Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1986
Wakefulness during cesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined.
Thirty-six pregnant women (ASA class I or II) at term who underwent general anesthesia and cesarean section received either ketamine, 1 mg/kg (n = 12); thiopental, 4 mg/kg (n = 13); or a combination of ketamine, 0.5 mg/kg, and thiopental, 2 mg/kg (n = 11). A blood pressure cuff inflated to 250 mm Hg isolated one arm from the effects of succinylcholine so that awareness during anesthesia could be assessed by asking the patient to move her hand. Although only one patient receiving ketamine responded to commands during anesthesia, 46% of patients receiving either thiopental or the combination responded to commands intraoperatively. ⋯ Three patients (8%) had postoperative recall of intraoperative awareness; one had received thiopental and two the combination. Maternal intraoperative cardiovascular responses among the groups were similar, as were umbilical blood gas values, newborn Apgar scores, and neonatal neurobehavioral test scores at 4 and 24 hr. Ketamine more effectively blocked maternal responsiveness to commands and strong stimuli during the first few minutes after anesthetic induction for cesarean section than did thiopental or a combination of thiopental and ketamine, each at a lower dose.
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Anesthesia and analgesia · Jul 1986
Randomized Controlled Trial Clinical TrialPrevention of silent aspiration due to leaks around cuffs of endotracheal tubes.
Significant aspiration may occur around correctly inflated high volume, low pressure endotracheal tube cuffs. The prevention of silent aspiration due to leaks around cuffs of endotracheal tubes was investigated during general anesthesia for hip replacement in 47 patients. The patients were randomly assigned to one of three groups, in which one of three endotracheal tubes of different designs were used for intubation. ⋯ At termination of the operation, the trachea below the cuff was inspected with a fiberoptic bronchoscope. Aspiration was found in 12.5% with the Rüsch tube, in 31.2% with the Mallinckrodt tube, and in 0% with the NL tube. Our results show that silent aspiration is still a problem with standard endotracheal tubes, but that it may be minimized by use of appropriate tubes, cuffs, and control of cuff inflation.