Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1999
Assessing the relative quality of anesthesiology and critical care medicine Internet mailing lists.
We studied the relative quality of a subset of anesthesiology and critical care medicine Internet mailing lists regarding the publishing capacity of their members to compare them with the major journals and conferences regarding these specialties. Using systematic searches on MEDLINE and according to the Science Citation Index 1995, we investigated the impact factor of mailing list subscribers, of the first authors of the selected articles, and of the first authors of published abstracts from conferences. We studied six mailing lists, seven journals, and four conferences. Journals and conferences showed a higher percentage of published authors and higher average impact factor among their first authors than the mailing lists did per subscriber. However, when only the subset of publishing authors from the three media was considered, no significant differences were found. We conclude that qualified authors may be found among the subscribers of Internet medical mailing lists on anesthesiology and critical care medicine. These professional discussion groups could complement peer-reviewed publications and conferences in professional information exchange and continuing medical education. ⋯ Internet publishing is not governed by rules that assure certain basic quality standards. Methods for assessing these standards are needed. We compared discussion groups with medical journals and conferences on anesthesiology and critical care medicine by calculating the impact factor of their members and first authors, respectively. Our study shows that qualified authors may be found in all three media.
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Anesthesia and analgesia · Aug 1999
Randomized Controlled Trial Clinical TrialEarly and late reversal of rocuronium and vecuronium with neostigmine in adults and children.
We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. ⋯ These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration.
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Anesthesia and analgesia · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialA cost comparison of methohexital and propofol for ambulatory anesthesia.
Methohexital is eliminated more rapidly than thiopental, and early recovery compares favorably with propofol. We designed this study to evaluate the recovery profile when methohexital was used as an alternative to propofol for the induction of anesthesia before either sevoflurane or desflurane in combination with nitrous oxide. One hundred twenty patients were assigned randomly to one of four anesthetic groups: (I) methohexital-desflurane, (II) methohexital-sevoflurane, (III) propofol-desflurane, or (IV) propofol-sevoflurane. Recovery times after the anesthetic drugs, as well as the perioperative side effect profiles, were similar in all four groups. A cost-minimization analysis revealed that methohexital was less costly for the induction of anesthesia. At the fresh gas flow rates used during this study, the costs of the volatile anesthetics for maintenance of anesthesia did not differ among the four groups. However, at low flow rates (< or = 1 L/min), the methohexital-desflurane group would have been the least expensive anesthetic technique. In conclusion, methohexital is a cost-effective alternative to propofol for the induction of anesthesia in the ambulatory setting. At low fresh gas flow rates, the methohexital-desflurane combination was the most cost-effective for the induction and maintenance of general anesthesia. ⋯ Using methohexital as an alternative to propofol for the induction of anesthesia for ambulatory surgery seems to reduce drug costs. When fresh gas flow rates < or = 1 L/min are used, the combination of methohexital for the induction and desflurane for maintenance may be the most cost-effective general anesthetic technique for ambulatory surgery.