscope, and a magnet was held over the thyroid cartilage. ⋯ This magnet-guided technique can be used when it is difficult to expose a patient's larynx. It is noninvasive, simple, and can be used without any delay when expensive flexible fiberoptic endoscopes are not readily available. The procedure takes an average of 1 to 2 min.