Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2001
Comparative StudyA comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis.
IV regional anesthesia can offer a more favorable patient recovery profile and shorter postoperative nursing care time and hospital discharge time than an isoflurane-based general anesthetic or brachial plexus block technique for hand surgery.
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Anesthesia and analgesia · Nov 2001
Clinical TrialT-wave amplitude as an indicator for detecting intravascular injection of epinephrine test dose in awake and anesthetized elderly patients.
Aging is associated with reduced heart rate (HR) responsiveness to a simulated IV test dose containing epinephrine. We tested the hypothesis that a more contemporary T-wave criterion (positive if there was a > or = 25% decrease in T-wave amplitude) was applicable in both awake and anesthetized older patients. Sixteen healthy patients > or = 65 yr old first received 3 mL of normal saline IV, followed 4 min later by 1.5% lidocaine 3 mL containing 15 microg epinephrine (1:200,000) IV in the supine position when awake, and they were anesthetized with stable 2% end-tidal sevoflurane and 67% nitrous oxide. HR, systolic blood pressure (SBP) determined invasively, and lead II of the electrocardiogram were continuously recorded for 4 min after the IV injections of saline and the test dose. A sensitivity of 88% and a negative predictive value of 89% were obtained in awake patients on the basis of the conventional HR criterion (positive if there was a > or = 20 bpm increase), whereas a sensitivity of 81% and a negative predictive value of 84% were obtained during sevoflurane anesthesia on the basis of the modified HR criterion (positive if there was a > or = 10 bpm increase). However, sensitivities, specificities, and positive and negative predictive values were all 100% on the basis of the SBP (positive if a > or = 15 mm Hg increase was recorded with an arterial line) and the T-wave criteria for both awake and anesthetized conditions. These results suggest that the SBP and T-wave criteria should be applied in awake and anesthetized elderly patients for detecting accidental intravascular injection of the epinephrine-containing test dose. ⋯ To determine whether an epidural catheter is in a blood vessel, an epidural test dose containing 15 microg epinephrine is often used. We found that an increase in systolic blood pressure and a decrease in T-wave amplitude, but not an increase in heart rate, seem to be reliable indicators for detecting accidental intravascular injection in both awake and sevoflurane-anesthetized patients > or = 65 yr old.
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Anesthesia and analgesia · Nov 2001
The impact of business cards on physician recognition after general anesthesia.
Despite their contribution to overall perioperative treatment of patients, anesthesiologists often remain in anonymity. We evaluated the impact of business cards on physician recognition after general anesthesia. Using a questionnaire, 441 patients were interviewed for recall of the anesthesiologist's name, the surgeon's name, and their overall satisfaction with anesthetic care 6 wk after undergoing surgery during general anesthesia. Of these patients, 155 had and 137 had not randomly received a business card during the preoperative visit, with another 149 patients serving as a control group. Business card recipients responded significantly more frequently than did nonrecipients or patients from the control group (65.8% vs 54.7% vs 53%), with recall of the anesthesiologist's name being significantly more frequent in the Business Card Recipient group (51.5% vs 14.3% vs 11.4%). Patient satisfaction with anesthetic care and recall of the surgeon's name were similar in all groups. The use of a simple tool such as a business card can indeed produce a measurable positive change in physician recognition on the part of the patient. ⋯ Anesthesiologists often remain anonymous in everyday clinical practice. Handing a business card to the patient during the preoperative visit increased the postoperative recall of the anesthesiologist's name from 11% to 51%.
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Anesthesia and analgesia · Nov 2001
Luciferase as a model for the site of inhaled anesthetic action.
The in vivo potencies of anesthetics correlate with their capacity to suppress the reaction of luciferin with luciferase. In addition, luciferin has structural resemblances to etomidate. These observations raise the issues of whether luciferin, itself, might affect anesthetic requirement, and whether luciferase resembles the site of anesthetic action. Because the polar luciferin is unlikely to cross the blood-brain barrier (we found that the olive oil/water partition coefficient was 100 +/- 36 x 10(-7)), we studied these issues in rats by measuring the effect of infusion of luciferin in artificial cerebrospinal fluid into the lumbar subarachnoidal space and into the cerebral intraventricular space on the MAC (the minimum alveolar anesthetic concentration required to eliminate movement in response to a noxious stimulus in 50% of tested subjects) of isoflurane. MAC in rats given lumbar intrathecal doses of luciferin estimated to greatly exceed anesthetizing doses of etomidate, did not differ significantly from MAC in rats receiving only artificial cerebrospinal fluid into the lumbar intrathecal space. MAC slightly decreased when doses of luciferin estimated to greatly exceed anesthetizing doses of etomidate were infused intraventricularly (P < 0.05). In contrast to the absent or minimal effects of luciferin, intrathecal or intraventricular infusion of etomidate at similar or smaller doses significantly decreased isoflurane MAC. Luciferin did not affect +-aminobutyric acid type A or acetylcholine receptors expressed in Xenopus oocytes. These results suggest that luciferin has minimal or no anesthetic effects. It also suggests that luciferin/luciferase may not provide a good surrogate for the site at which anesthetics act, if this site is on the surface of neuronal cells. ⋯ In proportion to their potencies, anesthetics inhibit luciferin's action on luciferase, and luciferin structurally resembles the anesthetic etomidate. However, in contrast to etomidate, luciferin given intrathecally or into the third cerebral ventricle does not have anesthetic actions, and it does not affect +-aminobutyric acid or acetylcholine receptors in vitro. Luciferase may not provide a good surrogate for the site at which anesthetics act.