Articles: anesthetics.
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Comparative Study
Pharmacokinetics of alfentanil in children undergoing surgery.
Alfentanil pharmacokinetics and protein binding were determined in 20 children aged 10 months-6.5 yr. The data were compared with those from 10 adult patients. ⋯ The degree of plasma protein binding was also similar in children and adults with mean free fractions of 11.5 +/- 0.9% (+/- SD) and 11.8 +/- 3.9%, respectively. There were marked differences in the elimination half-life of alfentanil (63 +/- 24 min in children; 95 +/- 20 min in adults (P less than 0.001] and plasma clearance of alfentanil (11.1 +/- 3.9 ml min-1 kg-1 in children and 5.9 +/- 1.6 ml min-1 kg-1 in adults (P less than 0.001].
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The pharmacokinetics of alfentanil were studied in 18 children (3 months to 14 yr of age) undergoing surgery. Alfentanil was administered as a 30-s infusion of either 50 or 120 micrograms.kg-1. Pharmacokinetic values were independent of dose. ⋯ The mean value of Vdss was 0.419 (SE .028) l.kg-1) for the whole group, and elimination t1/2 was 76.3 (SE 6.5) min. The clearance rate [TBC = 7.9 (SE 0.41) ml.kg-1.min-1] was within the range of values previously determined in adult studies. From these data, it would appear that, although there may be differences in the disposition kinetics between children aged 3 months to 14 yr and those measured in adults in some studies by other investigators, age-related differences within this group were not demonstrable.
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Randomized Controlled Trial Clinical Trial
[Hemodynamics under propofol-nitrous oxide anesthesia: effects of premedication with lormetazepam and of additional fentanyl].
Propofol, in both its new oil-in-water emulsion and the former cremophor-EL solution, is known to produce significant decreases in arterial blood pressure. The aim of this study was to obtain a precise hemodynamic profile of anesthesia induction with propofol under conditions of daily routine (additional 70% nitrous oxide) and to evaluate the influence of (1) premedication with lormetazepam and (2) additional i.v. injection of fentanyl. Forty patients (ASA classes I and II) were randomly assigned to one of four groups (A, B, C, and D). ⋯ The following parameters were determined immediately prior to induction of anesthesia and 1, 3, 5, 8, and 10 min after the start of the propofol injection: heart rate (HR), mean arterial blood pressure (MAP), mean pulmonary artery pressure (PAP), central venous pressure (CVP), pulmonary occlusion pressure (POP), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). In all four groups a slight decrease in HR and SVR occurred while a marked decrease in arterial blood pressure (SAP, MAP, DAP) and cardiac output was seen. PAP and preload pressures showed no significant changes.(ABSTRACT TRUNCATED AT 250 WORDS)
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A survey was conducted to investigate the attitudes of anaesthetists and nurses to anaesthetic pollution. In order that the results could be viewed in context, attitudes to other possible occupational hazards, including radiation exposure and work-related stress, were also investigated. Four hundred (66%) completed questionnaires were returned. ⋯ Levels of concern were similar for radiation exposure; however, both occupational groups expressed higher levels of concern about work-related stress. Seventeen (21%) anaesthetists and 46 (14%) nurses reported having suffered adverse health effects which they thought were due to anaesthetic pollution. The most frequent complaints were headache and fatigue.