Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane versus isoflurane for maintenance of anesthesia: are serum inorganic fluoride ion concentrations of concern?
Sevoflurane administration can result in increased serum inorganic fluoride ion concentrations, which have been associated with inhibition of renal concentrating ability. We measured serum fluoride levels, renal function, and recovery variables as a function of time in ASA grade I-III patients administered general anesthesia with isoflurane or sevoflurane for at least 1 h. Fifty patients were exposed to sevoflurane (< or = 2.4% inspired concentration) or isoflurane (< or = 1.9% inspired concentration) for maintenance of anesthesia as part of a multicenter trial. ⋯ Those two patients also demonstrated an increase in serum blood urea nitrogen and creatinine at 24 h after sevoflurane administration compared with baseline. The elimination half-life of serum fluoride ion was 21.6 h. The results of this study suggest the possibility of sevoflurane induced nephrotoxicity.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia.
Ketorolac prolongs bleeding time and inhibits platelet aggregation and platelet thromboxane production in healthy, awake volunteers. However, platelet function was recently shown not to worsen after ketorolac was given during general anesthesia. The purpose of this study was to investigate platelet function changes during a standardized spinal anesthetic and surgery, as well as after a single intraoperative dose of intravenous (IV) ketorolac. ⋯ Platelet TxB2 production decreased dramatically in the ketorolac group from preoperative to poststudy drug data points (157.2 +/- 129.4 to 0.3 +/- 0.3 ng/mL; P < 0.01). Platelet function does not appear to be accentuated during spinal anesthesia as it is during general anesthesia. Unlike during general anesthesia, platelet function during spinal anesthesia is impaired, with respect to bleeding time and platelet aggregometry to collagen, by a single intraoperative dose of IV ketorolac.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialDose-response study of intrathecal morphine versus intrathecal neostigmine, their combination, or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty.
This study was designed to examine postoperative analgesia with intrathecal neostigmine in a randomized, blinded trial with morphine as the active control in patients undergoing anterior and posterior vaginoplasty. A secondary aim was to provide preliminary data on the interaction between these two drugs. The incidence of adverse effects was also assessed. ⋯ Increasing doses of intrathecal morphine (50 micrograms, 100 micrograms, and 200 micrograms) and intrathecal neostigmine (50 micrograms, 100 micrograms, and 200 micrograms) showed a dose-dependent pattern of analgesia (P < 0.001). The M50 + N50 combination resulted in a better analgesic effect with fewer side effects than M50, N50, and control groups. These preliminary data suggest that spinal neostigmine produces analgesia for vaginoplasty surgery similar in duration to spinal morphine and that the combination of morphine and neostigmine may allow a reduction in the dose of each component for postoperative analgesia.
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Anesthesia and analgesia · Jun 1996
Comparative StudyThe neuromuscular effects of mivacurium chloride during propofol anesthesia in children.
Previous studies examined the neuromuscular effects of mivacurium in doses up to, but not exceeding, 2.5 times 95% effective dose (ED95) in children. To determine whether larger doses offer clinical advantages, we compared the onset and duration of neuromuscular block, intubating conditions, and changes in plasma histamine concentration (PHC) after mivacurium (0.2, 0.3, or 0.4 mg/kg) with those after succinylcholine (2.0 mg/kg) during propofol/N2O anesthesia in 48 children aged 3-10 yr. The evoked electromyograph (EMG) of the adductor digiti minimi after supramaximal train-of-four (TOF) stimulation was recorded. ⋯ PHC increased significantly after mivacurium 0.3 and 0.4 mg/kg; however, mean arterial pressure did not change significantly. We conclude that mivacurium 0.3 mg/kg provides a relatively rapid onset and short duration of neuromuscular block in healthy children. Increasing the dose to 0.4 mg/kg does not significantly accelerate the onset of neuromuscular block.