Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery.
Carotid endarterectomy may be performed under cervical plexus block with local anesthetic supplementation by the surgeon as necessary during surgery. It is unclear, however, whether deep or superficial cervical plexus block offers the best operating conditions or patient satisfaction. Therefore, the authors compared the two in patients undergoing carotid endarterectomy. ⋯ Carotid endarterectomy may be performed satisfactorily during superficial or deep cervical plexus block placement with no differences in terms of supplemental local anesthetic requirements, although this is influenced by whether paresthesia is elicited during placement of the deep block. Therefore, the clinician's decision to use one block rather than another need not be based on any assumed superiority of one block based on intraoperative conditions or patient satisfaction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antiemetic activity of propofol after sevoflurane and desflurane anesthesia for outpatient laparoscopic cholecystectomy.
Controversy exists regarding the effectiveness of propofol to prevent postoperative nausea and vomiting. This prospective, randomized, single-blinded study was designed to evaluate the antiemetic effectiveness of 0.5 mg/kg propofol when administered intravenously after sevoflurane- compared with desflurane-based anesthesia. ⋯ A subhypnotic intravenous dose of propofol (0.5 mg/kg) administered at the end of outpatient laparoscopic cholecystectomy procedures was more effective in preventing postoperative nausea and vomiting after a sevoflurane-based (compared with a desflurane-based) anesthetic.
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Randomized Controlled Trial Clinical Trial
Non-thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia.
Although cold-induced shivering is an obvious source of postanesthetic tremor, other causes may contribute. Consistent with this theory, the authors had previously identified an abnormal clonic component of postoperative shivering and proposed that it might be nonthermoregulatory. A subsequent study, however, failed to identify spontaneous muscular activity in normothermic volunteers. These data suggested that the initial theory was erroneous or that a yet-to-be identified factor associated with surgery might facilitate shivering in patients after operation. Therefore, the authors tested the hypothesis that some postoperative tremor is nonthermoregulatory. ⋯ The incidence of postoperative shivering is inversely related to core temperature. Therefore, it was not surprising that shivering was most common among the hypothermic patients. The major findings, however, were that shivering remained common even among patients who were kept scrupulously normothermic and that many shivered while they were vasodilated. Thus, postoperative patients differ from nonsurgical volunteers in demonstrating a substantial incidence of nonthermoregulatory tremor.
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Randomized Controlled Trial Clinical Trial
Combined intravenous lidocaine and inhaled salbutamol protect against bronchial hyperreactivity more effectively than lidocaine or salbutamol alone.
Airway instrumentation in persons with asthma is linked to the risk of life-threatening bronchospasm. To attenuate the response to airway irritation, intravenous lidocaine is recommended (based on animal experiments) and mitigates the response to histamine inhalation in asthmatic volunteers. However, the effects of lidocaine have not been compared with standard prophylaxis with beta-sympathomimetic aerosols. Therefore, the effect of lidocaine, salbutamol, combined treatment, and placebo control were tested in awake volunteers with bronchial hyperreactivity. ⋯ In volunteers with bronchial hyperreactivity, both lidocaine and salbutamol attenuate the response to an inhalational histamine challenge, and their combined administration has much greater effects than does either drug alone. Accordingly, pretreatment of patients with bronchial hyperreactivity with both beta-mimetic aerosol and intravenous lidocaine is recommended before airway irritation.
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Randomized Controlled Trial Clinical Trial
Concentration-response relationships for fentanyl and sufentanil in patients undergoing coronary artery bypass grafting.
Concentration-response relationships for sufentanil and fentanyl are undefined in patients undergoing coronary artery bypass grafting. ⋯ Serum sufentanil and fentanyl concentrations of 0.71 +/- 0.13 ng/ml and 7.3 +/- 1.3 ng/ml, respectively, are on the steep parts of the concentration-response relationships and facilitate prebypass hemodynamic control in patients undergoing coronary artery bypass grafting with opioid-isoflurane anesthesia. Concentrations of sufentanil > or = 1.25 +/- 0.21 ng/ml and of fentanyl > or = 13.3 +/- 2.2 ng/ml minimize isoflurane requirements but do not improve hemodynamic control.