Articles: general-anesthesia.
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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.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of epidural versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing radical prostatectomy.
Although preemptive analgesia has been shown to decrease postinjury pain in animals, studies in humans have provided controversial results. The authors studied whether surgical epidural anesthesia with local anesthetics could affect postoperative pain and analgesic demands, when compared with general anesthesia. ⋯ In patients undergoing lower abdominal surgery, the neuraxial blockade and surgical anesthesia achieved by epidural local anesthetics was associated with decreased postoperative analgesic demands. Lower postoperative analgesic requirements in the EA group, when compared with both the EG and GA groups, indicate that: (1) EA patients had less postoperative pain, and (2) an efficient intraoperative blockade of noxious afferent signals to the central nervous system is fundamental in reducing postoperative pain.
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Acta Anaesthesiol Scand · Jan 1994
Randomized Controlled Trial Clinical TrialFlumazenil facilitates intraoperative arousal during scoliosis surgery: a randomized, double-blind, placebo-controlled study.
Intraoperative arousal was evaluated in 24 patients (median age 16.5 years), undergoing spondylodesis with Cotrel-Dubousset or Harrington-Luque instrumentation. Flumazenil and placebo groups of 12 patients each were similar with respect to age, body weight, dosage of anaesthetic drugs and surgery times. Premedication consisted of diazepam 0.2-0.3 mg kg-1 orally. ⋯ Postoperatively, motor responses were assessed after 12.0 min (5-42 min) in the flumazenil group, and after 15.2 min (4-40 min) in the placebo group (NS). Recovery from anaesthesia took 27.5 min (7-415 min) in the flumazenil group, and 25.0 min (8-160 min) in the placebo group (NS). One patient given flumazenil and one patient given placebo remembered moving their feet, but neither of them could recall anything unpleasant.(ABSTRACT TRUNCATED AT 250 WORDS)
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General anesthesia is the most common form of anesthetic management for ambulatory surgery. Patients, in general, prefer general anesthesia because it is less anxiety provoking. During the last decade, the availability of several short-acting agents with high clearance has made general anesthetic techniques much safer and more predictable for outpatients. ⋯ The introduction of several new agents (e.g., propofol, desflurane, vecuronium, atracurium, mivacurium, rocuronium, alfentanil, ondansetron, ketorolac) has made ambulatory general anesthesia less challenging and more interesting. In the future, the new anesthetic sevoflurane, and the new opioid remifentanil, may prove useful for ambulatory anesthesia. The LMA has all but revolutionized airway management during general anesthesia for ambulatory surgery.