Journal of clinical anesthesia
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Review Case Reports
Propofol in patients susceptible to malignant hyperthermia: a case report and review of the literature.
Propofol is an intravenous (IV) drug recently introduced into the United States for induction and maintenance of anesthesia. In spite of extensive laboratory evaluation, it is not possible to predict all the potential side effects that might be associated with a new drug. Because malignant hyperthermia (MH) remains a serious and potentially life-threatening complication of anesthesia, all new anesthetic drugs should be considered potential triggering drugs until proven otherwise. We report the use of IV propofol for the induction and maintenance of general anesthesia in an MH patient and review the literature on this subject.
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Randomized Controlled Trial Clinical Trial
The efficacy of intramuscular ketorolac in combination with intravenous PCA morphine for postoperative pain relief.
To examine the efficacy of intramuscular (IM) ketorolac used in combination with intravenous (IV) patient-controlled analgesia (PCA) morphine for postoperative pain relief following intra-abdominal gynecologic surgery. ⋯ IM ketorolac significantly decreased PCA morphine requirements. The analgesic effects of the two drugs appear to be additive.
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Randomized Controlled Trial Clinical Trial
Effects of nilvadipine on the cardiovascular responses to tracheal intubation.
To evaluate the efficacy of nilvadipine given orally in attenuating the hypertensive response to laryngoscopy and intubation. ⋯ Oral administration of nilvadipine before induction of anesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction under additional 1% enflurane-N2O anesthesia.
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Randomized Controlled Trial Clinical Trial
Epidural opioids during laminectomy surgery for postoperative pain.
To determine whether morphine applied directly to the dura during laminectomy surgery provides superior postoperative analgesia during the first 24 hours. ⋯ Morphine 3 mg applied topically to the dura at the end of laminectomy surgery is a simple, safe, and effective way of providing improved postoperative analgesia.
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To investigate the effects of different clinical induction techniques on heart rate variability (HRV). ⋯ In Study 1, the greater reduction in HRV with the thiopental sodium technique provides evidence that the depressant effects of anesthetics on HRV are related in part to their effects on cardiovascular reflexes. However, the significant depression in HRV caused by the etomidate technique suggests that mechanisms other than baroreflex depression (e.g., impaired consciousness) also are important in these depressant effects. In Study 2, the decrease in HRVHI caused by sufentanil documents that absolute power measurements of vagally mediated HRV are not correlated with changes in parasympathetic tone during a potent opioid induction. This lack of a correlation may result from the decrease in total HRV observed with loss of consciousness. The increase in %HRVHI suggests that normalized measurements of HRV may still provide an index of changes in sympathetic-parasympathetic balance, even when total HRV is decreased following anesthetic administration.