Journal of anesthesia
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Journal of anesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyEfficacy of a heat and moisture exchanger in inhalation anesthesia at two different flow rates.
In general anesthesia with endotracheal intubation, a circle system with a heat and moisture exchanger (HME) and a low total flow is often used to prevent hypothermia and to maintain inspired gas humidity. The purpose of the present study was to compare the inspired gas humidity and body temperature, in general anesthesia with or without an HME at two different total flow rates. Eighty patients (American Society of Anesthesiologists [ASA] I or II) scheduled to undergo either orthopedic or head and neck surgery were studied. ⋯ Group 4L had significantly lower absolute humidity than group 2L. The pharyngeal temperature did not decrease significantly for 2 h in any of the groups. During general anesthesia with a total flow of 2 lxmin(-1) in 2 h, HME might not be necessary, while with a total flow of 4 lxmin(-1), HME could be useful to maintain inspired gas humidity.
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Journal of anesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyComparison of the effects of fentanyl and remifentanil on splanchnic tissue perfusion during cardiac surgery.
The purpose of this study was to compare the effects of fentanyl and remifentanil on splanchnic perfusion during coronary artery bypass graft (CABG) surgery. Fifty patients were randomized to receive either fentanyl (10 microgxkg(-1) at induction and 5 microgxkg(-1)xh(-1) infusion for maintenance) or remifentanil (3 microgxkg(-1) at induction and 1 microgxkg(-1)xmin(-1) infusion for maintenance). Patients in both groups were comparable with regard to demographics. ⋯ However, there were no statistically significant differences in respiratory data at any time between the two groups (P > 0.05). Both fentanyl and remifentanil seemed to be effective and well tolerated in this CABG population. Episodes of hypotension and transient reduction in splanchnic perfusion were more common in patients treated with remifentanil when compared to those receiving the fentanyl opioid regimen.
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Journal of anesthesia · Jan 2007
Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects.
Many obstetric patients receiving epidural analgesia are encouraged to ambulate. This current study was designed to determine the potential for maximizing the time to first epidural supplement when adding clonidine to a 0.625 mg.ml(-1) bupivacaine continuous epidural infusion following epidural fentanyl bolus in early labor for patients allowed to ambulate. Maternal and fetal effects secondary to clonidine were also evaluated. ⋯ In early laboring patients, addition of clonidine prolongs the analgesia duration of a 0.625 mg.ml(-1) bupivacaine continuous epidural infusion following 100 microg epidural fentanyl (after a lidocaine-epinephrine test dose) without a clinically significant increase in side effects.
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Journal of anesthesia · Jan 2007
Case ReportsConsiderations for general anesthesia combined with epidural anesthesia in a patient with stiff-person syndrome.
We report the successful management of anesthesia in a patient with stiff-person syndrome (SPS) undergoing a thymectomy using a volatile anesthetic combined with epidural anesthesia. The anesthetic concern in patients with SPS is the possibility of postoperative hypotonia due to the presence of excessive gamma-aminobutyric acid (GABA) resulting from an interaction between the anesthetic agents and preoperatively taken therapeutic drugs. Epidural anesthesia has the advantages of decreasing the required amount of anesthetics with GABAergic action, and relieving the postoperative pain that causes the symptoms of SPS. Epidural anesthesia could be a useful technique in SPS patients.
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Journal of anesthesia · Jan 2007
Randomized Controlled TrialThe use of droperidol decreases postoperative nausea and vomiting after gynecological laparoscopy.
We evaluated whether or not routine prophylaxis with 2.5 mg of droperidol would efficiently prevent postoperative nausea and vomiting (PONV). Fifty-two patients scheduled for elective gynecological laparoscopic surgery were eligible for this study. Anesthesia was induced using propofol, fentanyl, and vecuronium, and maintained with sevoflurane in nitrous oxide, fentanyl, and vecuronium. ⋯ Episodes of nausea and vomiting and the need for metoclopramide in group 1 were lower than in group 2, though the total fentanyl dose in group 1 was higher than in group 2. There were no differences in the need for analgesics between the groups. The use of 2.5 mg droperidol safely decreased PONV after gynecological laparoscopy.