Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia.
Hypercapnia abolishes cerebral autoregulation, but little is known about the interaction between hypercapnia and autoregulation during general anesthesia. With normocapnia, sevoflurane (up to 1.5 minimum alveolar concentration) and propofol do not impair cerebral autoregulation. This study aimed to document the level of hypercapnia required to impair cerebral autoregulation during propofol or sevoflurane anesthesia. ⋯ Even mild hypercapnia can significantly impair cerebral autoregulation during general anesthesia. There is a significant difference between propofol anesthesia and sevoflurane anesthesia with respect to the effect of hypercapnia on cerebral autoregulation. This difference occurs at clinically relevant levels of Paco2. When inducing hypercapnia, carbon dioxide reactivity is significantly affected by the MAP.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery.
Given the current practice environment, it is important to determine the anesthetic technique with the highest patient acceptance and lowest associated costs. The authors compared three commonly used anesthetic techniques for anorectal procedures in the ambulatory setting. ⋯ The use of local anesthesia with sedation is the most cost-effective technique for anorectal surgery in the ambulatory setting.
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Randomized Controlled Trial Clinical Trial
Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma.
The ability of intravenous lidocaine to prevent intubation-induced bronchospasm is unclear. The authors performed a prospective, randomized, double-blind, placebo-controlled trial to test the ability of intravenous lidocaine and inhaled albuterol to attenuate airway reactivity after tracheal intubation in asthmatic patients undergoing general anesthesia. ⋯ Inhaled albuterol blunted airway response to tracheal intubation in asthmatic patients, whereas intravenous lidocaine did not.
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Randomized Controlled Trial Comparative Study Clinical Trial
Low- and medium-molecular-weight hydroxyethyl starches: comparison of their effect on blood coagulation.
High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than medium-molecular-weight HES. The authors compared medium molecular weight HES (200 kd [HES200]) and low-molecular-weight HES (70 kd [HES70]). ⋯ Low-molecular-weight hydroxyethyl starch (70 kd) compromises blood coagulation slightly less than HES200, but it is unclear whether this is clinically relevant.
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Randomized Controlled Trial Comparative Study Clinical Trial
Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis.
The development of metabolic acidosis during cardiopulmonary bypass (CPB) is well recognized but poorly understood. The authors hypothesized that the delivery of pump prime fluids is primarily responsible for its development. Accordingly, acid-base changes induced by the establishment of CPB were studied using two types of priming fluid (Haemaccel, a polygeline solution, and Ringer's Injection vs. Plasmalyte 148) using quantitative biophysical methods. ⋯ Cardiopulmonary bypass-induced metabolic acidosis appears to be iatrogenic in nature and derived from the effect of pump prime fluid on acid-base balance. The extent of such acidosis and its duration varies according to the type of pump prime.