Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1995
Comparative StudyDoes hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring.
The use of CO2 to create and maintain a pneumoperitoneum during laparoscopic surgery may lead to hypercarbia and acidosis. CO2 is also insufflated into the preperitoneal space to create and maintain a pneumopreperitoneum for laparoscopic herniorrhaphy. This study examined the influence of CO2 pneumopreperitoneum on the development of hypercarbia and acidosis assessed with continuous intraarterial blood gas monitoring. ⋯ Pneumopreperitoneum resulted in a significantly faster development of hypercarbia (P = 0.023) and acidosis (P = 0.027) than pneumoperitoneum. These results were not explained when corrected for changes in hemodynamic and ventilatory variables using analysis of covariance. We conclude that the more rapid development of hypercarbia and acidosis during pneumopreperitoneum can be explained by increased CO2 absorption through an increasing gas exchange area during the procedure and through a larger wound bed.
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Anesthesia and analgesia · Dec 1995
Randomized Controlled Trial Comparative Study Clinical TrialAwake endotracheal intubation in patients with cervical spine disease: a comparison of the Bullard laryngoscope and the fiberoptic bronchoscope.
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Anesthesia and analgesia · Dec 1995
Comparative StudySevoflurane versus desflurane for outpatient anesthesia: a comparison of maintenance and recovery profiles.
The recovery characteristics of desflurane and sevoflurane were compared when used for maintenance of ambulatory anesthesia. After obtaining informed consent, 42 healthy, unpremedicated women undergoing laparoscopic sterilization procedures were studied. Anesthesia was induced with propofol, 1.5-2.0 mg/kg, and maintained with either desflurane 3%-6% (n = 21) or sevoflurane 1%-2% (n = 21) with 60% nitrous oxide in oxygen. ⋯ Intermediate recovery times, postoperative VAS and DSST scores, and side effects were similar in the two treatment groups. Although sevoflurane was associated with a slower emergence from anesthesia than desflurane after laparoscopic surgery, recovery of cognitive function and discharge times were similar in the two anesthetic groups. Thus, it would appear that sevoflurane is an acceptable alternative to desflurane for maintenance of outpatient anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Dec 1995
Decreases in anesthesia-controlled time cannot permit one additional surgical operation to be reliably scheduled during the workday.
We tested whether anesthesiologists can decrease operating room (OR) costs by working more quickly. Anesthesia-controlled time (ACT) was defined as the sum of 1) the time starting when the patient enters an OR until preparation or surgical positioning can begin plus 2) the time starting when the dressing is finished and ending when the patient leaves the OR. Case time was defined as the time starting when one patient undergoing an operation leaves an OR and ending when the next patient undergoing the same operation leaves the OR. ⋯ Statistical analysis of measured OR times showed that ACt would have to be decreased by more than 100% to permit one additional scheduled, short (30-min) operation to be performed in an OR during an 8-h workday after a prior series of cases, each lasting more than 45 min. Anesthesiologists alone cannot reasonably decrease case times sufficiently to permit one extra case to be reliably scheduled during a workday. Methods to decrease ACT (e.g., using preoperative intravenous catheter teams, procedure rooms, and/or shorter acting drugs) may simply increase costs.