Anesthesiology
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Sevoflurane previously has been reported to undergo extensive degradation in the presence of soda lime. To more completely characterize the extent and significnce of this reaction, we studied degradation of sevoflurane with and without soda lime, as well as the toxicity and mutagenicity of the degradation products. Two degradation products detected were CF2 = C(CF3)OCH2F (compound A) and CH3OCF2CH(CF3)OCH2F (compound B). ⋯ Exposure of fibroblasts to 7,500 ppm of compound A for 1 h, compound A did not induce structural change. In a study of acute toxicity of compound B, there was no toxicity in Wistar rats after 3 h of exposure at 2,400 ppm. The reverse (Ames) test for compound B was negative at 625-1,250 micrograms/dish.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia.
A number of recent studies have suggested that the analgesic effects of highly lipid-soluble opioids are similar when these agents are administered either epidurally or intravenously. We sought to test whether the lipid-soluble opioid sufentanil was more effective when administered intrathecally than when administered epidurally or intravenously. Twenty-four women during active labor received sufentanil 10 micrograms either intrathecally (n = 9), epidurally (n = 8), or intravenously (n = 7), using a combined spinal-epidural technique. ⋯ No patient developed post-dural puncture headache. We conclude that sufentanil 10 micrograms intrathecally provides rapid and effective analgesia of 1-2-h duration during labor. Epidural and intravenous use of this dose of sufentanil did not provide evidence of satisfactory analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of the laryngeal mask airway as an alternative to a face mask during outpatient arthroscopy.
The laryngeal mask airway (LMA) has recently become available in the United States, and several authors have suggested that it is superior to an anesthesia mask. To test this hypothesis, 64 patients undergoing outpatient arthroscopic knee surgery were randomly assigned to have anesthesia maintained via either a laryngeal mask airway (LMA) (n = 31) or a standard face mask (n = 33). Anesthesia was induced with fentanyl 1 microgram.kg-1 and propofol 2 mg.kg-1 and maintained with a variable-rate propofol infusion (50-180 micrograms.kg-1 x min) and nitrous oxide 67% in oxygen. ⋯ Insertion of the LMA was not associated with any acute changes in hemodynamic values. Intraoperative hemodynamic values and anesthetic requirements did not differ significantly between the two treatment groups. There were no significant differences in the emergence and recovery times or in the incidence of postoperative sore throats between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)