Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1992
Comment Letter Comparative StudyPreemptive analgesia: an early observation.
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Anesthesia and analgesia · Oct 1992
Randomized Controlled Trial Clinical TrialEpidural clonidine enhances postoperative analgesia from a combined low-dose epidural bupivacaine and morphine regimen.
In a randomized, double-blind, placebo-controlled trial, the value of adding clonidine to a low-dose epidural regimen for postoperative pain treatment was assessed. Twenty-four patients scheduled for hysterectomy during combined thoracic epidural (bupivacaine and morphine) and general anesthesia were studied. Postoperative analgesia consisted of epidural bupivacaine (5 mg/h) and morphine (0.1 mg/h) for 12 h. ⋯ We found no significant difference in pain scores at rest between the clonidine and placebo groups but an enhanced analgesic effect by clonidine during cough and mobilization (P less than 0.05). Arterial blood pressure decreased significantly during clonidine infusion and remained lower than in the control group throughout the study. We conclude that a continuous low-dose epidural clonidine infusion enhances analgesia from a combined low-dose epidural bupivacaine and morphine regimen after hysterectomy; however, the concomitant decrease in arterial blood pressure during epidural clonidine deserves further study before such a regimen can be recommended.
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This prospective study was performed to determine whether anesthesia clinicians (i.e., both anesthesiologists and nurse anesthetists) can identify operating room alarms by their distinctive sounds and to identify factors related to alarm recognition accuracy. Nineteen alarms from 15 commonly used devices were recorded. These sounds were played, in a quiet room, to 44 anesthesia clinicians. ⋯ Complexity of the sound did not influence accuracy of recognition. Most errors were attributed to similarities in sound or function, or both, among alarms. We conclude that anesthetists cannot reliably identify current operating room alarms by their distinctive sounds.
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Anesthesia and analgesia · Oct 1992
ReviewDesflurane animal and human pharmacology: aspects of kinetics, safety, and MAC.
Substitution of fluorine for the single chlorine atom in isoflurane produces the new anesthetic, desflurane. This seemingly small change produces several pharmacologic changes. The potency of desflurane (MAC equals 6.0% in middle-aged patients) is one-fifth that of isoflurane (1.15%), with MAC for each agent decreased by aging, hypothermia, or the addition of depressants such as midazolam, fentanyl, or nitrous oxide. ⋯ Of great importance, the substitution of fluorine for chlorine markedly decreases blood (desflurane blood-gas partition coefficient 0.42) and tissue solubility (e.g., brain-blood partition coefficient 1.3) relative to isoflurane (values 1.4 and 1.6, respectively). As a result, desflurane alveolar concentrations may be adjusted more rapidly and precisely; desflurane enters and leaves the lungs and tissues more rapidly; and recovery is quicker both for the short (first 10-20 min) and long (0.5-1.5 h) term. This greater precision of control and more rapid recovery are consistent with trends for new drug development in anesthesiology.
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Anesthesia and analgesia · Oct 1992
Randomized Controlled Trial Clinical TrialLack of interaction between propofol and vecuronium.
We estimated the potency of vecuronium and measured the onset and duration of its action during total intravenous anesthesia with propofol to examine the possibility of any interaction between these two drugs. Propofol infusion was administered according to a three-step dosage scheme, and neuromuscular block was monitored by measuring the force of contraction of the adductor pollicis muscle after single-twitch stimulation of the ulnar nerve at 0.1 Hz. A control group of patients were similarly studied during anesthesia with thiopental, nitrous oxide, oxygen, and fentanyl. ⋯ The onset of action of an 80-micrograms/kg dose (2 x ED95) of vecuronium was 3.6 +/- 1.2 and 4.1 +/- 1.7 min (mean +/- SD), in the propofol (n = 10) and control (n = 10) groups, respectively. The respective times to recovery of the twitch height to 25% of control and the recovery indices (25%-75% recovery of twitch height) in the propofol versus control groups were 28.3 +/- 6.6 and 28.0 +/- 1.7 min and 13.3 +/- 6.8 and 15.4 +/- 11.9 min, respectively. There were no significant differences in any of the measured variables between the propofol and control groups, indicating the lack of any interaction between propofol and vecuronium.