Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialComparison between the cuffed oropharyngeal airway and the laryngeal mask with respect to breathing pattern and capnography.
This study evaluates spontaneous breathing and CO2-monitoring under sevoflurane anesthesia with a cuffed oropharyngeal (COPA) or laryngeal mask (LMA) as airway. Forty patients (ASA I-II) scheduled for varicose vein surgery were given 2 mg.kg-1 propofol for insertion of a COPA or a LMA. Anesthesia was maintained with sevoflurane at 2.5 vol% in 40/60% O2/N2O, while the patients breathed spontaneously. ⋯ Correlation of PE'CO2 and PaCO2 was 0.87 when measured in the COPA group and 0.88 in the LMA group. The prediction of PaCO2 by PE'CO2 was more sensitive in the LMA group as compared to the COPA group. We conclude that spontaneous breathing is better with the LMA.
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Many drugs interact with neuromuscular blocking drugs and often enhance the induced block; this is of clinical importance for volatile anaesthetics, antimicrobials, magnesium and some more specific drugs. Difficulty in reversing the block occurs with calcium-channel blockers and polymyxin. Phenytoin, carbamazepine and other anticonvulsants may cause resistance to neuromuscular blocking drugs. ⋯ Finally, liver dysfunction, renal failure, disturbances of acid-base balance, change in temperature and neurological diseases all have an effect on the profile of the neuromuscular blocking drugs; the response to an induced block may be altered in patients under intensive care and those with cancer. Although knowledge of the most important theoretical interactions of neuromuscular blocking drugs is favourable, the anaesthetist should be aware that pharmacological interactions can lead to an unpredictable induced neuromuscular block in many cases in daily clinical practice. Therefore anaesthetists should become familiar with the use of neuromuscular transmission monitoring in order to manage the block correctly.
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Acta Anaesthesiol Belg · Jan 2001
Randomized Controlled Trial Clinical TrialUse of remifentanil in combination with desflurane or propofol for ambulatory oral surgery.
We evaluated the use of remifentanil administered as a component of an inhalation or of a Target Controlled Infusion (TCI) anesthetic technique during outpatient oral surgery. Sixty-three unpremedicated patients undergoing removal of four impacted third molars participated to this prospective, randomized study. Anesthesia was induced with Propofol and Rocuronium. ⋯ The incidence of nausea and vomiting was similar in both groups. No other side effect was observed. These data suggest that the association of Remifentanil, Methylprednisolone, Diclofenac and Tramadol is an useful technique in ambulatory oral surgery in two comparable anesthetic regimens.
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Acta Anaesthesiol Belg · Jan 2001
Comparative StudyLiver and renal function after volatile induction and maintenance of anesthesia (VIMA) with sevoflurane versus TIVA with sufentanil-midazolam for CABG surgery.
We compared liver and renal function after volatile induction and maintenance of anesthesia (VIMA) with sevoflurane and minimal dose sufentanil versus total intravenous anesthesia (TIVA) with moderate dose of midazolam and sufentanil in patients undergoing CABG surgery. Eighty nine patients were studied retrospectively after VIMA (44 patients) or after TIVA (45 patients). Liver and renal function were measured before (T0), then 1 (T1), 2 (T2), 5 (T3) days and 6 weeks (T4) after the operation. ⋯ Six weeks after the operation all liver and renal functions were normal in both groups. We concluded that VIMA with sevoflurane during cardiac surgery has no untoward effects on liver or renal functions. The transient reversible elevation was comparable in the VIMA and TIVA groups which was most probably due to the effect of the operation itself.
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Acta Anaesthesiol Belg · Jan 2001
Case ReportsTarget controlled infusion of remifentanil and propofol for cesarean section in a patient with multivalvular disease and severe pulmonary hypertension.
A 36 year old parturient with known valvular heart disease was admitted with respiratory distress and fatigue after 35 weeks of pregnancy. Echocardiography revealed severe tricuspid regurgitation, mitral stenosis and aortic valve insufficiency. Following clinical examination and insertion of a radial and pulmonary artery catheter it was decided to perform a Caesarean Section. ⋯ Umbilical artery pH was 7.29. The patient's haemodynamic status gradually improved over the following few days. Two months following delivery she underwent unevenful valvular surgery.