Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2001
Monitoring end-tidal carbon dioxide during weaning from cardiopulmonary bypass in patients without significant lung disease.
End-tidal carbon dioxide tension (PETCO(2)) changes with fluctuations in cardiac output (CO). We compared PETCO(2) to pulmonary artery blood flow (PAQt) during weaning from cardiopulmonary bypass (CPB) in normothermic patients without significant pulmonary disease. Fifteen consecutive adult cardiac surgical patients were prospectively studied during and shortly after weaning from CPB. ⋯ One patient had TDCO of 4.69 L/min (2.39 L/min/m(2)). In normothermic patients without significant pulmonary disease, PETCO(2) is a useful index of PAQt during separation from CPB. Under the clinical settings in this study, a PETCO(2) greater than 30 mm Hg was invariably associated with a CO more than 4.0 L/min or a cardiac index >2.0 L/min/m(2).
-
Anesthesia and analgesia · Feb 2001
How much are patients willing to pay to avoid postoperative nausea and vomiting?
Postoperative nausea and vomiting (PONV) are unpleasant experiences. However, there is no drug that is completely effective in preventing PONV. Whereas cost effectiveness analyses rely on specific health outcomes (e.g., years of life saved), cost-benefit analyses assess the cost and benefit of medical therapy in terms of dollars. ⋯ Seventy-six percent of patients considered avoiding postoperative nausea and 78% of patients considered avoiding vomiting as important (> or = 50 mm on a 0--100-mm visual analog scale). Nausea or vomiting in the postanesthetic care unit, greater patient income, previous history of PONV, more importance placed on avoiding nausea and vomiting, increasing age, and being married are independent covariates that increase the willingness to pay estimates. Patients associated a value with the avoidance of PONV and were willing to pay between US$56 and US$100 for a completely effective antiemetic.
-
Anesthesia and analgesia · Feb 2001
Case ReportsThe use of lepirudin for anticoagulation in patients with heparin-induced thrombocytopenia during major vascular surgery.
The method of anticoagulation in patients undergoing major vascular surgery with a history of heparin-induced thrombocytopenia (HIT) is controversial. We present two cases in which a bolus only technique using recombinant hirudin (Lepirudin or Refludan) was used successfully in patients with HIT scheduled for vascular surgery.
-
Anesthesia and analgesia · Feb 2001
Blockage of one class of potassium channel alters the effectiveness of halothane in a brain circuit of Drosophila.
At concentrations comparable to those used in the clinic, halothane has profound effects on a neuronal pathway devoted to the escape reflex of the fruit fly, Drosophila melanogaster. We studied the influence of the potassium channel that is encoded by the Shaker gene on the halothane sensitivity of this circuit. Shaker channels were specifically inactivated either by genetic means, using strains with two different severe Shaker mutations, or by pharmacologic means, using ingestion of millimolar concentrations of 4-aminopyridine. ⋯ To ensure that the genetic alteration was specific, both mutations were studied as stocks that had been repeatedly backcrossed to a control strain. The specificity of the pharmacologic inhibition was demonstrated by the fact that 4-aminopyridine had no effect on halothane potency in a Shaker mutant. Quantitative differences in the effects of channel inhibition between males and females suggested a sexual dimorphism in the functional brain anatomy of the reflex circuit.