Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children.
To determine the frequency of 5% halothane induction and behavioral distress during inhalation induction with both oral midazolam and parental presence compared with parental presence alone. ⋯ The combination of parental presence plus oral midazolam reduces the likelihood of needing a 5% rapid halothane induction when compared with parental presence without premedication.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemodynamic effects of intrathecal sufentanil compared with epidural bupivacaine in laboring parturients.
To provide information on the central hemodynamic effects of intrathecal sufentanil after a standard intravenous preload using thoracic bioimpedance monitoring to obtain noninvasive measurements of cardiac index (CI), stroke index (SI), and systemic vascular resistance (SVR). To compare hemodynamic parameters after intrathecal sufentanil labor analgesia to those after a standard dose of epidural bupivacaine in laboring parturients. ⋯ No significant differences in CI, SI, or SVR index were seen after either method of analgesia. A few patients in both groups experienced hypotension requiring treatment with ephedrine. Both techniques of labor analgesia appear to provide effective pain relief but care must be taken with either method to monitor maternal BP.
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To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery. ⋯ The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.
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Review Comparative Study
Effects of regional anesthesia on perioperative outcome.
To provide an overview of current knowledge, this article reviews experimental and clinical data from investigations examining effects of regional anesthesia on perioperative morbidity in specific physiologic systems. The issues of morbidity and mortality following general and regional anesthesia are addressed, as are the development of perioperative thromboembolism and blood loss, which are known to be increased during general anesthesia. Finally, the effects of regional anesthesia on the vascular system, the perioperative stress response, and the pulmonary function are discussed.
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Until 1952, the administration of inhaled volatile anesthetics was inexact because vaporizers in general use were not calibrated for either concentration or volume of vapor produced. These devices diverted a variable portion of fresh gas flow either through or over the liquid to be vaporized, but they lacked vernier or fine control. Therefore, changes in the concentration of the anesthetic vapor were not easily controlled. ⋯ Morris standardized the administration of volatile anesthetics with his invention of the Copper Kettle, which produced known volumes of saturated vapor, then diluted to calculated concentrations necessary for anesthesia. To achieve this, modifications had to be made in the liquid container, circuit design, and vaporizing surfaces in use at the time. Morris' design incorporated a separately metered flow of carrier gas through the vaporizer to produce known volumes of saturated vapor for introduction into the fresh gas flow delivery.