Articles: general-anesthesia.
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Anesthesia and analgesia · Feb 1983
Randomized Controlled Trial Comparative Study Clinical TrialThromboembolism after total hip replacement: role of epidural and general anesthesia.
The effects of continuous epidural anesthesia and of general anesthesia on the incidence of thromboembolism following total hip replacement were studied. Sixty patients were randomly allotted to one of two groups receiving either epidural or general anesthesia. Epidural anesthesia (N = 30) consisted of 0.5% bupivacaine with epinephrine intraoperatively; for pain relief in the postoperative period (24 h), 0.25% bupivacaine with epinephrine was given every 3 h. ⋯ Possible explanations for these differences include increased circulation in the lower extremities, less tendency for intravascular clotting to occur, and more efficient fibrinolysis in association with continuous epidural anesthesia. The decrease in blood loss associated with epidural anesthesia with lower transfusion requirements also might play a role. Epidural analgesia prolonged into the postoperative period, in addition to other appropriate thromboprophylactic measures, should be of value in patients undergoing operations associated with a high risk of thromboembolic complications.
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Comparative Study
Neuromuscular and cardiovascular effects of atracurium during nitrous oxide-fentanyl and nitrous oxide-isoflurane anaesthesia.
The neuromuscular and cardiovascular effects of atracurium were compared during nitrous oxide-isoflurane and nitrous oxide-fentanyl anaesthesia in healthy surgical patients. The dose-response curve was shifted significantly to the left during nitrous oxide-isoflurane anaesthesia (ED50 0.068 mg kg-1) as compared with nitrous oxide-fentanyl anaesthesia (ED50 0.083 mg kg-1). For equipotent doses, the time course of neuromuscular effects (onset and duration) was not appreciably different between the nitrous oxide-isoflurane group and the nitrous oxide-fentanyl group. ⋯ The onset time (time from injection to peak effect) for subparalytic doses of atracurium was approximately 6.5 min and is comparable to the onset time for equipotent doses of pancuronium and vecuronium. The duration of neuromuscular effects of atracurium (time from injection to 95% recovery) was approximately 20 min for subparalytic doses and is the same as that of vecuronium and one-third to one-half that of pancuronium. It is concluded that the peak effect of atracurium is enhanced more by nitrous oxide-isoflurane than by nitrous oxide-fentanyl anaesthesia, but for equipotent doses the time-course is the same.
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Comparative Study Clinical Trial Controlled Clinical Trial
Muscular relaxation with atracurium, vecuronium and duador under balanced anaesthesia.
The neuromuscular effects of three new nondepolarizing neuromuscular blocking drugs, atracurium, vecuronium and Duador, were investigated in surgical patients under balanced anaesthesia. (The numbers of patients in each study are given in the tables.) There were no significant differences in the neuromuscular effects of the three agents. None showed any cumulation after repeated administration of maintenance doses. Muscular relaxation for upper abdominal surgery was adequate as long as the isometric twitch tension (P) was no more than 25% of control. ⋯ The initial dose of Duador caused a 16.7% increase in heart rate. The findings indicate that the three new muscle relaxants merit further clinical trial. In our opinion, until the results of such studies become available, atracurium should not be used in patients with a history of allergic diathesis and Duador in those in whom increased heart rate may be harmful.