Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialAwakening, clinical recovery, and psychomotor effects after desflurane and propofol anesthesia.
We compared postanesthetic and residual recovery of desflurane versus propofol anesthesia. Twenty volunteers were anesthetized for 1 h at 1-wk intervals with either propofol (induction) plus desflurane (1.25 minimum alveolar anesthetic concentration) in O2 (PD), propofol plus desflurane in N2O-O2 (PDN), propofol plus propofol infusion with N2O-O2 (PPN), or desflurane (induction) plus desflurane in O2 (DD). Awakening and clinical recovery were measured. ⋯ At 1 h after anesthesia, the subjects given desflurane for maintenance (PD, PDN, and DD) performed significantly (P < 0.05-0.01) better in several psychomotor tests compared with those whose anesthesia was maintained with propofol (PPN). However, subjects met criteria for home readiness as fast after PPN as after PDN anesthesia (mean times +/- SE until fitness for discharge were 126 +/- 20, 81 +/- 14, 70 +/- 7, and 106 +/- 14 min after PD, PDN, PPN, and DD, respectively). Awakening and early psychomotor recovery for as long as 1 h after anesthesia is faster after desflurane than after propofol, but there was no difference in time to home readiness or in residual effects thereafter between propofol and desflurane with N2O in O2.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialThe effects of desmopressin and 6% hydroxyethyl starch on factor VIII:C.
In moderate doses of 20 mL/kg (1.2 g/kg), hydroxyethyl starch (HES) 6% decreases factor VIII:C activity. Desmopressin (DDAVP) increases circulating levels of factor VIII:C by stimulating the release of factor VIII:C from peripheral storage sites. The objective of this study was to monitor the changes in factor VIII:C associated with sequential HES and DDAVP administration. ⋯ After HES administration, factor VIII:C levels decreased significantly, to 69% of baseline, in both groups. After study drug administration, factor VIII:C in Group 1 increased significantly to 135% of baseline at 30 min and 115% of baseline at 60 min while in Group 2 average factor VIII:C levels remained below baseline at 30 and 60 min. DDAVP produced an increase in factor VIII:C activity despite HES administration and should be considered a treatment option for the mild coagulopathy infrequently associated with HES administration.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the neuromuscular blocking effects of atracurium, mivacurium, and vecuronium on the adductor pollicis and the orbicularis oculi muscle in humans.
Both the orbicularis oculi (OO) and the adductor pollicis (AP) muscles have been used to indirectly quantify the extent of neuromuscular block of the respiratory muscles. To clarify any differences in response of these muscles to neuromuscular blocking drugs, the effects of two different doses of atracurium, mivacurium, and vecuronium on the AP and OO were studied. A new technique was used to measure the evoked mechanical response of the OO with accelerometry. ⋯ TOF 0.7 was shorter with the smaller dose of each drug, but there was no difference with the higher doses. It is concluded that it is possible to record the mechanical response of the OO muscle using a noninvasive method. There are differences between the responses of the OO and the AP to neuromuscular blockers that depend upon both the specific drug itself and the dose used.
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Anesthesia and analgesia · Oct 1996
Comparative StudyIntravenous ketamine or fentanyl prolongs postoperative analgesia after intrathecal neostigmine.
The purpose of this study was to determine whether intravenous (i.v.) ketamine would enhance analgesia from intrathecal (IT) neostigmine compared with combining i.v. fentanyl with IT neostigmine. Sixty patients undergoing vaginoplasty under spinal anesthesia were assigned to one of six groups (n = 10). Patients were premedicated with midazolam plus the i.v. test drug. ⋯ The time to first rescue analgesic was longer for the FNG and KNG compared with the CG, with less rescue analgesic consumption (P < 0.02 and P < 0.01, respectively). Only the FNG had significantly intraoperative nausea/vomiting (P < 0.02). In conclusion, the combination of i.v. ketamine and IT neostigmine results in prolonged postoperative analgesia and less intraoperative nausea and vomiting than the combination of i.v. fentanyl and IT neostigmine.
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The Sellick maneuver or cricoid pressure is an effective means of preventing passive aspiration of gastric contents. Recent studies recommend a pressure of 20 newtons (N) when the patient is awake, increasing to 30-40 N with unconsciousness. This study was proposed to determine whether with education and practice, anesthesia providers and assistants could be taught a recommended cricoid pressure and retain this skill. ⋯ Initial attempts revealed inadequate force by all participants, "awake" and "anesthetized". All participants were able to learn the recommended amount of applied pressure and were able to retain this knowledge after 3 mo. This model represents an easy and practical means of teaching the application of the optimal level of force to practitioners and assistants.