Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1994
Comparative StudyComparison of high-dose thrombin time with activated clotting time for monitoring of anticoagulant effects of heparin in cardiac surgical patients.
The activated clotting time (ACT) is routinely used for monitoring of heparin effects during cardiopulmonary bypass (CPB). However, ACT is not a specific assay for heparin and may be influenced by several other factors, which may be misleading with regard to the proper administration of heparin and protamine. In this pilot study, we compared a new test, the high-dose thrombin time (HiTT), with the conventional ACT test for both in vitro and in vivo heparin-induced anticoagulation. ⋯ Hypothermia and hemodilution occurring during CPB did not alter HiTT results. ACT also correlated well with both heparin concentration and HiTT before CPB, but the linear relationship was lost during CPB. Our results suggest that HiTT is a useful assay for monitoring heparin effects during cardiac surgery, even during hypothermia and hemodilution.
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Anesthesia and analgesia · Jul 1994
Comparative StudyNasal intubation with Bullard laryngoscope: a useful approach for difficult airways.
Since the original technique using the Bullard laryngoscope requires considerable practice to be reliable, we have developed an easier method with a directional-tip endotracheal tube through the nostril. We first examined the feasibility of our method in patients with or without difficult airways. ⋯ We found that a combination of the Bullard laryngoscope and the Endotrol tube had a higher probability of accessing the center of the glottis than the others. In conclusion, nasal insertion of a directional-tip tube assisted by the Bullard laryngoscope is an assured and prompt procedure for intubating the tracheas of patients with difficult airways.
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialThe role of continuous background infusions in patient-controlled epidural analgesia for labor and delivery.
The use of a background infusion with intravenous patient-controlled analgesia (IV-PCA) increases drug consumption without any additional contribution to analgesia. There are no data on the potential advantage of a background infusion administered with patient-controlled epidural analgesia (PCEA) for labor and delivery. Sixty women were randomized to one of four groups and received either: (a) demand dose PCEA (demand dose = 3 mL; lockout interval = 10 min); (b) continuous infusion plus demand dose PCEA (two separate infusion rates: 3 mL/h and 6 mL/h); or (c) a fixed-rate continuous epidural infusion (CEI) at 12 mL/h. ⋯ However, use of PCEA (in whatever mode) provided a 35% dose-sparing effect in comparison to CEI. The PCEA groups receiving no background infusion or a 3-mL/h background infusion had a greater need for physician-administered supplemental bupivacaine during the first stage of labor. While not statistically significant, a trend toward increased need for supplementation was seen in these same patient groups over the entire course of labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Clinical TrialEpidural droperidol reduces the side effects and duration of analgesia of epidural sufentanil.
The postoperative combination of epidural sufentanil and epidural droperidol was assessed in 40 patients with hip or knee arthroplasties. Patients were given a single intravenous (i.v.) bolus of sufentanil 50 micrograms with either droperidol 2.5 mg or placebo (0.9% NaCl) epidurally in a double-blind, randomized design at the first request for postoperative analgesia. Pain scores, side effects, and sufentanil plasma concentrations were regularly assessed for 5 h after injection. ⋯ Only the tonic heat pain thresholds were increased 1 h after sufentanil and droperidol (P < 0.002). The addition of epidural droperidol significantly reduced the excitatory side effects of epidural sufentanil while diminishing the duration of analgesia. These interactions may be of clinical significance in reducing the toxicity of opioids, but the effect on duration of analgesia must be considered when repeated doses of opioids are prescribed.
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialAnesthesia for electroconvulsive therapy: effects of propofol and methohexital on seizure activity and recovery.
The influence of methohexital and propofol on seizure activity and recovery profiles was assessed in a randomized, crossover study involving 13 adult outpatients undergoing electroconvulsive therapy (ECT). Arterial blood pressure, heart rate, hemoglobin oxygen saturation, and electroencephalogram (EEG) activity were monitored during the ECT procedure. After premedication with glycopyrrolate, 0.2 mg intravenously (i.v.), and labetalol 20-30 mg i.v. hypnosis was induced with a bolus injection of either methohexital or propofol, 0.75 mg/kg. ⋯ Although awakening times were similar, both hemodynamic stability and cognitive recovery were more favorable after propofol. Compared with methohexital, the use of propofol was associated with a clinically insignificant decrease in seizure duration. However, propofol was associated with improved hemodynamic stability and an earlier return of cognitive function after ECT.