Articles: anesthetics.
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Anesthesia and analgesia · Dec 1989
Interaction between nondepolarizing neuromuscular blocking agents and inhalational anesthetics.
Although many studies have presented data based on administration of nondepolarizing neuromuscular blocking agents to patients given inhalation anesthesia for 30-45 min, no data exist on the interaction in a clinical situation where the relaxant is administered immediately after the start of anesthesia. We therefore studied the effect of the commonly used inhalation anesthetics, halothane and enflurane, on the clinical pharmacology of atracurium, vecuronium, pipecuronium, and pancuronium. No significant influence of the anesthetic technique on the onset time of the various neuromuscular blocking agents was observed. ⋯ The prolongation of atracurium blockade was clinically irrelevant. A fact that is statistically significant but clinically irrelevant is that a cumulative effect with atracurium and vecuronium was only seen during enflurane anesthesia and after the fourth maintenance dose. We conclude that there is no clinical indication that the dosage of atracurium and vecuronium during inhalation anesthesia should be reduced, but the doses of pipecuronium and pancuronium should be reduced when prolonged paralysis is not desired.
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Pediatric emergency care · Dec 1989
Comparative StudyInfluence of topical anesthesia on the sedation of pediatric emergency department patients with lacerations.
Local anesthetic infiltration of wounds causes pain which distresses children. A painless topical anesthetic solution containing tetracaine, adrenaline, and cocaine (TAC) may reduce this distress. We hypothesized that the use of TAC for anesthesia may reduce the utilization of sedation for laceration repair. ⋯ However, there was a significant reduction in the percent of patients with lacerations receiving DPT during the experimental period, from 12% to 7.6% (P less than 0.05). There were no significant differences in laceration frequency (119/mo and 116/mo), length (2.7 and 2.7 cm), location (85% and 93% total for face and digits), or complexity (64% and 63%) for preTAC and TAC periods, respectively. We conclude that TAC used for local anesthesia may reduce the need for sedation in PED patients with lacerations that require suturing.
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One hundred and fifty-seven patients who warranted the injection of local anaesthetic were divided into two groups. One group received local anaesthetic at room temperature (21 degrees C) and the other at body temperature (37 degrees C). ⋯ There was no significant difference in the level of pain experienced by the two patient groups. It is concluded that no advantage is gained by the warming of local anaesthetic before its administration.
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Comparative Study
Vascular response of human skin after analgesia with EMLA cream.
We investigated vascular responses after cutaneous application of EMLA cream (a eutectic mixture of lignocaine and prilocaine) by skin reflectance spectroscopy and laser Doppler blood flowmetry. In healthy subjects, EMLA cream produced a biphasic vascular response with an initial vasoconstriction, maximal after 1.5 h of application. ⋯ Vasoconstriction was also observed initially with two non-EMLA creams applied under occlusion, whereas the occlusive plastic film alone did not alter the vascular state. Thus late vasodilatation was unique to EMLA cream.
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This study examined the interaction between thiopental and epinephrine in inducing ventricular arrhythmias in dogs. The arrhythmogenic threshold of epinephrine was determined during anesthesia with either halothane alone, thiopental alone, etomidate plus different doses of thiopental, or halothane plus different doses of thiopental. The arrhythmogenic dose and the corresponding plasma concentration of epinephrine during thiopental anesthesia (plasma thiopental concentration: 46-57 micrograms/ml) were 0.77 +/- 0.04 micrograms.kg-1.min-1 and 10.7 +/- 1.5 ng/ml, respectively. ⋯ During halothane plus thiopental anesthesia, at plasma thiopental concentrations of 0, 10 +/- 0.86, 18.3 +/- 0.87, and 31.8 +/- 1.05 micrograms/ml, the corresponding epinephrine concentrations were 45.3 +/- 9.2, 34.6 +/- 8.9, 16.2 +/- 1.74, and 15.1 +/- 1.32 micrograms/ml, respectively. These results suggest that thiopental sensitizes the heart to epinephrine in a dose-dependent manner. This sensitizing action of thiopental would in part explain the thiopental potentiation of hydrocarbon anesthetic-epinephrine arrhythmias.