Anesthesiology
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Randomized Controlled Trial Clinical Trial
Postoperative behavioral outcomes in children: effects of sedative premedication.
Although multiple studies document the effect of sedative premedication on preoperative anxiety in children, there is a paucity of data regarding its effect on postoperative behavioral outcomes. ⋯ Children who are premedicated with midazolam before surgery have fewer negative behavioral changes during the first postoperative week.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia.
This study intends to evaluate the benefits of the administration of intermittent bolus doses of ropivacaine (0.125%) compared with bupivacaine (0.125%) after addition of sufentanil for analgesia during labor. ⋯ Ropivacaine 0.125% with sufentanil affords reliable analgesia with minimal motor blockade.
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Randomized Controlled Trial Clinical Trial
Dose-response effects of spinal neostigmine added to bupivacaine spinal anesthesia in volunteers.
Intrathecal adjuncts often are used to enhance small-dose spinal bupivacaine for ambulatory anesthesia. Neostigmine is a novel spinal analgesic that could be a useful adjunct, but no data exist to assess the effects of neostigmine on small-dose bupivacaine spinal anesthesia. ⋯ The addition of 50 microg neostigmine prolonged the duration of sensory and motor block. However, high incidences of side effects and delayed recovery from anesthesia with the addition of 6.25 to 50 microg neostigmine may limit the clinical use of these doses for outpatient spinal anesthesia.
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In the absence of explicit memories such as the recall and recognition of intraoperative events, memory of auditory information played during general anesthesia has been demonstrated with several tests of implicit memory. In contrast to explicit memory, which requires conscious recollection, implicit memory does not require recollection of previous experiences and is evidenced by a priming effect on task performance. The authors evaluated the effect of a standardized anesthetic technique on implicit memory, first using a word stem completion task, and then a reading speed task in a subsequent study. ⋯ Implicit memory was demonstrated after anesthesia by the reading speed task but not by the word stem completion task. Some methodologic aspects, such as using low frequency words or varying study and test modalities, may account for the negative results of the word stem completion task. Another explanation is that anesthesia with propofol, alfentanil, and nitrous oxide suppressed the word priming but not the reading speed measure of implicit memory. The reading speed paradigm seems to provide a stable and reliable measurement of implicit memory.
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Comparative Study
Mechanisms of bronchoprotection by anesthetic induction agents: propofol versus ketamine.
Propofol and ketamine have been purported to decrease bronchoconstriction during induction of anesthesia and intubation. Whether they act on airway smooth muscle or through neural reflexes has not been determined. We compared propofol and ketamine to attenuate the direct activation of airway smooth muscle by methacholine and limit neurally mediated bronchoconstriction (vagal nerve stimulation). ⋯ The local bronchoprotective effects of ketamine and propofol on airways is through neurally mediated mechanisms. Although the direct effects on airway smooth muscle occur at high concentrations, these are unlikely to be of primary clinical relevance.