Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Comparative StudyMaturation decreases ethanol minimum alveolar anesthetic concentration in mice as previously demonstrated in rats: there is no species difference.
The potency of conventional inhaled anesthetics increases with maturation: the 50% effective dose (minimum alveolar anesthetic concentration [MAC]) for conventional inhaled anesthetics in the neonatal rat or human exceeds MAC in the young adult. This increase also applies to ethanol in rats tested using MAC as the measure of anesthesia. However, the converse appears to be true for studies in mice assessed with the righting reflex; that is, adult mice are six times more resistant than neonates to the effects of ethanol. ⋯ Accordingly, we investigated whether maturation decreased ethanol potency in mice, using MAC as the measure of anesthesia. Applying standard techniques, we tested MAC for ethanol in 15 CF-1 mice aged 10 days (6-8.5 g) and in 13 mice aged 77-84 days (34-39 g). MAC decreased with maturation, and the decrease was indistinguishable from that found in our previous studies of rats.
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Anesthesia and analgesia · Jul 1997
Non-operating room emergency airway management and endotracheal intubation practices: a survey of anesthesiology program directors.
Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. We conducted a survey of anesthesia program directors regarding emergency airway management practices at their institutions. A questionnaire was sent to anesthesia program directors listed in the Graduate Medical Education Directory for 1995-1996. ⋯ EW physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. Anesthesiologists are most represented in airway management on hospital floors.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialMidazolam premedication delays recovery after propofol without modifying involuntary movements.
Midazolam has GABAergic effects in children that may modify propofol-induced involuntary movements, yet delay recovery. In a double-blind, randomized study, 24 children (2-7 yr of age, ASA physical status I or II) undergoing short surgical procedures received midazolam 0.5 mg/kg (Group M) or placebo (Group P) per os 20-30 min before propofol anesthesia (5 mg/kg intravenously followed by an infusion). Blind observers scored sedation and anxiety levels (scale 1-4) before premedication, at separation from parents, and at induction of anesthesia. ⋯ Anxiety and sedation scores were similar in Group P and Group M, but recovery took longer after midazolam, with eye opening (mean +/- SD) 24 +/- 7 vs 43 +/- 18 min, maximum SS (median and range) 27 (13-37) vs 55 (24-138) min, and maximum VSRS 51 (30-100) vs 80 (50-130) min. Children returned to normal activity in 1 (0-5) day, and none exhibited neurological complications. We conclude that an oral premedicant dose of midazolam prolongs recovery from anesthesia in children without affecting dystonic movements after propofol.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialMidlatency auditory evoked potentials predict movements during anesthesia with isoflurane or propofol.
To determine threshold values, sensitivity, and specificity of midlatency auditory evoked potentials (MLAEP) for prediction of spontaneous intraoperative movements, 40 patients undergoing elective laparotomy were studied. Continuous epidural analgesia was used in all patients. To maintain general anesthesia, the patients in Group 1 (n = 20) received isoflurane (0.4-1.2 vol%), and the patients in Group 2 (n = 20) received propofol (3-5 mg x kg(-1) x h(-1) intravenously). ⋯ Before and during spontaneous movement observed intraoperatively or during emergence from anesthesia, the latencies of the peaks Na, Pa, Nb, and P1 decreased, and the amplitudes Na/Pa, Pa/Nb, Nb/P1 increased significantly. A threshold value of 60 ms of Nb proved to be most predictive of movement during anesthesia. MLAEP recording seems to be a promising method to monitor the level of anesthesia as defined by spontaneous movement during anesthesia.