Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients.
This study compares the emergence and recovery characteristics of sevoflurane, desflurane, and halothane in children undergoing adenoidectomy with bilateral myringotomy and the insertion of tubes. Eighty children 1-7 yr of age were studied. Thirty minutes prior to the induction of anesthesia, all patients received 0.5 mg/kg midazolam orally. ⋯ It is concluded that, although desflurane resulted in the fastest early emergence from anesthesia, it was associated with a greater incidence of postoperative agitation. Sevoflurane resulted in similar emergence and recovery compared with halothane. Desflurane and sevoflurane did not result in faster discharge times than halothane in this patient population.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of isoflurane versus fentanyl as primary anesthetics for mitral valve surgery.
We conducted a randomize study of fentanyl compared to isoflurane anesthesia in patients with pulmonary hypertension undergoing mitral valve surgery. Patients were premedicated and randomly assigned to one of two groups: 21 patients had anesthesia induced with thiopental and maintained with isoflurane; 23 patients had anesthesia induced with a fentanyl bolus and maintained with a fentanyl infusion. Adjustments of fentanyl infusion and isoflurane concentration, as well as fentanyl boluses and vasoactive/positive inotropic medication, were administered to maintain preoperative arterial blood pressure. ⋯ Adequate hemodynamic profiles were achieved in both groups with comparable use of inotropic and vasoactive medication, with the exception of norepinephrine that was administered intraoperatively to significantly (P < 0.05) more patients in the isoflurane-based anesthesia group. Neither technique was associated with acute improvement of right heart performance or pulmonary hypertension, in large part because of morphologic changes of the pulmonary arterial bed, occurring with long-standing mitral valve disease. We conclude that isoflurane-based anesthesia is adequate for this type of surgery, although there is a higher anesthetic algorithm failure rate than with fentanyl-based anesthetic technique.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Clinical TrialThe effect of epidural fentanyl on the minimum local analgesic concentration of epidural chloroprocaine in labor.
The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-mL volume in the first stage of labor. The aim of this study was to determine the local anesthetic sparing efficacy of epidural fentanyl by its effect on the MLAC of chloroprocaine. Fifty-six parturients, not exceeding 7 cm cervical dilation, who requested epidural analgesia were allocated to one of two groups in this double-blind, randomized, prospective study. ⋯ Analgesic efficacy was assessed using 100-mm visual analog pain scores with 10 mm or less within 30 min defined as effective. The MLAC of chloroprocaine was reduced from 0.43% wt/vol to 0.26% wt/vol by fentanyl (P = 0.023). Thus, the addition of epidural fentanyl 3 micrograms/mL (60 micrograms resulted in a significant 40% reduction in the MLAC of chloroprocaine in the first stage of labor.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block.
This study assessed the minimum dose of clonidine required to prolong the duration of both anesthesia and analgesia after axillary brachial plexus blockade. Eighty patients scheduled for elective hand surgery were divided into eight groups in a randomized, double-blind fashion. An axillary brachial plexus block was performed with 40 mL 1% mepivacaine plus 1:200,000 epinephrine. ⋯ The minimum dose of clonidine required to significantly prolong the duration of analgesia and anesthesia was, respectively, 0.1 and 0.5 microgram/kg. No side effects (sedation, drowsiness, bradycardia, arterial hypotension) were reported. We conclude that the dose of clonidine required to prolong significantly the duration of both anesthesia and analgesia after axillary brachial plexus blockade is 0.5 microgram/kg and that, at this dose, clonidine may be used without important reported side effects even in outpatients.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of cisatracurium and atracurium: onset of neuromuscular block after bolus injection and recovery after subsequent infusion.
Cisatracurium is a new nondepolarizing muscle relaxant. In patients randomized to receive either cisatracurium (n = 40) or atracurium (n = 20) we compared the time course of neuromuscular block. The initial bolus dose of cisatracurium was 0.1 mg/kg, that of atracurium 0.5 mg/kg. ⋯ The infusion rates for a 95% +/- 4% neuromuscular block were 1.5 +/- 0.4 micrograms.kg-1.min-1 for cisatracurium and 6.6 +/- 1.7 micrograms.kg-1.min-1 for atracurium, 3.3 times those of cisatracurium when referenced to the active cations. After the infusion, the spontaneous recovery intervals 25%-75% of 18 +/- 11 min and 18 +/- 8 min for cisatracurium and atracurium (P = 0.896) were shortened to 5 +/- 2 min and 4 +/- 3 min (P = 0.921) after neostigmine. While attributing different onset times also to differences in the initial doses, we conclude that time profiles for neuromuscular block of both muscle relaxants, when given in equipotent doses, are not different.