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Items 1 - 27 of 27 |
One page. |
Anaesthesia in patients with Brugada syndrome.
Kim JS, Park SY, Min SK, Kim JH, Lee SY, Moon BK, Chae YJ.
Department of Anaesthesia and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
Brugada syndrome is characterized by right bundle branch block, ST segment elevation in the precordial leads and sudden death caused by ventricular fibrillation. We present two successful anaesthetic management cases in patients with Brugada syndrome.
PMID: 15315627 [PubMed - in process]
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Influence of formulation on propofol pharmacokinetics and pharmacodynamics in anesthetized patients.
Calvo R, Telletxea S, Leal N, Aguilera L, Suarez E, De La Fuente L, Martin-Suarez A, Lukas JC.
Department of Pharmacology, Faculty of Medicine, University of the Basque Country, Leioa, Vizcaya, Spain. rcalvo@lg.ehu.es
BACKGROUND: In anesthesia with propofol, variability persists besides sophisticated effect targeting. Drug formulation may be another factor. We have analyzed, retrospectively, the pharmacokinetics (PK) and pharmacodynamics (PD) in monitored surgery patients anesthetized with one each of five formulations of propofol. METHODS: Propofol 1% ('form' 1: Diprivan(Zeneca Limited, Macclesfield, UK), 2: Recofol(Schering Espana, Madrid, Spain), 3: Ivofol(Juste, Madrid, Spain), 4: Propofol Abbott (Abbott Laboratories, Madrid, Spain), 5: Fresenius (Fresenius Kabi Espana, Barcelona, Spain)) was administered to 77 ASA I-II patients of age [mean (range) 44 (18-65) years]. Induction of anesthesia was with varying propofol doses up to endpoints of either 60 on the Bispectral Index system (BIS) in group I (n = 48, model development) or standard clinical signs in group II (n = 29, validation). Maintenance was with three 10-min infusions of 10, 8 and 6 mg kg(-1) h(-1). Three blood samples were obtained from each subject, immediately after induction, and at 15 and 30 min on maintenance, with BIS and hemodynamic variables recorded at these times also. Total and free blood concentrations (Cb) of propofol were determined with HPLC. Pharmacokinetic and PD models with link equilibration rate ke0, were studied with a mixed-effects procedure (NONMEM). RESULTS: The induction dose (group I) showed large interindividual variability [mean (range) 163 (90-290 mg)] that correlated significantly with age, basal systolic blood pressure and formulation. The PK of propofol (basic model) was described by a one-compartment model with (typical value [interindividual coefficient of variation percent (CV%)]) CL=2.30 l min(-1) (27%) and V=8.40 l (80%). Weight (WT) and formulation, within NONMEM, were found to be significant covariates for CL and V, reducing their CV% to 25% and 74%, respectively. The final PK/PD model, which includes formulation, showed a 50% reduction in the CV% for both the ke0 and the residual error. This PK/PD model was validated in group II with 33% precision and no bias. CONCLUSION: The PK and PD are not equal for all formulations, which contributes to an increase in variability of the observed effect.
PMID: 15315624 [PubMed - in process]
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Is the ARX index a more sensitive indicator of anesthetic depth than the bispectral index during sevoflurane/nitrous oxide anesthesia?
Nishiyama T, Matsukawa T, Hanaoka K.
Department of Anesthesiology, The University of Tokyo, Japan. nishit-tky@umin.ac.jp
BACKGROUND: During general anesthesia, hypnotic components have been monitored with electroencephalogram. The bispectral index is derived from a cortical electroencephalogram, but the A-line ARX index is the electroencephalographic response to auditory stimuli. The purpose of this study was to compare the changes of the A-line ARX index and the bispectral index during sevoflurane - nitrous oxide anesthesia. METHODS: One hundred females aged 30-60 years, and scheduled for partial mastectomy, were divided into two groups. Anesthesia was induced with sevoflurane 5% and nitrous oxide in oxygen for 3 min. A laryngeal mask airway was inserted, and anesthesia was maintained with sevoflurane 1-2% and nitrous oxide in oxygen. During surgery, the sevoflurane end-tidal concentration was kept at 0.5%, 1%, or 2% for 5 min before each measurement. Blood pressure, heart rate, and the A-line ARX index (n = 50), and the bispectral index (n = 50) were measured. RESULTS: Blood pressure and heart rate increased following laryngeal mask airway insertion and blood pressure decreased at 2% sevoflurane in both groups similarly. The A-line ARX index, but not the bispectral index, increased significantly by laryngeal mask airway insertion and skin incision. The A-line ARX index decreased at 2% sevoflurane compared with 0.5%, while the bispectral index remained unchanged. CONCLUSION: During sevoflurane-nitrous oxide anesthesia, the A-line ARX index might be a more sensitive indicator of anesthetic depth than the bispectral index.
PMID: 15315622 [PubMed - in process]
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Scandinavian research in anaesthesiology 1981-2000: visibility and impact in EU and world context.
Skram U, Larsen B, Ingwersen P, Viby-Mogensen J.
Academic Department of Anaesthesia, Department of Anaesthesia and Intensive Care, Copenhagen University Hospital (Rigshospitalet), Denmark. skram@dadlnet.dk
BACKGROUND: We wished to assess the development in number and impact of publications in anaesthesiology and intensive care medicine from 1981 to 2000 in the four Scandinavian countries: Sweden, Norway, Finland, and Denmark. For comparison, we also analyzed data from the UK and the Netherlands. METHODS: Publication and citation data from 1981 to 2000 were gathered from National Science Indicators (2001), covering 33 journals indexed in Current Contents. Data were analyzed in running 5-year periods. The following informetric indicators were used: absolute number of publications; absolute number of citations; absolute citation impact (average number of citations per publication per 5-year period); citation impact relative to the European Union and the world; and the percentage of cited papers from each country. RESULTS: The annual number of publications from Denmark was stable over the 20-year period. Sweden increased its production by 35%, while the remaining four countries showed increases from 100% to 146%. Thus, Sweden and Denmark lost visibility within the European Union (EU) and in world context. The EU and world citation shares of Finland and Norway increased slightly, whereas those of Sweden, Denmark, the UK, and the Netherlands all declined significantly. The absolute citation impact (ACI) increased for all the four Scandinavian countries. The ACI of the Netherlands did not change and was surpassed by all the Scandinavian countries by 1994-98, while the UK finished below the other five countries. CONCLUSIONS: (1) The annual number of publications from Sweden, Norway, Finland, the UK, and the Netherlands increased after the late eighties, whereas the net publication output from Denmark was stagnant over the 20-year period investigated; (2) the international publication and citation visibility of Finland and Norway increased slightly, as opposed to the significant decrease seen by the other four countries; (3) judging from the increase in absolute and relative citation impact and in the percentage of cited papers, the recognition of publications from the four Scandinavian countries increased over the past 20 years.
PMID: 15315619 [PubMed - in process]
5: id: 15310386 Error occurred: Document retrieval error: document does not exist
Comment on:
A response to 'Auscultation of the chest after tracheal intubation', Khan A W and Morris S, Anaesthesia 2004; 59: 626-7.
Greenland K.
Publication Types:
PMID: 15310384 [PubMed - indexed for MEDLINE]
Comment on:
A response to 'The sterility of fentanyl vials', Bayshev F K, Anaesthesia 2004; 59: 627.
MuraliKrishna G.
Publication Types:
PMID: 15310383 [PubMed - indexed for MEDLINE]
Comment on:
A response to 'The effect of epidural analgesia in labour on maternal respiratory function', von Ungern-Sternberg B S et al. Anaesthesia 2004; 59: 350-3.
Meek T.
Publication Types:
PMID: 15310381 [PubMed - indexed for MEDLINE]
Comment on:
A response to 'Temperature measurement after severe head injury', Childs C et al. Anaesthesia 2004; 59: 192-3.
Fallis WM.
Publication Types:
PMID: 15310379 [PubMed - indexed for MEDLINE]
Comment on:
A response to 'Magnet-safe is not the same as magnet compatible in the MR scanner', Keens S J and Laurence A S, Anaesthesia 2004; 59: 516-7.
Train JJ.
Publication Types:
PMID: 15310378 [PubMed - indexed for MEDLINE]
Comment on:
A response to 'Magnet-safe is not the same as magnet compatible in the MR scanner', Keens S J and Laurence A S, Anaesthesia 2004; 59: 516-7.
Farling P.
Publication Types:
PMID: 15310377 [PubMed - indexed for MEDLINE]
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Use of combined spinal-epidural by obstetric anaesthetists.
Blanshard HJ, Cook TM.
Publication Types:
PMID: 15310368 [PubMed - indexed for MEDLINE]
Comment on:
Reluctance of anaesthetists to perform awake intubation.
Basi SK, Cooper M, Ahmed FB, Clarke SG, Mitchell V.
Publication Types:
PMID: 15310360 [PubMed - indexed for MEDLINE]
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Left lateral vs. supine, wedged position for development of block after combined spinal-epidural anaesthesia for Caesarean section.
Lewis NL, Ritchie EL, Downer JP, Nel MR.
Department of Anaesthesia, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex UB8 3NN, UK.
This prospective, randomised controlled trial compared a spinal block developing in the left lateral position (LL), after sitting a combined spinal-epidural for Caesarean section with the woman sitting -- using intrathecal hyperbaric bupivacaine and fentanyl -- with a block developing in the supine, wedged position (SW). The median (IQR) block onset times for loss of cold sensation to T4 bilaterally for LL and SW women were 15 (13-19) and 12 (10.8-14) min, respectively (p = 0.004). Unilateral blocks did not occur in the left lateral group. There were no other significant differences between groups, except the median [range] 1-min Apgar scores, which were 9 [8-10] and 9 [6-9] in the LL and SW groups, respectively (p = 0.04). In summary, the LL position is associated with a relatively slower block onset, but produces a spinal block with similar characteristics to that obtained in the SW position.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15310354 [PubMed - indexed for MEDLINE]
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Maintenance of anaesthesia with sevoflurane or isoflurane effects on adverse airway events in smokers.
Wild MR, Gornall CB, Griffiths DE, Curran J.
Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. mwild1@ncht.trent.nhs.uk
Patients who smoke are at risk of coughing and other adverse airway events during induction of anaesthesia. We have studied the incidence of adverse airway events in smokers under isoflurane or sevoflurane anaesthesia after induction with propofol. Smokers inhaling isoflurane had a 45% incidence of adverse airway events compared to 10% in those inhaling sevoflurane (p = 0.013).
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15310353 [PubMed - indexed for MEDLINE]
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Interobserver reliability between a nurse and anaesthetist of tests used for predicting difficult tracheal intubation.
Hilditch WG, Kopka A, Crawford JM, Asbury AJ.
Consultant, Department of Anaesthesia, Gartnavel General Hospital, 30 Shelley Court, Glasgow, G12 0YN, UK. Graeme.Hilditch@NorthGlasgow.Scot.nhs.uk
We examined the interobserver reliability, between a nurse and anaesthetist, of five tests used to predict difficult tracheal intubation: mouth opening; thyromental distance; head and neck movement; mandibular luxation; and assessment of oropharyngeal view. For each test, an anaesthetic nurse and a specialist registrar anaesthetist were trained to use a standard method of examination. Most of the tests had either good or very good reliability. Assessment of mouth opening demonstrated only moderate reliability and assessment of oropharyngeal view demonstrated poor reliability. The interobserver reliability estimates between a nurse and an anaesthetist are similar to those previously demonstrated between two anaesthetists.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15310351 [PubMed - indexed for MEDLINE]
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'Safety in sleep': anaesthetists, patients and the European Working Time Directive.
Cassidy CJ, Griffiths E, Smith AF.
Publication Types:
PMID: 15310344 [PubMed - indexed for MEDLINE]
[Nitrous oxideSense or nonsense for todays anaesthesia]
[Article in German]
Schonherr ME, Hollmann MW, Graf B.
Klinik fur Anaesthesiologie, Universitat Heidelberg.
Nitrous oxide has been used in addition to other volatile anaesthetics to provide general anaesthesia and short time sedation for more than 150 years. However, the exact mechanisms of action remain unclear. For decades nitrous oxide was considered to be the ideal anaesthetic because of his favourable physical properties and low cardiovascular side effects. However, the known side effects of nitrous oxide as well as the implementation of new anaesthetic agents and short acting opiates led to more and more criticism about the administration of this gas. Nitrous oxide is still frequently used for mask induction primarily in paediatric anaesthesia and gynaecology. However, recent studies have shown that omitting nitrous oxide can also be a risk factor because of an increased susceptibility to intraoperative awareness. Careful consideration of the illustrated contraindications and side effects as well as the available alternatives, shows that nitrous oxide is still an option in general anaesthesia.
PMID: 15316643 [PubMed - in process]
More on regional anesthesia induction rooms.
Dalens B.
Publication Types:
PMID: 15310648 [PubMed - in process]
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Neuromuscular blockade does not change the incidence or severity of pharyngolaryngeal discomfort after LMA anesthesia.
Hemmerling TM, Beaulieu P, Jacobi KE, Babin D, Schmidt J.
Department of Anesthesiology, Universite de Montreal, Hotel-Dieu, 3840 St. Urbain, Montreal, Quebec H2W 1T8, Canada. thomashemmerling@hotmail.com
PURPOSE: Positive pressure ventilation using a laryngeal mask airway (LMA) has gained increased popularity. This study examined the influence of neuromuscular blockade on the incidence and severity of pharyngolaryngeal discomfort after positive pressure ventilation using a LMA. METHODS: 130 patients were included in this prospective, double-blind, randomized two-centre study. Anesthesia was induced with remifentanil and propofol and maintained using remifentanil and sevoflurane in 30% oxygen and 70% air. Patients were mechanically ventilated at 15 breaths.min(-1) with tidal volumes to maintain Petco(2) 30-40 mmHg. Patients were randomly assigned to receive no neuromuscular blocking agent (NOBLOCK group) or cisatracurium prior to LMA insertion (BLOCK group). Prior to the end of surgery, morphine 3 to 5 mg iv were injected. The ease of insertion of the LMA, cuff pressure, and inspiratory pressure were recorded. Patients were asked immediately after two hours, and 24 hr after surgery to rate sore throat, dysphonia, or dysphagia as absent, minimal, moderate or severe. Continuous and categorical data were compared using t test and Chi-squared test, respectively. RESULTS: 68 and 62 patients were randomized to the NOBLOCK and BLOCK groups, respectively. Successful insertion on first attempt were 89% and 92% in the NOBLOCK and BLOCK groups, respectively. Mean intracuff and inspiratory pressures were 85 +/- 35 mmHg and 13 +/- 3 mmHg for the NOBLOCK group, and 96 +/- 34 mmHg and 15 +/- 2 mmHg for the BLOCK group. The immediate, two and 24 hr postoperative incidences and severity of sore throat, dysphonia, and dysphagia did not differ significantly between the two groups. CONCLUSION: Neuromuscular blockade does not influence the ease or rate of success of LMA insertion nor the incidence and severity of pharyngolaryngeal discomfort after positive pressure ventilation using a LMA.
PMID: 15310644 [PubMed - in process]
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Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia.
Tusman G, Bohm SH, Suarez-Sipmann F, Turchetto E.
Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. gtusman@hotmail.com
PURPOSE: The goal of this study was to analyze the effect of positive end-expiratory pressure (PEEP), with and without a lung recruitment maneuver, on dead space. METHODS: 16 anesthetized patients were sequentially studied in three steps: 1) without PEEP (ZEEP), 2) with 5 cm H(2)O of PEEP and 3) with 5 cm H(2)O of PEEP after an alveolar recruitment strategy (ARS). Ventilation was maintained constant. The single breath test of CO(2) (SBT-CO(2)), arterial oxygenation, end-expiratory lung volume (EELV) and respiratory compliance were recorded every 30 min. RESULTS: Physiological dead space to tidal volume decreased after ARS (0.45 +/- 0.01) compared with ZEEP (0.50 +/- 0.07, P < 0.05) and PEEP (0.51 +/- 0.06, P < 0.05). The elimination of CO(2) per breath increased during PEEP (25 +/- 3.3 mL.min(-1)) and ARS (27 +/- 3.2 mL.min(-1)) compared to ZEEP (23 +/- 2.6 mL.min(-1), P < 0.05), although ARS showed larger values than PEEP (P < 0.05). Pa-etCO(2) difference was lower after recruitment (0.9 +/- 0.5 kPa, P < 0.05) compared to ZEEP (1.1 +/- 0.5 kPa) and PEEP (1.2 +/- 0.5 kPa). Slope II increased after ARS (63 +/- 11%/L, P < 0.05) compared with ZEEP (46 +/- 7.7%/L) and PEEP (56 +/- 10%/L). Slope III decreased significantly after recruitment (0.13 +/- 0.07 1/L) compared with ZEEP (0.21 +/- 0.11 1/L) and PEEP (0.18 +/- 0.10 1/L). The angle between slope II and III decreased only after ARS. After lung recruitment, PaO(2), EELV, and compliance increased significantly compared with ZEEP and PEEP. CONCLUSION: Lung recruitment improved the efficiency of ventilation in anesthetized patients.
PMID: 15310643 [PubMed - in process]
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Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100beta protein levels.
Kanbak M, Saricaoglu F, Avci A, Ocal T, Koray Z, Aypar U.
Department of Anesthesiology and Reanimation, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey. orhankan@ttnet.net.tr
PURPOSE: Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100beta protein and neuropsychological tests after coronary artery bypass grafting (CABG). METHODS: Twenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group P. Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100beta protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24(th) hr postoperatively (T5). RESULTS: Postoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P, S-100beta protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05). CONCLUSIONS: Despite reports about the neuroprotective effects of propofol, S-100beta protein levels were significantly elevated in group P. Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.
PMID: 15310641 [PubMed - in process]
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Lung recruitment during general anesthesia.
[Article in English, French]
Johnson D.
Department of Anesthesia, Royal University Hospital, Saskatoon, Saskatchewan S7N 0W8, Canada. cujecjohnson@shaw.ca
Publication Types:
PMID: 15310630 [PubMed - in process]
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Factors associated with use of regional anaesthesia: a multivariate analysis in seven surgical procedures in France.
Benhamou D, Pequignot F, Auroy Y, Jougla E, Clergue F, Laxenaire MC, Lienhart A.
Publication Types:
PMID: 15318474 [PubMed - in process]
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Catalan anaesthetists and the European Union.
Arino Lambea P, Castillo Monsegur J, Cortada Almirall V, Sanchez Sanjose JC, Castano Santa J.
Publication Types:
PMID: 15318471 [PubMed - in process]
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Comparison of cuff-pressure changes in LMA-Classic and the new Soft Seal laryngeal masks during nitrous oxide anaesthesia in spontaneous breathing patients.
van Zundert AA, Fonck K, Al-Shaikh B, Mortier EP.
Catharina Hospital, Department of Anesthesiology, Intensive Care and Pain Therapy, Eindhoven, The Netherlands. zundert@iae.nl
BACKGROUND AND OBJECTIVE: There are concerns over the intra-cuff pressure of the laryngeal mask and laryngopharyngeal morbidity. In a randomized study, the authors compared cuff-pressure changes in the LMA-Classic and the new disposable Soft Seal laryngeal mask during nitrous oxide anaesthesia. METHODS: Two-hundred adult patients were randomly assigned to a size 4 laryngeal mask in two equal-sized groups for airway management: (a) the re-usable LMA-Classic, or (b) the new disposable Soft Seal laryngeal mask. Anaesthesia was administered with fentanyl, propofol, nitrous oxide, O2 and sevoflurane. The cuff pressures, adjusted to 45 mmHg at insertion, were monitored continuously until the end of the operation without any further attempt to reduce cuff pressure. On removal of the laryngeal mask, any blood at all was considered positive. Patients were requested to report any sore throat at 2 and 24 h postoperatively. RESULTS: During nitrous oxide anaesthesia, cuff pressures increased in the LMA-Classic group from 45 to 100.3 mmHg and from 45 to 46.8 mmHg in the Soft Seal laryngeal mask group (P < 0.001). The incidence of sore throat was significantly higher at 2 h postoperatively when using the LMA-Classic, although there was no difference at 24 h following the operation. Macroscopic blood was only seen on four occasions in the LMA-Classic group (not significant). CONCLUSIONS: During nitrous oxide anaesthesia, cuff pressure increases in the LMA-Classic mask were significantly higher than those of the Soft Seal laryngeal mask. Trauma to patients, as assessed by the incidence of sore throat in the early postoperative period was significantly higher in the LMA-Classic group. Cuff pressures should be monitored during nitrous oxide anaesthesia when LMA-Classic is used but to do so is of less importance when using the disposable Soft Seal laryngeal mask.
PMID: 15318467 [PubMed - in process]
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Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia.
Demirbilek S, Togal T, Cicek M, Aslan U, Sizanli E, Ersoy MO.
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey. sedemirbilek@inonu.edu.tr
BACKGROUND AND OBJECTIVE: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 microg kg(-1) was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction. METHODS: One hundred and twenty children (2-7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg(-1). After intravenous induction with thiopental and atracurium to facilitate endotracheal intubation, patients were randomly assigned to one of four groups: Patients in Groups 1 and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 microg kg(-1) during induction. Anaesthesia was maintained with sevoflurane in Groups 1 and 2 and with desflurane in Groups 3 and 4. After discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded. RESULTS: The time to tracheal extubation was significantly shorter in Groups 3 (5.2+/-1.7 min) and (6.4+/-2.1 min) than in Groups 1 (8.1+/-2.1 min) (P = 0.0001 and 0.006, respectively) and 2 (8.8+/-1.9 min) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0+/-3.9 min) than in Groups 1 (13.8+/-4.9 min) (P = 0.017) and 2 (14.9+/-4.1 min) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10% in Groups 2 and 4, respectively (P > 0.05). CONCLUSIONS: After midazolam premedication and intravenous induction of anaesthesia with thiopental administration of intravenous fentanyl 2.5 microg kg(-1) did not provide any clinically significant benefit on emer gence agitation in children who receive sevoflurane or desflurane anaesthesia.
PMID: 15318465 [PubMed - in process]
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