Articles: general-anesthesia.
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Randomized Controlled Trial Clinical Trial
Addition of nitrous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with ischemic heart disease.
Although nitrous oxide is commonly administered to patients with ischemic heart disease, recent reports suggest that it may induce myocardial ischemia in these patients. The authors compared the effects of nitrous oxide on segmental left ventricular (LV) function and the ST segment of the electrocardiogram with the effects of an equal concentration of nitrogen (crossover design) before the start of surgery in 18 patients who required coronary-artery bypass grafting. The patients studied did not have valvular or LV dysfunction. ⋯ Surgery did not begin until the study was concluded. No patient experienced an ST segment change greater than 1 mm during the study, and none developed a new segmental wall motion abnormality during inhalation of either nitrous oxide or nitrogen. The authors conclude that nitrous oxide does not induce myocardial ischemia when used as an adjunct to fentanyl anesthesia in patients who have severe coronary-artery disease accompanied by well-preserved valvular and LV function.
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J Cardiothorac Anesth · Dec 1987
Randomized Controlled TrialThe role of intrathecal morphine in the anesthetic management of patients undergoing coronary artery bypass surgery.
The study was undertaken to assess the effects of intrathecal morphine (ITM) on perioperative hemodynamics, and anesthetic and postoperative analgesic requirements in patients anesthetized with fentanyl/enflurane undergoing coronary artery bypass surgery. Forty patients were randomized in a double-blind fashion to receive either intrathecal morphine or saline. Nineteen patients received ITM, 0.02 mg/ kg, and 21 intrathecal saline (ITS) after induction of anesthesia. ⋯ No significant difference was found between ITM and ITS groups for postoperative requirements of morphine (3.5 +/- 0.5 v 4.5 +/- 0.6 mg), diazepam (5.6 +/-1.25 v 3.9 +/- 1.26 mg), and vasodilators (6 v 13 patients), respectively. Comparable and significant reductions of peak expiratory flow rates (PEFR), forced vital capacity (FVC), and forced expiratory volume (FEV1) occurred in both groups postextubation when compared with preoperative values. Intrathecal morphine at the dose of 0.02 mg/kg does not offer any clear benefit to patients anesthetized with fentanyl, 40 microg/kg, for coronary artery bypass surgery.
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Anaesth Intensive Care · Nov 1987
Comparative Study Clinical Trial Controlled Clinical TrialComparison of propofol and antagonised midazolam anaesthesia for day-case surgery.
A technique of midazolam/fentanyl/isoflurane/nitrous oxide anaesthesia, in which the benzodiazepine was antagonised by the specific antagonist, flumazenil, was compared with propofol/fentanyl/nitrous oxide anaesthesia for minor outpatient urological surgery. No significant difference was found in the overall ease of anaesthesia; however, using subjective (linear analogue sedation scales) and objective (letter deletion and simple reflex time) tests, recovery was found to be significantly slower for the antagonised midazolam group. ⋯ The midazolam group displayed the greatest degree of residual sedation at the 4-hour time of discharge and on arrival home a significantly larger number of patients in the midazolam group slept for a period. It is likely that the dose of flumazenil chosen (1 mg) was inadequate to completely antagonise the dose of midazolam (mean 17 mg) for the full duration of recovery.