Background The bispectral index (BIS), a value derived from the electroencephalograph (EEG), has been proposed as measure of anesthetic effect. To establish its utility for this purpose, it is important to determine relation among BIS, measured drug concentration, and increasing levels sedation. This study was designed evaluate four commonly used drugs: propofol, midazolam, isoflurane, alfentanil. Methods Seventy-two consenting volunteers were studied at institutions. Volunteers given either...

Background The bispectral index (BIS), a parameter derived from the electroencephalograph (EEG), has been shown to correlate with increasing sedation and loss of consciousness. This study determined whether addition BIS monitoring standard anesthetic practice results in improvements conduct anesthesia or patient outcomes. Methods Three hundred two patients receiving propofol-alfentanil-nitrous oxide were studied at four institutions. Thirty-four initially enrolled determine preexisting...

High doses of morphine produced peripheral vasodilation and frequently significant hypotension. These effects are thought to be due, in part, the release histamine. One putative advantage high-dose fentanyl anesthesia is its relatively small effect on vascular resistance. In a randomized study, authors examined possibility that hemodynamic differences between might attributable histamine release. Fifteen patients were studied prior coronary artery bypass surgery. Subjects received infusion...

Background The bispectral index (BIS) measures changes in the interfrequency coupling of electroencephalogram (EEG). purposes this study were (1) to determine whether BIS correlates with responses command during sedation and hypnosis induced by propofol or nitrous oxide, (2) compare targeted measured concentrations predicting participants' commands. Methods Twenty volunteers (15 men 5 women, aged 22-50 yr) given computer-controlled infusion, EEG was recorded for off-line analysis BIS....

The bispectral index (BIS) has been developed in adults and correlates well with clinical hypnotic effects of anesthetics. We investigated whether BIS reflects markers hypnosis demonstrates agent dose-responsiveness infants children. In an observational arm this study, values children undergoing general anesthesia were observed compared similar data collected previously a study adults. second the range steady-state end-tidal concentrations sevoflurane was administered corresponding...

Background Remifentanil, a new mu-opioid agonist with an extremely short duration of action, is metabolized by circulating and tissue esterases; therefore, its clearance should be relatively unaffected changes in hepatic or renal function. This study was designed to determine whether severe disease affects the pharmacokinetics pharmacodynamics remifentanil. Methods Ten volunteers chronic, stable, awaiting liver transplantation ten matched controls were enrolled. Each subject given 4-h...

High doses of morphine can produce significant cardiovascular effects generally attributed to histamine release. The authors examined the possibility that H1 and H2 antagonists might prove beneficial in preventing these responses. In a randomized double-blind study, four groups 10 patients each received 1 mg/kg either placebo, diphenhydramine (H1), cimetidine (H2), or both antagonists. morphine-placebo group demonstrated marked elevation plasma levels (880 +/- 163 7437 2684 pg/ml), decrease...

Background Remifentanil is an opioid analgesic for use in anesthesia. An ester linkage renders it susceptible to rapid metabolism by blood and tissue esterases. Thus was hypothesized that remifentanil elimination would be independent of renal function. Because its principal metabolite (GR90291) eliminated renally, depend on This study designed evaluate the pharmacokinetics pharmacodynamics persons with without failure. Methods Two groups volunteers received two-stage infusions remifentanil:...

Recovery from general anesthesia is governed by pharmacodynamic and pharmacokinetic factors. Gender has not previously been recognized as a factor influencing the time to emergence anesthesia.This multicenter study was originally designed measure effects of bispectral index on intraoperative anesthetic management patient recovery. We compared wake-up recovery times 274 adults after propofol/alfentanil/nitrous oxide anesthesia. Patients were randomly assigned have titration propofol performed...

Background A new pulmonary drug delivery system produces aerosols from disposable packets of medication. This study compared the pharmacokinetics and pharmacodynamics morphine delivered by an AERx prototype with intravenous morphine. Methods Fifteen healthy volunteers were enrolled. Two subjects administered four inhalations 2.2 mg each at 1-min intervals or 4.4 over 3 min infusion. Thirteen given twice above doses, i.e., eight 8.8 intravenously 7 min. Arterial blood sampling was performed...

Diazepam has been reported to produce hypotension when administered with anesthetic doses offentanyl. Twenty patients undergoing coronary bypass surgery were randomly assigned one of four treatment groups: group 1, no diazepam; groups 2, 3, and 4, 0.125, 0.25, 0.5 mg·kg−1 diazepam, respectively. All then received 50 μg·kg−1 fentanyl at 400 μg·min−1 0.4 metocurine 2 mg·min−1. Hemodynamic parameters recorded blood was sampled for measurement plasma catecholamine histamine concentrations. Heart...

The administration of d-tubocurarine (dTc) to animals and humans has been reported produce hypotension. Experiments in suggest that the hypotension is a result both ganglionic blockade histamine release. In order determine role release dTc-induced humans, authors developed sensitive radioenzymatic assay for plasma measured following dTc (0.25-0.75 mg/kg) 21 surgical patients. While neither fentanyl (3 microgram/kg) nor thiopental (6 produced significant change histamine, caused...

These studies were undertaken to determine the effects of morphine and other opiate opioid agonists on body temperature in mouse. Mice lightly restrained, rectal temperatures monitored after injection analgesics at each three ambient temperatures. The drugs tested pure representing eight different chemical classes. At 20 degrees C, morphine, hydromorphone, levorphanol, oxymorphone, methadone, etonitazene, fentanyl, etorphine meperidine produced hyperthermia low doses hypothermia as raised....

HOKE, J. FRANK; SHLUGMAN, DAVID; DERSHWITZ, MARK; MICHALOWSKI, PIOTR; MALTHOUSE-DUFORE, SHERRY; CONNORS, PATRICIA M.; MARTEL, DAVE; ROSOW, CARL E.; MUIR, KEITH T.; RUBIN, NINA; GLASS, PETER S. A. Author Information

GLASS, PETER S.; BLOOM, MARC; KEARSE, LEE; ROSOW, CARL; SEBEL, PETER; MANBERG, PAUL Author Information

This placebo-controlled, randomized, double-blind trial was designed to evaluate the efficacy of three prophylactic antiemetic regimens on postoperative nausea and vomiting (PONV) during patient-controlled analgesia (PCA) with morphine. We studied 286 elective surgical patients for 36 h postoperatively. Group 1 saline control. In Groups 2 3, metoclopramide or droperidol administered as an intravenous (IV) bolus then added morphine in PCA device. 4, tropisetron, a long-acting investigational...

Peripheral mechanisms may be involved in opioid actions on the urinary bladder. This double-blind study investigated whether inhibition of bladder function is reversed by methylnaltrexone, a peripheral antagonist. Thirteen healthy male volunteers received an intravenous (i.v.) infusion remifentanil, 0.15 mcg/kg/min, then single i.v. dose medication (methylnaltrexone 0.3 mg/kg, naloxone 0.01 or saline). Urodynamics were measured with indwelling and rectal catheters, pupil size was assessed...