ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03743.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This study was a prospective, randomized comparison of the ventilatory effects of equianalgesic single‐doses of morphine, 100 μg/kg, and buprenorphine, 3.0 μg/kg, administered intravenously to 20 children (5–8 years of age) after elective ophthalmic surgery. The decrease in ventilatory rate and acute change in the arteriolar oxygen saturation and the increase in end‐tidal CO2levels were statistically significantly greater in magnitude and duration after buprenorphine than after morphine. For both drugs, the time, duration and magnitude of ventilatory changes varied appreciably between individuals. No child had apnea or hypoventilation requiring assistance. The authors conclude that acutely administered buprenorphine depresses ventilation to a greater degree than morphine. The maximal ventilatory effect of buprenorphine occurs later than with morphine, and ventilatory depression after buprenorphine may develop late. For safety, all children given opioids intravenously should be observed until they are fully responsive and ventilatory control has sta

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03744.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

As glycopyrrolate has been reported superior to atropine with respect to reduction of salivation, stability of cardiac rate and rhythm, and recovery, a comparison of these properties of the two drugs and placebo was made in 45 patients undergoing direct laryngoscopy and 45 patients undergoing bronchoscopy, in most cases followed by mediastinoscopy. When given i.m. 30 min before anaesthesia (midazolam, alfentanil, thiopentone, and suxamethonium), the two test drugs were found to be equally potent regarding the antisialogogic effect. The same increase in heart rate after the test drugs was seen before induction, and during anaesthesia heart rate rose to the same level in the placebo group as the test groups. During anaesthesia, blood pressure was lowest in the atropine group. No differences could be demonstrated with respect to cardiac arrhythmias, possibly due to the small size of the material. The present study gives no reason for preferring either drug, and only the efficacy of both test drugs in controlling airway secretions provides an argument for using any anticholinergic drug when laryngoscopy or bronchoscopy is performed under the conditions of the present study.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03745.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The Effective Blood Concentration (EC) of propofol required to prevent response to surgical incision was determined in 65 ASA I or II female patients breathing either 100% oxygen or 67% N2O in oxygen. Propofol was administered via a microcomputer‐controlled infusion system programmed to maintain the blood propofol concentration at predetermined target values. The blood propofol concentrations predicted by the micro‐computer were validated by measurement of whole blood propofol concentration. Predicted and measured concentrations differed during infusion of propofol, but became similar after discontinuing the infusion for at least 90 s, suggesting that equilibration within the central compartment was incomplete during infusion. The response to the initial incision was observed and probit analysis used to determine the predicted blood concentration at which 50% of patients responded. The predicted EC50 for propofol/N2O/ O2and propofol/O2was 4.5 μg ml‐1and 6.0 μg ml‐1respectively, and the measured EC50 propofol/N2O/ O2and propofol/O2was 5.36 μg ml‐1and 8.1 μg ml‐1, 67% nitrous oxide in oxygen reducing the predicted EC50 by 25% and the measured EC50 of propofol by 33%. The predicted EC may be more representative of the equilibrated concentration in the central compartment and thus reflective of tissue propofol

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03746.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Endotracheal intubation conditions 60 s after intravenous administration of either high‐dose vecuronium (0.3 mg kg‐1; n = 25) or suxamethonium (1.0 mg kg‐1; n = 25) were compared in a blind, randomised study. No significant differences were found between the two drugs. In 96% of the patients intubation conditions were characterized as excellent or good. In only one patient (4%) in each group were intubation conditions unsatisfactory. According to our findings, high‐dose vecuronium provides satisfactory intubation conditions after 60 s and may be used instead of suxamethonium for rapid sequence intubation when a long duration of neuromuscular blockade is acc

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03747.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Fourteen adult patients undergoing elective major abdominal surgery were divided into two groups. One group received epidural and general anesthesia (epidural group), and 20 ml of 0.125% bupivacaine and 2 mg of morphine were administered epidurally about 30 min before the end of the operation for post‐anesthetic analgesia. The other group (control group) received general anesthesia alone with nitrous oxide, oxygen and enfiurane. Flow‐directed pulmonary arterial and radial arterial catheters were inserted preoperatively, and hemodynamic, respiratory, neuroendocrine and metabolic variables were measured serially. The data were compared during anesthesia and the immediate post‐anesthetic recovery period. In the control group, the plasma epinephrine level in the post‐anesthetic recovery period increased about four times over the anesthetic period. Oxygen consumption was increased and mixed venous oxygen saturation was decreased significantly. There was a close linear correlation between oxygen consumption (Y) and plasma epinephrine (X) level: Y = 285.7X + 90.5 (P<0.01, r = 0.72). On the other hand, plasma epinephrine, oxygen consumption and mixed venous oxygen saturation did not change significantly in the epidural group in the post‐anesthetic recovery period. There was also a close linear correlation between oxygen consumption (Y) and oxygen delivery (X): Y = 0.22X ‐32.0 (P<0.01, r = 0.89). We conclude that the surgical stress and anesthetic reversal may seriously influence neuroendocrine responses and subsequently increase plasma epinephrine. Tissue oxygenation and metabolic imbalance may occur due to the rapid increase of epinephrine in the postanesthetic recovery period. Epidural analgesia at this period may play a more important role and have a more favorable effect on the tissue

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03748.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow‐up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty‐five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming stud

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03749.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We investigated the adequacy of using dose and onset time as variables to predict the duration of action of vecuronium in patients. The onset time until 95% twitch depression and the duration until 25% twitch recovery were measured for doses ranging from 0.1 to 0.3 mg kg‐1. Statistical analyses were performed by simple and multiple regressions. The duration of action was better predicted by dose (r2= 0.61) than by onset time (r2= 0.51). However, the predictability was significantly improved by a multiple regression model of the variables, and the explanatory power was largest when using the square root of duration as the dependent variable (r2= 0.69). We conclude that the duration of neuromuscular blockade after vecuronium can be predicted more accurately by the combined use of dose and onset time than by dose alon

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03750.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The effects of oral omeprazole and oral ranitidine on gastric fluid volume and pH were compared in 95 elective surgical patients, randomly assigned to one of three groups. The patients received either 80 mg of omeprazole or 300 mg of ranitidine orally at 6.00 on the morning of surgery. One third of the patients received no antacid therapy. Following induction, a no. 18 nasogastric tube was passed into the stomach and all available gastric fluid was aspirated. pH and volumes were measured. In the omeprazole‐ and ranitidine‐treated groups, the mean pH was>5.4 after induction, at completion of surgery and 1 h after operation, although at least one patient in both groups had pH<2.5. The volumes of gastric aspirates were reduced equally by both drugs. Two patients in the omeprazole group, none in the ranitidine group and eight in the control group (26%) had pH25 ml at induction. Both drugs appeared to be effective in reducing the volume of intragastric fluid and acidity to acceptable val

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03751.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Recent studies suggest that abnormalities occur at the lipid level in malignant hyperthermia susceptible humans and pigs. To test this hypothesis, we first investigated the physical state of plasma membranes of lymphocytes isolated from normal and malignant hyperthermia susceptible swine. In halothane‐challenged pigs, malignant hyperthermia susceptibility was also assessed by ryanodine binding assay on purified sarcoplasmic reticulum membranes. The results clearly show that plasma membrane of lymphocytes from malignant hyperthermic pigs are significantly more fluid than controls. We then attempted to apply the same methodology to lymphocytes prepared from human patients previously diagnosed by the halothane and caffeine contracture test. In that case, there was no clear relationship between malignant hyperthermia susceptibility and the fluidity state of lymphocyte plasma membrane

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03752.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY