Anesthesia and analgesia
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Anesthesia and analgesia · May 2010
Level of sedation with nitrous oxide for pediatric medical procedures.
Nitrous oxide (N(2)O) delivered at a concentration <50% is accepted as a minimal sedation drug by both the American Society of Anesthesiologists and the American Academy of Pediatrics. The expected level of sedation at an N(2)O concentration >50% is less clear. ⋯ A significant number of children remain minimally sedated while receiving N(2)O at concentrations >50% via nasal hood using a system designed to titrate N(2)O concentration from 0% to 70%. Adverse event rates of patients receiving >50% N(2)O in this manner are similar to rates reported in large studies of 50% N(2)O administration.
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Anesthesia and analgesia · May 2010
A clinical prediction rule for pulmonary complications after thoracic surgery for primary lung cancer.
There is controversy surrounding the value of the predicted postoperative diffusing capacity of lung for carbon monoxide (DLCOppo) in comparison to the forced expired volume in 1 s for prediction of pulmonary complications (PCs) after thoracic surgery. ⋯ These data show that PCs after thoracic surgery for lung cancer can be predicted with moderate accuracy based on DLCOppo and whether patients had chemotherapy. Forced expired volume in 1 s was not a predictor of PCs.
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Anesthesia and analgesia · May 2010
The effect of sex on the minimum local analgesic concentration of ropivacaine for caudal anesthesia in anorectal surgery.
Caudal anesthesia is routinely used in our hospital for most of ambulatory anorectal surgery; patients need to recover as quickly as possible. The dose of local anesthetic may be different for male and female patients. We designed this study to investigate the effect of sex on the minimum local anesthetic concentration (MLAC) of ropivacaine for caudal anesthesia. ⋯ We conclude that the ropivacaine MLAC for caudal anesthesia in female patients is 31% larger than in male patients.
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Anesthesia and analgesia · May 2010
Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation: dose-response data and safety profile.
Adenosine-induced transient flow arrest has been used to facilitate clip ligation of intracranial aneurysms. However, the starting dose that is most likely to produce an adequate duration of profound hypotension remains unclear. We reviewed our experience to determine the dose-response relationship and apparent perioperative safety profile of adenosine in intracranial aneurysm patients. ⋯ For intracranial aneurysms in which temporary occlusion is impractical or difficult, adenosine is capable of providing brief periods of profound systemic hypotension with low perioperative morbidity. On the basis of these data, a dose of 0.3 to 0.4 mg/kg ideal body weight may be the recommended starting dose to achieve approximately 45 seconds of profound systemic hypotension during a remifentanil/low-dose volatile anesthetic with propofol induced burst suppression.
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Anesthesia and analgesia · May 2010
Isoflurane anesthesia does not satisfy the homeostatic need for rapid eye movement sleep.
Sleep and general anesthesia are distinct states of consciousness that share many traits. Prior studies suggest that propofol anesthesia facilitates recovery from rapid eye movement (REM) and non-REM (NREM) sleep deprivation, but the effects of inhaled anesthetics have not yet been studied. We tested the hypothesis that isoflurane anesthesia would also facilitate recovery from REM sleep deprivation. ⋯ Unlike propofol, isoflurane does not satisfy the homeostatic need for REM sleep. Furthermore, the regulation and organization of hippocampal events during anesthesia are unlike sleep. We conclude that different anesthetics have distinct interfaces with sleep.