Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1991
Randomized Controlled Trial Comparative Study Clinical TrialPlasma inorganic fluoride concentrations during and after prolonged (greater than 24 h) isoflurane sedation: effect on renal function.
We studied the effect of prolonged sedation (greater than 24 h) with isoflurane on plasma inorganic fluoride concentrations and renal function in 60 critically ill patients allocated randomly to receive either isoflurane or midazolam for sedation. In the isoflurane group, plasma fluoride increased from a mean concentration of 3.1 mumol/L to 20.0 mumol/L at the end of sedation, continued to increase to a peak of 25.3 mumol/L 16 h later, and then decreased exponentially (t1/2 = 111 h) to reach normal levels by the fifth day. ⋯ Serum and urinary electrolytes, urine osmolality, and creatinine clearance during and after sedation were similar in the two groups. Isoflurane sedation was associated with an increase in plasma fluoride concentration without any clinical deterioration of renal function.
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Anesthesia and analgesia · Dec 1991
Comparative StudyHypertonic/hyperoncotic fluid resuscitation after hemorrhagic shock in dogs.
We compared canine systemic and cerebral hemodynamics after resuscitation from hemorrhagic shock with 4 mL/kg (a volume approximating 12% of shed blood volume) of 7.2% saline (HS; 1233 mEq/L sodium), 20% hydroxyethyl starch (HES) in 0.8% saline, or a combination fluid consisting of 20% hydroxyethyl starch in 7.2% saline (HS/HES). Eighteen endotracheally intubated mongrel dogs (18-24 kg) were ventilated to maintain normocarbia with 0.5% halothane in nitrous oxide and oxygen (60:40). After a 30-min period of hemorrhagic shock (mean arterial blood pressure = 40 mm Hg), extending from time T0 to T30, animals received one of three randomly assigned intravenous resuscitation fluids: HS, HES, or HS/HES. ⋯ After resuscitation, cerebral blood flow increased, exceeding baseline in the HS and HS/HES groups but remaining low in the HES group (P less than 0.05 HS vs HES at T35). We conclude that small-volume resuscitation (4 mL/kg) with HS, HS/HES, or HES does not effectively restore or sustain systemic hemodynamics in hemorrhaged dogs. In dogs without intracranial pathology, the effects on cerebral hemodynamics are also comparable, except for transiently greater cerebral blood flow in the HS group in comparison with the HES group.