Anesthesia and analgesia
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The low solubility of desflurane contributes to rapid emergence after outpatient anesthesia. Compared with isoflurane, recovery times to eye opening, response to verbal commands, and orientation to person, place, and time have been significantly shorter. Even when compared with the rapid, short-acting intravenous anesthetic propofol for induction and maintenance of outpatient anesthesia, desflurane displayed more favorable early recovery characteristics. ⋯ As desflurane is pungent and possesses respiratory irritant properties, propofol will likely remain the induction agent of choice in the outpatient setting. In conclusion, desflurane appears to have few adverse effects on recovery after ambulatory surgery, but nausea and emesis were lower with propofol. Desflurane's relative ease of administration versus propofol may be an important determinant of its future role in outpatient anesthesia.
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Anesthesia and analgesia · Oct 1992
Comparative StudyBuccal pulse oximeter is more accurate than finger pulse oximeter in measuring oxygen saturation.
Although there have been several anecdotal reports of the use of buccal pulse oximeter monitoring (Spo2) when digital Spo2 monitoring cannot be used, there have been no objective evaluations of the accuracy of buccal Spo2 monitoring. The purpose of this study was to systematically compare buccal Spo2 monitoring to both digital Spo2 and arterial O2 saturation monitoring (Sao2) in both generally anesthetized patients in the operating room (n = 31) and critically ill patients in the intensive care unit (n = 23). Buccal Spo2 probes were prepared by taping a malleable metal bar securely over the back of a Nellcor Oxisensor D-25 probe and bending the metal bar and buccal probe firmly around the corner of the patient's mouth. ⋯ We found that buccal Spo2 was higher than finger Spo2 and agreed more closely with Sao2 for both patient groups (98.1% +/- 2.6%, 96.8% +/- 3.5%, 98.5% +/- 2.5%, respectively [mean +/- SD]). The operating room patients had higher buccal and finger Spo2 and Sao2 (99.3% +/- 1.5%, 98.9% +/- 1.4%, 99.5% +/- 0.7%, respectively) than the intensive care unit patients (96.4% +/- 2.9%, 94.1% +/- 3.5%, 96.6% +/- 3.5%, respectively). Although buccal Spo2 monitoring has several disadvantages (i.e., the probe requires preparation, can be more difficult to place, may be less readily accepted in awake patients, and is often mechanically dislodged during airway maneuvers), we conclude that buccal Spo2 monitoring is a more than adequate oximetry alternative when digital Spo2 monitoring is not an option (digits are unavailable or available digits are mechanically interfered with).
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Anesthesia and analgesia · Oct 1992
ReviewCharacteristics and implications of desflurane metabolism and toxicity.
The metabolism of desflurane has been assessed both in animals and humans by measuring the appearance of fluoride metabolites (fluoride ion, nonvolatile organic fluoride, trifluoroacetic acid) in blood and urine. Desflurane administered to rats (either pretreated or not pretreated with phenobarbital or ethanol) for 3.2 MAC-hours and to swine for 5.5 MAC-hours produced fluoride ion levels in blood that were almost indistinguishable from values measured in control animals. In contrast, a significant 17% increase in plasma fluoride ion concentration in swine was detected 4 h after exposure to desflurane. ⋯ Peak serum concentrations averaging 0.38 +/- 0.17 microM trifluoroacetic acid (mean +/- SD) and peak urinary excretion rates averaging 0.169 +/- 0.107 mumol/h were detected in volunteers 24 h after desflurane exposure. Although these increases in trifluoroacetic acid after exposure to desflurane were statistically significant, they are approximately 10-fold less than levels seen after exposure to isoflurane. Desflurane strongly resists biodegradation, and only a small amount is metabolized in animals and humans.
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Anesthesia and analgesia · Oct 1992
Comment Letter Comparative StudyPreemptive analgesia: an early observation.