Anesthesiology
-
Randomized Controlled Trial Clinical Trial
Effect of flumazenil on recovery after midazolam and propofol sedation.
Flumazenil, a benzodiazepine antagonist, reverses midazolam-induced sedation and amnesia. We designed a double-blind study to evaluate the effects of flumazenil on patient outcome when flumazenil was used to reverse large or small doses of midazolam as part of standardized monitored anesthesia care. ⋯ Early recovery after breast biopsy procedures with midazolam sedation and flumazenil reversal is similar to recovery after propofol sedation. However, the beneficial effects of flumazenil were apparent only during the first 60 min after the procedure and resedation after discharge is an important consideration in the outpatient setting.
-
Randomized Controlled Trial Clinical Trial
Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination.
Rocuronium is a new nondepolarizing neuromuscular blocking agent with a rapid onset but with intermediate duration of action. Mivacurium, on the other hand, is a new short-acting nondepolarizing neuromuscular relaxant, but of slower onset of action. The current study was undertaken to characterize the interaction between rocuronium and mivacurium. ⋯ The interaction between rocuronium and mivacurium was found to be synergistic.
-
Clinical Trial Controlled Clinical Trial
Long-duration, low-flow sevoflurane anesthesia using two carbon dioxide absorbents. Quantification of degradation products in the circuit.
Sevoflurane reacts with soda lime, generating degradation products. The concentrations of sevoflurane degradation products in a low-flow circuit have been reported for anesthesia times of less than 5 h. In this study, sevoflurane degradation products generated during low-flow anesthesia exceeding 10 h were examined. ⋯ The degradation products detected were at low concentrations in long-duration, low-flow anesthesia with sevoflurane. Baralyme produced higher concentrations of degradation products than soda lime.
-
Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients.
We prospectively studied surgical cancer patients who received epidural bupivacaine-morphine to determine perioperative morphine use, side effects, and complications. ⋯ Continuous epidural analgesia with 0.05-0.1% bupivacaine and 0.01% morphine is an effective method of postoperative analgesia with a low incidence of side effects, that can be safely administered on the surgical wards with no special monitoring equipment.
-
Comparative Study
Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function.
Transesophageal echocardiography (TEE) is used to diagnose hypovolemia despite the lack of validation studies. The objective was to determine the effects of acute graded hypovolemia on TEE and conventional hemodynamic determinants of left ventricular (LV) preload in anesthetized patients with normal and abnormal LV function. ⋯ TEE and hemodynamic determinants of LV preload detected changes in LV function caused by acute blood loss. Acute blood loss caused directional changes in LV end-diastolic area, pulmonary artery occlusion pressure, and LV end-diastolic wall stress even in patients with LV wall motion abnormalities. Changes in LV end-diastolic wall stress, derived from both TEE and hemodynamic measurements corresponded to changes in cardiac output, stroke volume, and mixed venous oxygen saturation that occurred during acute blood loss.