Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialOral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain.
Oral transmucosal fentanyl citrate (OTFC) has been used in a variety of clinical situations. This study was designed to determine if OTFC could provide analgesia to patients with acute pain after major surgery. Following written informed consent, 38 ASA Physical Status I-III patients undergoing either a total hip replacement or total knee arthroplasty were studied prospectively. ⋯ Twenty-eight patients completed the study, 13 in the control group and 15 in the OTFC group. There were no significant differences between the study groups as to patients' age, gender, ASA classification, or surgical procedure. In addition, there were no differences between the groups in the number of PCA attempts or delivered dose of morphine during the prestudy or poststudy periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialOnset, intensity of blockade and somatosensory evoked potential changes of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine.
The onset and intensity of blockade of the lumbosacral dermatomes after epidural anesthesia with alkalinized lidocaine were investigated in a randomized, double-blind study in 26 patients. Control subjects (n = 13) received 20 mL of 1.37% lidocaine (1.5% lidocaine plus 1 mL saline per 10 mL lidocaine) with added 1:200,000 epinephrine; the solution pH was 6.20 +/- 0.08. Patients in the alkalinized lidocaine group (n = 13) were given 20 mL of 1.37% lidocaine plus added bicarbonate (1 mL sodium bicarbonate per 10 mL 1.5% lidocaine) and 1:200,000 epinephrine; the solution pH was 7.18 +/- 0.10. ⋯ Motor blockade was significantly more profound in the alkalinized lidocaine group. Thirteen of 78 PTN and L5 and S1 dermatomal SSEPs were abolished in the alkalinized lidocaine group compared to 4 of 78 SSEPs in the nonalkalinized group. Alkalinization of lidocaine is recommended to shorten the time to block the L5-S1 dermatomes when epidural anesthesia is planned for lower extremity surgery.
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialInfluence of different glucose-insulin-potassium regimes on glucose homeostasis and hormonal response in cardiac surgery patients .
Intravenous infusion of glucose/insulin in combination with potassium (GIK) is an often used technique to improve myocardial preservation in cardiac surgery. In a randomized study in 50 patients undergoing elective aortocoronary bypass grafting with good ventricular function, the influence on glucose homeostasis and hormonal response to four different glucose/insulin regimes were compared to an untreated control: 1) 50 g of glucose mixed with 100 U of human insulin (HI/100); 2) 50 g of glucose mixed with 100 U of bovine insulin (BI/100); 3) 50 g of glucose mixed with 50 U of human insulin (HI/50); and 4) 50 g of glucose mixed with 50 U of bovine insulin (BI/50) [corrected]. Glucose/insulin were given in combination with 70 mmol of potassium 40 min before beginning the operation. ⋯ Blood glucose levels showed no differences among all GIK groups (groups 1-4) but were significantly higher than in the control patients. The incidence of severely reduced (< 50 mg/dL) or elevated blood glucose level (> 300 mg/dL) did not differ between HI- and BI-treated patients but was significantly lower in the untreated control. Insulin plasma level increased significantly after infusion of GIK with higher levels in HI- than BI-treated patients (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1993
"Do not resuscitate" (DNR) orders and the anesthesiologist: a survey.
Anesthesiologists were surveyed to determine their experience and opinions regarding "Do Not Resuscitate" (DNR) orders in the perioperative period. Four hundred fifteen questionnaires were mailed and 193 (47%) were returned. One hundred sixty-one (87%) of 186 respondents had been requested to provide (and more than two-thirds had provided) monitored anesthesia care, regional anesthesia, or general anesthesia to a patient with a DNR order. ⋯ After agreeing to a patient's decision to retain their DNR status, > 67%, > 58%, < 49%, and < 33% would utilize positive pressure ventilation with a mask, vasoactive drugs, endotracheal intubation, or defibrillation, respectively, in the event of a cardiopulmonary arrest in the perioperative period. These findings suggest much ambiguity regarding DNR orders in the perioperative period. Further discussion among physicians and patients is warranted.
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Anesthesia and analgesia · Feb 1993
Influence of age on awakening concentrations of sevoflurane and isoflurane.
We determined whether age, duration of anesthesia, gender, or type of surgery significantly influenced end-tidal concentrations on awakening from anesthesia with sevoflurane and isoflurane in 39 healthy ASA physical status I patients. Postoperatively, the end-tidal anesthetic concentration was maintained at a constant level at least for 15 min. If patients failed to open their eyes on request, the end-tidal concentration was decreased and again maintained at a constant level for 15 min. ⋯ The end-tidal concentrations on awakening from anesthesia were 0.62 +/- 0.02% (mean +/- SE) for sevoflurane and 0.41 +/- 0.02% for isoflurane. Awakening concentration of sevoflurane and isoflurane correlated significantly with age (P < 0.001), but not with duration of anesthesia, gender, or type of surgery. The authors conclude that awakening concentration decreases at the similar rate of decrease in minimum alveolar concentration (MAC) with increasing age; and therefore, the ratios to MAC are fairly constant, being 0.34 for both sevoflurane and isoflurane.