Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Intrathecal neostigmine for postoperative analgesia after orthopedic surgery.
To establish a dose-response curve for the analgesic effect of intrathecal neostigmine in patients undergoing below knee surgery with spinal anesthesia. To assess adverse effects, principally nausea and vomiting. ⋯ Intrathecal neostigmine produced a dose-independent analgesia and a dose-dependent incidence of adverse effects with the doses studied.
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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 Despite the formidable side effect profile of succinylcholine, it has not been replaced by a nondepolarizing agent for use in emergency conditions.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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The pharmacokinetic and pharmacodynamic interactions between opioids and propofol increasingly have been described and used in clinical practice. It is now known that propofol inhibits both alfentanil and sufentanil metabolism, thereby increasing the plasma concentrations of these opioids, while alfentanil also elevates propofol concentrations. ⋯ From the interaction data, the optimal propofol concentrations have been extracted that assure adequate anesthesia and the most rapid recovery possible. In the presence of fentanyl, sufentanil, and alfentanil, the optimal propofol concentration is approximately 3.5 microgram/ml, whereas in the presence of remifentanil, lower propofol concentrations of 2.5 to 3 microgram/ml are required.
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Modern anesthetic techniques involve combinations of intravenous (i.v.) and inhaled anesthetic drugs that may produce synergistic (supraadditive), additive, or antagonistic interactions. Synergistic interaction is most likely to occur when two or more drugs produce similar effects by different mechanisms. ⋯ The usefulness of a drug interaction depends on whether it produces greater efficacy or reduced toxicity. Surprisingly, these outcomes have only been specifically measured for a handful of common drug combinations.
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Randomized Controlled Trial Clinical Trial
Active warming, not passive heat retention, maintains normothermia during combined epidural-general anesthesia for hip and knee arthroplasty.
to compare passive heat retention by low-flow anesthesia, alone and with additional thermal insulation by reflective blankets, with forced-air warming preventing intraoperative hypothermia during combined epidural-general anesthesia. ⋯ During combined epidural-general anesthesia for elective hip and knee arthroplasty, passive heat retention by means of low-flow anesthesia alone and in combination with reflective blankets is ineffective in maintaining intraoperative normothermia and definitely inferior to active forced-air warning.