Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialUptake of desflurane and isoflurane during closed-circuit anesthesia with spontaneous and controlled mechanical ventilation.
Although theoretical models predict uptake of inhaled anesthetics during closed-circuit anesthesia (CCA), clinical data for most anesthetics are conflicting or non-existent. In addition, the effects of patient characteristics and mode of ventilation on anesthetic uptake are unclear. Forty-one ASA physical status I or II adult patients undergoing a variety of 1-1.5 h surgical procedures were randomly allocated to receive CCA with desflurane or isoflurane with ventilation being either spontaneous or controlled. ⋯ Patient characteristics (age, height, weight, weight3/4, and body surface area) were comparable between groups and did not correlate with uptake. The virtually constant uptake after wash-in of desflurane and isoflurane contrasts with the square root of time model of Lowe and Ernst. These findings may greatly simplify CCA.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialParental desire for perioperative information and informed consent: a two-phase study.
The purpose of this investigation was to identify the perioperative anesthetic information parents want from the anesthesiologist, and to determine whether the provision of detailed anesthetic risk information is associated with increased parental anxiety. The investigation consisted of a cross-sectional study followed by a randomized controlled trial. In Phase 1, baseline and situational anxiety, coping strategy, and temperament were obtained from parents of children undergoing surgery (n = 334). ⋯ Also, the interaction between time and group assignment was not significant [F(3,135) = 1.66, P = 0.18]. We conclude that parents of children undergoing surgery desire comprehensive perioperative information. Moreover, when provided with highly detailed anesthetic risk information, the parental anxiety level did not increase.
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Anesthesia and analgesia · Feb 1997
Extended duration of action of rocuronium in postpartum patients.
We studied the time course of action of a single bolus of 600 micrograms/kg rocuronium given during anesthesia with propofol, fentanyl, and nitrous oxide was studied in 12 nonpregnant and 12 postpartum patients. Neuromuscular effects were quantified by recording the indirectly evoked twitch response of the adductor pollicis muscle after ulnar nerve stimulation. ⋯ The time required for recovery from 25% to 75% of the control twitch response after reversal with neostigmine and atropine was significantly longer (P = 0.003) in postpartum (4.8 +/- 0.9 min) than in nonpregnant patients (3.2 +/- 0.6 min). These data suggest that pregnancy-induced changes result in prolonged effects of rocuronium in postpartum patients.
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Anesthesia and analgesia · Feb 1997
The efficacy of the "BURP" maneuver during a difficult laryngoscopy.
The displacement of the larynx in the three specific directions (a) posteriorly against the cervical vertebrae, (b) superiorly as possible, and (c) slightly laterally to the right have been reported and named the "BURP" maneuver. We evaluated the efficacy of the BURP maneuver in improving visualization of the larynx. Six hundred thirty patients without obvious malformation of the head and neck participated in this study. ⋯ The maneuver of Back and BURP significantly improved the laryngoscopic visualization from initial inspection. The BURP maneuver also significantly improved the visualization compared with the Back maneuver. We concluded that the BURP maneuver improved the visualization of the larynx more easily than simple back pressure on the larynx.
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Anesthesia and analgesia · Feb 1997
Recovery from doxacurium infusion administered to produce immobility for more than four days in pediatric patients in the intensive care unit.
Doxacurium was administered by titrated infusion to 14 pediatric patients for 4.7-12.3 days after laryngotracheal reconstruction to produce minimum spontaneous movement and less than five posttetanic movements of the first toe after stimulation of the posterior tibial nerve. Recovery was documented by stimulation of the ulnar nerve with 2 Hz for 2 s (train-of-four [TOF]) at intervals of 1 min and measurement of the ratio of the fourth to the first response (TOF ratio) at the adductor pollicis. ⋯ In six of the patients, weakness and decreased coordination were noted for a few days to weeks postoperatively. There were no complications related to impairment of upper airway function or ventilation in those patients who had recovery of neuromuscular transmission to the extent of TOF ratio equal to 1 prior to extubation or in those patients in whom weakness or lack of coordination was noted after tracheal extubation.