Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1995
Randomized Controlled Trial Clinical TrialA prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery.
This study investigated the impact of perioperative fluid status on adverse clinical outcomes in ambulatory surgery. Two hundred ASA grade I-III ambulatory surgical patients were prospectively randomized into two groups to receive high (20 mL/kg) or low (2 mL/kg) infusions of isotonic electrolyte solution over 30 min preoperatively. A standardized balanced anesthetic was used. ⋯ Adverse outcomes were assessed by an investigator blinded to the fluid treatment group at 30 and 60 min after surgery, at discharge, and the first postoperative day. The incidence of thirst, drowsiness, and dizziness was significantly lower in the high-infusion group at all intervals. We recommend perioperative hydration of 20 mL/kg for patients undergoing general anesthesia for short ambulatory surgery.
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Anesthesia and analgesia · Apr 1995
Randomized Controlled Trial Clinical TrialThe effects of clonidine on desflurane-mediated sympathoexcitation in humans.
This study explored the effectiveness of oral clonidine premedication in attenuating sympathetic activation, tachycardia, and hypertension triggered by desflurane. After institutional review board approval, informed consent was obtained from 15 young, healthy male volunteers. Heart rate (HR, electrocardiogram), mean arterial pressure (MAP, radial artery catheter), and central venous pressure (CVP, jugular vein) were monitored. ⋯ In both groups propofol decreased SNA and MAP, and increased HR. The administration of desflurane via a mask resulted in significant increases in SNA, HR, and MAP. Clonidine reduced the HR and MAP responses by approximately 30%-40% during induction and transition periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1995
Randomized Controlled Trial Clinical TrialPrediction of movement using bispectral electroencephalographic analysis during propofol/alfentanil or isoflurane/alfentanil anesthesia.
Conventional electroencephalographic (EEG) analysis techniques do not use the phase information from the Fourier analysis. This study used a new technique of EEG analysis, bispectral analysis, which measures interfrequency phase relationships in the EEG. Using a reference database, and a process of multivariate discriminant analysis, we developed a univariate bispectral variable, the bispectral index (BIS). ⋯ These findings suggest the possibility that different anesthetics have different effects on BIS, and thus BIS may not be independent of the anesthetic. Interfrequency phase coupling, a nonlinear feature of the EEG which is measured with bispectral analysis, may contain clinically useful information for the assessment of anesthetic adequacy. In this study, BIS was a better predictor of patient response than other currently available variables including hemodynamic status.
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Anesthesia and analgesia · Apr 1995
Combined carbon monoxide and cyanide poisoning: a place for treatment.
During fires, victims can inhale significant carbon monoxide (CO) and cyanide (CN) gases, which may cause synergistic toxicity in humans. Oxygen therapy is the specific treatment for CO poisoning, but the treatment of CN toxicity is controversial. To examine the indication for treatment of CN toxicity, we have established a canine model to delineate the natural history of combined CO and CN poisoning. ⋯ On the other hand, CN severely depressed most hemodynamic and metabolic functions. Compared to baseline values, CN caused significant (P < 0.01) decreases in cardiac output (6.4 +/- 2.0 to 3.1 +/- 0.5 L/min) and heart rate (169 +/- 44 to 115 +/- 29 bpm) and decreases in oxygen consumption (VO2) (133 +/- 19 to 69 +/- 21 mL/min) and carbon dioxide production (VCO2) (128 +/- 27 to 103 +/- 22 mL/min). However, these critical hemodynamic and metabolic variables recovered to baseline values by 15 min after stopping the CN infusion, except lactic acidosis which persisted for at least 25 min after the CN infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1995
The pharmacokinetics and neuromuscular effects of rocuronium bromide in patients with liver disease.
To determine the effect of liver disease on the pharmacokinetics of rocuronium, the authors administered 0.6 mg/kg (twice the ED95) to 10 patients with liver disease and compared these results to values in 10 healthy surgical patients. Anesthesia was induced with thiopental and maintained with isoflurane (0.9%-1.1% end-tidal concentration) and nitrous oxide (60%). Venous blood samples were obtained for 6 h after rocuronium injection and plasma concentrations were measured using gas chromatography. ⋯ In turn, elimination half-life was longer in patients with liver disease (111 min) compared to controls (75.4 min). The authors conclude that liver disease alters the pharmacokinetics of rocuronium by increasing its volume of distribution. The longer elimination half-life might result in a longer duration of action of rocuronium in patients with liver disease, particularly after prolonged administration.