Anesthesia and analgesia
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Despite increased use of ambulatory surgery, few data exist regarding patient recovery patterns and home-readiness. We prospectively identified the pattern of home-readiness, the persistent symptoms after surgery, and the factors that delay discharge after home-readiness criteria are satisfied. Five hundred patients were scored by the same investigator using the Postanesthetic Discharge Scoring System (PADSS) every 30 min, commencing 30 min after surgery, until the PADSS score was > or = 9. ⋯ In summary, periodic objective evaluation of home-readiness revealed that the majority of patients would achieve a satisfactory score on or before 2 h after surgery. The time to home-readiness by objective evaluation correlated with the type of surgery. Most delays after satisfactory home-readiness scores were reached were due to nonmedical reasons.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1995
The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension.
We investigated the effects of the prone position on the mechanical properties (compliance and resistance) of the total respiratory system, the lung, and the chest wall, and the functional residual capacity (FRC) and gas exchange in 17 normal, anesthetized, and paralyzed patients undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique. ⋯ L-1.s, P < 0.05). Both FRC and PaO2 markedly (P < 0.01) increased from the supine to the prone position (1.9 +/- 0.6 vs 2.9 +/- 0.7 L, P < 0.01, and 160 +/- 37 vs 199 +/- 16 mm Hg, P < 0.01, respectively), whereas PaCO2 was unchanged. In conclusion, the prone position during general anesthesia does not negatively affect respiratory mechanics and improves lung volumes and oxygenation.
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Anesthesia and analgesia · May 1995
Comparative Study Clinical Trial Controlled Clinical TrialAnalgesic and hemodynamic effects of epidural clonidine, clonidine/morphine, and morphine after pancreatic surgery--a double-blind study.
This study characterizes analgesia an hemodynamics after epidural clonidine 8 micrograms/kg (Group C) or clonidine 4 micrograms/kg+morphine 2 mg (Group CM) in comparison to epidural morphine 50 micrograms/kg (Group M). Forty-five patients scheduled for pancreatectomy in combined general/epidural anesthesia were studied. The study drugs were administered 75 min postoperatively and for 10 h pain intensity (visual analog scale [VAS]), heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO) were measured; filling pressures were kept > 5 mm Hg. ⋯ In Groups C and CM, HR, CO, and MAP were reduced significantly compared to baseline within the first 15-90 min, while stroke volume and systemic vascular resistance remained stable. We conclude, that hemodynamic alteration after epidural clonidine under conditions of stable filling pressures is caused mainly by a decrease in HR. It is not an effect of analgesia but of the intrinsic antihypertensive action of clonidine.
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Anesthesia and analgesia · May 1995
Randomized Controlled Trial Clinical TrialMild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium.
Mild intraoperative hypothermia is common. We therefore studied the effects of mild hypothermia on propofol pharmacokinetics, hepatic blood flow, and atracurium duration of action in healthy volunteers. Six young volunteers were studied on two randomly assigned days, at either 34 degrees C or 37 degrees C. ⋯ A three-compartment mamillary model fitted the data best. Inclusion of hepatic blood flow change from the prepropofol baseline as a covariate for total body clearance significantly improved the fit. The intercompartmental clearances were decreased in the presence of hypothermia.(ABSTRACT TRUNCATED AT 250 WORDS)