Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of a left-sided Broncho-Cath with the torque control blocker univent and the wire-guided blocker.
Lung isolation can be accomplished in two ways: the first, a double-lumen endotracheal tube (DLT) and the second, a bronchial blocker (Univent or Arndt blocker). Previous studies have found that the DLT and the Univent are comparable when providing lung isolation. A new bronchial blocker, the wire-guided endobronchial blocker (Arndt blocker), has been introduced. However, there is no study to report its effectiveness with lung isolation during elective thoracic surgical cases. Therefore, we designed a prospective, randomized trial to compare the effectiveness of lung isolation among the 3 endotracheal tubes: the left-sided DLT Broncho-Cath Group A (n = 16 patients), the torque control blocker Univent Group B (n = 16 patients), and the wire-guided Arndt blocker Group C (n = 32 patients). The following variables were recorded: 1) time to initially position the assigned tube, 2) frequency of malpositions, 3) frequency of use of fiberoptic bronchoscope, 4) overall surgical exposure, and 5) tube acquisition cost. The Arndt blocker took longer to place (3:34 min/s) compared with the other 2 groups: the DLT group (2:08 min/s) or the Univent group (2:38 min/s) (P < 0.0004). There was no statistical difference in tube malpositions among the three groups: two for the DLT group, four for the Univent group, and nine in the Arndt group. Excluding the time for tube placement, the Arndt group also took longer for the lung to collapse (26:02 min/s), compared with the DLT group (17:54 min/s) or Univent group (19:28 min/s) (P < 0.0060). Furthermore, unlike the other two groups, the majority of the Arndt patients required suction to achieve lung collapse. Once lung isolation was achieved, overall surgical exposure was rated excellent for the three groups. Acquisition cost for the DLT group was $1663.20 (21 tubes opened), $2329.00 for the Univent group (17 tubes opened), and $3567.00 for the Arndt group (33 wire-guided blockers opened). This study demonstrates that the Arndt blocker takes longer to position and longer to deflate the isolated lung. For elective thoracic surgical cases, once the lung was isolated, the management seemed to be similar for all three tube groups. ⋯ We compared the latest design of double-lumen tubes Broncho-Cath, Univent, and Arndt blockers during lung isolation. Our results show that the Arndt blocker takes longer to position and longer to deflate the isolated lung. Once the lung was isolated, the management seemed to be similar for all three devices.
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Anesthesia and analgesia · Jan 2003
Randomized Controlled Trial Clinical TrialSupplemental oxygen does not reduce the incidence of postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.
Supplemental 80% oxygen administration halves the incidence of postoperative nausea and vomiting (PONV) in inpatients. Whether it prevents PONV after ambulatory surgery is unknown. We tested the efficacy of supplemental 80% oxygen in decreasing the incidence of PONV after ambulatory gynecologic laparoscopy. One hundred patients were given a standardized sevoflurane anesthetic. They were randomly assigned to two groups: routine oxygen administration with 30% oxygen, balance nitrogen (Group A); and supplemental oxygen with 80% oxygen, balance nitrogen (Group B). Oxygen was administered during surgery and up to 1 h after surgery. The incidence of nausea and vomiting and the need for rescue antiemetics did not differ between the groups in the postanesthesia care unit, in the Phase II unit, or during the 24-h follow-up. The overall incidence of nausea and vomiting during the first postoperative 24 h was 62% in Group A and 55% in Group B (P = 0.486). There were no differences in the recovery profiles and patient satisfaction between the groups. In this study, supplemental oxygen did not prevent PONV in patients undergoing ambulatory gynecologic laparoscopy. ⋯ Supplemental 80% oxygen administration during surgery and until 1 h after surgery compared with 30% oxygen administration did not prevent postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.
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Anesthesia and analgesia · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-nitrous oxide anesthesia enhances the heart rate response to intravenous isoproterenol infusion.
Heart rate (HR) response to IV atropine is attenuated during propofol-nitrous oxide (N(2)O) anesthesia. We studied the effects of propofol-N(2)O anesthesia on isoproterenol-induced HR changes. The control group (n = 15) received no propofol and no N(2)O. Patients in the propofol-N(2)O group (n = 21) received IV propofol 2.5 mg/kg over 1 min followed by a continuous infusion of propofol 10 mg x kg(-1) x h(-1). After tracheal intubation, anesthesia was maintained with propofol 5 mg. kg(-1) x h(-1) and 67% N(2)O in oxygen. All patients in both groups received IV isoproterenol at incremental infusion rates (2.5, 5, 7.5, 10, 12.5, 15, and 17.5 ng x kg(-1) x min(-1) for 2 min at each dose) until HR increased more than 20 bpm from baseline values. At the end of each infusion period, hemodynamic data were collected. The HR response to isoproterenol 7.5 ng. kg(-1) x min(-1) was increased more in the propofol group than in the control group (20 +/- 5 versus 14 +/- 4 bpm; P < 0.05). During the isoproterenol infusion at 10 ng. kg(-1) x min(-1), HR increased by more than 20 bpm in all patients in the propofol group but in only 31% of patients in the control group (P < 0.0001). These results suggest that continuous isoproterenol infusion might be useful when a large dose of atropine is ineffective in restoring normal HR during propofol-N(2)O anesthesia. ⋯ We demonstrated that the heart rate response to IV isoproterenol infusion is enhanced during propofol-nitrous oxide anesthesia. This suggests that continuous isoproterenol infusion may be useful when a large dose of atropine is ineffective for restoration of normal heart rate in patients receiving propofol-nitrous oxide anesthesia.
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Anesthesia and analgesia · Jan 2003
Comparative Study Clinical Trial Controlled Clinical TrialLidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation.
To determine whether lidocaine sprayed down the endotracheal tube (ETT) would attenuate airway-circulatory reflexes during emergence, we compared the reflex responses after endotracheal or IV lidocaine (IVL) in 75 patients receiving a standardized anesthetic protocol. At the end of surgery, the patients were divided into 3 groups (n = 25 for each group) and given no drug (Group 1), given 1 mg/kg of 2% lidocaine sprayed down the ETT 5 min before (Group 2), or given the same dose of IVL 3 min before extubation (Group 3). Blood pressure and heart rate were recorded at predetermined time points from 5 min (baseline) before until 5 min after extubation. The number of coughs per patient was continuously monitored during this period. The number (mean +/- SD) of coughs was decreased in Group 2 (4.5 +/- 3.7) compared with the control (10.2 +/- 6.0) (P < 0.01) with no difference for the control versus Group 3 (7.8 +/- 4.6). The increase in blood pressure was only attenuated immediately before extubation (P < 0.05), whereas the increase in heart rate was attenuated (P < 0.05) at all (except baseline) time points (P < 0.05) in Group 2 compared with the control with no difference for the control versus Group 3. The results indicate that lidocaine sprayed down the ETT suppresses the reflexes whereas using the same dose IVL does not, which is probably attributable to the mucosa-anesthetizing effect of lidocaine. ⋯ Lidocaine sprayed down the endotracheal tube suppresses the airway-circulatory reflex responses whereas using the same dose IV lidocaine does not. This effect seems to be from the direct local anesthesia rather than from systemic absorption from the airway.
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Anesthesia and analgesia · Jan 2003
Clinical TrialThe predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery.
Hemorrhage after cardiopulmonary bypass (CPB) remains a clinical problem. Point-of-care tests to identify hemostatic disturbances at the bedside are desirable. In the present study, we evaluated the predictive value of two point-of-care tests on postoperative bleeding after routine cardiac surgery. Prospectively, 255 consecutive patients were studied to compare the ability of modified thromboelastography (ROTEG) as well as a platelet function analyzer (PFA-100) to predict postoperative blood loss. Measurements were performed at three time points: preoperatively, during CPB, and after protamine administration with three modified thromboelastography and PFA tests. The best predictors of increased bleeding tendency were the tests performed after CPB. The angle alpha is the best predictor (area under the receiver operating characteristic curve 0.69) and, in combination with the adenosine diphosphate-PFA test, the predictive accuracy is enhanced (area under the receiver operating characteristic curve 0.73). The negative predictive value for the angle alpha is 82%, although the positive predictive value is small (41%). Thromboelastography is a better predictor than PFA. In routine cardiac surgery, impaired hemostasis as identified by point-of-care tests does not inevitably lead to hemorrhage postoperatively. However, patients with normal test results are unlikely to bleed for hemostatic reasons. Bleeding in these patients is probably caused surgically. The high negative predictive value supports early identification and targeted treatment of surgical bleeding by distinguishing it from a significant coagulopathy. ⋯ Thrombelastography and platelet function analysis in routine cardiac surgery demonstrate high negative predictive values for postoperative bleeding, which supports early identification and targeted treatment of surgical bleeding by distinguishing it from a significant coagulopathy. The positive predictive values are small. The best predictors are thrombelastography values obtained after cardiopulmonary bypass.