Articles: patients.
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Journal of anesthesia · Jun 1997
Circulatory and catecholamine responses to tracheal intubation and skin incision during sevoflurane, isoflurane, or halothane anesthesia.
The anesthetic suppression of responses to noxious stimuli might reflect a summation of the suppression of the basal functions and the response capability. We investigated the basal suppression and response capability in hemodynamics and plasma catecholamine levels with different anesthetics at the same minimum alveolar concentration (MAC) level. Fifty-four patients were allocated to one of 6 groups to receive sevoflurane, isoflurane, or halothane at 1.25 or 2.0 MAC. ⋯ The mean arterial pressure, heart rate, rate-pressure product, and plasma levels of noradrenaline and adrenaline at the prestimuli period showed no difference between agents at each MAC. The rises in these variables by tracheal intubation and skin incision were greatest in the sevoflurane group, least in the halothane group, and intermediate in the isoflurane group. Although basal hemodynamic suppression is similar at the same MAC, the suppressive action of sevoflurane on the circulatory response capability to noxious stimuli is weaker than that of isoflurane and halothane.
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Journal of anesthesia · Jun 1997
Effect of external high-frequency oscillation on severe cardiogenic pulmonary edema.
Effective gas exchange can be maintained in animals without endotracheal intubation using external high-frequency oscillation (EHFO). The aim of this study was to evaluate the effect of EHFO in patients with respiratory failure due to severe cardiogenic pulmonary edema. Seven patients were ventilated with EHFO for 2h at 60 oscillations·min(-1), with a cuiras pressure of 36 cmH2O (-26 to +10) and an inspiratory to expiratory ratio of 1:1, with EHFO. ⋯ Arterial CO2 pressure (Paco2) did not, however, decrease. Increased stroke volume without a change in pulmonary artery wedge pressure (preload) suggests either improved inotropic function of the left ventricle or reduced left ventricular afterload with EHFO. The use of EHFO may be effective not only for gas exchange but also for left ventricular function in patients with severe cardiogenic pulmonary edema.
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Journal of anesthesia · Jun 1997
Oral clonidine premedication does not alter the efficacy of epidural test doses in adult patients anesthetized with isoflurane.
Clonidine premedication has been increasingly used in clinical anesthesia. Though clonidine was found to alter pressor responses to various sympathomimetics, its effect on epidural test dose efficacy to detect intravascular injection has never been evaluated. Eighty healthy patients were randomly assigned to one of four groups, each of which was anesthetized with 1% end-tidal isoflurane and 67% nitrous oxide in oxygen after endotracheal intubation. ⋯ On the other hand, all of 20 patients in the control-epinephrine and the clonidine-epinephrine groups exhibited positive SBP responses (SBP increment ≥15 mmHg). Therefore, based on the SBP criterion, sensitivities, specificities, and positive and negative predictive values were all found to be 100% regardless of the presence of clonidine. We conclude that oral clonidine 5μg·kg(-1) premedication alters neither (a) hemodynamic responses to the intravenously administered epidural test dose containing 15 μg epinephrine, nor (b) the efficacy for detecting intravascular injection based on either criterion in adult patients under stable isoflurane anesthesia.