Journal of anesthesia
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Journal of anesthesia · Mar 1996
Does increasing end-tidal carbon dioxide during laparoscopic cholecystectomy matter?
To examine the adverse effects of peritoneal carbon dioxide (CO2) insufflation during laparoscopic cholecystectomy, both hemodynamic and respiratory alterations were continously monitored in 17 adult patients using noninvasive Doppler ultrasonography and a continuous spirometric monitoring device. During the surgery, which was performed under inhalational general anesthesia, intraabdominal pressure was maintained automatically at 10mmHg by a CO2 insufflator, and a constant minute ventilation, initially set to 30-33 mmHg of end-tidal CO2 (ETCO2), was maintained. ⋯ The stress of 10mmHg pneumoperitoneum was a major cause of hemodynamic changes during laparoscopic cholecystectomy. Some clinical strategies such as deliberate intraabdominal insufflation at the initial phase might be required to minimize these hemodynamic changes.
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Journal of anesthesia · Mar 1996
A comparison of sympathetic adrenal nerve responses to intravenous high-dose morphine and fentanyl administration in rats.
We compared the effects of intravenous morphine (5 mg·kg(-1)) and fentanyl, (50μg·kg(-1)) on systolic blood pressure (SBP), heart rate (HR), and efferent sympathetic adrenal nerve action potentials (SANA) in rats. We also determined the extent of the reflex responses of these parameters of 9% carbon dioxide (CO2) challenge during the above narcotic anesthesia. In the morphine group, SBP was elevated and the elevated levels were maintained, while changes in SBP in the fentanyl group were not significant. ⋯ CO2 challenge induced only very small changes in SBP and HR, suggesting that during high-dose narcotic anesthesia the hypercapnic stimulus may not be reflected in circulatory parameters. In both groups, hypercapnia increased SANA to 30% of the baseline values from the pre-challenge level. However, these values were only 91% and 56% of the baseline value in the morphine and the fentanyl, groups, respectively.
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Journal of anesthesia · Mar 1996
Oral clonidine reduces thiamylal requirement for induction of anesthesia in adult patients.
Although preanesthetic clonidine, an α-2 agonist, is known to reduce anesthetic requirements, the effect of preanesthetic oral clonidine medication per se on the requirement of thiamylal in adult humans has not yet been examined. One hundred and sixty-one adult patients (14-78 years of age) were randomly assigned to groups that received oral clonidine (5μg·kg(-1) (n=51), 2.5μg·kg(-1) (n=55), or none (n=55)) in addition to 20mg oral famotidine 90min before anesthesia induction. ⋯ Thiamylal requirements were significantly less in both clonidine groups (2.95±0.09 and 3.14±0.10 mg·kg(-1) (mean±SE) for patients receiving 5μg·kg(-1) and 2.5μg·kg(-1) clonidine, respectively) than in the control group (3.81±0.11 mg·kg(-1),P<0.05); however, no difference was found between the two clonidine groups. Although mean blood pressure and heart rate during the study period were significantly lower in both clonidine groups than in the control group, no profound hypotension or marked bradycardia were noted in the clonidine groups.
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Journal of anesthesia · Mar 1996
Halothane anesthesia suppresses reflex tachycardia caused by calcitonin gene-related peptide in dogs.
Calcitonin gene-related peptide (CGRP) is known to produce vasodilation, hypotension, and tachycardia. To investigate the interaction between CGRP and anesthetics, the hemodynamic response to infusions of CGRP was studied in dogs anesthetized with halothane or pentobarbital. In halothane-anesthetized dogs given 0.4 μg·kg(-1) of CGRP, mean arterial pressure (MAP) did not change significantly. ⋯ The results show that the hemodynamic profiles induced by CGRP during halothane or pentobarbital anesthesia are a decrease in MAP accompanied by a reduction in SVR and no consistent alterations in CI. However, CGRP effects on HR showed in a different way. The results also show that HR response differs depending on the anesthetics used: HR increases during pentobarbital anesthesia, while it does not increase during halothane anesthesia.
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Journal of anesthesia · Mar 1996
Epidural anesthesia during upper abdominal surgery provides better postoperative analgesia.
Since repeated noxious stimuli may sensitize neuropathic pain receptors of the spinal cord, we tested the hypothesis that the appropriate blockade of surgical stimuli with epidural anesthesia during upper abdominal surgery would be beneficial for postoperative analgesia. Thirty-six adult patients undergoing either elective gastrectomy or open cholecystectomy were randomly allocated to receive either inhalational general anesthesia alone (group G) or epidural anesthesia along with light general anesthesia (group E) throughout the surgery. ⋯ While there was no significant difference in the bupivacaine dose, more patients undergoing gastrectomy in group G required supplemental analgesics than those in group E, and the VAS scores in group E demonstrated significantly better postoperative analgesia compared to group G after both types of surgery. Thus, an appropriate epidural blockade during upper abdominal surgery likely provides better postoperative pain relief.