AANA journal
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Comparative Study Clinical Trial Controlled Clinical Trial
Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: assessment of drug concentration in gastric aspirate.
This placebo-controlled trial compared the effects of preoperative, intravenous cimetidine (300 mg) or ranitidine (50 mg) on gastric pH and gastric volume in 31 adult patients requiring general anesthesia. The elapsed time from drug administration to initial gastric sampling did not differ significantly between ranitidine (45 minutes), cimetidine (48 minutes), or placebo (52 minutes) treated patients. Ranitidine, but not cimetidine, significantly (P = 0.02) increased gastric pH when compared with placebo. ⋯ The H2 blockers did not significantly alter gastric volume when compared with placebo. The number of patients with gastric pH less than = 2.5 and gastric volume = greater than 25 ml did not differ significantly between cimetidine (8%), ranitidine (10%), and placebo (22%). No clinical evidence of aspiration pneumonitis was found in our study patients.
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The benefits of epidural anesthesia for the relief of pain associated with childbirth has long been recognized. Although epidurals are widely used for pain relief during the labor process, side effects and complications associated with epidurals do occur. The purpose of this review is to summarize the benefits, as well as the disadvantages of epidurals, in an effort to minimize those complications.
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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.
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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.