Articles: general-anesthesia.
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The laryngeal mask airway (LMA) was recently introduced in pediatric anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance. The authors report their experience with LMA on 120 consecutively treated children who underwent elective inguinal herniorrhaphy or orchidopexy. The patients were monitored with electrocardiograms, noninvasive blood pressure determinations, pulse oxymetry, and capnometry. ⋯ In five patients, LMA was successfully inserted on the third attempt. The ease of insertion was not significantly different between the groups. Anesthesia was maintained by halothane (mean, 1.34%; range, 0.8% to 2.54%) for an average of time of 39.2 minutes (range, 15 to 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)
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A cuffed nasopharyngeal airway was used in five cases of difficult intubation, initially to maintain anaesthesia, and subsequently to act as a landmark for the passage of a fibreoptic laryngoscope loaded with a tracheal tube. In all cases, airway patency was well preserved with the device and there were no significant problems with its use. The notion of a 'dedicated airway' for difficult intubation cases is developed. A trouble-free airway will permit time to consider solutions for difficult cases and time for the novice to learn fibreoptic laryngoscopy technique.
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A 51 year-old female with spinocerebrellar degeneration was anesthetized with O2-N2O-isoflurane for abdominal total hysterectomy. After monitoring of both orbicularis oculi and adductor pollicis twitches in the response to train-of-four stimulation of the facial and ulnar nerves had been prepared, vecuronium was administered as a bolus. ⋯ The onset with the adductor pollicis did not indicate good intubating conditions. In patients with spinocerebrellar degeneration, the twitch response of the orbicularis oculi should be monitored to determine accurately the degree of neuromuscular blockade when neuromuscular blocking drugs are administered.
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Randomized Controlled Trial Clinical Trial
MAC reduction of isoflurane by sufentanil.
We have shown previously that a plasma fentanyl concentration of 1.67 ng ml-1 reduced the MAC of isoflurane by 50%. By comparing equal degrees of MAC reduction by sufentanil, we may determine the potency ratio of these opioids. Seventy-six patients were allocated randomly to receive predetermined infusions of sufentanil, and end-tidal concentrations of isoflurane in oxygen. ⋯ The MAC reduction of isoflurane produced by sufentanil was obtained using a logistic regression model. A sufentanil plasma concentration of 0.145 ng ml-1 (95% confidence limits 0.04, 0.26 ng ml-1) resulted in a 50% reduction in the MAC of isoflurane. At a plasma concentration greater than 0.5 ng ml-1, sufentanil exhibited a ceiling effect.