Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous intravenous infusion of rocuronium (ORG 9426) in patients receiving balanced, enflurane, or isoflurane anesthesia.
Rocuronium (ORG 9426) is a new nondepolarizing neuromuscular blocking agent with a rapid onset and an intermediate duration of action. This study obtains the infusion requirements of rocuronium in 30 patients in whom anesthesia was maintained with barbiturate-nitrous oxide-opioid, nitrous oxide and enflurane, or nitrous oxide and isoflurane. ⋯ The infusion requirements to maintain 95% twitch depression approximated 10 micrograms.kg-1.min-1 during barbiturate-nitrous oxide-opioid anesthesia. These requirements were reduced by 40% during anesthesia involving enflurane or isoflurane.
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Randomized Controlled Trial Clinical Trial
Assessment of ketorolac as an adjuvant to fentanyl patient-controlled epidural analgesia after radical retropubic prostatectomy.
Opioids, although effective postoperative analgesics, are associated with undesirable side effects. In an attempt to determine whether adjuvant, nonopioid medication would permit a reduction of the amount of fentanyl required for postoperative analgesia, the efficacy of ketorolac, an injectable nonsteroidal antiinflammatory drug, was studied as an adjuvant to fentanyl patient-controlled epidural analgesia (PCEA) for postoperative pain management following radical retropublic prostatectomy. ⋯ Ketorolac is a beneficial adjuvant to fentanyl PCEA for postoperative pain management after radical retropubic prostatectomy.
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Comparative Study
The effect of cricoid pressure on preventing gastric insufflation in infants and children.
The use of cricoid pressure for the possible prevention of regurgitation of gastric contents during induction of anesthesia in both adults and children has been recommended. However, equally important is the technique in possibly preventing insufflation of gas into the stomach. This study was designed to determine the efficacy of cricoid pressure application in preventing gastric gas insufflation in pediatric patients and to determine the airway pressure at which gas entered the stomach (pop-off point). ⋯ Appropriate application of cricoid pressure prevents gastric gas insufflation during airway management via mask up to 40 cm H2O PIP in infants and children. An additional benefit of cricoid pressure occurs in paralyzed patients in whom gastric insufflation occurs at lower inflation pressures.
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Clinical Trial
Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response.
A previous study has demonstrated a decrease in the hypoxic ventilatory response in volunteers partially paralyzed with vecuronium. However, in this study, hypocapnia was allowed to occur. Because hypocapnia counteracts the ventilatory response to hypoxia during partial vecuronium-induced neuromuscular block and isocapnia, the hypoxic ventilatory response (HVR) was tested in 10 awake volunteers. ⋯ We conclude that a vecuronium-induced partial neuromuscular block impairs HVR more than it does HCVR in humans, suggesting an effect of vecuronium on carotid body hypoxic chemosensitivity.
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The subcutaneous injection of formalin in the rat paw results in several minutes of flinching (phase 1) followed by cessation of activity then resumption of flinching (phase 2), which depends on facilitation of spinal transmission evoked by C-fiber activity generated immediately after the noxious stimulus. It was hypothesized that suppression of dorsal horn activity during and immediately after formalin injection by inhalation anesthetics or intrathecal opiates would block spinal facilitation and inhibit phase 2 flinching, even if the anesthetic or opiate were eliminated before phase 2. ⋯ Isoflurane, even at high concentrations, administered during and shortly after a noxious stimulus produces only a modest reduction in facilitation of afferent processing. The addition of intrathecal morphine during the period of nociceptor activity results in marked attenuation of the facilitated state.