Journal of anesthesia
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Journal of anesthesia · Sep 1994
Assessment of postoperative pain: Contributing factors to the differences between patients and doctors.
This study was undertaken to compare the assessment of pain intensity by 50 patients and by their doctors according to a visual analog scale 5 h and 20 h after major abdominal surgery, and to examine the relationships between the differences in rating of patients and doctors and the factors inherent in the patients which include preoperative expectation of pain, level of anxiety, and the surgical history of the patient. The ratings given by the patients were significantly higher than those given by the doctors at both time periods. ⋯ The results of analysis using Hayashi's quantification theory Type II indicated a moderate association between the rating difference and the patient's age, surgical history, preoperative state of anxiety, and expectation of pain. It is concluded that postoperative pain management, whether in clinical practice or in research, necessitates more consideration of the several above-mentioned individual factors and a preoperative interview in which the patient's level of anxiety and the amount of information the patient has concerning the surgery and post-operative pain is clearly assessed.
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Journal of anesthesia · Sep 1994
Crossover effects of acidosis on the recovery of neuronal function following glucose-oxygen deprivation in rat hippocampal slices.
The present study was designed to determine whether acidosis modifies the effect of simulated ischemia on neuronal function. Hippocampal evoked potentials were recorded in vitro from the CA1 region after stimulation of the Schaffer collaterals and the change in the evoked potentials was analyzed in response to glucose-oxygen deprivation under variable acid-base conditions ranging from pH 7.4 to pH 4.5. ⋯ The recovery of PS amplitude during recovery from glucose-oxygen deprivation was not significantly inhibited by moderate acidosis of pH 6 and 5.5 but was significantly inhibited when the pH was 5 or lower. The results suggest that severe acidosis may depress PS amplitude and prevent their recovery after reversal of glucose-oxygen deprivation, and that moderate acidosis may have no significant effect on PS amplitudes on their recovery.
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Journal of anesthesia · Sep 1994
Flecainide is effective against premature supraventricular and ventricular contractions during general anesthesia.
The effect of intravenously administered flecainide on premature supraventricular (PSCs) and ventricular contractions (PVCs) which developed under general anesthesia was evaluated. Flecainide was infused intravenously at a rate of 0.2 mg/kg/min until the efficacy of this drug appeared or for 10 min; thus, the maximum dose was determined to be 2 mg/kg. Flecainide was administered to 10 patients who experienced more than 5 supraventricular and/or ventricular contractions/min for a period of more than 5 min (PVCs, 4 patients; PSCs, 6 patients). ⋯ This dose of flecainide did not affect the heart rate and QRS interval, but caused a transient decrease in systolic blood pressure from 127±6 mmHg (SE) to 114±6 mmHg, a 14% increase in the PQ interval, and a 6.3% increase in the QT interval. These results suggest that flecainide is a promising drug for the treatment of PSCs and PVCs which develop during general anesthesia. Transient hypotension and cardiac conduction disturbances immediately after injection may occur when flecainide is used intravenously.
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Journal of anesthesia · Sep 1994
The pharmacodynamics of rocuronium in pediatric patients anesthetized with halothane.
The aim of this study was to determine the neuromuscular blocking potency of rocuronium (ORG 9426) in 4-to 14-year old children anesthetized with halothane. After induction of anesthesia, the ulnar nerve was stimulated with electrical impulses of 0.2 ms duration every 12 s and the force of contraction of the thumb (P) was continuously recorded. Doses of 0.12, 0.16, 0.20, and 0.24 mg·kg(-1) rocuronium were administered, in a randomized fashion, to 4 groups of 12 patients each. ⋯ When at termination of anesthesia T4/T1 ratios were lower than 0.75, the residual neuromuscular block could be antagonized with 0.5 mg·kg(-1) edrophonium in 2 min. Rocuronium, 0.3 mg·kg(-1) caused a 13.5% increase of heart rate but had no effect on blood pressure. In conclusion, in 4 to 14-year-old children, rocuronium appears to have a more rapid onset and shorter duration of action than other steroid-type muscle relaxants.
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Journal of anesthesia · Sep 1994
Effects of halothane and enflurane on the peripheral vasoconstriction and shivering induced by internal body cooling in rabbits.
General anesthetic agents have central and peripheral effects on body temperature regulation, and its alterations are related to the depth of anesthesia. To evaluate the effect of halothane and enflurane on thermoregulation, we investigated the threshold of body core temperatures to induce peripheral vasoconstriction and shivering in spontaneously breathing rabbits. Rabbits were anesthetized with halothane or enflurane at 0.0 (control), 0.2, and 0.4 MAC (minimum alveolar concentration). ⋯ The incidence of peripheral vasoconstriction was not significantly affected by halothane or enflurane. However, the incidence of shivering decreased in a dose-dependent fashion with both anesthetic agents. At 0.2 MAC, the incidence of shivering in the enflurane group was significantly higher than that in the halothane group, suggesting that suppression of shivering by halothane is stronger than enflurane.