Anesthesia and analgesia
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Anesthesia and analgesia · May 1996
Lidocaine plasma concentrations in pediatric patients after providing airway topical anesthesia from a calibrated device.
The aim of this prospective study was to evaluate plasma lidocaine concentrations in infants and children after laryngeal spray using a calibrated device. Twenty-one patients aged 3 to 24 mo requiring laryngoscopy or bronchoscopy were included in the study. Anesthesia was induced via a mask with halothane up to 2% in 100% O2. ⋯ The dose of lidocaine administered ranged between 0.9 and 2.6 mg/kg. Maximum plasma lidocaine concentration (Cmax) was 1.05 +/- 0.55 micrograms/mL (mean +/- SD; range 0.24-2.29 micrograms/mL). With this procedure, we demonstrated the safety of administering lidocaine to children by laryngeal spraying using a 5% sprayer.
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Anesthesia and analgesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialSpontaneous versus edrophonium-induced recovery from paralysis with mivacurium.
This study compared spontaneous with edrophonium-induced recovery of neuromuscular transmission (NMT) after mivacurium infusion. During nitrous oxide-narcotic-propofol anesthesia, the electromyogram (EMG) of the adductor pollicis (AP) was recorded and the movement of the first toe in response to stimulation of the posterior tibial nerve was noted. Mivacurium infusion was titrated to produce posttetanic count of 1-5 at the toe and absence of NMT at the AP. ⋯ Spontaneous recovery to T4/T1 = 0.9 occurred 12.9 +/- 0.7 min after the first measurable AP EMG. There was no significant relationship between duration of infusion, which ranged from 16 to 135 min, and time to appearance of AP EMG after the infusion, which averaged 3.1 +/- 0.5 min. We recommend that administration of edrophonium to induce reversal of mivacurium be delayed until two responses to a TOF stimuli are observed because this will produce the most rapid recovery and decrease the interval in which residual block may be underestimated.
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Anesthesia and analgesia · May 1996
Randomized Controlled Trial Clinical TrialDural puncture with a 26-gauge spinal needle affects spread of epidural anesthesia.
Combined spinal and epidural anesthesia may increase the risk of epidurally administered drugs spreading into the subarachnoid space through the dural hole. We studied the effect of dural puncture with a 26-gauge needle on the spread of analgesia induced by epidural injection of local anesthetics. Forty patients were randomly assigned to control and dural puncture groups. ⋯ Analgesia was assessed by pinprick at 5, 10, 15, and 20 min after injection and at the end of surgery. The caudal spread of analgesia was significantly greater in the dural puncture group than in the control group 15 and 20 min after injection (P < 0.01), but the cranial spread of analgesia was not different between the two groups. We conclude that dural puncture (without drugs) using a 26-gauge Whitacre spinal needle before epidural injection increases caudal spread of analgesia induced by epidural local anesthetics.
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Anesthesia and analgesia · May 1996
Rapid core-to-peripheral tissue heat transfer during cutaneous cooling.
Perioperative thermal manipulations are usually directed at the skin surface because methods of directly warming the core are invasive or ineffective. However, inadequate heat flow between peripheral and core compartments will decrease the rate at which core temperature changes. We therefore determined whether core hypothermia is delayed after initiation of surface cooling. ⋯ There was no delay between initiation of active cooling and the decrease in core temperature. Furthermore, peripheral (arm and leg) and core (trunk and head) tissue heat contents decreased at virtually the same rates: approximately 50 kcal/h and approximately 47 kcal/h, respectively. These data indicate that there is little restriction of heat flow between peripheral and core tissues in vasodilated, anesthetized subjects.