Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1996
Comparative StudyA comparative study of early postoperative hypoxemia in infants, children, and adults undergoing elective plastic surgery.
To determine the influence of age on postoperative hypoxemia, we studied postoperative hypoxemia in 1152 patients, from infants to adults, ASA physical status I, undergoing elective plastic surgery. Subjects were divided into four groups on the basis of age: Group 1, infants aged 1 yr or less (n = 108); Group 2, children aged 1-3 yr (n = 240); Group 3, children aged 3-14 yr (n = 482); and Group 4, adults aged 14-58 yr (n = 322). Arterial oxygen saturation (Spo2) levels were recorded while patients were breathing room air in the postanesthesia recovery room shortly after arrival (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120, and 180 min thereafter. ⋯ Hypoxemia occurred most commonly within 1 h after anesthesia, particularly during the first 40 min in infants and during the first 15 min in older children and adults. A significant correlation was found by linear regression analysis between low Spo2 levels on admission to the recovery room and children's age. Thereafter, Spo2 levels and the incidence of hypoxemia during the early postoperative period were related only to infants' recovery scores.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialThe importance of the postoperative anesthetic visit: do repeated visits improve patient satisfaction or physician recognition?
This study evaluates whether repeated postoperative visits by the anesthesiologist improve patient ability to recall the anesthesiologist's name and the patient's perception of and satisfaction with anesthesia services. In a randomized, prospective trial, 144 patients with an anticipated postoperative length of stay of at least three days were enrolled in three groups: Group A patients (n = 48) had one postoperative visit, Group B (n = 48) had two postoperative visits, and Group C (n = 48) had three postoperative visits. All postoperative visits were performed by the attending anesthesiologist on consecutive postoperative days. ⋯ Patients could identify the anesthesiologist's gender approximately 85% of the time, regardless of group, and were more likely to identify female anesthesiologists (P = 0.026, odds ratio 3.3). Patient evaluation of hospital, surgical, and anesthesia care was favorable in all groups and did not vary with group. Increasing the number of postoperative visits does not improve patient name recognition of the anesthesiologist or increase patient satisfaction with or perception of anesthesia services.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialInteractions between mivacurium, rocuronium, and vecuronium during general anesthesia.
This study was designed to examine the interactions between mivacurium and rocuronium or vecuronium when administered during a standardized anesthetic technique. Seventy healthy women undergoing abdominal hysterectomy procedures with a standardized thiopental-sufentanil-desflurane-nitrous oxide anesthetic technique were randomly assigned to one of seven treatment groups (10 patients each). After a tracheal intubating dose of vecuronium 100 micrograms/kg (Groups 1 and 2), rocuronium 600 micrograms/kg (Groups 3 and 4), or mivacurium 250 micrograms/kg (Groups 5, 6, and 7), patients received vecuronium, 25 micrograms/kg (Groups 1 and 6), rocuronium 150 micrograms/kg (Groups 3 and 7), or mivacurium 50 micrograms/kg (Groups 2, 4, and 5) for maintenance of neuromuscular blockade. ⋯ The clinical duration of maintenance doses of vecuronium (18 +/- 6 min) and rocuronium (13 +/- 2 min) were significantly shorter after an intubating dose of mivacurium than that after an intubating dose of vecuronium (30 +/- 5 min) or rocuronium (42 +/- 12 min), respectively. These data suggest that with consecutive administration of neuromuscular blocking drugs, the initial duration of action depends more on the kinetics of the first neuromuscular blocking drug than the subsequent drug. Thus, there appears to be no clinical advantage in using mivacurium for maintenance of neuromuscular blockade after initial administration of rocuronium or vecuronium.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialAxillary brachial plexus anesthesia: electrical versus cold saline stimulation.
The aim of this study was to investigate which of two methods of nerve stimulation, cold saline-induced paresthesia or use of a nerve stimulator, was more effective in increasing the successful brachial plexus block rate by the axillary approach. Twenty patients were randomly assigned to Group A (saline below 11 degrees C), and 20 patients to Group B (nerve stimulator). All blocks were performed by the same anesthesiologist using 40 mL of 1.5% mepivacaine and 4 mL of 8.4% sodium bicarbonate. ⋯ A motor response was evoked by a nerve stimulator in 17 patients (85%). Two patients (10%) had a paresthesia in the hand without a motor response with the current at less than 1 mA. A successful block was achieved in 19 patients in each group.
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Anesthesia and analgesia · Oct 1996
Practice patterns of anesthesiologists regarding situations in obstetric anesthesia where clinical management is controversial.
A survey consisting of 47 questions, 40 regarding clinical practice and 7 regarding demographics, was mailed to 153 directors of obstetric anesthesia in academic practice and to 153 anesthesiologists in private practice. Questions relating to the following areas of practice were asked: 1) preoperative laboratory testing; 2) preeclampsia and possible coagulopathies; 3) epidural catheter placement in women with "spinal problems"; and 4) use of epidural opioids and intravenous supplementation. ⋯ These eight questions related to preoperative laboratory testing in the healthy parturient, preoperative laboratory testing in the preeclamptic patient, and the use of intravenous supplementation during a cesarean section with regional anesthesia. Although there were some differences in the responses between anesthesiologists in academic and private practice, overall the responses were similar.