Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2003
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of airway responses during desflurane and sevoflurane administration via a laryngeal mask airway for maintenance of anesthesia.
Although sevoflurane is less pungent than desflurane at larger concentrations, neither anesthetic seems to irritate the airway when administered at the smaller concentrations often used during maintenance of anesthesia. Both anesthetics may be delivered effectively via a laryngeal mask airway, with minimal evidence of airway irritation.
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Anesthesia and analgesia · Mar 2003
Randomized Controlled Trial Comparative Study Clinical TrialSequential use of midazolam and propofol for long-term sedation in postoperative mechanically ventilated patients.
Acute withdrawal syndromes, including agitation and a long weaning time, are common adverse effects after long-term sedation with midazolam. We performed this study to determine whether the sequential use of midazolam and propofol could reduce adverse effects as compared with midazolam alone. We studied 26 patients receiving mechanical ventilation for three or more days after surgery. Patients were randomly assigned to two groups. In Group M, patients were sedated with midazolam alone. In Group M-P, midazolam was switched to propofol approximately 24 h before the expected stopping of sedation. The level of sedation was maintained at 4 or 5 on the Ramsay sedation scale. The sedation agitation scale was evaluated for 24 h after extubation. The recovery time from stopping of sedation to extubation was significantly shorter in Group M-P (1.3 +/- 0.4 h) compared with Group M (4.0 +/- 2.4 h). The incidence of agitation in Group M-P (8%) was significantly less frequent than that in Group M (54%). The results indicate that sequential use of midazolam and propofol for long-term sedation could reduce the incidence of agitation compared with midazolam alone. ⋯ Our study indicates that sequential use of midazolam and propofol could reduce the incidence of agitation compared with midazolam alone.
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Anesthesia and analgesia · Mar 2003
Continuous intrathecal clonidine and tizanidine in conscious dogs: analgesic and hemodynamic effects.
Alpha-2-adrenergic agonists, such as clonidine, produce antinociception in animal pain models after intrathecal administration. However, clinical usage is limited by cardiovascular side effects. To investigate alternative alpha(2)-adrenergic agonists as analgesics, we implanted six dogs with an intrathecal catheter and infusion pump. After baseline saline infusion, animals received clonidine or tizanidine (crossover study) each week at escalating doses of 125-750 microg/h. Analgesia, blood pressure, heart rate, respiratory rate, sedation, and coordination were evaluated. A 28-day safety study was performed with another nine dogs receiving intrathecal tizanidine (3 or 6 mg/d) or saline. Equal doses of clonidine and tizanidine produce the same antinociception in thermal withdrawal tests. Blood pressure was reduced with 125-500 microg/h of clonidine, but not with tizanidine at any dose. Clonidine 250 microg/h reduced heart rate by 45.8%, and five of six animals had bradyarrhythmias (marked bradycardia), whereas tizanidine decreased heart rate by 15.1% without arrhythmias, even at the largest dose. Respiratory rate decreased with 250 microg/h of clonidine and larger doses. Sedation or incoordination occurred only at the largest dose for either drug. The safety study indicated that 3 mg/d of tizanidine in dogs produced no side effects or histopathologic changes. Tizanidine may be a useful alternative in patients experiencing cardiovascular side effects with intrathecal infusion of clonidine. ⋯ Clonidine is an effective spinal analgesic, but it is dose-limited by cardiovascular side effects. We compared the analgesic properties and side effects of clonidine with those of a similar drug, tizanidine. Continuous spinal infusion of tizanidine produced similar analgesia as clonidine, but with fewer adverse effects on blood pressure and heart rate.
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The 1995 Tokyo subway strike proved nerve gas to be a fearsome terrorist weapon of mass destruction. Because the clear liquid is easily hidden until released, rescuers must aid nonbreathing casualties near instantly. Anesthesiologists are uniquely qualified to train these rescue squads and to manage nerve gas victims in the hospital.
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Anesthesia and analgesia · Mar 2003
Case ReportsCase series: IV regional anesthesia with ketorolac and lidocaine: is it effective for the management of complex regional pain syndrome 1 in children and adolescents?
We report our experience with ketorolac/lidocaine IV regional anesthesia (Bier block) (IVRA) in two adolescents with complex regional pain syndrome 1. IVRA resulted in complete resolution of symptoms.