Articles: general-anesthesia.
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Clinical Trial Controlled Clinical Trial
Minimum alveolar concentration of isoflurane for tracheal extubation in deeply anesthetized children.
The end-tidal anesthetic gas concentration required to prevent the anesthetized patient from coughing or moving during or immediately after tracheal extubation is not known. ⋯ In 50% of anesthetized children age 4-9 yr tracheal extubation may be accomplished without coughing or moving at 1.27% end-tidal isoflurane concentration.
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Clinical Trial Controlled Clinical Trial
Reduction of postoperative nausea and vomiting with granisetron.
The antiemetic effects of granisetron, a selective 5-hydroxy-tryptamine type 3 receptor antagonist, on postoperative nausea and vomiting were studied and compared with placebo and metoclopramide in 60 patients undergoing general anaesthesia for major gynaecological surgery. The patients received a single i.v. dose of either granisetron (3 mg, n = 20) metoclopramide (10 mg, n = 20), or placebo (saline, n = 20) immediately after recovery from anaesthesia. The effects were assessed during the first three and the next 21 hr after recovery from anaesthesia by means of a nausea and vomiting score; 0 = no emetic symptoms, 1 = nausea, 2 = vomiting. ⋯ The scores of the metoclopramide and the granisetron groups were different from the placebo group in the first three hours (P < 0.05). Although there were no differences in the scores during 0-3 hr between the metoclopramide and the granisetron groups, there were differences during 3-24 hr (P < 0.05). It is concluded that granisetron is superior to metoclopramide in the long-term prevention of postoperative nausea and vomiting after anaesthesia.
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Clinical TrialFacilitation of fiberoptic orotracheal intubation with a flexible tracheal tube.
Advancement of a tracheal tube (TT) over a flexible fiberoptic bronchoscope (FOB) is often impeded by obstruction at the arytenoid cartilage or epiglottis. We tested the hypothesis that the use of a flexible, spiral-wound TT, rather than the standard, preformed TT would facilitate tube passage into the trachea over the FOB. Forty patients scheduled to undergo general anesthesia with tracheal intubation were randomized to two groups. ⋯ In the patients randomized to the spiral-wound TT, 95% (19/20) of first attempts were successful (P < 0.0001). Of the 13 regular TTs that were not successfully advanced on the first attempt, seven could not be passed after the second or third attempt (necessitating the use of the cross-over spiral-wound TT). In the only instance in which a spiral-wound tube was not successfully passed into the trachea on the first attempt, passage also was not achieved after the second or third attempt.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Delayed ACTH response to human corticotropin releasing hormone during cardiopulmonary bypass under diazepam-high dose fentanyl anaesthesia.
The inhibitory effect of high dose fentanyl (0.1 mg.kg-1) and diazepam (0.5 mg.kg-1) anaesthesia on the pituitary-adrenal response to coronary artery surgery during cardiopulmonary bypass was assessed by comparison of the adrenocorticotropic hormone and cortisol responses to intravenous boluses of either 0.1 mg (n = 14) or 0.2 mg (n = 14) human corticotropin releasing hormone administered 5 min after starting cardiopulmonary bypass, with the responses obtained in a control group (n = 14). Blood samples were taken before inducing anaesthesia, just before cardiopulmonary bypass and at 5, 20, 35, 50, 65 and 80 min thereafter. ⋯ Plasma cortisol concentrations did not vary between the three groups at any sampling time. During cardiopulmonary bypass the early adrenocorticotropic responses to human corticotropin releasing hormone are blunted but later there is a good response, suggesting that the inhibitory effect of high dose fentanyl and diazepam anaesthesia takes place in the hypothalamus.
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We sought to determine the effectiveness of a magnet placed over the thyroid cartilage in the neck to guide an endotracheal tube into the trachea. Forty patients aged 18 to 60 yr with normal airway anatomy (ASA grade I) who required general anesthesia with an endotracheal tube and paralysis for their surgery were chosen and informed consents were obtained. The tip of the epiglottis was exposed with a No. 3 MacIntosh laryngoscope, and a magnet was held over the thyroid cartilage. ⋯ This magnet-guided technique can be used when it is difficult to expose a patient's larynx. It is noninvasive, simple, and can be used without any delay when expensive flexible fiberoptic endoscopes are not readily available. The procedure takes an average of 1 to 2 min.