Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialObjective and subjective impairment from often-used sedative/analgesic combinations in ambulatory surgery, using alcohol as a benchmark.
Impairment caused by different sedative/analgesic combinations commonly used in ambulatory settings was compared to that of alcohol at blood alcohol concentrations (BACs) higher than or equal to 0.10%. Impairment was measured via subjective (mood) and objective (psychomotor performance) assays. Twelve healthy human volunteers (10 males and 2 females; age range 21-34 yr) participated in this prospective, double-blind, randomized, cross-over study. ⋯ Psychomotor impairment caused by alcohol at 15 min postingestion (at a BAC of 0.11% +/- 0.03% [mean +/- SE]) was used as a benchmark with which impairment caused by other sedative/analgesic combinations was compared. All the study drug combinations produced impairment (i.e., impairment greater than that seen with PLC), similar to that observed with alcohol at a BAC of 0.11%. We have demonstrated that some sedative/analgesic drug combinations used in anesthesia for ambulatory procedures produce impairment similar to or greater than that observed with a large dose of alcohol.
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparative analgesic efficacy of patient-controlled analgesia with ketorolac versus morphine after elective intraabdominal operations.
We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (by visual analog scale [VAS]), patients were randomly assigned to one of two groups. ⋯ Mean pain scores were less in Group 1 than in Group 2 at each time, but only significantly so at 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) after starting PCA. Time to acceptance of oral liquids was equivalent in Groups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, although well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.
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Anesthesia and analgesia · Jun 1995
Comparative StudyResuscitation from bupivacaine-induced asystole in rats: comparison of different cardioactive drugs.
The objective of this study was to compare the success of resuscitation attempts with different cardioactive drugs after bupivacaine-induced asystole. Saline, amrinone (1 mg/kg), dopamine (5 micrograms/kg), norepinephrine (2 micrograms/kg), epinephrine (10 micrograms/kg), or isoproterenol (1 microgram/kg) were tested. Sixty rats assigned to six treatment groups (n = 10/group) were lightly anesthetized (0.5% halothane, 70% N2O), paralyzed (doxacurium), and given bupivacaine intravenously at 4 mg.kg-1.min-1 until asystole. ⋯ Cardiac rhythm disturbance disappeared within 20 min after successful resuscitation with norepinephrine. Amrinone was no more effective than saline in treating bupivacaine-induced asystole. A drug such as norepinephrine, which has both cardiostimulator (beta 1-receptor agonist) and peripheral vasoconstrictor (alpha 1-receptor agonist) activity, may be the drug of choice for treating asystole induced by bupivacaine.
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Anesthesia and analgesia · Jun 1995
Hypertonic saline dextran does not increase cardiac contractile function during small volume resuscitation from hemorrhagic shock in anesthetized pigs.
Small volumes of hypertonic saline dextran (10% of shed blood volume [SBV] restore cardiac output (CO) and increase arterial pressure in hemorrhagic shock. Besides rapid expansion of plasma volume, a positive inotropic effect has been proposed as an additional mechanism for the immediate onset of the cardiovascular response. This study compares the effects of 7.2% saline/10% dextran 60 (HSDex, n = 8) and normal saline (NS; n = 6) on central hemodynamics and cardiac contractility assessed by end-systolic elastance (Ees; conductance technique) and segmental preload recruitable stroke work (sPRSW; sonomicrometry). ⋯ Within 5 min after infusion of either solution CO returned to baseline values and MAP (NS +55%, HSDex +64%) and Ved (+100%) increased. Neither HSDex nor NS increased Ees above shock levels (NS, 8.7 +/- 4.9 mm Hg/mL; HSDex, 7.3 +/- 2.6 mm Hg/mL) and no group differences occurred in other measurements of contractility (dP/dt40,sPRSW). Plasma osmolality increased to 328 +/- 3 mOsmol/kg with HSDex.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Jun 1995
Comment Letter Comparative StudyCost comparison: a desflurane- versus a propofol-based general anesthetic technique.