Anesthesia and analgesia
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Anesthesia and analgesia · May 2000
Randomized Controlled Trial Clinical TrialInhaling nitrous oxide reduces the induction dose requirements of propofol.
Inhaling nitrous oxide (N(2)O) before propofol induction appears to decrease propofol usage. To investigate the efficacy of N(2)O as a component of the drugs used to induce anesthesia, the effect of inhaling a N(2)O:oxygen (O(2)) mixture on the dose of propofol required to induce anesthesia was determined in a double-blinded manner. We randomized 117 unpremedicated patients scheduled for elective surgery into three groups. ⋯ Propofol was infused at 20 mg/min after 1 min of gas mixture inhalation, and the infusion stopped when there was loss of response to verbal command. The mean (SD) propofol dose was 0.75 (0.30), 0.84 (0.26), and 1.33 (0.51) mg/kg, and the induction time 133 (57), 142 (47), and 226 (78) s for Groups FN, PN, and FO, respectively. We conclude that inhalation of 66% N(2)O in O(2) 1 min before the IV induction of anesthesia with propofol at 20 mg/min, reduces the induction dose of propofol by 44% and decreases the time required for the induction of anesthesia (P < 0.001).
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Anesthesia and analgesia · May 2000
Randomized Controlled Trial Clinical TrialThe onset time of rocuronium is slowed by esmolol and accelerated by ephedrine.
Administration of ephedrine prior to rocuronium decreases the onset time of neuromuscular blockade from rocuronium by 26%. This effect was attributed to a increased cardiac output. If so, beta adrenergic-blocking drugs, which decrease cardiac output, should prolong the onset time of rocuronium. ⋯ The onset time of rocuronium was significantly shorter after ephedrine (22%) and longer after esmolol (26%), as compared to placebo. No differences were observed among the three groups with regard to heart rate, systolic, diastolic or mean blood pressure. We concluded that a dose of 0.5 mg. kg(-1) of esmolol significantly prolongs the onset time of rocuronium with minimal hemodynamic changes.
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The elective use of succinylcholine in anesthesia has largely been abandoned because of unwanted side effects. Alternatives now exist for short, intermediate, or long elective surgical procedures. NMBDs are frequently used only to facilitate tracheal intubation; rapacuronium fills an important niche particularly for a short elective case (e.g., same-day surgery). ⋯ Figure 1 shows such a plot for mivacurium (13). There is less variability in the maximum block at the larger dose of rapacuronium but still variability in onset time. Further studies will be important in defining the role of rapacuronium for rapid sequence induction in various clinical settings.
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Anesthesia and analgesia · May 2000
A retrospective examination of regional plus general anesthesia in children undergoing open heart surgery.
The use of regional anesthesia in combination with general anesthesia for children undergoing cardiac surgery is receiving increasing attention from clinicians. The addition of regional anesthesia may improve clinical outcomes and decrease costs as a result of the reduced need for postoperative mechanical ventilation. ⋯ We found no significant differences in the incidence of clinically significant changes in vital signs, oxygen desaturation, hypercarbia, or vomiting. Patients in the SAB group received significantly more sedative/analgesic interventions than those in the EPID group.