Anesthesia progress
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Anesthesia progress · Jan 2000
Randomized Controlled Trial Clinical TrialOral transmucosal fentanyl pretreatment for outpatient general anesthesia.
The oral transmucosal formulation of fentanyl citrate (OTFC) has been reported to be an effective sedative, providing convenient and atraumatic sedation for children prior to general anesthesia or painful diagnostic procedures. Thirty-three young children (24-60 months of age) scheduled for outpatient general anesthesia for treatment of dental caries were enrolled in this randomized placebo-controlled clinical trial. To determine the effectiveness of the OTFC premedication, patient behavior was evaluated using three distinct outcome ratings. ⋯ The duration of surgery and the time of recovery did not differ between placebo and active premedication. Side effects including respiratory and cardiovascular complications were reported more frequently in the active fentanyl group. Continuous monitoring of respiratory function is essential when using this unique and effective formulation of fentanyl for pediatric preanesthetic sedation.
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Anesthesia progress · Jan 2000
ReviewAnesthetic considerations for orthognathic surgery with evaluation of difficult intubation and technique for hypotensive anesthesia.
Orthognathic surgery is carried out to improve facial appearance and/or to improve malocclusion. Usually, patients are young and healthy. However, they may have airway problems. ⋯ During osteotomies, severe bradycardia may occur and may even lead to cardiac arrest. In the early postoperative period, bleeding may be a problem. Later ulceration at the tip of the nose and on the buttocks may be seen if preventive measures are not carried out.
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Anesthesia progress · Jan 2000
Randomized Controlled Trial Clinical TrialSevoflurane and isoflurane reduce oxygen saturation in infants.
Volatile anesthetics are generally known to exert several influences on the respiratory system, but their direct effect on oxygen saturation as measured by pulse oximetry (SpO2) in infants remains unknown. In this study, 70 infants under 2 years of age who received general anesthesia were examined to determine the effects of several volatile anesthetics and nitrous oxide on SpO2. ⋯ Significantly lower SpO2 values (paired t test, P < .05) were observed when the subjects were ventilated with oxygen, 67% nitrous oxide, and sevoflurane or isoflurane--but not with oxygen, 67% nitrous oxide, and enflurane--than when they were administered oxygen, 50% nitrous oxide, and the original concentration of each volatile anesthetic. These results suggest that sevoflurane and isoflurane have different effects from enflurane on gas exchange systems.
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Anesthesia progress · Jan 2000
Comparative StudyThe use of bispectral analysis to monitor outpatient sedation.
The bispectral (BIS) index has been used to interpret partial EEG recordings to predict the level of sedation and loss of consciousness in patients undergoing general anesthesia. The author has evaluated BIS technology in determining the level of sedation in patients undergoing outpatient deep sedation. These experiences are outlined in this review article. ⋯ This can be invaluable in comparing studies of techniques. The BIS index provides additional information to standard monitoring techniques that helps guide the administration of sedative-hypnotic agents. The trend to earlier return of motor function in BIS-monitored patients warrants further investigation.
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Anesthesia progress · Jan 2000
Inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen: radiographic study of local anesthetic spread in the pterygomandibular space.
We studied the spread of local anesthetic solution in the inferior alveolar nerve block by the injection of local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique). Seventeen volunteers were injected with 1.8 mL of a mixture containing lidocaine and contrast medium utilizing the anterior technique. ⋯ The results indicate that the contrast medium mixture spreads rapidly in the pterygomandibular space to the inferior alveolar nerve in the subjects who exhibited inferior alveolar nerve block effect. We concluded that the anesthetic effect due to the anterior technique was produced by the rapid distribution of anesthetic solution in the pterygomandibular space toward the mandibular foramen, and individual differences in the time of onset of analgesia may be due to differences in the histologic perineural tissues.