Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialEpidural morphine combined with epidural or intravenous butorphanol for postoperative analgesia in pediatric patients.
We performed a prospective, randomized, double-blinded study in 60 postoperative pediatric patients aged 6 wk to 7 yr to compare the efficacy of butorphanol given epidurally or intravenously in preventing the side effects of epidural morphine. Three groups of patients received 60 micrograms/kg epidural morphine; 20 patients also received epidural butorphanol 30 micrograms/kg, and 20 patients also received 30 micrograms/kg intravenous butorphanol. ⋯ Sedation was seen more frequently in the groups receiving butorphanol, but was most pronounced in the epidural butorphanol group. We conclude that butorphanol has little or no effect on the side effects of epidural morphine.
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Anesthesia and analgesia · Aug 1994
Review Case ReportsBronchospasm after intravenous adenosine administration.
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Anesthesia and analgesia · Aug 1994
Changes in heart rate variability under propofol anesthesia: a possible explanation for propofol-induced bradycardia.
We propose to study the bradycardia associated with propofol anesthesia. Ten women undergoing laparoscopy for benign disease were studied using ambulatory electrocardiogram monitoring. Anesthesia was induced with an intravenous bolus of propofol and maintained with an infusion. ⋯ We conclude that high-frequency variability reflects parasympathetic tone. Propofol anesthesia reduces parasympathetic tone to a lesser degree than sympathetic tone. This autonomic milieu predisposes the patient to developing bradycardia in response to parasympathetic stimuli.
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Anesthesia and analgesia · Aug 1994
Experimental hypothermia: effects of core cooling and rewarming on hemodynamics, coronary blood flow, and myocardial metabolism in dogs.
Conflicting results have been reported as to the extent that cardiovascular function can be reestablished after rewarming from hypothermia. We measured hemodynamic function, myocardial metabolism and tissue water content in dogs core-cooled to 25 degrees C and later rewarmed. At 25 degrees C left ventricular (LV) systolic pressure (LVSP) was 54% +/- 4%, maximum rate of LV pressure rise (LV dP/dtmax) 44% +/- 5%, aortic pressure (AOP) 50% +/- 6%, heart rate (HR) 40% +/- 0%, cardiac output (CO) 37% +/- 5%, myocardial blood flow (MBF) 34% +/- 5%, and myocardial oxygen consumption (MVO2) 8% +/- 1%, compared to precooling. ⋯ Increased myocardial contents of creatine phosphate and water were found during both hypothermia and rewarming. The present study demonstrates a persistent depression of cardiac function after hypothermia and rewarming in spite of adequate energy stores. Thus, a direct influence on myocardial contractile function by the cooling and rewarming process is suggested.
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The effect of mivacurium after atracurium was evaluated in 36 children anesthetized with halothane-nitrous oxide-oxygen by measuring the force of contraction of the adductor pollicis during train-of-four stimulation at 0.1 Hz. The children were evaluated in two main groups. In Group 1 the effect of bolus doses of mivacurium after equipotent repeat doses of atracurium were evaluated. ⋯ The infusion requirement increased gradually (P < 0.0001) until, at 90 min of infusion, it was 7.4 +/- 0.8 micrograms.kg-1.min-1. In Group 2 the recovery indices were similar to those seen when mivacurium is the sole relaxant given. When mivacurium is given after atracurium, evidence of the residual neuromuscular effects of the atracurium are detected beyond the usual recovery range.