Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1985
Comparative StudyHalothane and isoflurane do not decrease PaO2 during one-lung ventilation in intravenously anesthetized patients.
We examined the effect of the inhalational anesthetics halothane (H) and isoflurane (IF) on arterial oxygenation during one-lung ventilation. Twenty consenting patients who required thoracotomy and one-lung ventilation were initially anesthetized only with the intravenous agents, diazepam, fentanyl, pancuronium, metocurine, and infusions of either ketamine or methohexital. A double lumen endotracheal tube was inserted, and each patient's lungs were mechanically ventilated (two-lung ventilation, step 1) with 100% O2 while the patient was in the lateral decubitus position. ⋯ The inhalational anesthetics were then discontinued, and intravenous agents were reinstituted, allowing PETH and PETIF to decrease below 0.50 mm Hg (step 4). Two-lung ventilation was resumed at the end of the surgical procedure (step 5). PaO2 decreased from 441 +/- 64 to 252 +/- 70 mm Hg when one-lung ventilation was achieved (steps 1-2), and PaO2 increased from 258 +/- 72 to 395 +/- 65 mm Hg when two-lung ventilation was resumed (steps 4-5).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Oct 1985
Antiarrhythmic effect of diltiazem during halothane anesthesia in dogs and in humans.
The antiarrhythmic effects of diltiazem (DL), a slow channel inhibitor, were evaluated in the presence of epinephrine-halothane-induced arrhythmias in dogs, of premature ventricular contractions (PVCs) during anesthesia in patients (n = 10), and of tachyarrhythmias with associated atrial fibrillation (AF) during anesthesia in patients (n = 9). The arrhythmogenic dose of epinephrine (ADE) during one MAC of halothane in dogs was increased from 1.13 +/- 0.21 to 3.14 +/- 0.89 microgram X kg-1 X min-1 by the administration of 0.3 mg/kg of DL. This suggests that DL significantly increases the threshold for the induction of arrhythmias associated with epinephrine and halothane. ⋯ With an additional nine patients who had had AF preoperatively and suffered tachyarrhythmias during anesthesia, the intraoperative intravenous administration of DL significantly decreased heart rate (to less than 100 beats/min) within 10-15 min. Diltiazem is an effective means for the treatment of PVCs and AF-mediated tachyarrhythmias during anesthesia. Because of the pharmacologic properties of DL (e.g., depressing sinus and atrioventricular (AV) node function), DL should be used with caution in patients with a sick sinus syndrome or an AV block, or in the presence of beta-adrenergic antagonists.
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Anesthesia and analgesia · Sep 1985
Comparative StudyA comparison of edrophonium and neostigmine for the antagonism of atracurium-induced neuromuscular block.
Edrophonium, 0.5 mg/kg, or neostigmine, 0.05 mg/kg, was administered to groups of 20 patients each, for antagonism of atracurium-induced block at varying degrees of spontaneous recovery. Neuromuscular block was studied using train-of-four (TOF) stimulation. ⋯ Five of the seven patients in the edrophonium group who failed to be reversed adequately had shown three or fewer twitches to a TOF stimulation. It is concluded that edrophonium in a dose of 0.5 mg/kg does not consistently antagonize neuromuscular blockade induced by atracurium, particularly if all four responses to a TOF stimulation are not elicited prior to antagonism of the block.
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Anesthesia and analgesia · Sep 1985
Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation.
The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. ⋯ A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.