Journal of clinical anesthesia
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For more than 40 years, succinylcholine has been the traditional choice of muscle relaxant to facilitate tracheal intubation, particularly for anesthesia in the emergency patient with a full stomach. This presentation reviews factors that determine the onset of neuromuscular blockade, particularly with regard to tracheal intubation. Measurement of neuromuscular block, both clinical and via nerve stimulators, is described and compared, and correlations with intubating conditions are attempted. ⋯ None of the currently available drugs, or those undergoing clinical investigation, possesses the rapid onset and prompt recovery of succinylcholine. Despite the formidable side effect profile of succinylcholine, it has not been replaced by a nondepolarizing agent for use in emergency conditions. However, the alternatives, particularly rocuronium and mivacurium, are drugs with a greater safety profile that, in many circumstances, can substitute for succinylcholine.
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Multiple drugs are used to provide anesthesia. Volatile anesthetics are commonly combined with opioids. Several studies have demonstrated that small doses of opioid (i.e., within the analgesic range) result in a marked reduction in minimum alveolar concentration (MAC) of the volatile anesthetic that will prevent purposeful movement in 50% of patients at skin incision). ⋯ Recovery from anesthesia when an opioid is combined with a volatile anesthetic is dependent on the rate of decrease of both drugs to their respective concentrations that are associated with adequate spontaneous ventilation and awakening. Through an understanding of the pharmacodynamic interaction of volatile anesthetics with opioids and the pharmacokinetic processes responsible for the recovery from drug effect, optimal dosing schemes can thus be developed. A review of these pharmacodynamic and pharmacokinetic principles that will allow clinicians to administer drugs to provide a more optimal anesthetic is provided.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ondansetron versus droperidol or placebo when given prophylactically for the prevention of postoperative nausea and vomiting in patients undergoing middle ear procedures.
To compare the prophylactic administration of ondansetron with droperidol or placebo to determine its effectiveness in reducing postoperative nausea and vomiting after middle ear procedures. ⋯ Ondansetron 4 mg i.v. is as effective as droperidol and better than placebo in preventing nausea and vomiting in patients undergoing middle ear surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter PACU times was noted after the prophylactic administration of ondansetron.
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Clinical Trial Controlled Clinical Trial
Perioperative hypercoagulability in uremic patients: a viscoelastic study.
To examine whole blood coagulation in uremic patients presenting for surgery with the thromboelastogram and the Sonoclot analyzer. ⋯ The high incidence of arteriovenous graft and fistulae thromboses in uremic patients belies in vitro laboratory evidence of platelet dysfunction. We have demonstrated perioperative hypercoagulability in uremic patients with viscoelastic measures of whole blood coagulation. These data suggest that traditional concern for coagulopathy and platelet dysfunction in uremic patients may require re-assessment in light of this "pro-thrombotic" state.
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Anesthesia often involves the administration of several drugs belonging to different classes. In addition, many patients will be taking a number of drugs related to their surgical condition or for other medical diseases. ⋯ Other important interactions involve monoamine oxidase inhibitors, some antibiotics, and the tricyclic and tetracyclic antidepressants. These adverse interactions are the subject of this review.