Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1986
The effects of atracurium besylate (Tracrium) on intracranial pressure and cerebral perfusion pressure.
Twenty-five patients with expansive pathologic brain lesions, who were anesthetized with thiopental, nitrous oxide in oxygen, and fentanyl, and who were mechanically ventilated to ensure normocarbia, received atracurium besylate 0.6 mg/kg, intravenously. Intracranial pressure, mean arterial pressure, central venous pressure, heart rate, and end-tidal CO2 were simultaneously recorded for 5 min before and for 10 min after administration of the muscle relaxant. No statistically significant changes were observed after administration of atracurium besylate. These results suggest that atracurium besylate may be used for muscle relaxation during neurosurgical operations, despite its potential for histamine release and excitement of the central nervous system.
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Anesthesia and analgesia · Mar 1986
Clinical Trial Controlled Clinical TrialDouble-blind comparison of intravenous doses of dezocine, butorphanol, and placebo for relief of postoperative pain.
The safety and efficacy of intravenous doses of dezocine (5 or 10 mg), butorphanol (1 mg), and placebo were compared in a double-blind study in 160 patients with moderate to severe postoperative pain. Analgesic efficacy was assessed for 6 hours after each dose. Mean pain relief scores were consistently higher, indicating greater pain relief, for the three active treatment groups than for the placebo group. ⋯ Changes in degree of sedation were similar in the three active therapy groups. Adverse reactions were rare, mild, and equally distributed among the four treatment groups. We conclude that 10 mg of dezocine is superior to 1 mg of butorphanol, and that 5 mg of dezocine is as effective as 1 mg of butorphanol for the relief of moderate to severe postoperative pain.
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The pharmacokinetics of fentanyl were studied in fourteen neonates undergoing major surgical procedures. Five patients were less than 1 day of age, seven were 1-4 days old, and two were 7-14 days old. Fentanyl was given intravenously, 10 micrograms/kg (n = 1), 25 micrograms/kg (n = 4), or 50 micrograms/kg (n = 9), and plasma concentrations measured at intervals of up to 18 hr. ⋯ In seven patients transient rebound in plasma fentanyl concentrations of 0.5 ng/ml or greater occurred. In three patients with markedly increased intraabdominal pressure, the t 1/2 beta was 1.5-3 times the population mean. Thus fentanyl disposition in neonates is highly variable, but the t 1/2 beta is predictably prolonged in the presence of increased abdominal pressure.
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Anesthesia and analgesia · Mar 1986
Comparative StudyA comparison of morphine, fentanyl, and sufentanil anesthesia for cardiac surgery: induction, emergence, and extubation.
We compared anesthetic doses of three popular opiates, morphine (n = 10), fentanyl (n = 9), and sufentanil (n = 9) in patients undergoing cardiac surgery. Opiate administration after induction was based upon EEG and cardiovascular signs of the depth of anesthesia. ⋯ The following times (mean and SEM) were significantly (P less than 0.05) shorter for sufentanil than for fentanyl or morphine: induction (15 +/- 2.3 min, 5.9 +/- 0.7 min, and 3.0 +/- 0.2 min for morphine, fentanyl, and sufentanil, respectively); return of consciousness (morphine 109.7 +/- 34.4 min, fentanyl 62.3 +/- 17.9 min, sufentanil 17 +/- 8.7 min); return of acceptable and stable cardiovascular status (morphine 587.3 +/- 139.3 min, fentanyl 537.9 +/- 144.8 min, sufentanil 173.7 +/- 56.8 min); and extubation (morphine 1121.3 +/- 61.8 min, fentanyl 1005.7 +/- 77.7 min, sufentanil 533.3 +/- 67.8 min). We conclude that sufentanil administered in the dosage range of 19 micrograms/kg allows more rapid induction, earlier emergence from anesthesia, and faster extubation of patients than either morphine or fentanyl.
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Anesthesia and analgesia · Mar 1986
Biography Historical ArticleHarvey Cushing: his contribution to anesthesia.