Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1996
Comparative Study Clinical TrialUnilateral spinal anesthesia using low-flow injection through a 29-gauge Quincke needle.
Restriction of sympathetic denervation during spinal anesthesia may minimize hemodynamic alterations. Theoretically, the use of nonisobaric anesthetics may allow unilateral anesthesia and thus restrict sympathetic denervation to one side of the body. The present prospective study investigates the incidence of unilateral spinal anesthesia using hyperbaric bupivacaine 0.5% (1.4 mL, 1.6 mL, 1.8 mL, or 2.0 mL) injected via a 29-gauge Quincke needle with a pump-controlled injection flow of 1 mL/min. ⋯ Twenty minutes after injection of the local anesthetic, mean arterial blood pressure decreased significantly in patients with bilateral sympathetic blockade from 87 +/- 8 to 83 +/- 8 mm Hg (P < 0.01) but not in patients with unilateral sympathetic blockade (from 87 +/- 11 to 85 +/- 10 mm Hg). In conclusion, low-flow injection (1 mL/min) of hyperbaric bupivacaine 0.5% via a 29-gauge Quincke needle prevented bilateral sympathetic blockade in more than 69% of the patients. The data further suggest that loss of temperature discrimination alone is not a reliable estimation of sympathetic block.
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Anesthesia and analgesia · Jun 1996
Comparative Study Clinical TrialTransesophageal echocardiography in myocardial revascularization: I. Accuracy of intraoperative real-time interpretation.
Transesophageal echocardiography (TEE) is increasingly used intraoperatively as a monitor of ventricular function and volume. Despite its increasing use, whether data from TEE monitoring can be interpreted accurately on-line in real-time is unknown. We studied the performance of five community-based, full-time cardiac anesthesiologists during 75 surgical procedures in which biplane TEE monitoring was used. ⋯ Recognition of normal and severe regional wall-motion abnormality, such as akinesis, had more concordance between real-time and off-line analysis, 93% and 79%, respectively, than recognition of mild regional wall-motion abnormalities. Anesthesiologists can estimate EFA in real-time to within +/-10% of off-line values in 75% of all cases. Real-time identification of normal regional function is more accurate than identification of abnormal function, i.e., there is variability in quantifying the severity of regional dysfunction.
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Anesthesia and analgesia · Jun 1996
Comparative StudyThe neuromuscular effects of mivacurium chloride during propofol anesthesia in children.
Previous studies examined the neuromuscular effects of mivacurium in doses up to, but not exceeding, 2.5 times 95% effective dose (ED95) in children. To determine whether larger doses offer clinical advantages, we compared the onset and duration of neuromuscular block, intubating conditions, and changes in plasma histamine concentration (PHC) after mivacurium (0.2, 0.3, or 0.4 mg/kg) with those after succinylcholine (2.0 mg/kg) during propofol/N2O anesthesia in 48 children aged 3-10 yr. The evoked electromyograph (EMG) of the adductor digiti minimi after supramaximal train-of-four (TOF) stimulation was recorded. ⋯ PHC increased significantly after mivacurium 0.3 and 0.4 mg/kg; however, mean arterial pressure did not change significantly. We conclude that mivacurium 0.3 mg/kg provides a relatively rapid onset and short duration of neuromuscular block in healthy children. Increasing the dose to 0.4 mg/kg does not significantly accelerate the onset of neuromuscular block.
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Anesthesia and analgesia · Jun 1996
Comparative StudyAnesthesia providers, patient outcomes, and costs.