Anesthesia and analgesia
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Anesthesia and analgesia · May 1988
Effects of etomidate, midazolam, and thiopental on median nerve somatosensory evoked potentials and the additive effects of fentanyl and nitrous oxide.
In 30 patients undergoing spinal disc operations, the effects of bolus injections followed by intravenous infusions of thiopental, etomidate, and midazolam on median nerve somatosensory-evoked potentials (SSEPs) were studied. Possible additive effects of fentanyl and nitrous oxide were also evaluated. Serial SSEP measurements were made before and for 25 minutes after the start of anesthesia. ⋯ Midazolam had no effect on amplitude but increased latency. The addition of fentanyl and nitrous oxide had different effects in response to the three intravenous induction agents. This study emphasizes the differences in SSEP responses not only to different intravenous induction agents but also to the addition of fentanyl and nitrous oxide.
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Anesthesia and analgesia · Apr 1988
Randomized Controlled Trial Comparative Study Clinical TrialEffects of aerosolized and/or intravenous lidocaine on hemodynamic responses to laryngoscopy and intubation in outpatients.
A randomized, double-blind study was carried out on 40 unpremedicated, ASA I-II adult surgical outpatients to assess the effects of aerosolized lidocaine, intravenous lidocaine, both, or neither, on circulatory responses to laryngoscopy and intubation. Lidocaine (4 mg/kg) or saline was given by nebulizer in the holding area beginning at -15 minutes. The patient underwent a standardized induction of anesthesia that included IV curare (3 mg) and O2 by facemask at minute 2, followed by IV thiopental (5 mg/kg) and succinylcholine (1.5 mg/kg) at minute 5. ⋯ There were no differences among the four treatment groups (n = ten per group) in any of the four hemodynamic variables before laryngoscopy and intubation. Within each group, after intubation all four hemodynamic variables increased significantly over the corresponding baseline values for that group. However, the maximum values attained after intubation did not differ significantly among the four treatment groups for any of the four hemodynamic variables, whether those maxima were expressed as absolute values or as a percentage of baseline.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1988
Randomized Controlled Trial Clinical TrialCombined intrathecal morphine and bupivacaine for cesarean section.
The effects of adding 0.2 mg preservative-free morphine sulfate in 0.2 ml solution to hyperbaric spinal bupivacaine were evaluated in a double-blind randomized prospective study of 34 patients undergoing elective repeat cesarean section. In the control patients (n = 17), 0.2 ml saline instead of morphine was added to bupivacaine. ⋯ Neonatal condition was not adversely affected by this small dose of morphine administered 11 +/- 1 minutes before delivery. Combining 0.2 mg morphine with hyperbaric spinal bupivacaine for cesarean section is a safe and effective method of improving intraoperative pain relief and providing adequate prolonged postoperative analgesia.
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Anesthesia and analgesia · Apr 1988
Clinical Trial Controlled Clinical TrialSedative doses of midazolam depress hypoxic ventilatory responses in humans.
The effect of midazolam on the hypoxic ventilatory response of eight healthy volunteers was examined during isocapnic rebreathing. The magnitude of the slope of the ventilatory response to hypoxia (VE vs SaO2) decreased from 1.48 +/- 0.24 to 0.70 +/- 0.13 L.min-1.%SaO2(-1) (means +/- SE, P less than 0.005) after midazolam 0.1 mg/kg IV. The calculated ventilation at an arterial saturation of 90% also decreased from 28.6 +/- 4.4 to 19.9 +/- 2.7 L/min (P less than 0.05). ⋯ The change in hypoxic response slope after physostigmine 2.0 mg IV (an increase of 0.28 +/- 0.34 L.min-1.%SaO2(-1] did not differ significantly from that after placebo (an increase of 0.03 +/- 0.22 L.min-1.%SaO2(-1], although physostigmine significantly increased awareness. It is concluded that a sedative dose of midazolam depresses hypoxic ventilatory response and attenuates the hyperpnea and tachycardia associated with hypoxemia. Furthermore, physostigmine-glycopyrrolate reversal of midazolam-induced sedation was associated with nausea (five subjects), vomiting (three subjects), and tachycardia without reversal of the depressed hypoxic ventilatory response.