Anesthesiology
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Randomized Controlled Trial Clinical Trial
The effectiveness of pressure support ventilation for mechanical ventilatory support in children.
The rapid respiratory frequency of children may lead to patient-ventilator asynchrony and increase the work of breathing during mechanical ventilation, and the use of a small endotracheal tube and a demand valve can further increase this work of breathing. Although pressure support ventilation (PSV) is well known to reduce the work of breathing in adults, there are no reports regarding clinical studies of PSV in children. Therefore, the effect of PSV on breathing patterns and the work of breathing in children was studied. ⋯ It was concluded that PSV can effectively augment spontaneous breathing and reduce the work of breathing in children.
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Randomized Controlled Trial Clinical Trial
Intrathecal sufentanil for labor analgesia. Effects of added epinephrine.
Intrathecal sufentanil has been found to provide profound analgesia during labor. Epinephrine, when added to various local anesthetic agents or opioids, may modify the analgesic profile and incidence of side effects. The authors sought to determine the effect of adding 0.2 mg epinephrine to 10 micrograms sufentanil when administered for analgesia during labor. ⋯ Intrathecal sufentanil 10 micrograms, both with and without epinephrine, provided rapid-onset, albeit short-duration, analgesia during labor. Epinephrine did not prolong the duration of intrathecal sufentanil analgesia. The addition of epinephrine increased the incidence of nausea and decreased the incidence and severity of pruritus.
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Randomized Controlled Trial Clinical Trial
Isoflurane minimum alveolar concentration reduction by fentanyl.
Isoflurane is commonly combined with fentanyl during anesthesia. Because of hysteresis between plasma and effect site, bolus administration of fentanyl does not accurately describe the interaction between these drugs. The purpose of this study was to determine the MAC reduction of isoflurane by fentanyl when both drugs had reached steady biophase concentrations. ⋯ Defining the MAC reduction of isoflurane by all the opioids allows their more rational administration with inhalational anesthetics and provides a comparison of their relative anesthetic potencies.
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Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers.
This investigation extended the pharmacokinetic analysis of our previous study, of intravenous dexmedetomidine in 10 healthy male volunteers, and prospectively tested the resulting compartmental pharmacokinetics in an additional six subjects using a computer-controlled infusion pump (CCIP) to target four different plasma concentrations of dexmedetomidine for 30 min at each concentration. ⋯ Pharmacokinetics of dexmedetomidine are best described by a three-compartment model. Addition of age, weight, lean body mass, and body surface area do not improve the predictive value of the model. Additional improvement in CCIP accuracy for dexmedetomidine infusions would require magnification modification of the model based on the targeted concentration.
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The tendency of intravenous fluid exiting the heat exchanger of a fluid warmer to cool to room temperature increases as the rate of infusion slows and the length of tubing between the heat exchanger and the patient increases. Thus, slow to moderate flow rates result in the delivery of fluid near room temperature despite the use of a fluid warmer. The volumes infused even at low flow rates may be large relative to the size of infants and children and may result in a significant decrease in patient temperature. ⋯ The Hotline is more effective than conventional warmers at slow flow rates, and may be useful for preventing hypothermia when large volumes of fluid relative to patient size are infused at slow rates.