Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialPharmacodynamics, pharmacokinetics, and intubation conditions after priming with three different doses of vecuronium.
The effects of three different priming doses of vecuronium on pharmacokinetics, pharmacodynamics, and endotracheal intubation conditions were investigated. Forty-two patients were studied in two parts. In each part, 21 patients were allocated into three groups (n = 7/group) receiving 10, 15, or 20 micrograms/kg vecuronium as a priming dose, followed by a 50- micrograms/kg intubating dose 6 min later. ⋯ Recovery index was significantly increased after priming with 20 micrograms/kg (13.2 +/- 6.6 min, P < 0.05) compared with 10 micrograms/kg (9.2 +/- 4.8 min) and 15 micrograms/kg (6.7 +/- 1.5 min). Between groups no differences in onset time, clinical duration, and pharmacokinetic variables were found. In Part II, onset time and intubating scores showed no significant differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1995
Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass.
Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstrictor therapy required to maintain systolic blood pressure at more than 85 mm Hg despite a normal cardiac output after CPB in 4301 adults undergoing elective coronary artery and/or valve surgery. Hypothermic, nonpulsatile CPB and either opioid or ketamine-benzodiazepine anesthesia were common features of the operations. ⋯ In the first 4 h after arrival in the intensive care unit, the need for vasoconstrictor infusions to treat hypotension with adequate cardiac output did not differ, although more ACE-inhibited patients (6.4%) exhibited low values of systemic vascular resistance (< 600 dyne.s.cm-5) than patients not receiving ACE inhibitors (2.8%; P = 0.0002). Logistic regression analysis identified preoperative ACE inhibitor use, congestive heart failure, poor left ventricular function, duration of CPB, reoperative surgery, age, and opioid anesthesia as independent risk factors for requiring > or = 2 vasoconstrictor infusions after CPB. No other preoperative drug therapy significantly altered this outcome.
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Anesthesia and analgesia · Mar 1995
Anesthesia with increasing doses of sufentanil and midlatency auditory evoked potentials in humans.
Our interest focused on the question whether sufentanil differs from alfentanil, fentanyl, and morphine with regard on its effects on midlatency auditory evoked potentials (MLAEP). Therefore, we studied MLAEP during general anesthesia with increasing doses of sufentanil in 16 patients scheduled for elective major urologic surgery. Anesthesia was induced with sufentanil (1 microgram/kg every 7 min to a total dose of 3 micrograms/kg). ⋯ For the amplitudes Na/Pa and Pa/Nb there was only a slight and statistically insignificant reduction. After the largest dose of sufentanil (3-5 micrograms/kg) Na and Pa showed a similar pattern as in awake patients. We conclude that sufentanil does not differ essentially from alfentanil, fentanyl, and morphine with regard on its effects on MLAEP.
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Anesthesia and analgesia · Mar 1995
Who uses transesophageal echocardiography in the operating room?
A survey was made of 155 anesthesiology residency programs in the United States to determine the patterns of use, responsibility for interpretation, and training of those responsible for intraoperative transesophageal echocardiography (TEE). Survey questions included numbers and types of cases for which TEE is used, who interprets TEE data and how they are trained, the extent of resident training in TEE, and beliefs about the utility of TEE. One hundred eight completed surveys were returned (70% response). ⋯ Forty-two percent of anesthesiologists who use TEE leave a formal interpretation on the chart apart from the anesthesia record, and 43% bill specifically for performing TEE. Although 69% of those responding thought that formal credentials should be required for anesthesiologists to use intraoperative TEE, only 32% reported that their institutions actually mandated this. 38% of those responding stated that they offer a dedicated TEE rotation to their residents, and 13% thought that their graduating residents were trained well enough to use TEE on their own. Among academic institutions responding, the use of intraoperative TEE is nearly universal, responsibility for its interpretation is split almost evenly between cardiologists and anesthesiologists, and there is a disparity between opinions and reality with regard to TEE credentialing for anesthesiologists.
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Anesthesia and analgesia · Mar 1995
Effects of intrathecal mu, delta, and kappa agonists on thermally evoked cardiovascular and nociceptive reflexes in halothane-anesthetized rats.
Despite significant opioid binding in the intermediolateral cell column, the effects of intrathecal injections of mu, delta, and kappa opioid agonists on the cardiovascular response to noxious stimulation have not been examined systematically. The pharmacology of intrathecally administered opioid agonists (mu, morphine, [D-Ala2,N-MePhe4,Gly5-ol]enkephalin (DAGO); delta, metkephamid, [D-Ala2-D-Leu5]enkephalin (DADL), [D-Pen2,D-Pen5]enkephalin (DPDPE); kappa, U50488H and PD117,302) or agonist-antagonist (nalbuphine) on somatomotor (tail-flick) and cardiovascular changes (blood pressure and heart rate) evoked by immersing the tail in 53 degrees C water were examined in rats anesthetized with halothane (0.75%) and in which intrathecal catheters had been chronically implanted. ⋯ In addition, intrathecal administration of mu and delta but not kappa or agonist-antagonist had little effect on resting heart rate and blood pressure. These data indicate that the agonist occupancy of spinal mu and delta, but not kappa agonists can profoundly modulate the autonomic and somatomotor response evoked by high threshold thermal stimuli.