Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialEfficacy of an epidural test dose in adult patients anesthetized with isoflurane: lidocaine containing 15 micrograms epinephrine reliably increases arterial blood pressure, but not heart rate.
When continuous epidural anesthesia is combined with general anesthesia, the only objective sign of intravascular migration of the epidural catheter are the increments of heart rate (HR) or arterial blood pressure after a local anesthetic test dose containing epinephrine. However, the efficacy of a simulated intravenous (IV) test dose in adult patients under general anesthesia has not been determined. Thirty adult patients were randomly assigned to one of two groups, each of which was anesthetized with 1% end-tidal isoflurane and nitrous oxide after endotracheal intubation. ⋯ In the epinephrine group, significant increases in HR compared with the baseline value were observed from 40 to 80 s after the IV test dose with a mean maximum HR increase of 24 +/- 2 bpm (mean +/- SEM) occurring at 48 +/- 3 s. However, 5 of 15 patients in the epinephrine group developed HR increments smaller than 20 bpm (sensitivity 67%). Since HRs were essentially unchanged in the saline group, specificity, positive predictive value (+PV), and negative predictive value (-PV) were 100%, 100%, and 75%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1995
Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease.
The purpose of this study was to determine the incidence of different postoperative pulmonary complications (PPCs) and their associated risk factors in patients with severe chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 s [FEV1] < or = 1.2 L and FEV1/forced vital capacity (FVC) < 75%) undergoing noncardiothoracic operations. Thirty-nine of 105 patients (37%) had one or more PPCs (death, pneumonia, prolonged intubation, refractory bronchospasm, or prolonged intensive care unit (ICU) stay). Thirty-eight of 39 patients (97%) with a PPC had an anesthetic duration > 2 h. ⋯ Multiple logistic regression identified composite scoring systems, such as the ASA physical status, as the best preoperative predictors of PPCs, probably because they include both pulmonary and nonpulmonary factors. During the intraoperative period, avoiding general anesthesia with tracheal intubation may decrease the risk of postoperative bronchospasm. Shortening the duration of surgery and anesthesia may decrease the risk of prolonged ICU stay.