Articles: anesthetics.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of intravenous agents for rapid sequence induction--thiopental, ketamine, and midazolam.
The pharmacologic effects of ketamine, midazolam, and a midazolam-ketamine combination were compared with thiopental for rapid induction of general anesthesia. Thiopental, 4 mg/kg, 1.5 mg/kg ketamine, 0.3 mg/kg midazolam, or 0.15 mg/kg midazolam, and 0.75 mg/kg ketamine, were administered intravenously in a randomized fashion to 80 patients undergoing emergency surgery. Adequacy of induction, hemodynamic changes, and postoperative effects were assessed during and after a standardized induction-maintenance anesthetic technique. ⋯ Thus, midazolam effectively attenuated both the cardiostimulatory responses and unpleasant emergence reactions associated with ketamine. The author concludes that both midazolam and the midazolam-ketamine combination are safe and effective induction agents for emergency surgery, which may offer an advantage over thiopental in situations where hemodynamic stability is crucial. Furthermore, midazolam effectively attenuates the side effects of ketamine.
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The effects of methohexitone, Althesin, ketamine and etomidate on single fibre discharge of cardiac vagal efferents and on heart rate were studied in cats. Cardiac vagal efferents were inhibited markedly and regularly for equihypnotic doses of methohexitone (2.0 mg kg-1), Althesin (0.1 ml kg-1) and ketamine (5.0 mg kg-1), but not of etomidate (0.8 mg kg-1). These inhibitory effects were independent of arterial pressure and mirrored the increases of heart rate elicited by the first three agents. ⋯ Thus methohexitone. Althesin and ketamine inhibit efferent cardiac vagal drive by their central action independently of baroreflex function. This central vagolysis is probably the cause of their positive chronotropic effects.
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Malignant hyperthermia is a relatively rare condition which strikes susceptible patients undergoing surgery. This disorder is an inherited biochemical defect, triggered by certain anesthetic agents and stress. ⋯ If a patient, by family history or test, is suspected of being susceptible to malignant hyperthermia, special precautions must be taken before proceeding with surgery. The clinical engineer must: 1) prepare special anesthesia equipment which is free of trace gases capable of triggering an episode of malignant hyperthermia; 2) provide special monitoring facilities to detect the onset of an episode; and 3) have treatment facilities on hand in the event that an episode does develop.
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Anesthesia and analgesia · Sep 1982
Comparative StudyComparative cardiovascular effects of midazolam and thiopental in healthy patients.
Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction-sized dose (0.25 mg/kg) of midazolam in A. S. ⋯ Midazolam is, then, as acceptable for induction of anesthesia as thiopental from a hemodynamic point of view in A. S. A. class I and II patients.