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
Comparative Study Clinical Trial Controlled Clinical TrialA comparison of the laryngeal mask and tracheal tube for controlled ventilation.
The use of laryngeal mask airway (LMA), size 3 or 4, and endotracheal tube (ETT) 8.0 mm was studied comparatively to determine the adequacy of respiratory function during positive pressure ventilation (PPV) by applying a series of given peak inspiratory pressures (PIPs) of 10.0, 12.5, 15.0, 17.5, 20.0 and 30.0 cm H2O. Eleven anesthetised patients underwent a double comparative trial. ⋯ Higher values of VT (1.7 mk.kg-1) were expired via the LMA compared with ETT when a given PIP of less than 20 cmH2O was applied. LMA as opposed to ETT secured normocapnia during PPV with low PIPs.
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Ketorolac is an efficient drug for the treatment of moderate to severe pain following minor or intermediate types of surgery. Its use is associated with improved quality of recovery, reduced incidence of side effects and earlier discharge from the recovery unit and the hospital in patients treated on an ambulatory basis. ⋯ However, it is an effective adjunct to all forms of opioid analgesia being associated with a significant opioid sparing effect. Large scale studies have demonstrated that this combination of improved analgesia and opioid sparing is of clinical benefit.
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Acta Anaesthesiol Belg · Jan 1996
ReviewPain relief and clinical outcome: from opioids to balanced analgesia.
If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts should aim at including physical rehabilitation programs in the pain treatment regimen.
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This review focuses on the effects of the newest volatile anesthetic, sevoflurane, on the cardiovascular system. In general, the cardiovascular effects of sevoflurane are quite similar to isoflurane but quite different from desflurane. Sevoflurane is not associated with increases in heart rate in adult patients and volunteers whereas higher MAC of isoflurane and desflurane and rapid increases in the inspired concentrations of these two agents have been associated with increased heart rates in unstimulated volunteers. ⋯ Sevoflurane decreases myocardial contractility similar to equi-MAC concentrations of isoflurane and desflurane and does not potentiate epinephrine-induced cardiac arrhythmias. In several multi-center studies where patients with coronary artery disease or patients at high risk for coronary artery disease were randomized to receive either sevoflurane or isoflurane for cardiac or noncardiac surgery, the incidence of myocardial ischemia and infarction did not differ between treatment groups. Thus, sevoflurane has not been associated with untoward cardiovascular changes in volunteers and patients undergoing elective surgery and may have less potent effects on the vascular smooth muscle of select circulations.