Anesthesia and analgesia
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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 Clinical TrialEffects of end-tidal gas monitoring and flow rates on hemodynamic stability and recovery profiles.
This study was designed to evaluate the impact of routine end-tidal anesthetic gas monitoring on the intraoperative hemodynamic stability and early recovery profile in 253 consenting ASA physical status I-III patients undergoing elective otolaryngologic procedures with isoflurane or enflurane anesthesia. Patients were randomly assigned to one of six treatment groups: Group I, monitored high-flow isoflurane; Group II, unmonitored high-flow isoflurane; Group III, monitored low-flow isoflurane; Group IV, unmonitored low-flow isoflurane; Group V, monitored low-flow enflurane; or Group VI, unmonitored low-flow enflurane. After a standardized induction sequence, anesthesia was maintained by administering variable concentrations of isoflurane or enflurane in an air/oxygen mixture at two different total gas flow rates (0.7 L/min or 3.5 L/min, respectively). ⋯ Intraoperative hemodynamic stability was assessed in each patient and reported as the average error from the preincisional (baseline) MAP, average absolute error from the baseline MAP, coefficients of variation for HR, systolic, diastolic, and MAP values, and ET anesthetic concentrations. Recovery times from discontinuation of the volatile drug until awakening, following commands, and postanesthesia care unit (PACU) discharge were recorded. The six study groups had similar intraoperative MAP and HR values, coefficients of variation, and numbers of episodes of hypertension, hypotension, tachycardia, and bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
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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
The effects of carrier gas composition on the performance of the Tec 6 desflurane vaporizer.
The new Tec 6 desflurane vaporizer is an electrically heated, pressurized, electromechanically coupled dual-circuit blender. We hypothesized that carrier gas viscosity should affect the electromechanical coupling of the fresh gas and vapor circuits, and that desflurane output should vary with different carrier gases. In the first portion of the study, the performance of eight vaporizers was evaluated using a constant dial setting of 10% desflurane with four different carrier gases and three different fresh gas flow rates. ⋯ At a flow rate of 1.0 L/min with a constant dial setting of 10%, the averaged output from vaporizers was 10.3 +/- 0.66, 9.4 +/- 0.58, 8.7 +/- 0.52, and 8.1 +/- 0.44 vol% for 100% oxygen, air, 30% oxygen plus 70% nitrous oxide, and 100% nitrous oxide, respectively. With 100% nitrous oxide as the carrier gas at a flow rate of 1.0 L/min, the vaporizer delivered 2 vol% less than the dial setting at dial settings in excess of 12%. Differences between the analyzed concentration and the dial setting were most pronounced with high concentrations of nitrous oxide at low fresh gas flow rates.
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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.