Anesthesia and analgesia
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Anesthesia and analgesia · May 1993
Randomized Controlled Trial Clinical TrialAccelerated onset and delayed recovery of neuromuscular block induced by mivacurium preceded by pancuronium in children.
The goal of this study was to describe a technique which could shorten the time from mivacurium administration to peak neuromuscular block (NMB) after administration of the maximum recommended dose of mivacurium. Forty-eight pediatric patients were randomized into three groups and studied during nitrous oxide-alfentanil-thiopental anesthesia. Every patient received two blinded injections 3 min apart: either 15 micrograms/kg of pancuronium in 1 mL of saline followed by 170 or 200 micrograms/kg of mivacurium or saline followed by 200 micrograms/kg of mivacurium. ⋯ Time from injection to 90% NMB averaged 116 (SEM 11) s after administration of 200 micrograms/kg of mivacurium, and 71 (7) s and 94 (11) s when 200 micrograms/kg or 170 micrograms/kg of mivacurium, respectively, was preceded by pancuronium (P = 0.0095). Mean times from injection to recovery of neuromuscular function to > 25% of baseline (T25) and to train-of-four ratio of 0.75 were 9.1 (0.7) and 15.8 (1.2) min, respectively, after administration of 200 micrograms/kg of mivacurium alone. T25 and train-of-four of 0.75 occurred significantly later at 21.9 (1.8) and 35.0 (2.8) min, respectively (P = 0.0001), when 200 micrograms/kg of mivacurium was preceded by 15 micrograms/kg of pancuronium.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1993
Randomized Controlled Trial Clinical TrialEffects of alfentanil on the hemodynamic and catecholamine response to tracheal intubation.
A randomized, placebo-controlled study was conducted in 60 ASA Class I, II, and III patients to determine the dose response of alfentanil in moderating the cardiovascular and catecholamine response to tracheal intubation (INT). Patients were randomly allocated into one of four groups to receive either 15 micrograms/kg alfentanil (A15), 30 micrograms/kg alfentanil (A30), 45 micrograms/kg alfentanil (A45), or normal saline (control), given intravenously (i.v.) before induction of anesthesia. One minute after administration of 4.0 mg/kg thiopental and 1.5 mg/kg succinylcholine i.v., tracheal intubation was performed using direct laryngoscopy. ⋯ In the control group, epinephrine and norepinephrine serum concentrations increased by 152 +/- 52% and 58 +/- 62%, respectively, following INT (different from A30 and A45, P < 0.05). However, up to a dose of 30 micrograms/kg (A30), a dose-dependent decrease in the maximum percent changes of both epinephrine and norepinephrine occurred in response to INT. A larger dose of alfentanil was no more efficacious as the catecholamine response to tracheal intubation was not significantly different when comparing the A45 and A30 groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1993
Fentanyl plasma concentrations maintained by a simple infusion scheme in patients undergoing cardiac surgery.
The ability of a simple infusion scheme for fentanyl to achieve and maintain one of two target concentrations of fentanyl in plasma was studied in 17 patients having cardiac surgery that required the use of moderate hypothermic cardiopulmonary bypass (CPB). All patients received preanesthetic medication including morphine, a benzodiazepine, and/or scopolamine. Anesthesia was induced and maintained by one of two fentanyl infusion regimens: HIGH-FEN (n = 6), a priming infusion of 2.4 micrograms.kg-1 x min-1 for 20 min in combination with a continuous infusion of 0.3 microgram.kg-1.min-1 for the duration of the operation to produce a plasma fentanyl concentration of 20-25 ng/mL; or LOW-FEN (n = 11), priming and maintenance infusions of 2.4 and 0.15 micrograms.kg-1 x min-1 designed to produce a fentanyl concentration of 12-15 ng/mL of plasma. ⋯ The 11 patients receiving LOW-FEN had a plasma fentanyl concentration maintained below 20 ng/mL (range 13-17 ng/mL). Eight patients before and 10 patients after CPB required anesthetic supplementation for adverse hemodynamic or somatic responses. For comparison purposes, another eight patients received a single 75 micrograms/kg dose of fentanyl during 20 min for induction of anesthesia, and 7 of the 8 required supplemental anesthetic agents before and after CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1993
Randomized Controlled Trial Clinical TrialEffects of ketorolac on postoperative analgesia and ventilatory function after laparoscopic cholecystectomy.
Ketorolac, a nonsteroidal anti-inflammatory drug, is alleged to produce postoperative analgesia without opioid-related side effects. Patients undergoing laparoscopic cholecystectomy were assigned randomly to receive either ketorolac or a placebo (saline) according to a double-blind protocol. Preoperative (baseline) pulmonary function was evaluated using a Respiradyne II monitor. ⋯ In the ketorolac group, only values of forced expiratory volume at 1 s and forced expiratory flow at 25%-75% of the forced vital capacity at 4 h after the operation were significantly higher than those in the saline group (P < 0.05). Incidences of nausea (45% vs 52%) and vomiting (10% vs 10%) were similar in both groups. In conclusion, ketorolac decreased the postoperative requirement for opioid analgesic medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1993
Comparative StudyThe effect of fentanyl, sufentanil, and alfentanil on cerebral arterioles in piglets.
The effect of fentanyl, sufentanil, and alfentanil on cerebral arterioles was determined in 17 halothane-anesthetized newborn piglets. A closed cranial window was inserted over the parietal cortex, and changes in the luminal diameter of pial arterioles were measured by intravital microscopy as increasing concentrations of opioid (10(-9)-10(-5) M) were suffused over the cortical surface. ⋯ Naloxone alone had no effect at concentrations < or = 10(-5) M, suggesting that endogenous opioids contribute little to resting cerebrovascular tone. These results indicate that fentanyl, sufentanil, and alfentanil produce cerebral vasoconstriction by action at an opioid receptor and that their vasoconstrictive potency appears to differ from their analgesic potency.