Anesthesia and analgesia
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Anesthesia and analgesia · May 1996
Comparative Study Clinical Trial Controlled Clinical TrialThe effects of transnasal butorphanol on mood and psychomotor functioning in healthy volunteers.
Transnasal butorphanol is effective in relieving migraine and postoperative pain. The extent to which this drug preparation impacts on cognitive and psychomotor performance, as well as mood, has not been examined. Accordingly, the cognitive and psychomotor, subjective, and physiological effects of two clinically relevant doses of transnasal butorphanol (1 and 2 mg) were compared to that of placebo, and a common analgesic drug combination given for pain relief in ambulatory settings, 600 mg of acetaminophen and 60 mg of codeine, in healthy volunteers (n = 10). ⋯ The smaller dose had no psychomotor-impairing effects, but had subjective effects (including increased ratings of "sleepy"). All three active drug conditions including miosis. These laboratory results suggest that patients should use caution when using the 1-mg dose of transnasal butorphanol, and should curtail certain activities if they administer the 2-mg dose of transnasal butorphanol for analgesia.
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Anesthesia and analgesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of sevoflurane and isoflurane on the neuromuscular block produced by vecuronium continuous infusion.
Volatile anesthetics enhance the action of neuromuscular blockade to various degrees, although the influence of sevoflurane on the neuromuscular block has not yet been characterized. The purpose of this investigation is to determine the vecuronium infusion rate requirement under sevoflurane anesthesia and to compare it to that of isoflurane anesthesia. Twenty patients scheduled for otorhinolaryngologic surgery were randomly assigned to receive either sevoflurane (SEV) or isoflurane (ISO) at 1 minimum alveolar anesthetic concentration (MAC) (1.7% and 1.2%, respectively) in combination with 67% nitrous oxide. ⋯ The plasma concentrations of vecuronium (CVEC) and 3-desacetylvecuronium (CDES) at steady state were measured with a gas chromatographic assay. There was no difference between SEV and ISO in the following variables: the vecuronium infusion rate requirements to achieve 90% muscle relaxation (0.42 +/- 0.11 [SEV] vs 0.40 +/- 0.10 [ISO] microgram-kg-1.min-1), CVEC (144.4 +/- 38.1 [SEV] vs 149.7 +/- 69.2 [ISO] ng/mL), CDES (57.2 +/- 20.3 [SEV] vs 65.3 +/- 26.1 [ISO], ng/mL), and plasma vecuronium clearance (2.85 +/- 0.86 [SEV] vs 3.19 +/- 1.24 [ISO] mL.kg-1.min-1). This study indicates that SEV at 1 MAC requires a vecuronium infusion rate similar to that of ISO at 1 MAC to achieve 90% muscle relaxation.
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Anesthesia and analgesia · May 1996
Randomized Controlled Trial Clinical TrialBolus metoclopramide does not enhance morphine analgesia after cesarean section.
Intravenous metoclopramide potentiates the analgesic effects of opioids in postoperative patients. We speculate that increased spinal concentrations of acetylcholine from metoclopramide-induced acetylcholinesterase inhibition is the mechanism responsible for enhanced morphine analgesia from metoclopramide. Sixty patients undergoing elective cesarean section with subarachnoid anesthesia were randomized to receive either 20 mg metoclopramide or saline intravenously 30-60 min prior to subarachnoid injection. ⋯ CSF cholinesterase activity was similar to values in nonpregnant patients demonstrated previously. This study failed to confirm the morphine-enhancing action of 20 mg intravenous metoclopramide in postoperative patients. Furthermore, this dose of metoclopramide does not inhibit CSF acetylcholinesterase.
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Anesthesia and analgesia · May 1996
Tracheal extubation of children in the operating room after atrial septal defect repair as part of a clinical practice guideline.
Early tracheal extubation in the operating room after atrial septal defect (ASD) surgery was recommended as part of a clinical practice guideline (CPG) established in the Cardiovascular Program at the Children's Hospital, Boston, MA. This retrospective review was undertaken to determine whether this practice was efficient without compromising patient care. The charts and hospital charges for 102 patients undergoing secundum ASD or sinus venosus defect surgery between March 1992 and July 1994 were reviewed; 36 patients (Group I) had surgery prior to introduction of the CPG, and 66 patients were managed according to the CPG. ⋯ There was no difference among groups in the hospital charges for OR, anesthesia and CICU time. However, when the combined hospital charges for services provided both in the OR and CICU were included, patients in Group II were charged significantly less, and this primarily reflects the absence of postoperative mechanical ventilation charges. Tracheal extubation in the OR after ASD surgery in children can result in lower patient charges without significantly compromising patient care.
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Anesthesia and analgesia · May 1996
Comparative StudyInteraction of heart rate and hypothermia on global myocardial contraction of the isolated rabbit heart.
We studied the effects of mild hypothermia on cardiac contractility in isolated rabbit hearts perfused with Krebs-Henseleit solution according to the technique of Langendorff. Isovolumetric left ventricular pressure (LVP) was measured with a fluid-filled balloon. Hearts were paced after induction of atrioventricular block. ⋯ At pacing rates > or = 90 bpm, lower systolic LVP, higher diastolic LVP, and lower positive and negative LV dP/dt were obtained in hypothermic (93 +/- 12 mm Hg, 55 +/- 18 mm Hg, 584 +/- 137 mm Hg/s, and 323 +/- 57 mm Hg/s at 210 bpm, respectively) compared to normothermic hearts (123 +/- 4 mm Hg, 10 +/- 4 mm Hg, 1705 +/- 145.5 mm Hg/s, and 1155 +/- 78 mm Hg/s at 210 bpm, respectively.) The duration of mechanical diastole was reduced or suppressed in these hearts. Exposure to the beta-adrenoreceptor agonist, isoproterenol, improved this diastolic dysfunction during hypothermia and pacing at high rates, suggesting that the sarcoplasmic reticulum Ca2+ uptake might be involved. Our data are also consistent with an increase in myofilament Ca2+ sensitivity that is opposed by isoproterenol during hypothermia.