Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2005
Comparative StudyComparison of a combination of midazolam and diazepam and midazolam alone as oral premedication on preanesthetic and emergence condition in children.
Preanesthetic anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Thus, midazolam has been used as premedication for children. However, midazolam alone is not effective for emergence agitation. The present study tested the effect of a combination of midazolam and diazepam on the preanesthetic condition and emergence behavior in children. ⋯ Children in the Mi + Di group were significantly more sedated at induction of anesthesia and less agitated during emergence from anesthesia.
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Acta Anaesthesiol Scand · May 2005
Plasma concentrations of meperidine and normeperidine following continuous intrathecal meperidine in patients with neuropathic cancer pain.
Intrathecal administration of meperidine, an opioid with local anesthetic activity, can induce analgesia in patients with intractable cancer pain. However, continuous intrathecal administration may result in the accumulation of normeperidine, responsible for central nervous system toxicity. ⋯ We conclude that continuous intrathecal administration of meperidine alone, or in combination with clonidine, can provide significant pain relief in patients with poor pain control despite pharmacological treatment. However, accumulation of meperidine and normeperidine resulting in central nervous system toxicity may occur during this treatment.
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Acta Anaesthesiol Scand · May 2005
Clinical TrialHaemodynamic changes during positive-pressure ventilation in children.
Positive-pressure ventilation may alter cardiac function. Our objective was to determine with the use of impedance cardiography (ICG) whether altering airway pressure modifies the central haemodynamics in mechanically ventilated children with no pulmonary pathology. Central venous saturation (S(cv)O(2)) was measured as an indicator of tissue perfusion. ⋯ We did not find significant haemodynamic changes following PEEP elevation in ventilated children, as measured using impedance cardiography. Reducing the value of PEEP to 5 cmH(2)O resulted in statistically significant SVI elevations. The values of S(cv)O(2) remained unaffected.
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Acta Anaesthesiol Scand · May 2005
Effects on intracranial pressure of dural puncture in supine and head-elevated positions. A study on the cat.
Lumbar dural puncture may reduce intracranial pressure (ICP) due to a hydrostatic pressure gradient created by distal opening of the spinal fluid column towards the atmosphere. The magnitude of the reduction in hydrostatic force on the brain should depend on the vertical distance between the brain and the dural opening, and thus will increase by head elevation. No studies have analyzed ICP after dural puncture in supine and upright positions. ⋯ The results show that a significant ICP reduction may occur following opening of the spinal canal. The reduction can be explained more by hydrostatic forces than by loss of CSF; also explaining why it is more significant when upright than supine. The decrease in ICP increases transvascular pressure, which may induce the disappearance of the normally present subdural venous collapse with an increase in venous blood volume.
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Acta Anaesthesiol Scand · May 2005
Randomized Controlled Trial Clinical TrialEffect of hypercapnia on arterial hypotension after induction of anaesthesia.
We evaluated the effectiveness of intentional hypercapnia against hypotension after induction of anaesthesia with thiopental and isoflurane (TI) or propofol (P). For each group, 24 patients were anaesthetized with thiopental 4 mg kg(-1) (TI) or propofol 2 mg kg(-1) (P) for tracheal intubation and then lightly anaesthetized with isoflurane at 0.6% end-expiratory concentration (TI) or by 6 mg kg(-1) h(-1) infusion of propofol (P). In both anaesthesia groups, patients were randomly assigned to either normocapnia (end-tidal CO(2) = 35 mmHg) or hypercapnia (end-tidal CO(2) = 45 mmHg), which were achieved through adjusting the tidal volume. ⋯ Hypercapnia prevented the decrease in SAP in TI but not in P. No patient in the TI-hypercapnia group experienced SAP below 100 mmHg, unlike those in the other groups. In conclusion, mild hypercapnia was effective in the prevention of hypotension in patients receiving thiopental followed by 0.6% end-expiratory isoflurane, but not in patients receiving 6 mg kg(-1) h(-1) propofol.