ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The authors examined the American Society of Anesthesiologists Closed Claims Study database to define the role of nerve damage in the overall spectrum of anesthesia-related injury that leads to litigation. Of 1,541 claims reviewed, 227 (15%) were for anesthesia-related nerve injury. Ulnar neuropathy represented one-third of all nerve injuries and was the most frequent nerve injury. Less-frequent sites of nerve injury were the brachial plexus (23%) and the lumbosacral nerve roots (16%). In a large proportion of cases, the exact mechanism of injury was unclear despite evidence of intensive investigation in the claim files. Median payment for nerve damage claims involving disabling injury was $56,000, which was significantly lower than the $225,000 median payment for claims for disabling injury not involving nerve damage (P< 0.01). The closed claims reviewers judged that the standard of care had been met significantly more often in claims involving nerve damage than in claims not involving nerve damage. The authors conclude that nerve damage is a significant source of anesthesia-related claims but that the exact mechanism of nerve injury is often unclear. In particular, ulnar nerve injuries seemed to occur without identifiable mechanism.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A significant association exists between the use of epidural morphine (EM), reactivation of herpes labialis (HL) commonly known as coldsores, and pruritus in the obstetric population. A randomized prospective study was designed to eliminate previously identified confounding variables. Immediately following delivery, parturients having undergone cesarean section with epidural anesthesia with carbonated lidocaine (Xylocaine® CO2, Astra, Mississauga, Ontario, Canada) with 1:200,000 epinephrine were sequentially randomized to receive either EM or im opioids for postoperative analgesia. One blood sample was collected for viral serology and two mouthwashes (day 0 and 2) were collected to determine oral viral shedding. The patients were observed daily for 5 days. Coldsores were cultured for herpes simplex virus (HSV). Of 187 patients, 96 received EM and 91 im opioids; herpes labialis occurred in 14 of 96 (14.6%) of the former but in 0 of 91 of the latter (P= 0.0004). All 14 experienced facial pruritus. The two groups were at equal risk for reactivation (seropositivity 64.6% and 62.6%, respectively). Analysis of data for those with positive HSV serology reveals 14 of 62 (22.5%) had EM and herpes labialis compared with 0 of 57 in the im group (P< 0.0001). The incidence of oral viral shedding was low. Surgical stress, the local anesthetic solution, and epinephrine addition to the local anesthetic were eliminated as confounders. Stepwise logistic regression analysis revealed that EM and a history of herpes labialis in these patients were predictive for reactivating oral HSV.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The pharmacokinetics of propofol were determined in nine patients (seven men, two women, (mean ± SD) 55.8 ± 21.2 yr. 65.2 ± 8 kg) requiring prolonged mechanical ventilation of their lungs. After an initial dose of 1–3 mg/kg, propofol was administered iv at 3 mg/kg/h for 72 h. Arterial blood samples were collected at selected times during and up to 72 h after infusion. Propofol whole blood concentrations were determined by high-performance liquid chromatography with fluorescence detection. Individual pharmacokinetic parameters were estimated by noncompartmental analysis. Derived pharmacokinetic parameters showed a long terminal phase (T1/2= 1878 ± 672 min), a large volume of distribution at steady state (Vd22= 1666 ± 756 I), and a high total body clearance (CI = 1.57 ± 0.56 1/min). While the propofol terminal elimination half-life is longer than that previously reported, emergence from sedation after prolonged administration will be governed by both redistribution mechanisms arising from the large distribution volumes and elimination from the body.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The authors determined the efficacy of four postoperative warming devices by measuring cutaneous and tympanic membrane temperatures, and heat loss/gain using 11 thermocouples and ten thermal flux transducers in five healthy, unanesthetized volunteers. Overall thermal comfort was evaluated at 5–10-min intervals using a 10-cm visual analog scale. The warming devices were: 1) a pair of 250-W infrared heating lamps mounted 71 cm above the abdomen; 2) the Thermal Ceiling® MTC XI UL (500 W) set on “high” and mounted 56 cm above the volunteer; 3) a 54-by-145-cm circulating-water blanket set to 40° C placed over the volunteer; and 4) the Bair Hugger® forced air warmer with an adult-sized cover set on “low” (≈33° C), “medium” (≈38° C), and “high” (≈43° C). Following a 10-min control period, each device was placed over the volunteer and activated for a 30-min period. All devices were started “cold” and warmed up during the study period. The Bair Hugger® set on “medium” decreased heat loss more than each radiant warming device and as much as the circulating-water blanket. All methods reached maximum efficacy within 20 min. Set on “high,” the Bair Hugger® increased skin-surface temperature more than the circulating-water blanket. The Bair Hugger® (all settings) and the water blanket raised skin temperature more than the radiant heaters. The circulating-water blanket was the most effective device for heating an optimally placed transducer on the chest (directly under and parallel to the radiant heat sources, and touching the water and Bair Hugger® blankets). However, when the entire skin surface was considered, the Bair Hugger® set on “high” transferred the most heat, enough to increase mean body temperature ≈ 1.5° C/h in a postoperative patient without thermoregulatory responses. Central temperature decreased slightly (the expected thermoregulatory response) during skin-surface warming, the decrease being roughly in proportion to the efficacy of the warming devices. Cutaneous heat flux correlated well with skin-surface temperature, but not with thermal comfort. There was no correlation between forehead and tympanic membrane temperatures.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A combined pharmacokinetic and pharmacodynamic model of mcthohcxital was used to establish and evaluate feedback control of methohexital delivery during total intravenous anesthesia with fentanyl in 11 surgical patients. The median frequency of the EEG power spectrum served as the pharmacodynamic variable constituting feedback. Based on previous investigations a median frequency from 2–3 Hz was chosen as the desired EEG set point. In addition to methohexital, patients were given a 10-min loading infusion of 0.5 mg of fentanyl followed by a constant-rate infusion of 0.22 mg/h. In agreement with an earlier similar study in volunteers given only methohexital and aiming at the same set point, identical distribution of EEG power was achieved in the current study. The decrease of median EEG frequency to 2–3 Hz was primarily induced by an increase in fractional power in the 0.5–2-Hz frequency band to 46 ± 4%. The average requirement of methohexital during the first 2 h was 675 ± 250 mg. The authors conclude that model-based feedback control of intravenous methohexital delivery can help establish and quantitate methohexital requirements during total intravenous anesthesia with fentanyl.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The effects of dexmedetomidine, an α2-adrenoccptor agonist, on vigilance, thiopental anesthetic requirements, and the hemodynamic, catecholamine, and hormonal responses to surgery were investigated in healthy (ASA physical status 1) women scheduled for dilatation and curettage (D & C) of the uterus. Fifteen minutes before induction they received single iv doses of either dexmedetomidine (0.5 μg/kg; n = 19) or saline (n = 20) in a double-blind fashion. Anesthesia was induced with thiopental and maintained with N2O/O2(70/30%) and thiopental. Dexmedetomidine was well tolerated and no serious drug-related subjective side-effects or adverse events were observed. The most prominent subjective effects were fatigue and decreased salivation. The total amount of thiopental needed to perform D & C of the uterus was reduced approximately 30% (from 456 ± 141 mg [mean ± SD] after saline to 316 ± 79 mg after dexmedetomidine). This was mostly due to a smaller induction dose in the group receiving dexmedetomidine. Dexmedetomidine appeared to improve the recovery from anesthesia as measured by visual analogue scales (VAS) on fatigue and nausea. The plasma concentration of norepinephrine was decreased by 56% after dexmedetomidine implying decreased sympathetic nervous activity. Systolic and diastolic blood pressure were moderately reduced after dexmedetomidine administration. The authors conclude that dexmedetomidine preanesthetic medication decreases thiopental anesthetic requirements and improves the recuperation from anesthesia with no serious hemodynamic or other adverse effects. Further studies in patients undergoing more stressful surgery are indicated.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Blockade of the superior hypogastric nerve plexus was performed for relief of chronic cancer related pelvic pain. The targeted sympathetic nerves lie anterior to the sacral promontory. Twenty-eight patients with neoplastic involvement of pelvic viscera secondary to cervical, prostate, and testicular cancer or radiation injury were treated with neurolytic superior hypogastric plexus block. Sympathetically mediated pain was significantly reduced or eliminated in all cases and no serious complications occurred. Superior hypogastric plexus block is recommended for diagnostic/prognostic and therapeutic purposes in patients with chronic pelvic pain, particularly when pain is of neoplastic origin.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The effect of sufentanil on human cerebral blood flow (CBF) was studied in seven unpremedicated, healthy volunteers 31 ± 3.5 yr of age (mean ± SD) and either sex. CBF (ml · 100 g−1· min−1) was measured noninvasively with the133Xe clearance technique and a scintillation camera before and after sufentanil 0.5 μg/kg administered intravenously. This technique provides values for global blood flow and for gray and white matter blood flow, and from 13 preselected regions in one hemisphere. After the administration of sufentanil, the volunteers were stimulated verbally in order to prevent their loss of consciousness and hypercarbia. Heart rate (HR), arterial pressure, oxyhemoglobin saturation, and end-tidal CO2(ETCO2were recorded during the measurements. Neither global CBF (46.1 ±1.6 control and 43 ± 1.9 after sufentanil, mean ± SEM) nor gray (76.5 ± 3.2 and 70.9 ± 6.1) or white (22.7 ± 1.5 and 24.2 ± 1.6) matter blood flow changed significantly after sufentanil administration. As well, no significant differences in HR (72 ± 4 control and 79 ± 4 beats per min after sufentanil) and ETCO2(39.8 ± 1.4 and 41.1 ± 1.1 mmHg) were observed. It is concluded that sufentanil has no significant effect on CBF in healthy human volunteers.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The authors compared tracheal intubating conditions using three techniques for rapid-sequence orotracheal intubation. Sixty patients were randomly assigned to one of three groups: priming with vecuronium (0.01 mg/kg priming dose, 4-min priming interval, 0.14-mg/kg intubating dose along with thiopental 4–6 mg iv); timing with vecuronium (0.15-mg/kg intubating dose given before thiopental and timed to weakness of hand grip); and succinylcholine (1.5 mg/ kg). Blinded intubators graded intubating conditions 60 s after the induction of anesthesia with thiopental. Intubation scores in the succinylcholine group were significantly better than in the priming group (P= 0.009). Intubation scores of the succinylcholine and the timing groups were not significantly different. Use of the timing principle for rapid-sequence orotracheal intubation is a reliable alternative in cases where succinylcholine is contraindicated.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID