Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Dec 1985
Randomized Controlled Trial Comparative Study Clinical TrialA hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery.
The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. ⋯ Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.
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Acta Anaesthesiol Belg · Dec 1985
Sciatic nerve block in the popliteal fossa with atraumatic needles and nerve stimulation.
Seventy-three popliteal sciatic nerve blocks were performed with the help of a nerve stimulator and teflon-sheathed needles in order to assess the usefulness and the reliability of the method in orthopaedic surgery. After a careful description of the technique, the results and complications are presented: successful blocks = 89%; supplementary local anesthesia = 5.5%; general anesthesia = 5.5%. The indications, the results and the technique of the popliteal sciatic nerve block are discussed. The benefits brought by the use of atraumatic needles and nerve stimulators in regional anesthesia are outlined.
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The requirements for muscle relaxation in out-patient anesthesia are: a short total relaxation enabling the induction of an endotracheal tube followed by a period of 15-20 minutes of clinical relaxation. Reversal should be spontaneous. ⋯ Spontaneous reversal of these small doses is achieved within 20-30 minutes. Potentiation of the relaxation by inhalational agents is not recommended.
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The effects of the intravenous anesthetic etomidate have been investigated on ACTH-induced steroidogenesis in vitro, using purified isolated rat adrenal cells. It was found that etomidate almost completely blocked corticosterone production induced by physiological concentrations of ACTH at doses of 200 ng or greater. The mean inhibitory etomidate concentration resulting in 50% inhibition approximated 1.5 X 10(-7)M which is in the range of concentrations measured after clinical doses of etomidate.