AANA journal
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison study of vecuronium bromide and atracurium besylate for rapid sequence induction.
Rapid sequence induction is necessary in emergency surgical operations to lessen the chance of aspiration of stomach contents. Succinylcholine usually is the relaxant of choice, because of its rapid onset. However, succinylcholine has side effects which may result in potentially life-threatening conditions. ⋯ Group I subjects showed a significantly faster time to 80-90% neuromuscular block when compared with subjects in Group II and III, but no difference in the time to 80-90% block was revealed between Group II and Group III subjects. Conditions for intubation at 80-90% neuromuscular blockade were the same for all three groups. It was concluded that the administration of vecuronium and atracurium using the priming principle did not allow onset times similar to succinylcholine and that the intubating conditions were similar among all three groups at 80-90% neuromuscular blockade.
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Laryngospasm is one of the more common forms of airway obstruction encountered by an anesthetist. Therapy usually is straightforward, with resolution of the obstruction normally occurring within minutes. ⋯ Two cases are presented that are quite typical of the development of this complication. The etiology, recognition and management of this form of non-cardiac pulmonary edema is discussed.
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Mixed venous oxygen saturation (SvO2) is an indirect indicator of cardiac output. Twenty-nine patients undergoing aortic reconstructive surgery were studied to determine whether a sustained 5% or greater change in SvO2 (1) is associated with a similar change in cardiac output, and (2) results in a change in therapy during anesthetic management of the patients. Pulmonary artery cannulation with a fiberoptic oximeter catheter was used for continuous monitoring of SvO2 values in addition to usual hemodynamic parameters. ⋯ This data suggests that the likelihood of a therapeutic intervention in a patient with a change in SvO2 of 5% or greater is highly significant. The relationship between change in SvO2 and cardiac output was also significant. This suggests that changes in SvO2 are reflective of changes in cardiac output, and thus, the hemodynamic status of the patient.
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Patients with neurologic diseases who require surgery may present the anesthetist with special challenges related to their pharmacotherapy. It is well established that such therapy may alter these patients' otherwise normal response to anesthesia. There are many classes of drugs utilized and this AANA Journal course addresses the pharmacokinetic, pharmacodynamic, and anesthetic implications of anticholinesterase and antiepileptic drugs.