Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 1995
Randomized Controlled Trial Clinical TrialEffectiveness of the self-inflating bulb for verification of proper placement of the Esophageal Tracheal Combitube.
The esophageal tracheal Combitube (ETC; Sheridan Catheter Corporation, Argyle, NY) is a twin-lumen tube used to establish emergency ventilation. After blind placement, ventilation is performed via the proximal lumen if it is in the esophagus or via the distal lumen if it is in the trachea. This investigation was designed to test the reliability of the self-inflating bulb (SIB) in identifying the location of the ETC and facilitating its proper positioning in anesthetized patients. ⋯ Instantaneous reinflation occurred in these three patients after repositioning of the ETC. In Group 2, the second anesthesiologist correctly identified the location of the ETC in all cases. The results confirm previous findings that blind introduction of the ETC leads to esophageal placement and yields adequate ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Jan 1995
Infants tolerate spinal anesthesia with minimal overall autonomic changes: analysis of heart rate variability in former premature infants undergoing hernia repair.
Unlike adults, neonates tolerate high thoracic spinal anesthesia with minimal changes in heart rate (HR) and arterial blood pressure. To examine the potential autonomic regulatory mechanisms which may account for these findings, the relation between short-term heart rate variability (HRV) and respiratory activity was analyzed in a group of eight ASA grade II former premature infants undergoing high thoracic spinal anesthesia for inguinal hernia repairs. Quantitative measures of sympathetic (As) and parasympathetic (Ap) modulation of HR were derived. ⋯ Group mean As and Ap both decreased, but the changes were not significant. Despite overall cardiovascular stability, HRV decreased with high thoracic spinal anesthesia, but the balance between LFP and HFP remained stable, suggesting that the reflex response to high thoracic spinal anesthesia was predominantly diminished parasympathetic modulation of cardiac function. The expected decrease in HR and blood pressure from the sympatholysis which results from high thoracic spinal anesthesia were apparently offset by withdrawal of cardiac vagal activity.
-
Anesthesia and analgesia · Jan 1995
Effect of ketanserin on global cerebral blood flow and middle cerebral artery flow velocity.
The aim of this study was to examine the influence of ketanserin, a 5-hydroxytryptamine antagonist antihypertensive agent, on the relationship between cerebral blood flow (CBF) and middle cerebral artery flow velocity (Vmean MCA) and to compare Doppler-sonographic indices of downstream resistance (pulsatility index, PI; resistance index, RI) with calculations of cerebrovascular resistance (CVR) in 17 male patients under fentanyl/midazolam anesthesia. CBF was measured with the Kety-Schmidt technique using argon as a tracer. Cerebral perfusion pressure (CPP) was calculated as the difference between mean arterial pressure (MAP) and jugular bulb pressure. ⋯ In contrast, after i.v. administration of ketanserin, CVR decreased (P < 0.05), whereas both Doppler-derived indices increased (P < 0.01). These results suggest that ketanserin in a clinically relevant dose does not alter the validity of serial Vmean MCA measurements as an index of global CBF and that ketanserin does not change the diameter of middle cerebral arteries (MCAs). Doppler-derived indices of pulsatility and resistance, which are supposed to estimate changes in downstream resistance, reflect changes, after administration of ketanserin, in systemic hemodynamics rather than changes in CVR.
-
Anesthesia and analgesia · Jan 1995
LetterRecent changes in the package insert for succinylcholine chloride: should this drug be contraindicated for routine use in children and adolescents? (Summary of the discussions of the anesthetic and life support drug advisory meeting of the Food and Drug Administration, FDA building, Rockville, MD, June 9, 1994)