Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Comparative Study Clinical TrialPancuronium or vecuronium for treatment of shivering after cardiac surgery.
This randomized double-blind study compared the hemodynamic and metabolic effects of pancuronium and vecuronium during treatment of shivering after cardiac surgery with hypothermic cardiopulmonary bypass. Thirty sedated and pain-free patients who shivered after cardiac surgery were treated with pancuronium (n = 15) or vecuronium (n = 15) 0.08 mg/kg. Baseline values of heart rate (HR), mean arterial pressure, arterial and venous blood gases, total body oxygen consumption indexed to body surface area (VO2-I), and pressure work index (PWI, an estimate of myocardial oxygen consumption) were measured on arrival in the intensive care unit, at onset of shivering, and repeatedly for 2 h after treatment. ⋯ The disproportionate relationship between VO2-I and PWI after treatment with muscle relaxants indicates that increased VO2-I does not contribute significantly to the hemodynamic disturbances associated with shivering. These disturbances are more likely the results of increased adrenergic activity related to pain and recovery from anesthesia. Shivering and its associated hemodynamic disturbances appear to be concomitant but independent signs of awakening.
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Anesthesia and analgesia · Sep 1994
Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty?
Peroneal nerve palsy is a rare complication of total knee arthroplasty (TKA). Previous studies have investigated surgical variables contributing to the development of peroneal nerve palsy after TKA, but have ignored potential medical and anesthetic risk factors. The charts of all patients undergoing TKA over a 1-yr period were retrospectively studied to identify medical, surgical, and anesthetic risk factors contributing to the development of peroneal nerve palsy after TKA; 361 TKAs were performed on 292 patients. ⋯ However, all cases of peroneal nerve palsy with motor deficits and partial neurologic recovery occurred in patients receiving postoperative epidural analgesia and were diagnosed after discontinuation of the epidural infusion. Since diagnosis of peroneal nerve palsy may be delayed in patients with postoperative epidural analgesia, these patients must be monitored closely. A dilute local anesthetic or an opioid infusion is recommended for patients at increased risk, such as those with preexisting neuropathies.
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Anesthesia and analgesia · Sep 1994
Comparative StudyThe partition coefficient as a predictor of local anesthetic potency for spinal anesthesia: evaluation of five local anesthetics in a mouse model.
Local anesthetic partition coefficients correlate with drug potencies in vitro, but in vivo data have not always complimented in vitro results. Despite extensive studies on intrathecal anesthetic action, whether there is correlation between the partition coefficient and local anesthetic potency has not been addressed. Mice (n = 150) were randomly allocated into 15 groups. ⋯ ED50 showed high correlation (R = 0.978) with partition coefficients of local anesthetics. This study implies that the partition coefficient is a predictor of intrathecal local anesthetic potency. We suggest that the mouse model is reliable for evaluation of intrathecal local anesthetic action.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Clinical TrialOndansetron reduces the incidence and severity of poststrabismus repair vomiting in children.
This prospective, randomized, placebo-controlled, double-blinded study evaluated the antiemetic efficacy of ondansetron and metoclopramide in 90 ASA physical status I or II children, 2-17 yr of age, undergoing strabismus repair. After anesthetic induction and prior to eye muscle manipulation, subjects received normal saline 0.3 mL/kg (Group 1), metoclopramide 0.25 mg/kg (Group 2), or ondansetron 0.15 mg/kg (Group 3), intravenously. There were no differences between groups with respect to age, weight, gender, fluids received, number of eye muscles repaired, anesthetic technique, or time in the operating room. ⋯ The number of children vomiting prior to discharge and within 24 h of surgery was significantly reduced in Group 3 compared with Group 1 (P < 0.003 and P < 0.015, respectively). The number of vomiting episodes per patient in Groups 1, 2, and 3 was 1.1, 0.5, and 0.1 prior to discharge, and 4.5, 2.6, and 1.2 during the 24 h after surgery (P < 0.0005 and P < 0.004, respectively). Ondansetron 0.15 mg/kg intravenously after the induction of anesthesia reduces the incidence and severity of vomiting after strabismus repair both prior to discharge from the hospital and during the 24 h after surgery.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Comparative Study Clinical TrialPropofol and thiopental anesthesia: a comparison of the incidence of dreams and perioperative mood alterations.
The purpose of this study was to investigate perioperative mood profiles and the incidence of dreams in patients receiving anesthesia with either propofol (n = 29) or thiopental (n = 27) in combination with nitrous oxide. The study was a prospective, randomized, and double-blind investigation of female patients undergoing outpatient dilation and curettage. Recall of dreams was assessed 1 h postoperatively and the following day by using a questionnaire designed for surgical patients. ⋯ In the postoperative period, patients receiving propofol exhibited sensation-seeking tendencies (i.e., active, adventurous, aggressive, daring, energetic, enthusiastic, merry) when compared to the thiopental patients (P < 0.02). The incidence of dreams was small and equal in both groups. We conclude that patients anesthetized with propofol and nitrous oxide, as compared to patients anesthetized with thiopental and nitrous oxide, were more likely to demonstrate adventurous tendencies in the postoperative period.