Articles: anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of propofol and thiopentone for induction of anaesthesia for elective caesarean section.
Propofol 2.5 mg/kg was compared with thiopentone 5 mg/kg as an induction agent for elective Caesarean section. Thirty-two healthy women with cephalopelvic disproportion were included in an open randomised study. The placental transfer of propofol was also studied in 10 other mothers given a single dose of 2.5 mg/kg. ⋯ Rapid placental transfer and significant fetal uptake were detected for propofol. There was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. Propofol appears to be a suitable alternative to thiopentone as an induction agent for anaesthesia in elective Caesarean section.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Air embolism in the sitting position. Oxygen/nitrogen versus oxygen/laughing gas].
Venous air embolism (VAE) is a well-known complication of neurosurgical procedures performed in the sitting position. Nitrous oxide (N2O) intensifies the hemodynamic alterations conditioned by VAE. Therefore the administration of N2O must be discontinued immediately if VAE occurs. Nevertheless, it is still not clear whether N2O should be avoided in such operations as a general policy. The aim of the present study was to investigate the incidence and severity of VAE with O2/N2 as opposed to O2/N2O anesthesia. METHODS. In all, 42 patients (19 men, 23 women) aged 23-80 years were investigated in a randomized order. In all cases an intracranial operation was carried out with the patient in the sitting position. The anesthesiologic management was uniform: modified neuroleptanalgesia (fentanyl, flunitrazepam, droperidol), relaxation with pancuronium, endotracheal intubation, moderate hyperventilation (PaCO2 30-35 mmHg) without PEEP. Half (21) of the patients (group 1) were ventilated with O2/N2 (1:1) and the remaining patients (group 2) with O2/N2O (1:1). Heart rate (HR) arterial blood pressure (AP), central venous pressure (CVP), end-tidal CO2 tension (PE'CO2), and body temperature were monitored continuously. Arterial blood gases were checked once per hour at least. VAE was signaled by changes in the ultrasonic Doppler sounds or a rapid decrease in the end-tidal CO2 tension. The diagnosis of VAE was confirmed by aspirating air bubbles through the right atrial catheter. A vacuum-driven device was used to suction off the embolized air and measure the aspirated air volume. Pulmonary gas exchange was defined by the arterial to end-tidal CO2 difference (PaCO2 - PE'CO2) and by the alveolar arterial O2 quotient (PAO2 - PaO2/PAO2). If a VAE was recognized N2O administration was stopped immediately and ventilation was continued with pure oxygen. Postoperatively all patients were ventilated. ⋯ The incidence of VAE was similar in both groups: VAE occurred in five patients in group 1 and in six patients in group 2. In isolated cases distinct increases in the CO2 difference (PaCO2 - PE'CO2) or the O2 quotient (PAO2 - PaO2/PAO2) resulted, with no significant difference between the groups. In patients with VAE the aspirated gas volume (median 6.0 ml in group 1, 75.5 ml in group 2; P less than 0.01) and the duration of aspiration (median 5.0 min in group 1, 22.5 min in group 2; P less than 0.05) were significantly different in the two groups. HR was significantly lower in group 2 1 and 4 h after the beginning and at the end of the operation. MAP was significantly lower in group 2 3 and 4 h after the beginning and at the end of the operation. CVP was significantly higher in group 2 3 h after the start of the operation. The total dose of fentanyl, flunitrazepam and droperidol administered was higher in group 1 than in group 2 (P less than 0.05). The duration of postoperative ventilation was similar in both groups.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Sufentanil-N2O2/O2 or halothane-N2O/O2 anesthesia in surgery of infants and children with congenital heart defects. Hemodynamics and plasma catecholamines].
Sufentanil-nitrous oxide/oxygen anesthesia was compared to halothane-nitrous oxide/oxygen anesthesia in 44 infants and children undergoing cardiac surgery. Patients were randomly assigned to one of the two techniques studied, with 22 patients in each group. The mean weight was 8.3 (4.4-15.8) kg in the sufentanil (S) group and 11.7 (5.2-18) kg in the halothane (H) group. ⋯ There were dose-dependent decreases in heart rate and small but significant decreases in mean and diastolic arterial pressure in the S group during deepening of anesthesia. There was a significantly greater decrease in systolic, diastolic and mean blood pressures during the same period in the H group whereas the reduction in heart rate was minimal. In addition, in 5 of 22 patients receiving H there were episodes of nodal rhythms with dramatic decreases in systemic arterial pressure and peripheral arterial oxygen saturation in cyanotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Opioid supplementation during propofol anaesthesia. The effects of fentanyl or alfentanil on propofol anaesthesia in daycase surgery.
Sixty patients of ASA grade 1 or 2 who presented for minor daycase gynaecological or urological procedures were randomly allocated to three groups. Group A received fentanyl 1 microgram/kg and Group B alfentanil 5 micrograms/kg prior to induction. ⋯ The pre-induction administration of fentanyl or alfentanil was not found significantly to affect either the doses of propofol required for induction or maintenance or the quality of anaesthesia compared with propofol alone. These results suggest that for minor outpatient procedures under general anaesthesia, the concomitant use of a short-acting opioid confers no benefits over propofol with oxide and oxygen alone.
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Anesthesia and analgesia · Aug 1989
Randomized Controlled Trial Clinical TrialNormovolemic hemodilution and lumbar epidural anesthesia.
This randomized study was designed to determine the cardiovascular effects of normovolemic hemodilution and lumbar epidural anesthesia in patients scheduled for vascular surgery. The patients were randomly assigned to three different groups: group 1 (N = 10) included patients undergoing lumbar epidural anesthesia without hemodilution; group 2 (N = 10) consisted of patients with normovolemic hemodilution without epidural anesthesia; and in group 3 (N = 10) normovolemic hemodilution was produced during lumbar epidural anesthesia. The three groups included several patients with a history of either myocardial infarction or stable mild angina or treated and controlled hypertension. ⋯ After normovolemic hemodilution, hemoglobin concentration decreased significantly (15%), whereas cardiac index increased significantly (15%) without significant changes either in mean arterial pressure or in heart rate. Systemic oxygen transport and total body oxygen consumption did not change significantly. No patient experienced chest pain or electrocardiographic evidence of myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)