Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2001
Randomized Controlled Trial Clinical TrialMultimodal perioperative management--combining thoracic epidural analgesia, forced mobilization, and oral nutrition--reduces hormonal and metabolic stress and improves convalescence after major urologic surgery.
We sought in this prospective study to use a multimodal approach to reduce stress and improve recovery in patients undergoing major surgery. During an initial study period, 30 patients were randomly allocated to receive general anesthesia (GA; Group 1) or a combination of GA and intraoperative thoracic epidural analgesia (TEA; Group 2) when undergoing radical cystectomy. Parenteral nutrition was provided for 5 days after surgery. ⋯ Multimodally treated patients reported less fatigue and better overnight recovery. Along with improved pain relief, recovery of bowel function, and ambulation, there were no differences in the postoperative complication rates among the three groups. The multimodal approach reduced stress and improved metabolism and recovery after radical cystectomy.
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Anesthesia and analgesia · Jun 2001
Clinical TrialThe association of high jugular bulb venous oxygen saturation with cognitive decline after hypothermic cardiopulmonary bypass.
This study was conducted to investigate whether jugular bulb venous oxygen saturation (SjVO(2)) predicted cognitive decline after cardiac surgery with hypothermic cardiopulmonary bypass (CPB). We studied 35 patients undergoing cardiac surgery. After the induction of anesthesia, a 5.5F fiberoptic oximetry catheter was retrogradely inserted into the jugular bulb, and SjVO(2) and other cerebral oxygenation variables were analyzed before, during, and after CPB. At each point, an oxyhemoglobin dissociation curve was drawn, and the P(50) value of jugular bulb venous blood was calculated by computer analysis. Cognitive function was assessed with the revised version of Hasegawa's Dementia Scale and the Benton Revised Visual Retention Test before and early after the operation. In 15 patients (the Decline group), cognitive function was declined after surgery, whereas it remained unchanged in 20 patients (the Normal group). SjVO(2) was significantly higher and cerebral oxygen extraction was significantly lower before and during CPB in the Decline group than in the Normal group (P < 0.05). The oxygen pressure at an oxygen saturation of 50% was significantly lower before and after CPB in the Decline group than in the Normal group (P < 0.05). Logistic regression analysis showed that high SjVO(2) was a predictor of cognitive decline after cardiac surgery. We conclude that high SjVO(2) was associated with cognitive decline after cardiac surgery with hypothermic CPB. ⋯ Jugular bulb venous oxygen desaturation has been suggested as a predictor of cognitive decline after cardiac surgery. However, the clinical value of jugular bulb venous oxygen saturation (SjVO(2)) may be limited during hypothermic cardiopulmonary bypass (CPB) when oxygen affinity to hemoglobin is increased. This study shows that high SjVO(2) before and during hypothermic CPB is a predictor of subsequent cognitive decline.
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Anesthesia and analgesia · Jun 2001
Comparative Study Clinical TrialNoninvasive monitoring of carbon dioxide during mechanical ventilation in older children: end-tidal versus transcutaneous techniques.
We prospectively compared the accuracy of end-tidal CO(2) (ETCO(2)) and transcutaneous CO(2) (TCCO(2)) monitoring in older pediatric patients (4 yr or older) receiving mechanical ventilation for respiratory failure. ETCO(2) and TCCO(2) were simultaneously monitored and compared with arterial CO(2) (PaCO(2)) values when arterial blood gas analysis was performed. Eighty-two sample sets were compared. The ETCO(2) to PaCO(2) difference was 6.4 +/- 6.3 mm Hg, whereas the TCCO(2) to PaCO(2) difference was 2.6 +/- 2.0 mm Hg (P < 0.0001). The absolute difference of ETCO(2) and PaCO(2) was 5 or less in 47 of 82 measurements, whereas the absolute TCCO(2) to PaCO(2) difference was 5 or less in 76 of 82 measurements (P < 0.00001). Regression analysis of ETCO(2) and PaCO(2) values revealed a correlation coefficient of 0.5418 and an r value of 0.8745. Regression analysis of TCCO(2) and PaCO(2) values revealed a correlation coefficient of 1.0160 and an r value of 0.9693. Bland-Altman analysis revealed a bias of -5.68 with a precision of +/-6.93 when comparing ETCO(2) with PaCO(2) and a bias of 0.02 with a precision of +/-3.27 when comparing TCCO(2) and PaCO(2) (P < 0.00001). TCCO(2) monitoring provided an accurate estimation of PaCO(2) over a wide range of CO(2) values and was superior to ETCO(2) monitoring in older pediatric patients with respiratory failure. TCCO(2) monitoring may be considered as a useful adjunct to monitoring of ventilation in this patient population. ⋯ The authors report on the accuracy of noninvasive, transcutaneous CO(2) monitoring during mechanical ventilation in children 4 yr or older. Application of this technique should be useful by decreasing the need for repeated, costly, and sometimes painful arterial blood gas analysis, and the continuity of assessment should facilitate proactive, rather than reactive, ventilator manipulations.
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Anesthesia and analgesia · Jun 2001
The effects of endogenous and exogenous vasopressin during experimental cardiopulmonary resuscitation.
Exogenous vasopressin is a promising vasopressor when blood pressure is critically threatened, but the role of endogenous vasopressin during cardiopulmonary resuscitation (CPR) is unknown. We assessed the role of endogenous versus exogenous vasopressin in a porcine open chest CPR model. Seven minutes before induction of cardiac arrest, seven pigs received 10 microg/kg of a selective vasopressin V(1)-receptor-antagonist (Blocked Vasopressin group); another 12 pigs in two groups received saline administration only. ⋯ In conclusion, pigs with blocked endogenous vasopressin had poor coronary perfusion pressure and left ventricular myocardial blood flow during open chest CPR, and could not be successfully resuscitated. All pigs with effective endogenous vasopressin or pigs with effective endogenous vasopressin and additional exogenous vasopressin had good left ventricular myocardial blood flow during experimental CPR, and survived the 1-h postresuscitation phase. We conclude that endogenous vasopressin is an adjunct vasopressor to epinephrine and may serve as a back-up regulator to maintain cardiocirculatory homeostasis.
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Anesthesia and analgesia · Jun 2001
Comparative Studyalpha-1 and alpha-2 Adrenergic antagonists relieve thermal hyperalgesia in experimental mononeuropathy from chronic constriction injury.
Phentolamine, a nonspecific alpha 1- and alpha 2-adrenergic antagonist, relieves pain in patients with reflex sympathetic dystrophy. We sought to determine whether phentolamine, prazosin (alpha 1 antagonist), or SKF86466 (alpha 2 antagonist) relieve thermal hyperalgesia in rats with neuropathic pain. Four days after producing a chronic constriction injury (CCI), thermal hyperalgesia was tested by measuring paw withdrawal latency (PWL). ⋯ PWL did not return to baseline levels after 1 or 2 mg/kg of prazosin or SKF86466 but did so after 35 min after phentolamine 2 mg/kg. After 5 mg/kg, PWL returned to preoperative values between 5 and 50 min for phentolamine, at 35 and 65 min for prazosin, and at 50 min for SKF86466. We conclude that both alpha1 and alpha2 peripheral receptors of the sympathetic nervous system are involved in the thermal hyperalgesia caused by CCI and that thermal hyperalgesia can be reversed by both alpha1 and alpha2 antagonists in a dose-dependent manner.