Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2000
Comparative StudyDefining segments and phases of a time capnogram.
The division of a time capnogram into inspiratory and expiratory segments is arbitrary and results in the inability of a time capnogram to detect rebreathing instantaneously. Demarcation of a time capnogram into inspiratory and expiratory components using gas flow signals will not only facilitate prompt detection of rebreathing, but will also allow application of standardized and physiologically appropriate nomenclature for better understanding and interpretation of time capnograms. A Novametrix((R)) CO(2)-SMO plus respiratory profile monitor (Novametrix Medical Systems, Wallingford, CT) was used to obtain a simultaneous display of CO(2) and respiratory flow waveforms on a computer screen during spontaneous and controlled ventilation using a circle system with the inspiratory valve competent (no rebreathing) and with the valve displaced (rebreathing). Because the response time of the CO(2) analyzer was similar to the response time of the flow sensor, a comparison was made between the two waveforms to determine the inspiratory segment (Phase 0) and the expiratory segment of the time capnogram and its subdivisions (Phases I, II, and III). The end of expiration almost coincides with the downslope of the CO(2) waveform in the capnograms when there is no rebreathing. However, in the presence of rebreathing, the alveolar plateau is prolonged and includes a part of inspiration (Phase 0), in addition to the expiratory alveolar plateau (Phase III). ⋯ Presently, the division of a time capnogram into inspiratory and expiratory segments is arbitrary. Demarcation of a time capnogram into various components using the gas flow signals facilitates prompt detection of the cause of abnormal capnograms that can widen the scope of future clinical applications of time capnography.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Comparative Study Clinical TrialA comparative study between a calcium channel blocker (Nicardipine) and a combined alpha-beta-blocker (Labetalol) for the control of emergence hypertension during craniotomy for tumor surgery.
We compared the efficacy of the combination of enalaprilat/labetalol with that of enalaprilat/nicardipine to prevent emergence postcraniotomy hypertension. A prospective, randomized open labeled clinical trial was designed to compare the incidence of breakthrough hypertension (systolic blood pressure [SBP] > 140 mm Hg) and adverse effects (hypotension, tachycardia, and bradycardia) between the two drug combinations. Secondarily, the effects of the drugs on SBP, mean blood pressure, and diastolic blood pressure were evaluated over the course of the study. ⋯ SBP was similarly controlled in both groups. There was a marginally smaller incidence of failures and adverse effects with labetalol. Blood pressure profiles were similar for both groups.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Comparative Study Clinical TrialPostdural puncture headache: a randomized comparison of five spinal needles in obstetric patients.
This prospective, blinded, randomized study compares the incidence of postdural puncture headache (PDPH) and the epidural blood patch (EBP) rate for five spinal needles when used in obstetric patients. One thousand two women undergoing elective cesarean delivery under spinal anesthesia were recruited. We used two cutting needles: 26-gauge Atraucan and 25-gauge Quincke, and three pencil-point needles: 24-gauge Gertie Marx (GM), 24-gauge Sprotte, and 25-gauge Whitacre. ⋯ Neither the PDPH rate nor the EBP rates differed among the pencil-point needles. The cost of EBP must be taken into consideration when choosing a spinal needle. We conclude that pencil-point spinal needles should be used for subarachnoid anesthesia in obstetric patients.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPercutaneous tracheostomy: ciaglia blue rhino versus the basic ciaglia technique of percutaneous dilational tracheostomy.
Percutaneous dilational tracheostomy (PDT), according to Ciaglia's technique described in 1985, has become the most popular technique for percutaneous tracheostomy and is demonstrably as safe as surgical tracheostomy. In 1999, an extensively modified technique of PDT was introduced, the Ciaglia Blue Rhino (CBR; Cook Critical Care, Bloomington, IL), that consists of one-step dilation by means of a curved dilator with hydrophilic coating. To compare CBR with the basic technique of PDT, we performed a prospective, randomized trial in 50 critically ill adults. Twenty-five of these patients had PDT, and 25 had CBR. Average operating times were <3 min for CBR (range: 50-360 s) and <7 min for PDT (range: 4-20 min; P<0.0001). Tracheostomy was successfully completed in all patients. When CBR was performed, 11 minor, nonlife-threatening complications were noted: nine fractures of tracheal cartilage and two short periods of intraoperative oxygen desaturation. During PDT, seven complications occurred, of which three were potentially life-threatening: two injuries to the posterior tracheal wall, one pneumothorax, two tracheal cartilage fractures (P< 0.05 vs CBR), one case of bleeding, and one short episode of intraoperative oxygen desaturation. Regardless of whether PDT or CBR was performed, oxygenation was not significantly affected, and there was no infection of the tracheostoma. Based on our data, we conclude that new CBR is more practicable than PDT. No life-threatening complications occurred during CBR. ⋯ To assess practicability and safety of the Ciaglia Blue Rhino (Cook Critical Care, Bloomington, IL)-an extensively modified technique of percutaneous dilatational tracheostomy-50 critically ill adults on long-term ventilation underwent either new Ciaglia Blue Rhino or percutaneous dilatational tracheostomy in a prospective, randomized clinical trial.