Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1997
An analysis of the predictive probability of the in vitro contracture test for determining susceptibility to malignant hyperthermia.
An objective estimate of the likelihood of correct designation of malignant hyperthermia (MH) susceptibility from in vitro contracture test (IVCT) results is essential if genetic linkage studies of MH are to be more informative. The aim of this study was to generate and test statistical models that could be used to predict the probability of susceptibility of an individual to MH from the results of their IVCTs. Logistic regression of the IVCT results of an index group of 50 patients (age range 9-73 years; MH susceptible [MHS], n = 13; MH normal [MHN], n = 32; MH equivocal [MHE], n = 5) who were either at low risk of MH or were proband cases were used to generate models to predict probability of MH susceptibility. ⋯ A further group of 153 patients (age range 9-74 years; MHS, n = 44; MHN, n = 92; MHE, n = 17) who were consecutively tested relatives of susceptible individuals was used to assess the generalizability of the best model. The model met the criteria for a useful discriminatory model with this group of patients, 125 of whom (including 9 MHE patients) could be designated as positive or negative for MH with a likelihood of more than 95%. The logistic regression models provide objective likelihoods for the MH phenotype that could be usefully incorporated into genetic linkage studies of the condition.
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Anesthesia and analgesia · Mar 1997
Comment Letter Multicenter Study Clinical TrialThere is no evidence of sevoflurane nephrotoxicity.
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Anesthesia and analgesia · Mar 1997
Reduced postoperative analgesic demand after inhaled anesthesia in comparison to combined epidural-inhaled anesthesia in patients undergoing abdominal surgery.
We studied the effect of epidural/general combination anesthesia, in comparison to inhaled anesthesia, on postoperative pain and analgesic consumption in patients undergoing upper abdominal surgery. Anesthesia was induced with propofol and maintained with enflurane in 70% N2O as necessary to maintain arterial blood pressure within 20% of baseline. Group I received bupivacaine 0.25% 0.2 mL/kg and sufentanil 1 microgram/kg 65 +/- 3 min before dermal incision and 0.1 mL/kg bupivacaine 0.25% + sufentanil 2 micrograms/mL (BS) every hour thereafter. ⋯ Inspiratory fraction of enflurane was lower (0.5% +/- 0.01% vs 1.6% +/- 0.04%; P < 0.001) in Group I compared with Group II. Cumulative postoperative consumption of PCEA BS was higher in Group I compared with Group II from the evening of POD 2 until the end of the study (301 +/- 19 mL vs 249 +/- 17 mL; P < 0.001), while pain intensities were comparable at all times. The intraoperative effects of combined BS and enflurane/N2O (inspiratory fraction [Fi] approximately 1 minimum alveolar anesthetic concentration [MAC]) did not preempt postoperative pain in contrast to enflurane/N2O anesthesia (Fi approximately 2.8 MAC).
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Anesthesia and analgesia · Mar 1997
Comparative Study Clinical Trial Controlled Clinical TrialA comparison of traditional textbook and interactive computer learning of neuromuscular block.
We designed an educational software package, RELAX, for teaching first-year anesthesiology residents about the pharmacology and clinical management of neuromuscular blockade. The software uses an interactive, problem-based approach and moves the user through cases in an operating room environment. It can be run on personal computers with Microsoft Windows (Microsoft Corp., Redmond, WA) and combines video, graphics, and text with mouse-driven user input. ⋯ Both groups took a posttest immediately after the intervention. The test scores of the computer group improved significantly more (P < 0.05) than those of the textbook group. Although prior to the study the two groups showed no statistical difference in their familiarity with computers, the computer group reported much higher satisfaction with their learning experience than did the textbook group (P < 0.0001).