Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1995
Real time versus slow-motion train-of-four monitoring: a theory to explain the inaccuracy of visual assessment.
The present study was undertaken to determine why visual assessment of thumb adduction in response to train-of-four (TOF) stimulation of the ulnar nerve commonly overestimates the ratio that is obtained mechanographically. In patients undergoing general endotracheal anesthesia plus vecuronium for relaxation, 73 data sets were collected at different depths of neuromuscular block in response to supramaximal TOF stimulation. Each data set consisted of: (i) visual estimation of the TOF ratio by an experienced observer; (ii) mechanographic measurement of the TOF ratio with an adductor pollicis force transducer; and (iii) determination of the TOF ratio by measuring the slow-motion thumb displacement recorded on videotape. ⋯ When the change in thumb position as a result of T1-3 was taken into account, the measured height of T4 was 40% less than it was when measured from the original baseline, and the T4/T1 ratio was identical to that obtained mechanographically. For the 23 data sets obtained at low current visual assessment overestimated the mechanographic value to a lesser degree than when obtained at high current. Again, correction for the T1-3 baseline shift improved the accuracy of videotape analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1995
Who uses transesophageal echocardiography in the operating room?
A survey was made of 155 anesthesiology residency programs in the United States to determine the patterns of use, responsibility for interpretation, and training of those responsible for intraoperative transesophageal echocardiography (TEE). Survey questions included numbers and types of cases for which TEE is used, who interprets TEE data and how they are trained, the extent of resident training in TEE, and beliefs about the utility of TEE. One hundred eight completed surveys were returned (70% response). ⋯ Forty-two percent of anesthesiologists who use TEE leave a formal interpretation on the chart apart from the anesthesia record, and 43% bill specifically for performing TEE. Although 69% of those responding thought that formal credentials should be required for anesthesiologists to use intraoperative TEE, only 32% reported that their institutions actually mandated this. 38% of those responding stated that they offer a dedicated TEE rotation to their residents, and 13% thought that their graduating residents were trained well enough to use TEE on their own. Among academic institutions responding, the use of intraoperative TEE is nearly universal, responsibility for its interpretation is split almost evenly between cardiologists and anesthesiologists, and there is a disparity between opinions and reality with regard to TEE credentialing for anesthesiologists.
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Anesthesia and analgesia · Mar 1995
Biography Historical ArticleIsabella Coler Herb, MD: an early leader in anesthesiology.
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Anesthesia and analgesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialA dose-response study of the effects of intravenous midazolam on cold pressor-induced pain.
The effects of intravenous midazolam (0.75, 1.5, and 3 mg/70 kg) were examined and compared to that of fentanyl (0.1 mg/70 kg; positive control) and saline on pain induced by a cold pressor test. Both sensory and affective components of the pain response were assessed, as there is some evidence that benzodiazepines reduce the affective component. Healthy volunteers (three females, nine males) were enrolled in a prospective, double-blind, randomized, cross-over trial in which mood and psychomotor performance were also examined. ⋯ During the first immersion, subjects reported significantly lower pain intensity and bothersomeness ratings after having been injected with fentanyl, relative to the saline and midazolam conditions, which did not differ significantly from each other. Fentanyl and midazolam had prototypical mood altering and psychomotor impairing effects. We conclude that midazolam in our laboratory setting at the doses and route of administration studied had no effects on either the sensory or affective components of the pain experience.
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Anesthesia and analgesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparative effects of esmolol and labetalol to attenuate hyperdynamic states after electroconvulsive therapy.
We studied 18 patients (age range, 53-90 yr) with at least one cardiovascular risk factor who were treated with electroconvulsive therapy (ECT) and compared effects of five pretreatments: no drug; esmolol, 1.3 or 4.4 mg/kg; or labetalol, 0.13 or 0.44 mg/kg. Each patient received all five treatments, during a series of five ECT sessions. Pretreatment was administered as a bolus within 10 s of induction or anesthesia. ⋯ The deviation of ST-segment values from baseline in any lead was not measurably influenced by either antihypertensive drug. SBP values were lower after labetalol 10 min after the seizure, but not after esmolol. Asystolic time after the seizure was not significantly longer with either drug.(ABSTRACT TRUNCATED AT 250 WORDS)