Anesthesia and analgesia
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The elective use of succinylcholine in anesthesia has largely been abandoned because of unwanted side effects. Alternatives now exist for short, intermediate, or long elective surgical procedures. NMBDs are frequently used only to facilitate tracheal intubation; rapacuronium fills an important niche particularly for a short elective case (e.g., same-day surgery). ⋯ Figure 1 shows such a plot for mivacurium (13). There is less variability in the maximum block at the larger dose of rapacuronium but still variability in onset time. Further studies will be important in defining the role of rapacuronium for rapid sequence induction in various clinical settings.
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Anesthesia and analgesia · May 2000
A report of two hundred twenty cases of regional anesthesia in pediatric cardiac surgery.
The use of regional anesthesia (ie, epidural, spinal, or caudal) has been reported in a few small series of children undergoing cardiac surgery, but not in larger studies. In this retrospective, descriptive study, we report the results of the use of regional anesthesia in 220 pediatric cardiac operations. We reviewed the records of children receiving a regional anesthetic for cardiothoracic surgery at Stanford Medical Center between January 1993 and February 1997. ⋯ The rate of adverse effects was lower in the thoracic catheter epidural approach as compared with various caudal, lumbar epidural, and spinal approaches. Hospital duration of stay was not effected by the presence of regional anesthetic complications. In this study, regional anesthesia was safe and effective in the management of pediatric patients undergoing cardiac surgery.
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Anesthesia and analgesia · May 2000
The effects of repeated doses of vasopressin or epinephrine on ventricular fibrillation in a porcine model of prolonged cardiopulmonary resuscitation.
This study evaluated ventricular fibrillation mean frequency and amplitude to predict defibrillation success in a porcine cardiopulmonary resuscitation (CPR) model using repeated administration of vasopressin or epinephrine. After 4 min of cardiac arrest and 3 min of CPR, 10 pigs were randomly assigned to receive either vasopressin (early vasopressin: 0.4, 0.4, and 0.8 units/kg, respectively, n = 5) or epinephrine (early epinephrine: 45, 45, and 200 microg/kg, respectively, n = 5). Another 11 animals were randomly allocated after 4 min of cardiac arrest and 8 min of CPR to receive every 5 min either vasopressin (late vasopressin: 0.4 and 0. 8 units/kg, respectively, n = 5) or epinephrine (late epinephrine: 45 and 200 microg/kg, n = 6). ⋯ In contrast to no epinephrine animals, all vasopressin animals were successfully defibrillated and survived 1 h (P < 0.05). Mean fibrillation frequency and amplitude predicted successful defibrillation and may serve as noninvasive markers to monitor continuing CPR efforts. Furthermore, vasopressin was superior to epinephrine in maintaining these variables above a threshold necessary for successful defibrillation.
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Anesthesia and analgesia · May 2000
Comparative StudyA comparison of hemodynamic changes after endotracheal intubation by using the lightwand device and the laryngoscope in normotensive and hypertensive patients.
We compared the effects of the lightwand technique on hemodynamic responses, time-to-intubation, number of attempts, and complications during tracheal intubation with those of direct-vision laryngoscopy in normotensive (LN and TN group; n = 20, respectively) and hypertensive (LH and TH group; n = 20, respectively) patients. Lightwand or laryngoscopic oral endotracheal intubation was performed after the induction of anesthesia with fentanyl and propofol and muscle relaxation with vecuronium. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded, and the change from "before intubation" to "immediately after intubation" (DeltaP) in each variable was calculated. ⋯ The number of patients who complained of hoarseness was larger in the lightwand groups than in the laryngoscope groups (P < 0.05). We conclude that the lightwand technique significantly attenuates hemodynamic changes after intubation in comparison with the laryngoscopic technique in normotensive patients. However, in hypertensive patients, there is no difference in hemodynamic changes between the two techniques.