Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Altered reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass is part of reperfusion injury.
To investigate whether a time sequence of acetylcholine (ACH) reactivity indicative of endothelial reperfusion injury could be demonstrated in the pulmonary circulation in patients after cardiopulmonary bypass (CPB). ⋯ The maintained reactivity to ACH directly after CPB, followed by no reaction at 1 to 1.5 and 4 hours, was in agreement with experimental findings and indicates endothelial reperfusion injury caused by the period with no blood flow through the pulmonary artery during CPB and subsequent reperfusion.
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To evaluate the onset of spinal anesthesia with power spectral heart rate analysis to determine the influence of the block on the autonomic nervous system. ⋯ Power spectral heart rate analysis during low thoracic bupivacaine spinal anesthesia is compatible with decreased sympathetic activity during stable hemodynamic intervals. Insertion of hip endoprosthesis resulted in a dramatic, transient increase in sympathetic activity, indicating that sympathetic activation was still possible despite the presence of surgical anesthesia from the subarachnoid block.
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Clinical Trial
Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome.
To determine the incidence of, outcome of, and risk factors for anesthesia-related pulmonary aspiration in the predominantly pediatric population receiving anesthesia care. ⋯ The overall incidence of anesthesia-related aspiration in our series (0.10%) was twice that reported in studies of adults, and four times (0.25%) higher for those at highest risk (ASA physical status III or IV vs. physical status I or II). Anesthesia-related pulmonary aspiration was proven to be a rare event in this tertiary pediatric center and its consequences relatively mild. Because of the very low frequency and the lack of serious outcome after aspiration in ASA physical status I and II pediatric patients, it appears that routine prophylactic administration of histamine blockers or propulsive drugs in healthy pediatric patients is unwarranted.
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Case Reports
Subcutaneous morphine is superior to intrathecal morphine for pain control in a patient with hypernephroma.
This case report illustrates differences in analgesia quality and morphine consumption between an intrathecal infusion and the subcutaneous instillation of morphine in a cancer patient with hypernephroma. Superior analgesia was obtained with a 450 mg dose of subcutaneous morphine [i.e., visual analog scale (VAS) score 0/10] than with 10 mg intrathecal morphine/day administered at the thoracolumbar (twelfth dorsal vertebra) level (VAS score 2/10). If the instillation occurs at the lumbosacral level (between the last lumbar and the first sacral vertebra), a dosage of 70 mg morphine/day cannot induce the same pain relief as 450 mg subcutaneous morphine (VAS score 5/10 vs. 0/10). In some cancer patients, subcutaneous morphine offers superior pain control than intrathecal morphine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Droperidol-ondansetron combination versus droperidol alone for postoperative control of emesis after total abdominal hysterectomy.
To investigate the hypothesis that the combination of ondansetron and droperidol would be more effective than droperidol alone in reducing nausea and vomiting. ⋯ For patients undergoing total abdominal hysterectomies, the addition of ondansetron to droperidol increases the time until first rescue and reduces the number of emetic episodes, as well as the percentage of patients, having at least one emetic episode.