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Controversies in Cardiovascular Anesthesia by Jan L. Kramer, David J. Wagner (auth.), Phillip N. Fyman

By Jan L. Kramer, David J. Wagner (auth.), Phillip N. Fyman M.D., Alexander W. Gotta M.D. (eds.)

On sixteen October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic impact of diethyl ether in a public demonstration within the "ether dome" of the Bulfinch construction of the Massachusetts normal health facility in Boston. The sufferer, Gilbert Abbott, suffered no ache, and the health care professional, Dr. John C. Warren, used to be in a position to whole a suture ligature of a vas­ cular tumor of the jaw with no the hurry that until eventually then was once so helpful. The operation proved a failure, because the tumor recurred; however the demonstration of ether's anesthetic impact was once a very good luck. Operative ache was once conquered, and surgical procedure may possibly enhance from a crude and unscientific perform the place pace was once paramount, and the most important physique cavities couldn't be entered, into the original mix of technological know-how and paintings that it's now. "Gentlemen, this can be no hum­ bug," supposedly muttered Warren, possibly the final noncontroversial check­ ment of anesthesiology to be made by way of a health practitioner. The screams of resisting sufferers in soreness have been stilled, and quiet entered the working room for the 1st time. however the new technology of discomfort aid used to be speedy wrapped in controversy. a controversy instantly arose as to who may perhaps legitimately declare primacy for the invention. Morton's try and conceal the real nature of his anesthetic agent, coupled with an attempt to patent the invention, clouded his popularity and encouraged different claimants to push themselves forward.

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Powerful coronary vasodilator in patients with coronary artery disease. Anesthesiology 59:91-97, 1983. Reiz S, Ostman M: Regional coronary hemodynamics during isoflurane-nitrous oxide anesthesia in patients with ischemic heart disease. Ancsth Analg 64:570- 576, 1985. WynandsJE, Wong P, Whalley DG, SpriggeJS, Townsend GE, Patel YC: Oxygen-fentanyl anesthesia in patients with poor left ventricular function: hemodynamics and plasma fentanyl concentrations. Anesth Analg (Cleve) 62:476-482, 1983. Ellison N: Morphine and the new narcotics in postoperative ventilatory control.

6. Heikkila H, Jalonen J, Arola M, Laaksonen V: Haemodynamics and myocardial oxygenation for coronary artery surgery: comparison between enflurane and high-dose fentanyl anaesthesia. Acta Anaesthesiol Scand 29:457-464, 1985. 7. Samuelson PN, RevesJG, KirklinJK, Bradley EJr, Wilson KD, Adams M: Comparison of sufentanil and enflurane-nitrous oxide anesthesia for myocardial revascularization. Anesth Analg 65:217-226, 1986. 8. Moffitt EA, Sethna DH: The coronary circulation and myocardial oxygenation in coronary artery disease: effects of anesthesia.

As indicated by these observations, variability in patient response to any given narcotic dose must be anticipated, and smoking, and alcohol, and/or caffeine consumption should be viewed as additional factors that affect fentanyl requirements for CABG surgery. A variety of fentanyl-dosing regimens have been used for induction and 20 2. An intravenous technique is preferable for CABG patients maintenance of anesthesia during cardiac surgery. The anesthetic dose of fentanyl is often determined empirically and administered as a single bolus at the time of induction.

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