Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery following outpatient anesthesia: use of enflurane versus propofol.
To compare the intraoperative conditions and postoperative recovery of patients following the use of either propofol-nitrous oxide (N2O) or enflurane-N2O for maintenance of outpatient anesthesia. ⋯ Induction of anesthesia with propofol is associated with a more rapid emergence from anesthesia than induction with thiopental. Maintenance of anesthesia with enflurane did not prolong recovery compared with maintenance with propofol, but enflurane was associated with increased frequency of postoperative nausea and vomiting.
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The LMA has been commercially available since 1988, and in the United States since 1992. The device combines several advantages of endotracheal tubes and face masks and may be used in many situations where either device was previously used routinely. ⋯ Although not suitable for all patients and procedures, the LMA has become widely used in all other countries where it is available. Many of the surgical procedures for which the LMA is most suited are performed in outpatients, and we expect this device will soon become popular in carefully selected cases in this country.
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Randomized Controlled Trial Clinical Trial
Heated breathing tubes affect humidity output of circle absorber systems.
To verify whether the airway climate in circle systems can be improved with heated breathing tubes. ⋯ Low-flow systems need at least 120 minutes to achieve a satisfactory airway climate. Heated breathing tubes effectively reduce this delay.
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Recent pharmacologic and technologic advances in anesthesia and surgery allow outpatients with complex medical problems to undergo a wide variety of diagnostic and surgical procedures on an ambulatory basis. Increasingly, however, anesthesia practitioners, as well as pharmacy and therapeutic committees, are demanding proof that a new, more costly drug or medical device is superior to existing products in achieving its desired effect, is associated with fewer adverse effects, enhances efficiency, and reduces health care costs. The new field of pharmacoeconomics has emphasized the importance of cost-effectiveness analyses that consider both direct and indirect costs of newer drugs and therapeutic modalities. ⋯ Ambulatory anesthesia and surgery will continue to increase because of the potential cost savings for patients undergoing elective operations on an outpatient basis. However, the challenge we face will be to continue to provide high-quality anesthesia care at a reduced cost. A careful examination of commonly accepted (but unproven) clinical practice patterns will be necessary to meet this challenge.
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To evaluate the ability of arterial waveform contour analysis to measure cardiac output (CO) continuously in postoperative critically ill patients. ⋯ The PCCO method appears to be able to estimate changes in CO under the conditions tested, in which PCCO was recalibrated after each TDCO measurement. However, limitations of this method in the immediate postoperative period following aortic aneurysm surgery were identified.