Journal of clinical anesthesia
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To identify indicators of prolonged length of stay (LOS) in the postanesthesia care unit (PACU) and to test the following hypotheses: (1) that patient age, pain medication administration at the time of PACU admission, length of surgery, and cardiovascular, pulmonary, and pain responses postoperatively predict prolonged PACU LOS and (2) that cardiovascular and pulmonary symptoms preoperatively predict cardiovascular and pulmonary symptoms postoperatively. ⋯ Patient history and postoperative symptoms predict only a small percentage of prolonged PACU stays. Organizational factors may be a more important predictor of prolonged PACU stay. Additionally, assessment of cardiovascular and pulmonary history needs refinement to improve prediction of patient responses postoperatively.
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Randomized Controlled Trial Comparative Study Clinical Trial
Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy.
To evaluate and compare the stress hormone responses during laparoscopic cholecystectomy during general anesthesia, general anesthesia supplemented by fentanyl, and general anesthesia combined with epidural anesthesia. ⋯ The fentanyl supplemented group received relatively small doses insufficient to inhibit an increase in catecholamines. Thoracic epidural anesthesia depressed the sympathetic response presumably by blocking afferent sympathetic pathways under the conditions of this study. However, it did not attenuate an increase in cortisol, one of the hypothalamic-pituitary-adrenal stress hormones, during carbon dioxide laparoscopic cholecystectomy in our study. This action may be due to the inability of epidural anesthesia to block phrenic nerves that can convey noxious surgical stimulation to the central nervous system.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of techniques for placement of double-lumen endobronchial tubes.
To compare two methods of double-lumen endobronchial tube placement for thoracic surgery and to identify factors that provide a rational basis for placement method selection. ⋯ Both the blind and directed approaches resulted in successful left mainstem placement of the endobronchial tube in the majority of patients but either method may fail when used alone. More time was required using the directed approach. Operator experience with both methods will increase the likelihood of success. The choice of the initial approach may be influenced by patient factors as well as available equipment and personnel.
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Randomized Controlled Trial Comparative Study Clinical Trial
Renal function in patients during and after hypotensive anesthesia with sevoflurane.
To evaluate renal function during and after hypotensive anesthesia with sevoflurane compared with isoflurane in the clinical setting. ⋯ Two hours of hypotensive anesthesia with sevoflurane under 5 L/min total gas flow in patients having no preoperative renal dysfunction transiently increased NAG, which is consistent with a temporary, reversible disturbance of renal tubular function.
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Randomized Controlled Trial Clinical Trial
Consideration of the optimal epidural fentanyl doses in abdominal surgery.
To determine an optimal dose of epidural fentanyl in open abdominal surgery by examining the effects of different doses of epidural fentanyl in combination with or without low concentration of lidocaine on hemodynamic and endocrine responses to surgical stress. ⋯ Epidural fentanyl 3 micrograms/kg with 0.5% lidocaine may be most adequate for laparotomy because these doses caused neither bradycardia nor increments of norepinephrine perioperatively.