Anesthesia progress
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Anesthesia progress · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialSafety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures.
Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care, and who could not be satisfactorily examined or treated, were administered one of three medications--ketamine (Ketalar), 3 mg/kg; midazolam (Versed), 0.4 mg/kg; or sufentanil (Sufenta), 1.5 or 1.0 micrograms/kg--intranasally in a randomized, double-blinded protocol. The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse's arms. Cardiorespiratory monitors were applied when tolerated, and the child was placed on the operating room table. ⋯ Ketamine also had a mean sedation score of 4 and a short recovery period (7 +/- 7 min); however, two children experienced brief desaturations. Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily sedated children (mean score 7), with a high incidence of significant oximetry desaturation (80%) and prolonged recovery room duration (58 +/- 40 min). Use of 1.0 microgram/kg sufentanil resulted in no desaturations, less sedation (mean score 4), and a brief recovery time (7 +/- 13 min).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia progress · Jan 1993
Comparative Study Clinical Trial Controlled Clinical TrialCerebral arterial blood flow velocity during induction of general anesthesia: rapid intravenous induction versus awake intubation.
Changes in middle cerebral arterial flow velocity (MCAV) during rapid intravenous induction and awake intubation using transcranial Doppler sonography were investigated. The study involved 20 patients without disorders of the central nervous or cardiovascular systems who were scheduled for maxillofacial surgery. In the intravenous induction group, anesthesia was induced with sodium thiopental, and orotracheal or nasotracheal intubation was facilitated with succinylcholine chloride or alcuronium chloride. ⋯ During awake intubation, blood pressures were increased by endotracheal intubation. MCAV was decreased from the administration of diazepam to the transtracheal injection of lidocaine, but returned to the control value from endotracheal spray to endotracheal intubation. These results suggest that smooth awake intubation may be the safest method of induction for patients with cerebrovascular disorders.
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Anesthesia progress · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialThe safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl.
This study examined midazolam and midazolam plus fentanyl in a placebo-controlled, double-blind clinical trial. It tested the hypothesis that combined drug therapy results in significantly poorer safety but no difference in efficacy compared to the single drug approach. Subjects were among 207 mildly anxious young adults having their third molars removed. ⋯ About twice as many subjects in the combination group had end-tidal carbon dioxide (EtCO2) levels greater than 25% above baseline. While these results are consistent with those for apnea, contingency analyses of the oxygen saturation and EtCO2 results were not statistically significant. Subjects in the combination group were more than four times as likely to have excellent versus good, fair, or poor sedation at a given level of intraoperative pain, and behavioral (movement and verbalization) but not cognitive measures of anxiety were attenuated.
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This article presents a different method of venous cannulation. It has been used successfully to teach dental residents working on pediatric and developmentally disabled patients. The technique includes using a syringe of 1% lidocaine hydrochloride attached to a 25-ga needle to produce a skin wheal by "jet injection." This is accomplished by placing the bevel of the needle downward and forcing the syringe in a downward and backward direction, with pressure being continuously exerted on the plunger. ⋯ The catheter is bent, with its bevel up, approximately three-fourths of the way from the tip to form a gradually sloping bend of approximately 40 degrees to 45 degrees. The catheter is then inserted into the skin wheal and advanced into the vein. The advantages of this technique are that it (1) can eliminate the pain associated with a subcutaneous infiltration of a local anesthetic solution, (2) provides a method of venous cannulation that is easier to master by the novice, and (3) gives a visual check on successful catheterization of the vein.
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Anesthesia progress · Jan 1993
Case ReportsTotal intravenous anesthesia with propofol for thymectomy in a patient with myasthenia gravis.
Experience with the use of propofol for induction and maintenance of anesthesia in patients with myasthenia gravis is limited. This case report documents the safe use of propofol in a patient with myasthenia gravis. Because of its unique pharmacodynamic and pharmacokinetic profile, propofol may be an ideal agent for safe use in the young patient with myasthenia gravis.