Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1996
Randomized Controlled Trial Clinical TrialCarboxyhemoglobin concentrations during desflurane and isoflurane closed-circuit anesthesia.
Desflurane has been implicated in carbon monoxide (CO) intoxication during general anesthesia under certain circumstances. Carboxyhemoglobin (COHb) concentrations were determined in forty-one patients who were randomly allocated to receive closed-circuit anesthesia (CCA) with 1.3 MAC of desflurane (n = 21) or isoflurane (n = 20) in oxygen. Soda lime was used to bind the produced CO2 in previous anesthetic procedures with fresh gas flows of < 21/min. ⋯ In the isoflurane group, COHb concentrations were 1.15 +/- 1.47% and 1.19 +/- 1.39% before and after 1 h of anesthesia, respectively. COHb concentrations did not increase after 2 h of CCA in seven patients. Our data suggest that closed-circuit anesthesia with desflurane or isoflurane does not produce clinically significant increases in COHb concentrations under conditions that allow the soda lime to remain sufficiently wet.
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Acta Anaesthesiol Belg · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of neuromuscular block of atracurium and rocuronium in adults.
We studied the time-course of action of atracurium 0.5 mg kg-1 and rocuronium 0.6 mg kg-1 in 24 healthy adult patients. Anesthesia was induced with thiopentone and sufentanil, and maintained with 50% nitrous oxide and 1% enflurane in oxygen. Neuromuscular transmission was monitored by stimulating the ulnar nerve at the wrist and measuring the acceleration of the thumb using the TOF-Guard accelerograph monitor. ⋯ Clinical duration of action (Tl25) was longer with atracurium (52.3 +/- 7.2 min) than with rocuronium (40.0 +/- 6.4 min). Recovery index (Tl25-Tl75) and time for TOF ratio to recover to 0.75 were 17.8 +/- 4.2 and 73.9 +/- 8.8 min with atracurium, and 13.8 +/- 4.1 and 70.4 +/- 14.1 min with rocuronium. The differences between both groups were statistically significant except the difference in the time for TOF to return to 0.75.
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Acta Anaesthesiol Belg · Jan 1996
ReviewAdult clinical experience with sevoflurane and pharmaco-economic aspects.
This article has reviewed the physical-chemical properties and performance characteristics of sevoflurane. Both drugs provide a greater degree of control of anesthetic depth and a more rapid immediate recovery from anesthesia than is currently available with other inhaled agents because of their decreased solubility. Sevoflurane is currently in widespread clinical use in Japan and parts of Europe and the Americas. ⋯ These by-products, including Compound A and fluoride have been extensively studied and although the possibility for iatrogenic sequella from sevoflurane exists, the likelihood of long-term toxicity appears quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane: 1) to renally impaired patients, and 2) to any patient with fresh gas flows less than 2 liters per minute. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anesthesia.
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Acta Anaesthesiol Belg · Jan 1996
ReviewEfficacy of nonsteroidal antiinflammatory drugs in postoperative pain.
Historically, NSAIDs, used for more than 25 years to treat rheumatologic diseases, were then introduced to relieve pain after tooth extraction, and finally about 10 years ago for postoperative analgesia. NSAIDs have been increasingly used over the past ten years in the treatment of postoperative pain, such that they now play an important role in the management of postoperative analgesia, either alone or combined with opioids. When used alone, they are effective in relieving minor or moderate pain such as that seen after maxillofacial, minor orthopedic, or some ambulatory surgical procedures, and postpartum pain (episiotomy). ⋯ A 20 to 50% reduction in opioid consumption, sometimes with improved quality of analgesia, has been reported using different NSAIDs following various types of surgery. Better respiratory function, improved sleep quality, and faster recovery of gastrointestinal function have been reported with NSAIDs. However, the use of NSAIDs has not been shown to be associated with improved outcome or more rapid recovery.
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Acta Anaesthesiol Belg · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialEsmolol for hypotensive anesthesia in middle ear surgery.
This study was performed to investigate the efficacy of esmolol, an agent used in hypotensive anesthesia for middle ear surgery. We compared 20 ASA I-II patients to 20 controls in whom we administered routine anesthesia. All patients were premedicated with intramuscular 0.05 mg/kg atropine, 1 mg/kg pethidine and 25 mg promethazine. ⋯ Hemodynamic values recovered to normal or to within -12.45% of normal at the end of intravenous esmolol infusion. During the postoperative period, no side effects were observed. In conclusion, esmolol is an appropriate hypotensive agent for patients undergoing middle ear surgery under hypotensive anesthesia because it yields no side effects, it is easy to control administration and it provides the desired degree of hypotension without complications.