Anesthesiology
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Randomized Controlled Trial Clinical Trial
Single-breath vital capacity rapid inhalation induction in children: 8% sevoflurane versus 5% halothane.
The authors compared the speed of induction of anesthesia with sevoflurane with and without nitrous oxide with the speed of halothane and nitrous oxide using a single-breath vital capacity induction. ⋯ Induction of anesthesia with a single breath of 8% sevoflurane with or without 66% nitrous oxide is more rapid than with 5% inspired halothane with 66% nitrous oxide in children. The incidence of movement and dysrhythmias during a single-breath induction with sevoflurane are less than they are with halothane.
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Randomized Controlled Trial Clinical Trial
Intrathecal sufentanil dose response in nulliparous patients.
Intrathecal sufentanil provides effective analgesia during the first stage of labor. A range of doses has been reported to provide adequate pain relief. This study determined the dose of intrathecal sufentanil that produced acceptable pain relief in 50% of nulliparous patients (ED50) who requested labor analgesia. ⋯ This is the first study to determine the ED50 of intrathecal sufentanil in spontaneously laboring nulliparous patients. As dose-response curves are determined for other labor analgesics, future studies can compare equianalgesic doses or dose combinations.
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Recent studies have questioned the classical gravitational model of pulmonary perfusion. Because the lateral position is commonly used during surgery, the authors studied the redistribution of pulmonary blood flow in the left lateral decubitus position using a high spatial resolution technique. ⋯ Perfusion to each lung did not change with movement from the supine to the left lateral position. These findings contradict the prediction of increased dependent lung and decreased nondependent lung blood flow based on the gravitational model. It was concluded that the distribution of blood flow in the lateral position in dogs is dominated by pulmonary vascular structure.
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Changes in pulmonary edema infiltration and surfactant after intermittent positive pressure ventilation with high peak inspiratory lung volumes have been well described. To further elucidate the role of surfactant changes, the authors tested the effect of different doses of exogenous surfactant preceding high peak inspiratory lung volumes on lung function and lung permeability. ⋯ Exogenous surfactant preceding high peak inspiratory lung volumes prevents impairment of oxygenation, lung mechanics, and minimal surface tension of bronchoalveolar lavage fluid and reduces alveolar influx of Evans blue dye. These data indicate that surfactant has a beneficial effect on ventilation-induced lung injury.