Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Comparative StudyNoninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants: end-tidal versus transcutaneous carbon dioxide.
We prospectively compared the accuracy of two noninvasive monitors of arterial CO2 (end-tidal and transcutaneous) in mechanically ventilated infants and toddlers with respiratory failure. The study included infants and toddlers less than 48 mo of age who required tracheal intubation and mechanical ventilation for respiratory failure. In each patient, both ETCO2 and transcutaneous CO2 (TC-CO2) were simultaneously monitored and compared with PaCO2 when an arterial blood gas analysis was performed. ⋯ The absolute difference of the TC-CO2 and PaCO2 was 4 mm Hg or less in 96 of the 100 values, while the ETCO2 to PaCO2 difference was 4 mm Hg or less in 38 of the 100 values (P < 0.0001). Bland-Altman analysis revealed a bias of -0.68 with a precision of +/-2.35 when comparing the TC-CO2 and the PaCO2 and a bias of -6.68 with a precision of +/-5.01 when comparing ETCO2 with PaCO2. In neonates and infants with respiratory failure, TC-CO2 monitoring provided a more accurate estimation of PaCO2 than ETCO2 monitoring.
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Anesthesia and analgesia · Jul 1997
Comparative StudyMaturation decreases ethanol minimum alveolar anesthetic concentration in mice as previously demonstrated in rats: there is no species difference.
The potency of conventional inhaled anesthetics increases with maturation: the 50% effective dose (minimum alveolar anesthetic concentration [MAC]) for conventional inhaled anesthetics in the neonatal rat or human exceeds MAC in the young adult. This increase also applies to ethanol in rats tested using MAC as the measure of anesthesia. However, the converse appears to be true for studies in mice assessed with the righting reflex; that is, adult mice are six times more resistant than neonates to the effects of ethanol. ⋯ Accordingly, we investigated whether maturation decreased ethanol potency in mice, using MAC as the measure of anesthesia. Applying standard techniques, we tested MAC for ethanol in 15 CF-1 mice aged 10 days (6-8.5 g) and in 13 mice aged 77-84 days (34-39 g). MAC decreased with maturation, and the decrease was indistinguishable from that found in our previous studies of rats.
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We describe a novel supraclavicular approach to the brachial plexus. Designated as the intersternocleidomastoid technique, this new approach was tested in unembalmed cadavers. It was then applied for evaluation to 150 ASA grade I or II patients scheduled for elective surgery or physiotherapy of the upper limb or for treatment of reflex sympathetic dystrophy associated with painful shoulder. ⋯ Postoperative analgesia was provided for 48 h or more in 45 patients and for 24 h in 18 patients. Only minor complications were observed: asymptomatic phrenic nerve block in 89 patients (60%), transient Horner's syndrome in 15 (10%), transient recurrent laryngeal nerve blockade in 2, and misplacement of the catheter into the subclavian vein in 1 patient. No pneumothorax was observed.
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Anesthesia and analgesia · Jul 1997
Thromboelastographic changes in healthy parturients and postpartum women.
Thromboelastography (TEG) using disposable plastic cups and pins was performed with native whole blood (native group) in 17 nonpregnant volunteers, 134 healthy term pregnant women (>36 wk gestation), and 69 postpartum women. Thromboelastography was also performed with celite-activated whole blood (celite group) in 15 nonpregnant female volunteers, 38 healthy term pregnant women, and 34 postpartum women. The thromboelastographic parameters r and K were significantly decreased in pregnant and postpartum women compared with nonpregnant women in both groups (P < 0.05). ⋯ The TEG coagulation index was significantly greater in pregnant and postpartum women compared with nonpregnant women in both groups. In this study, TEG showed that pregnancy is a hypercoagulable state and that postpartum women remain hypercoagulable through the first 24 h postdelivery. The use of celite in TEG accelerated the speed of TEG analysis.
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Anesthesia and analgesia · Jul 1997
Non-operating room emergency airway management and endotracheal intubation practices: a survey of anesthesiology program directors.
Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. We conducted a survey of anesthesia program directors regarding emergency airway management practices at their institutions. A questionnaire was sent to anesthesia program directors listed in the Graduate Medical Education Directory for 1995-1996. ⋯ EW physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. Anesthesiologists are most represented in airway management on hospital floors.