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 effect of graded hemorrhage and intravascular volume replacement on systolic pressure variation in humans during mechanical and spontaneous ventilation.
In dogs and humans, the magnitude of the variation in systolic pressure (SPV) over the respiratory cycle during mechanical ventilation appears to be inversely related to intravascular volume. Also reported to correlate with changes in volume status is delta down, the difference between systolic pressure at end-expiration and the lowest value during the respiratory cycle. These variables were examined during graded hemorrhage in eight anesthetized, mechanically ventilated subjects, and seven awake, spontaneously breathing subjects. ⋯ After hetastarch, both SPV and delta down were smaller than at baseline and may explain why the infusion of NS caused nonsignificant reductions in SPV and delta down. A SPV of 5 mm Hg or less, or a delta down of 2 mm Hg or less appeared to indicate minimal intravascular volume depletion. During spontaneous ventilation, delta down could not be determined accurately in several subjects, and SPV did not change in the appropriate direction in all cases of hemorrhage and volume infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1995
Effects of sevoflurane on the middle latency auditory evoked response and the electroencephalographic power spectrum.
We investigated the effects of sevoflurane on the middle latency auditory evoked response (MLR) and the power spectrum of the electroencephalogram (EEG) in 10 elective surgical patients. The MLR and the EEG power spectrum were recorded with a surface electrode placed at the central (Cz) scalp location. End-tidal sevoflurane concentrations of 0%, 0.25%, 0.5%, 0.75%, 1.0%, and 1.5% in 50% nitrous oxide and oxygen were studied. ⋯ The beta power, median power frequency (MPF), and 95% spectral edge frequency (SEF) decreased significantly according to the increases by 0.5% sevoflurane. Regarding the changes evoked by 0.25% sevoflurane, the Nb latency of the MLR responded significantly under 0.75% of sevoflurane. At these low concentrations of sevoflurane, the MLR seemed to be more sensitive to changes in anesthetic concentration than the various EEG variables.
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Anesthesia and analgesia · May 1995
Comparative StudyHydroxyethyl starch versus lactated Ringer's solution in the chronic maternal-fetal sheep preparation: a pharmacodynamic and pharmacokinetic study.
Administration of fluids intravenously prior to spinal and epidural analgesia in obstetrics is required to prevent maternal hypotension and fetal hypoxia. A colloid solution, such as hydroxyethyl starch (HES), might be preferable considering the capacity to stay intravascularly for a longer period. In this study the placental transfer of HES and the hemodynamic effects after infusion were investigated using a chronic maternal-fetal sheep preparation. ⋯ In contrast, infusion of RL did not significantly change these variables. Infusion of HES increases UBF, CO, and uterine and total oxygen-carrying capacity in the pregnant ewe. No significant transplacental transfer of HES was shown.