Anesthesia and analgesia
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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.
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Anesthesia and analgesia · Jul 1986
Intrathecal morphine and heroin in humans: six-hour drug levels in spinal fluid and plasma.
Lumbar spinal fluid and plasma concentrations of morphine were measured by radioimmunoassay after intrathecal administration of 1 mg of morphine (n = 13) or heroin (n = 10). Plasma levels of morphine were measured regardless of 'whether heroin or morphine was injected intrathecally, because of the rapid biotransformation of heroin to morphine in plasma. Significant drug concentrations appeared in plasma after intrathecal heroin (peak concentration 47.8 +/- 9.0 nmol/L, time to peak concentration 10 +/- 2.4 min); after intrathecal morphine plasma drug concentrations were significantly lower (8.1 +/- 1.0 nmol/L; P less than 0.002) and significantly later (216 +/- 39 min; P less than 0.002). Elimination half-life of heroin from spinal fluid (43 +/- 5 min) was significantly shorter than for morphine (73 +/- 5 min; P less than 0.02).