Journal of clinical anesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of midazolam, diazepam, and placebo as oral anesthetic premedicants in younger children.
To validate the superiority of higher-dose oral midazolam as an anesthetic premedicant in children 6 years of age and younger, to determine whether less expensive diazepam is a viable alternative oral premedicant in this age-group, and to assess the preoperative oxygenation effects of both benzodiazepines. ⋯ Even without premedication, a majority of children did not react negatively to an impending anesthetic. Therefore, neither midazolam nor diazepam appears to be necessary in most children younger than 6 years of age. Rather than implementing the routine use of an oral preoperative sedative, the challenge appears to be the selective identification of those children at risk for preanesthetic difficulties and psychological trauma.
-
Randomized Controlled Trial Clinical Trial
Headache prevention following accidental dural puncture in obstetric patients.
To evaluate the efficacy of a prophylactic saline patch and a prophylactic blood patch in prevention of headache following accidental dural puncture in obstetric patients. ⋯ The results of this study suggest that the administration of a prophylactic epidural blood patch is highly effective in the prevention of headaches following dural puncture, with headache frequency reduced from 87.5% to 5%.
-
Randomized Controlled Trial Clinical Trial
The synergistic effect of two different nondepolarizing muscle relaxants on intraocular pressure.
To evaluate the synergistic effect of neuromuscular blockade, produced by administering a priming dose of d-tubocurarine before or after pancuronium bromide, on endotracheal intubating conditions, intraocular pressure (IOP), and hemodynamic changes 1 minute following injection of intubating doses. To compare the results with equipotent doses of the individual muscle relaxants administered as a single bolus dose or in divided doses. ⋯ A smooth, rapid-sequence intubation with a concomitant reduction in IOP as required for open-eye, full-stomach patients can be achieved with a judicious mixture of nondepolarizing muscle relaxants as described for d-tubocurarine and pancuronium in Groups C and D.
-
Randomized Controlled Trial Clinical Trial
Neuromuscular effects of succinylcholine following different pretreatments.
To study the neuromuscular effects (onset, intensity, and duration of block) of succinylcholine following different pretreatments. ⋯ Of the pretreatments used, only d-tubocurarine interferes with the neuromuscular blocking effects of succinylcholine. Chlorpromazine, which attenuates the muscle pains as well as the increase in creatine kinase and can be administered with the same convenience, may be a better pretreatment in the prevention of side effects of succinylcholine.
-
The Risk Management Committee of the Harvard Medical School's Department of Anaesthesia developed a set of guidelines recommending administrative actions that should be taken immediately following an adverse anesthesia event. The guidelines are intended to limit patient injury from a specific event associated with anesthesia and to ensure that the causes of the event are identified to prevent recurrence. The guidelines direct the primary anesthetist to concentrate on continuing care but quickly notify someone in a leadership position, who would become the "incident supervisor." The incident supervisor would be knowledgeable of the details of the protocol and direct activities for ensuring appropriate medical care, sequestration of equipment, documentation of information, and contact of other appropriate administrative personnel. Experience with the guidelines has shown that they can be effective if applied but that it is difficult to do that consistently in our large medical centers.