Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1991
Study on the effects of six intravenous anesthetic agents on regional ventricular function in dogs (thiopental, etomidate, propofol, fentanyl, sufentanil, alfentanil).
This study evaluates the effects of 30 min increasing doses infusions of six intravenous anesthetic agents (thiopental, etomidate, propofol, fentanyl, sufentanil and alfentanil) on regional ventricular function in a normal and an acute ischemic heart segment in dogs. Part 1 discusses the methodology used in this experimental design with emphasis on the sensitivity and the limitations of the parameters used to assess ventricular performance and contractility. Part 2 reports the effects on regional and global ventricular function, which occur when one segment is made acutely ischemic. ⋯ Fentanyl increased regional end-diastolic length and systolic shortening at the highest infusion rate. This phenomenon is not apparent for sufentanil, suggesting that different mechanisms are involved to compensate for the expected bradycardia-induced hypotension. Alfentanil did not alter systemic and regional hemodynamics significantly in this study design.
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Acta Anaesthesiol Belg · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of various administration routes of lidocaine on hemodynamics and ECG rhythm during endotracheal intubation.
Observations of arterial blood pressure, heart rate and cardiac rhythm during endotracheal intubation and within a five minute period thereafter were made in 80 patients randomly assigned into four groups. The aim was to study the cardiovascular changes following endotracheal intubation using a standard anesthesia technique and to compare the efficacy of lidocaine in controlling cardiovascular changes using different administration techniques. Anesthesia was induced with thiopentone and succinylcholine followed by endotracheal intubation. ⋯ No significant differences were noticed between the lidocaine groups. We conclude from our study that those patients who had received lidocaine prior to endotracheal intubation showed minimal cardiovascular changes. Lidocaine should therefore routinely be used prior to endotracheal intubation.
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Acta Anaesthesiol Belg · Jan 1990
Randomized Controlled Trial Clinical TrialSurgical analgesia for knee arthroscopy with epidural lignocaine and sufentanil--effect of varying sufentanil doses.
In a double blind trial the additional analgesic effect of the combination of epidural lignocaine 2% + epinephrine 1/200,000 with varying epidural Sufentanil doses was studied per- and postoperatively in patients undergoing arthroscopy of the knee. Fifty patients were randomly divided into five groups. They received epidural lignocaine 2% + epinephrine 1/200,000 in addition with respectively 0, 20, 30, 40 or 50 micrograms Sufentanil. ⋯ On the other hand, at 40 and 50 micrograms of Sufentanil significantly more patients demonstrated respiratory depression and pronounced sedation during surgery as compared to lignocaine alone. Patients in these groups had better postoperative analgesia. In addition nausea, vomiting and pruritus were seen in some patients at all doses of Sufentanil.
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Neuromuscular diseases raise a lot of anesthesia related problems. The first is the hitherto unknown disease discovered by an unexpected adverse reaction to anesthetics or/and muscle relaxants up to a life-threatening incident. A second problem is the probable, suspected or proven disposition to malignant hyperthermia in patients with other neuromuscular diseases. ⋯ In the later stages of severe neuromuscular diseases the main problem concerning anesthesia is respiratory failure. The individual risk of every patient has to be evaluated before anesthesia. Recommendations for the anesthetic management are given.
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Acta Anaesthesiol Belg · Jan 1990
Comparative StudyClinical applications of low flow and closed circuit anesthesia.
Minimal Flow Anesthesia, an extreme technique of semiclosed use of rebreathing systems performed with a fresh gas flow of 0.5 l/min, can be managed with already available anesthesia machines. As a standardized fresh gas volume with fixed composition is used, due to the exponential decrease of the patient's gas uptake, the gas composition within the breathing system may change markedly during the time course of anaesthesia. ⋯ The need for continuous adjustment of the fresh gas controls, the insufficient accuracy of the dosaging systems and the impossibility to calculate precisely the uptake figures in the individual case are essential obstacles for the routine use of this method. An account of the clinical realization of both techniques is given and the specific advantages and disadvantages are considered: although modern anesthesia machines are designed especially for the use of even lowest fresh gas flow rates, quantitative Closed System Anesthesia will not become a technique for routine clinical practice until apparatus with computer-aided closed loop feedback control of the fresh gas supply will be available.