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
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.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Clinical TrialEffect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures.
We sought to determine whether topically applied eutectic mixture of local anesthetics (EMLA) would decrease analgesic requirement during extracorporeal shock wave lithotripsy (ESWL). Fifty-nine healthy out-patients undergoing elective ESWL using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive either a topical EMLA or placebo cream applied to the skin of the flank overlying the kidney 90 min prior to the ESWL procedure. Patients were given five test shocks at each of five different energy levels: 10, 12, 15, 18, and 20 kV. ⋯ EMLA cream was significantly more effective at decreasing cutaneous pain in male than in female patients. However, during the lithotripsy procedure, EMLA cream had no significant effect on the intraoperative requirement for intravenous alfentanil, hemodynamic variables, recovery times, or postoperative side effects. Although the topical application of EMLA cream produced cutaneous analgesia, these data suggest that it failed to produce any opioid-sparing effect during the immersion lithotripsy procedure.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of eltanolone and propofol in anesthesia for termination of pregnancy.
A randomized study was designed to compare eltanolone (pregnanolone) and propofol anesthesia in 60 unpremedicated women undergoing outpatient termination of pregnancy. The initial doses for induction of anesthesia were 0.8 mg/kg for eltanolone and 2 mg/kg for propofol followed by an additional 25% increment if necessary. The doses required for successful induction were 0.82 +/- 0.06 and 2.1 +/- 0.3 (mean +/- SD) mg/kg for eltanolone and propofol, respectively. ⋯ Both clinical (opening eyes, orientation, walking, tolerating oral fluids, voiding) and psychomotor recovery (Maddox Wing test and Digit Symbol Substitution test) returned to baseline more slowly after eltanolone than after propofol. Overall home readiness was achieved later in the eltanolone group [median 57 min (range 41-190 min)] compared to the propofol [37 (32-100 min)] group. We conclude that recovery from anesthesia is more rapid from propofol as compared to eltanolone anesthesia.
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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)