Anesthesia and analgesia
-
Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of methylnaltrexone versus naloxone for reversal of morphine-induced depression of hypoxic ventilatory response.
Methylnaltrexone (MNTX) is a quaternary derivative of naltrexone. It does not cross the blood-brain barrier and, thus, it reverses peripherally mediated effects of morphine without blocking its centrally located analgesic effects. The effects of MNTX on morphine-induced depression of hypoxic ventilatory response are unknown. ⋯ MNTX slope (69%) was not statistically different from the control, whereas VE80 (70%) was still depressed (P < 0.05). Placebo slope and VE80, at 120 min, remained lower than the control (P < 0.05). These data show that MNTX is not as effective as naloxone for reversal of morphine-mediated depression of respiration during acute hypoxia.
-
Anesthesia and analgesia · Apr 1994
Comparative Study"Do not resuscitate" (DNR) orders in the perioperative period--a comparison of the perspectives of anesthesiologists, internists, and surgeons.
The purpose of this descriptive study is to compare and contrast the experience, perceptions, and opinions of practicing anesthesiologists, internists, and surgeons regarding "do not resuscitate" (DNR) orders in the perioperative period. A questionnaire was mailed to 600 internists and 600 surgeons. Responses from these two groups were analyzed and compared with the results of a previously reported survey of 420 anesthesiologists. ⋯ All groups were more likely to require DNR suspension for elective than for palliative cases. The majority of all groups concurred that physician responsibility for defining DNR status in the perioperative period should be shared by the anesthesiologist, surgeon, and primary care physician and not prescribed by hospital policy. The manner in which a DNR order is perceived in the perioperative period varies considerably among specialties and warrants further discussion among these groups.
-
Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Clinical TrialFacilitation of fiberoptic orotracheal intubation with a flexible tracheal tube.
Advancement of a tracheal tube (TT) over a flexible fiberoptic bronchoscope (FOB) is often impeded by obstruction at the arytenoid cartilage or epiglottis. We tested the hypothesis that the use of a flexible, spiral-wound TT, rather than the standard, preformed TT would facilitate tube passage into the trachea over the FOB. Forty patients scheduled to undergo general anesthesia with tracheal intubation were randomized to two groups. ⋯ In the patients randomized to the spiral-wound TT, 95% (19/20) of first attempts were successful (P < 0.0001). Of the 13 regular TTs that were not successfully advanced on the first attempt, seven could not be passed after the second or third attempt (necessitating the use of the cross-over spiral-wound TT). In the only instance in which a spiral-wound tube was not successfully passed into the trachea on the first attempt, passage also was not achieved after the second or third attempt.(ABSTRACT TRUNCATED AT 250 WORDS)