Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Clinical pharmacology of rocuronium (Org 9426): study of the time course of action, dose requirement, reversibility, and pharmacokinetics.
To evaluate the time course of action, dose requirement, reversibility, and pharmacokinetics of rocuronium (Org 9426) under 3 anesthetic techniques (nitrous oxide-fentanyl supplemented with propofol, halothane, or isoflurane). ⋯ Isoflurane potentiates the rocuronium-induced neuromuscular block, resulting in a longer clinical duration and lower maintenance dose requirement. This difference is not explained by differences in pharmacokinetics but is probably due to increased sensitivity of the neuromuscular junction to rocuronium during isoflurane anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous administration of fentanyl for postoperative pain: a comparison of the epidural, intravenous, and transdermal routes.
To evaluate the influence of the route of administration [epidural, intravenous (IV), or transdermal] on onset and quality of analgesia and to evaluate the pharmacokinetics of continuous administration of fentanyl. ⋯ The epidural, transdermal, and IV administration of identical doses of fentanyl given at a constant rate provided almost equivalent degrees of analgesia. But continuing epidural administration produced a steady rise in systemic fentanyl concentrations into the ventilatory-depressant range, affecting the hypoxemic regulation of breathing.
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Comparative Study Clinical Trial Controlled Clinical Trial
Epidural administration of liposome-associated bupivacaine for the management of postsurgical pain: a first study.
To explore the influence of liposomes on the pharmacodynamic action of bupivacaine and to determine whether postsurgical analgesic advantages can be obtained from epidural delivery of liposomal bupivacaine compared with the current formulation. ⋯ The liposomal formulation of bupivacaine increased duration of analgesia without motor block or adverse side effects.
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Practice Guideline Guideline
Guidelines for sedation by nonanesthesiologists during diagnostic and therapeutic procedures. The Risk Management Committee of the Department of Anaesthesia of Harvard Medical School.
The increasing use of sedation to enhance patient comfort during diagnostic and therapeutic procedures has been noted by the Joint Commission of Accredited Healthcare Organizations, specialty societies, and the public. Although anesthesiologists, by virtue of training and experience, possess unique qualifications to provide such sedation services, their availability remains somewhat limited by primary commitments to the operating room, intensive care unit, or pain service. ⋯ Specific consideration is given to facilities, backup emergency services, equipment, education and training, issues of informed consent, documentation, and release of patients from medical care. These recommendations emphasize the collaboration of the department of anesthesia and other departments that provide sedation services in formulating policies and procedures that reflect values intrinsic to the practice of anesthesiology.
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Comparative Study
Predictive accuracy of midazolam in adult patients scheduled for coronary surgery.
To evaluate the predictive accuracy of midazolam during cardiac anesthesia so as to orient the selection of the most appropriate pharmacokinetic model for use in a computer-assisted continuous-infusion system. ⋯ Two of the 3 pharmacokinetic data sets of midazolam studied may be selected when using a computer-assisted infusion system in adult coronary patients.