Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children.
To determine the frequency of 5% halothane induction and behavioral distress during inhalation induction with both oral midazolam and parental presence compared with parental presence alone. ⋯ The combination of parental presence plus oral midazolam reduces the likelihood of needing a 5% rapid halothane induction when compared with parental presence without premedication.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial.
To evaluate the efficacy of intravenous lidocaine and two doses of esmolol for attenuating the cardiovascular responses to laryngoscopy and intubation, and to assess whether a combination of both drugs is more effective than either drug alone. ⋯ Esmolol 1 to 2 mg/kg is reliably effective in attenuating HR response to tracheal intubation. Neither of the two doses of esmolol tested nor that of lidocaine affected the BP response. Only the combination of lidocaine and esmolol attenuated both HR and BP responses to tracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
A mixture of mivacurium and rocuronium is comparable in clinical onset to succinylcholine.
To compare the clinical onset and duration of a combination of mivacurium and rocuronium with succinylcholine, and to determine the efficacy of this mixture for rapid tracheal intubation. ⋯ This combination of mivacurium and rocuronium is comparable to succinylcholine in both clinical onset time and quality of intubating conditions. When rapid onset of dense neuromuscular blockade and intermediate clinical duration is desirable, this mixture may be an acceptable alternative to succinylcholine.
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Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly better analgesic effects, and also fewer unwanted side effects. ⋯ Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing of analgesics and/or a reasonably large patient sample size. These data do not allow a proper meta-analysis to be performed because of the large variability in surgical procedures, dosing regimens, assessment criteria, among others.
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To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery. ⋯ The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.