ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Among the main causes for the relatively small number of organ donors, the delay in the diagnosis of brain death plays a major role. This prospective study was designed to evaluate whether pulsed Doppler mean and phasic common carotid blood flow (CCBF) combined with arterial and jugular venous blood gases could rapidly and specifically establish a diagnosis of brain death. CCBF was measured by an 8 MHz pulsed Doppler flowmeter, allowing measurement of the vessel diameterviaa double transducer probe, which fixed the ultrasonic incidence angle. From an initial series of patients (n = 28) with an established diagnosis [brain death n = 14; severe coma with a Glasgow Coma Scale (GCS) less than 7, n = 14], the results of the logistic regression analysis process yielded the most discriminating parameters for brain death diagnosis: end-diastolic velocity (Ved - 1.4 vs. 12.7 cm/s; t = 7.67,P= 0.001) and blood flow (Qed - 13.6 vs. 121.4 ml/min). These parameters were then tested in a blind fashion on a second series of 28 comatose patients (GCS = 7). They resulted in correct diagnosis (brain death n = 14 or severe coma n = 14) for all patients. Brain death diagnosis was confirmed by clinical signs, EEG, and/or angiography. From the analysis of the overall population (n = 56), a value of Qed of less than 31.4 ml/ mn indicates brain death. The authors conclude, that pulsed Doppler measurements of CCBF represent an early, low cost and noninvasive technique, the results of which may prompt legally accepted procedures, which in turn would reduce the delay required before brain death is diagnosed. Moreover, this technique could help in deciding on discontinuation of active therapy in severely in jured patients.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The onset of akinesia of the extraocular muscles was assessed after peribulbar block with a plain orpH-adjusted solution of 0.75% bupivacaine and hyaluronidase. Thirty-five patients were randomly assigned to receive either 0.75% bupivacaine with hyaluronidase 15 units/ml (pH 5.45 ± 0.12) or the samepH-adjusted solution (0.15 mEq, sodium bicarbonate per 30 ml of 0.75% bupivacaine to give a finalpH of 6.82 ± 0.09) in a double-blind, prospective manner. Onset of akinesia was determined to the nearest minute. Supplemental injections were given after 20 min in the event of incomplete akinesia. The group receivingpH-adjusted bupivacaine had a statistically faster onset time for complete akinesia than did the control group (5.3 ± 1.2 min vs. 14.3 ± 2.3 min, respectively;P< 0.001). Five of 17 patients in the control group required a supplemental injection, whereas only one of 17 patients in the treatment group had a supplemental block at 20 min (P< 0.05). Thus,pH adjustment of a solution of bupivacaine and hyaluronidase with sodium bicarbonate hastens the onset time and improves the initial success rate of peribulbar block.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The influence of two different doses of oral naltrexone on the adverse effects and the analgesia of epidural morphine were compared in a double-blind, placebo-controlled study. Forty-five patients undergoing cesarean section were provided postoperative analgesia with 4 mg epidural morphine. Five minutes later they received 6 mg naltrexone, 9 mg naltrexone, or placebo as an oral solution. Pain relief was assessed by the Visual Analog Scale (VAS) and by direct questioning of the patients. Requirement for additional analgesics and side effects were noted. Respiratory effects of epidural morphine and naltrexone were assessed using the ventilatory responses to CO2and by monitoring O2saturation (Spo2) using pulse oximetry. All patients in the placebo group had adequate analgesia. One of the 15 patients who received naltrexone 6 mg had inadequate analgesia versus five of the 15 patients who received naltrexone 9 mg (P< 0.05), 9 mg versus placebo. Ten patients (67%) in the placebo group had pruritus while no patient in the 6 mg naltrexone group and one patient in the 9 mg group experienced mild pruritus (P< 0.05), placebo versus other two groups. The CO2response slopes were depressed compared to control values from 6–16 h in the placebo group, from 6–12 h in the 6 mg naltrexone group. No significant depression was noted in the 9 mg naltrexone group. The authors conclude that oral naltrexone 6 mg significantly reduces the incidence of pruritus associated with epidural morphine without affecting analgesia and that 9 mg naltrexone is associated with shorter duration of analgesia than 6 mg naltrexone.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Nine patients who had developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI2) (12.5–35.0 ng·kg−1·min−1). Whether PGI2might decrease the pulmonary capillary pressure (PCP) obtained by analysis of the pulmonary artery occlusion pressure decay curve and improve systemic oxygen delivery was examined. Gas exchange alterations induced by PGI2were analyzed by using the multiple inert gas elimination technique. PGI2reduced the pulmonary artery pressure from 35.6 to 28.8 mmHg (P< 0.001) and the PCP from 22.9 to 19.7 mmHg (P< 0.01) without changing the contribution of the pulmonary venous resistance to the total pulmonary vascular resistance. The cardiac index increased from 4.2 to 5.7 1·min−1·m−1(P< 0.001) due to both increased stroke volume and heart rate. Despite a marked deterioration of ventilation-perfusion (VA/Q) matching with increased true intrapulmonary shunt flow from 28.6% to 38.6% (P< 0.01) of the cardiac output, the Pao2was unchanged due to increased mixed venous oxygen content indicated by an augmented mixed venous Po2(from 37.0 to 41.9 mmHg,P< 0.01). This caused a 35% (P< 0.001) increase of the systemic oxygen delivery rate. Thus, short-term infusions of PGI2reduced PAP and PCP without deleterious effects on arterial oxygenation in patients with ARDS. Hence, PGI2may be useful to lower pulmonary vascular pressures in patients with ARDS.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This randomized, double-blind study evaluated the efficacy of metoclopramide administered at the completion of surgery as an antiemetic agent in pediatric patients undergoing ambulatory strabismus surgery; 126 unpremedicated ASA Physical Status 1 and 2 children ranging in age from 2 to 18 yr served as subjects. All received general anesthesia with halothane, N2O, and O2; tracheal intubation was facilitated with intravenous (iv) atracurium 0.5 mg/kg. Intravenous atropine 0.02 mg/kg and lactated Ringer's solution with 5% dextrose equivalent to 4 h of maintenance fluids were administered during surgery. Neither opioids nor droperidol were given intraoperatively. At the completion of surgery, residual muscle paralysis was reversed with atropine 0.02 mg/kg (maximum dose 1.0 mg) and neostigmine 0.07 mg/kg (maximum dose 5.0 mg), and the stomach was decompressed prior to tracheal extubation. After the patient had been transferred to the pastanesthesia recovery room (PARR) either metoclopramide 0.15 mg/kg or normal saline was administered intravenously to the children over a 1-min period. A research associate monitored the children for the incidence of postoperative vomiting and the time required for each child to meet discharge criteria from Short Stay Recovery Unit (SSRU). If a child vomited more than three times in both the PARR and SSRU, the vomiting was construed to be severe and the patient was offered further antiemetic treatment with iv droperidol 70 mg/kg. The incidence of postoperative vomiting in the metoclopramide group was 37% versus 59% in the placebo group (P< 0.05). The time required for children who received meloclopramide to meet standard discharge criteria was 207.4 ± 60.0 min (range, 100–425 min), whereas that for controls was 248.8 ± 84.5 min (range, 110–480 min). This difference is also statistically significant (P< 0.002). Eight children who received the placebo required adjunct antiemetic therapy for protracted postoperative vomiting. None of the children who received metoclopramide had protracted or severe postoperative nausea and vomiting. This difference in the incidence of severe postoperative nausea and vomiting was statistically significant (P< 0.006). Finally, there were no adverse reactions to either metoclopramide or placebo, and none of the children appeared to be drowsy or sedated

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The effect of an intravenous (iv) injection of lidocaine with epinephrine was studied to determine if such a test dose would cause a reliably detectable increase in heart rate and systemic blood pressure in children anesthetized with halothane and nitrous oxide. The effect of the injection of atropine before the test dose on these parameters was also determined. Sixty-five children I month to 11 yr of age and weighing 3.9–35 kg were studied. The children were assigned to one of four groups, each of which was anesthetized with 1% halothane and 50% nitrous oxide. Group 1 (n = 20) received 10 μg/kg atropine followed 5 min later by an iv dose of 0.1 ml/kg 1% lidocaine with 1/200,000 epinephrine (0.5 μg/kg) to simulate an intravascularly administered epidural test dose. Group 2 (n = 21) was identical to group 1 but did not receive atropine prior to the simulated intravascular test dose. Groups 3 (n = 12) and 4 (n = 11) were identical to groups 1 and 2, but the simulated intravascular test dose did not contain epinephrine: group 3 received atropine prior to the test dose and group 4 did not. The simulated intravascular test dose increased heart rate in group 1 (with atropine) at each time period from 15 to 120 s, but only at 45 and 60 s in group 2 (without atropine). Following the iv test dose, 6 of 21 children in group 2 had an increase in heart rate of less than 10 beats/min, while only one child in group 1 had an increase in heart rate of less than 10 beats/min. Intravenous test doses that did not contain epinephrine (groups 3 and 4) had no effect on heart rate or blood pressure. Atropine, 10 μg/kg, improves the reliability of an epidural test does in children anesthetized with halothane an nitrous oxide but does not ensure total reliability in detecting an intravascular injection

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A prospective randomized clinical trial of enflurane, fentanyl, halothane, and isoflurane is described. The 17,201 patients were stratified into two groups (preanesthetic medication and no preanesthetic medication) and were randomized to one of four study agents: enflurane, fentanyl, halothane, and isoflurane. Fifteen university-affiliated hospitals in the United States and Canada participated. All patients were first assessed preoperatively. Data were collected during anesthesia, in the immediate recovery period, and for up to 7 days after anesthesia/surgery. The mean age of the patients was 43 yr, the mean height 167 cm, and the mean weight 68 kg. Sixty-five percent of patients were female. In this study 90.7% of patients were classified as ASA Physical Status 1 or 2, and 34.7% of patients smoked. It is concluded that pooling of data across institutions was valid and does allow determination of the efficacy and relative safety of the four study agents.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A prospective, stratified, randomized clinical trial of the safety and efficacy of four general anesthetic agents (enflurane, fentanyl, halothane, and isoflurane) was conducted in 17,201 patients (study population). Patients were studied before, during, and after anesthesia for up to 7 days. Nineteen patients died (0.11%), and in seven of these (0.04%) the anesthetic may have been a contributing factor. The rates of death, myocardial infarction, and stroke in the study population were so low (less than 0.15%) that no conclusions regarding the relative rates of these outcomes among the four anesthetic agents could be reached. The rates of 16 of 66 types of adverse outcomes in the study population were significantly different among the four study agents. Most of these outcomes were minor. However, severe ventricular arrhythmia (P<10−6) was more common with halothane, severe hypertension (P<10−6) and severe bronchospasm (P= 0.028) were more common with fentanyl, and severe tachycardia (P= 0.001) was more common with isoflurane. Recovery from anesthesia during the first 30 min was slowest in those patients who recevied halothane (P= 0.001). In addition, patients who received fentanyl experienced less pain during the first hour in the recovery room (P<10−6). In conclusion, clinically important differences do exist for some outcomes among the four study agents.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To determine whether administration of nitrous oxide, 50% and 70%, could provide analgesia and anxiolysis during venous cannulation in pediatric patients, 165 ASA Physical Status 1 patients scheduled for elective surgery were studied. Children, 3 weeks to 18 yr of age, were randomly assigned either to receive nitrous oxide, 50% or 70% in oxygen, or 100% oxygenviamask or to a group breathing room air, for 3 min prior to and during venous cannulation. A blinded observer using a behavioral scale for rating pain in children performed assessments of behavior and pain before and following venous cannulation. Children who received 50% or 70% nitrous oxide were more likely to be relaxed, 59% and 84%, respectively, and had little evidence of pain. Of those given 100% oxygen or no mask, only 30% and 21%, respectively, were considered relaxed, and 16% and 15% had little evidence of pain during venous cannulation. Side effects were seen in 28% of the group given 70% nitrous oxide and included excitement, dysphoria, nausea, restlessness, and opisthotonic movements. Both 50% and 70% nitrous oxide in oxygen administered to pediatric patients are effective at decreasing the pain and anxiety associated with venous cannulation, but use of the latter is associated with side effects.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID