Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 1990
Randomized Controlled Trial Clinical TrialEsmolol reduces autonomic hypersensitivity and length of seizures induced by electroconvulsive therapy.
We evaluated the clinical effectiveness of esmolol, an ultra-short-acting beta 1-adrenergic receptor blocking drug, to control the sinus tachycardia and increase in arterial blood pressures induced by electroconvulsive therapy (ECT). Each of 20 patients, ASA physical status I-III, participated in a double-blind, randomized study, involving four match-pair trials (placebo versus esmolol) during ECT. Each patient acted as his or her own control (total number of ECT procedures, 160). ⋯ Finally, the length of seizures decreased, as manifested clinically from 48 +/- 18 to 39 +/- 14 s and on electroencephalogram from 86 +/- 41 to 67 +/- 28 s. We conclude that esmolol effectively controls the hyperdynamic response to ECT and reduces the length of seizures. The significance of the latter to the overall effectiveness of ECT is not known.
-
Anesthesia and analgesia · Oct 1990
Comparative StudyHepatic blood flow in humans during isoflurane-N2O and halothane-N2O anesthesia.
Hepatic blood flow (HBF) (assessed by plasma clearance and hepatic extraction of indocyanine green), cardiac index, and hepatic venous oxygen saturation were measured in patients before and after induction of anesthesia with thiopental, fentanyl, and N2O, and again during halothane (1 MAC)-N2O (n = 5) or isoflurane (1 MAC)-N2O (n = 6) anesthesia before the start of surgery. Induction of anesthesia decreased HBF and cardiac index. ⋯ Hepatic venous oxygen saturation was also significantly greater during isoflurane than during halothane anesthesia. We conclude that isoflurane increases HBF in anesthetized patients and is associated with a higher hepatic venous oxygen saturation than is halothane.
-
Anesthesia and analgesia · Oct 1990
Pharmacokinetics of desflurane, sevoflurane, isoflurane, and halothane in pigs.
We tested the prediction that the alveolar washin and washout, tissue time constants, and pulmonary recovery (volume of agent recovered during washout relative to the volume taken up during washin) of desflurane, sevoflurane, isoflurane, and halothane would be defined primarily by their respective solubilities in blood, by their solubilities in tissues, and by their metabolism. We concurrently administered approximately one-third the MAC of each of these anesthetics to five young female swine and determined (separately) their solubilities in pig blood and tissues. The blood/gas partition coefficient of desflurane (0.35 +/- 0.02) was significantly smaller (P less than 0.01) than that of sevoflurane (0.45 +/- 0.02), isoflurane (0.94 +/- 0.05), and halothane (2.54 +/- 0.21). ⋯ As predicted from tissue solubilities, the tissue time constants for desflurane were smaller than those for sevoflurane, isoflurane, and halothane. Recovery (normalized to that of isoflurane) of the volume of anesthetic taken up was significantly greater (P less than 0.05) for desflurane (93% +/- 7% [mean +/- SD]) than for halothane (77% +/- 6%), was not different from that of isoflurane (100%), but was less than that for sevoflurane (111% +/- 17%). The lower value for halothane is consistent with its known metabolism, but the lower (than sevoflurane) value for desflurane is at variance with other presently available data for their respective biodegradations.