Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1993
Randomized Controlled Trial Comparative Study Clinical TrialMuscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia.
We determined the dose-response relationship, the onset time, the duration, and the recovery time of a rocuronium neuromuscular block under four anesthesia techniques. Patients were equally randomized to four different groups (n = 20) receiving 0.5%-1% halothane, 1.5%-2% enflurane, 1.2%-1.8% isoflurane end-tidal concentration in 34%/66% O2/N2O, or 6.0 mg.kg-1 x h-1 propofol without N2O for anesthesia and alfentanil for analgesia. Strength of thumb adduction in response to single and train-of-four stimulation of the ulnar nerve was quantitated. ⋯ There was a statistically significant difference between the halothane and TIVA, and between the enflurane and TIVA groups (P < 0.05). Rocuronium has a short onset time and an intermediate duration of action. The neuromuscular blocking potency and pharmacodynamic profile are moderately influenced by volatile anesthetics.
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Anesthesia and analgesia · Sep 1993
Randomized Controlled Trial Comparative Study Clinical TrialA clinical and laboratory study to compare the addition of 0.2 mg of morphine, 0.2 mg of epinephrine, or their combination to hyperbaric bupivacaine for spinal anesthesia in cesarean section.
The aim of this prospective, randomized, double-blind study was to compare the effects of adding either preservative-free morphine, 0.2 mg (n = 20), epinephrine, 0.2 mg (n = 21), or a combination of both (n = 29) to hyperbaric bupivacaine in parturients having elective cesarean sections during spinal anesthesia. Ten additional patients receiving spinal bupivacaine alone were studied as the Control Group. High-pressure liquid chromatography with a sensitivity of 20 micrograms/mL was used to measure serum bupivacaine in all subjects. ⋯ The concentrations of bupivacaine in umbilical arterial and venous sera were less than the sensitivity level of the analytical method. We conclude that the addition of 0.2 mg of morphine plus 0.2 mg of epinephrine to hyperbaric bupivacaine improves the intra- and postoperative analgesia without an added risk. This improvement is not due to vasoconstriction and a reduction in the absorption of bupivacaine from the subarachnoid space.
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Anesthesia and analgesia · Sep 1993
Randomized Controlled Trial Comparative Study Clinical TrialTime course of action and endotracheal intubating conditions of Org 9487, a new short-acting steroidal muscle relaxant; a comparison with succinylcholine.
In a randomized study, we evaluated lag time (time from the end of injection of muscle relaxant until the first depression of the train-of-four response [TOF]), onset time (time from the end of injection of muscle relaxant until the maximum depression of the first twitch of the TOF [T1]), neuromuscular block, and endotracheal intubating conditions at 1 min after 1 mg/kg succinylcholine (n = 15) and 1.5 mg/kg Org 9487 (n = 30). Two minutes after administration of Org 9487, 15 of the 30 patients received neostigmine for reversal. Recovery of neuromuscular block after succinylcholine, Org 9487 without and Org 9487 with neostigmine were compared using the time until T1 was 90% for the succinylcholine group, and the time until TOF was 70% for the Org 9487 groups. ⋯ Times until clinically sufficient recovery of neuromuscular block induced by succinylcholine (time until T1 = 90%: 10.6 [3.3] min) and Org 9487 with neostigmine (time until TOF = 70%: 11.6 [1.4] min) were not different. In contrast, in the Org 9487 without neostigmine group, more time was required until complete recovery (24.1 [6.2] min) (P < 0.05). In conclusion, ORg 9487 is a muscle relaxant suitable for endotracheal intubation and short-lasting interventions.
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Anesthesia and analgesia · Sep 1993
Comparative StudyNeurotoxicology of chronic infusion of the ganglioside GM1 in the ewe: phase I. intrathecal administration.
Gangliosides, including GM1, provide a measure of improved functional recovery after ischemic, toxic, and traumatic brain injuries in animal studies. Since systemically injected GM1 has provided equivocal results in a variety of human neurodegenerative conditions, the possibility exists that intrathecal or intracerebroventricular delivery might provide more effective concentrations along the neuroaxis. In preparation to consider clinical trials, the potential neurotoxicologic effects of chronic intrathecal GM1 were studied in ewes. ⋯ In both treated and control groups, the only consistent finding was a pericatheter-associated compression of white matter with axonal dilation, vacuolation, and occasional neuronal loss. Catheter tracts in both groups were also associated with variable leptomeningeal fibroproliferative changes in adjacent dura and pia, at times in conjunction with more generalized duromeningeal thickening. In summary, chronic intrathecal GM1 in doses up to 10 mg/d had no definable neuropathologic consequences.
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Anesthesia and analgesia · Sep 1993
Attitudes of anesthesiology residents toward critical care medicine training.
The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and training in CCM. ⋯ Written responses to open-ended questions suggested resident concerns with the following: stress of chronic care, financial consequences of additional year of training, ICU call frequency and load, ICU role ambiguity, and shared decision-making in the ICU. A recurring question was, "Are there jobs (outside of academics) for anesthesiologist intensivists?" Most residents knew a CCM anesthesiologist they admired and knew that there were unfilled fellowship positions available. Defining the job market, improving curriculum and teaching, supporting deferment of student loans, and introducing residents and medical students to the ICU earlier may increase the interest in CCM practice among anesthesiology residents.