Voveran

By Q. Vibald. Coe College. 2019.

Fast-track eligibility after ambulatory anesthesia: A comparison of desflurane voveran 50 mg line, sevoflurane and propofol cheap voveran online visa. Comparison of recovery profile after ambulatory anesthesia with propofol cheap voveran 50mg, isoflurane buy voveran 50 mg line, sevoflurane and desflurane: A systematic review. Patient state index: Titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. Titration of volatile anesthetics using bispectral analysis index facilitates recovery after ambulatory anesthesia. A postanesthetic discharge scoring system for home readiness after ambulatory surgery. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Comparative effects of ketorolac, dezocine and fentanyl as adjuvants during outpatient anesthesia. A single preoperative oral dose of valdecoxib, a new cyclooxygenase-2 specific inhibitor, relieves post-oral surgery or bunionectomy pain. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Dexamethasone for prophylaxis of postoperative nausea and vomiting: a quantitative systematic review. Dexamethasone for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled studies. Antiemetic prophylaxis does not improve outcomes after outpatient surgery when compared to symptomatic treatment. Surgery, special procedures, and anesthesia services performed in an office setting. This chapter will consider the care of the patient undergoing procedures in these locations. Discussion of anesthesia in stand-alone ambulatory centers, or offices, is addressed in Chapters 31 and 32. Anesthesia and analgesia provided for labor and delivery is discussed in Chapter 41. Children commonly require sedation or anesthesia for diagnostic and therapeutic procedures. The anesthesiologist must understand the nature of the procedure, including the position of the patient, how painful the procedure will be, and how long it will last. The optimum anesthesia plan provides safe patient care and facilitates the procedure. Discussions with the proceduralist must include contingencies for emergencies and adverse 2186 outcomes. Prior to the anesthetic, the presence and proper functioning of1 all equipment needed for safe patient care must be established; this is described in Table 33-3. The location of immediately available resuscitation equipment should be noted and protocols developed with the local staff for dealing with emergencies, including cardiopulmonary resuscitation and the management of anaphylaxis. Small, portable anesthesia machines and monitors are available if a site does not offer a permanent anesthesia work station. A preprepared cart containing essential equipment that is checked and restocked after each case is recommended. During transport the patient should be accompanied by skilled personnel to evaluate, monitor, and support the patient’s medical condition. A specialized transport team may contribute to reducing the number of critical incidents that occur during the transport of ventilated and critically ill patients. Patients are often mechanically15 ventilated and receiving a number of drug infusions for both sedation and hemodynamic support. Portable ventilators are useful for transport; these are often oxygen powered, and adequate supplies of oxygen must be available for the transfer. Infusion pumps and portable monitors should have adequate battery power for transit. The transport team should carry spare anesthetic and emergency drugs, equipment for intubation or reintubation, portable suction, and if the patient’s condition requires, a portable defibrillator. It is vital to notify the destination area that the patient is in transit, so that appropriate preparations to receive the patient can be made in advance. It is also useful to send personnel ahead to secure the elevators to prevent delays during transfer. This revised guideline places the responsibility and oversight for all anesthesia services under the direction of one suitably qualified individual, the “director of anesthesia services. The Continuum of Anesthesia Anesthesia exists along a continuum and the transition from minimal sedation to general anesthesia is not clear-cut (Table 33-5). The individual responsiveness of patients to different sedative agents varies, as do the levels of stimulation during the course of a procedure. In any circumstances where a particular level of sedation is being provided, services must be immediately available to rescue a patient from a deeper than intended level of sedation or general anesthesia. In medical x-ray tubes, the target is usually tungsten or a more crack-resistant alloy of rhenium (5%) and tungsten (95%). X-ray production is determined by, and directly proportional 2192 to, the tube current and the voltage. Fluoroscopy is a technique used to obtain real-time moving images of the internal structures. By coupling the fluoroscope to an x-ray image intensifier and a video camera, the images can be recorded and played on a monitor. Large, C-shaped, mobile fluoroscopy devices (C-arms) are used to provide images in multiple dimensions. The C-arm moves back and forth around the patient during the procedure, taking up large amounts of space, limiting access to the patient, and serving as a means of dislodging intravenous lines and endotracheal tubes (Fig. Table 33-5 Definition of General Anesthesia and Levels of Sedation/Analgesia18 2193 Figure 33-2 A radiology suite showing a C-arm and the high density of equipment that may separate the anesthesiologist from the patient. Patient exposure to radiation during imaging and treatment varies depending on the type of procedure as well as patient- and operator-related factors. Standard procedures exist to minimize patient exposure to radiation and efforts to reduce occupational exposure for staff including anesthesiologists working in radiology suites are an important consideration. A number of terms are used to define exposure to radiation ; these are22 summarized in Table 33-6. Table 33-6 Common Terms Used in Radiation Exposure22 Staff, including the anesthesiologists, must be aware of the hazards of occupational exposure to ionizing radiation and take appropriate measures to protect themselves. Patients are subjected to direct exposure where the beam enters the skin, whereas staff members working in fluoroscopy suites are more at risk from scattered radiation. As a general rule the exposure to staff is 1/1,000th the entrance skin exposure at 1 m from the fluoroscopy 2194 tube. This finding was attributed to24 anesthesiologists being less likely to use the protective shielding during their patient care activities. Another recent study demonstrated that anesthesiologists working in the neurointerventional suite were are at equal risk of developing cataracts as neuroradiologists, and that the radiation may even be directed away from the neuroradiologists and toward the anesthesiologist. These studies highlight the need for anesthesiologists to be25 aware of the risks and the means to protect themselves from radiation, especially in areas where fluoroscopy is used. Using protective shielding (lead-lined garments and fixed and/or movable shields). Lead aprons, thyroid shields, and leaded eyeglasses are recommended despite being bulky and contributing to staff fatigue. Anesthesiology staff should consider using movable or fixed lead-lined glass shields so that they can gain easy access to their patients while protecting themselves from radiation. These data should be regularly reviewed by the facility’s radiation safety section or medical physics department. Radiologic contrast media are iodinated 2195 compounds classified according to their osmolarity (high, low, or iso- osmolar), their ionicity (ionic or nonionic), and the number of benzene rings (monomer or dimer). Nonionic contrast agents cause less discomfort on injection and have a lower incidence of adverse reactions. Adverse reactions to contrast agents may be divided into renal adverse reactions and hypersensitivity reactions.

In the first otrez-ke it goes in superolateral direction lies horizontally in the second order voveran no prescription, and the third should be inclined downward order discount voveran line. Thoracica interna) buy voveran 50 mg on-line, thyrocervicalis trunk (truncus thyrocervicalis) The branches of the second segment: From the second segment of the subclavian artery departs edge-cervical trunk (truncus costocervicalis) heading up the dome of the pleura and dividing into two terminal branches: the deep cervical artery (a cheap 50 mg voveran mastercard. Jugularis externa) is formed at the angle of the lower jaw at the confluence of the posterior auricular vein (v. Thoracic duct, ductus thoracicus, collects lymph from both lower limbs, organs and pelvic wall and abdominal cavities of the left lung, the left half of the heart wall of the left half of the chest, on the left arm and the left side of the neck and head. The left and right lumbar trunks collect lymph from the lower extremities, and the walls of the pelvis, abdomen, lumbar and sacral regions of the spinal canal and spinal membranes. Initially, both the nerves are in the upper mediastinum, then move to the middle mediastinum and are located on the side of the pericardium, in front of the root of the corresponding lung. There phrenic nerve lies between the pericardium and mediastinal pleura and ends in the thickness of the diaphragm. Motor fibers innervate the diaphragm phrenic nerve, sensory fibers pericardial branch (r. Phrenicoabdominales), are in the abdominal cavity and innervate the peritoneum covering the diaphragm. The branches of the right phrenic nerve pass without stopping (in transit), through the celiac plexus to the liver. The vagus nerve in humans, the tenth pair of cranial nerves, doubles mixed nerve containing the motor, sensory and autonomic (sympathetic and parasympathetic) fibers. It has three core in the medulla oblongata, in common with the glossopharyngeal nerve: dorsal (vegetative), ventral, or double (motor), and the core t. Laryngeus inferior) - the final branch of the recurrent nerve, passes through the esophagealtracheal groove medial to the thyroid lobe and at the level of the cricoid cartilage is divided into two branches - the front and rear. Cervical plexus (plexus cervicalis) formed by the anterior branches of the upper four cervical nerves. Upon emerging through the intervertebral foramen (foramen intervertebrale) these nerves lie on the front surface of the deep muscles of the neck at the level of the upper four cervical vertebrae behind the sternocleidomastoid muscle. Because of the sensitive nerves cutaneous branches formed neck (transverse nerve of neck, medial, intermediate and lateral supraclavicular nerves, great auricular nerve and small occipital nerve) described above. Motor branch of the cervical plexus (rami musculares plexus cervicalis) innervate the anterior, middle and posterior scalene muscles (mm. By the motor branches of the cervical plexus include cervical loop (ansa cervicalis). The neck loop is formed by connecting the upper spine (radix superior) and lower spine (radix inferior). Upper spine is formed from fibers I cervical spinal nerve joins the hypoglossal nerve, it extends in its composition to the external carotid artery. On the front surface of the external carotid artery to the bifurcation it descends and further on the front surface of the common carotid artery to connect to the lower spine. The lower back carries the fibers of the second and third cervical spinal nerves and leaves directly from the cervical plexus. After connecting the root of the neck loop branches to depart sternohyoid, sterno-thyroid, scapular-hyoid and thyrohyoid muscle (m. Phrenic nerve formed anterior branches C3-4, rests on the front surface of the anterior scalene muscle (m. Scalenus anterior), for it descends into the mediastinum and on the lateral surface of the pericardium (in front of the root of the lung) reaches the diaphragm. Right phrenic nerve through the opening of inferior vena cava (foramen venae cavae) enters the abdominal cavity and, after passing through the celiac plexus (plexus celiacus), participates in the innervation of the liver. Pericardiacus), innervating the pericardium and pleura; sensitive diaphragmatic-abdominal branches (rr. Brachial plexus (plexus brachialis) is formed from the anterior branches of the four lower cervical and thoracic spinal nerve 1 - C5- 8, Th1. These five branches in the interscalene space form the trunks of the brachial plexus (trunci plexus brachialis). The trunks of the brachial plexus interscalene space out in greater supraclavicular fossa (fossa supraclavicularis major), where the front of their separation (divisiones ventrales). The branches of a divided barrel again combine to form the lateral, medial and posterior bundles (fasciculus lateralis, fasciculus medialis et fasciculus posterior). The brachial plexus is divided into two parts: the supraclavicular (pars supraclavicularis) and subclavian (pars infraclavicularis). Supraclavicular part of the brachial plexus at the exit of the interscalene space (spatium interscalenum) is located above the subclavian artery. Above the collarbone brachial plexus traverse laterally two arteries, above the surface passes cervical artery (a. Sympathetic trunk (truncus sympathicus) lies on the neck in front of the transverse processes of the cervical vertebrae from the neck to the base of the skull behind the ribs I or thicker prespinal fascias (fascia prevertebralis) on the front surface of the long muscles of the head and neck. Sympathetic trunk in the neck often consists of the upper and middle cervical and cervicothoracic nodes (ganglion cervicale superior, ganglion cervicale medium et ganglion cervicothoracicum) and cross-site branches (rr. In front of the upper cervical nodes are the internal carotid artery and internal jugular Vienna. From the middle of the cervical node depart following branches: Middle cervical cardiac nerve (n. Cervicothoracic (stellate) node, ganglion cervicothoracicum (stellatum) show ever. Node flattened in the anteroposterior direction, a stellate form of its diameter of about 8 mm. The larynx is associated with hyoid bone thyrohyoideus, membrane (membrana thyrohyoidea), stretched between the hyoid bone and the upper edge of the thyroid cartilage. Entrance to the larynx (aditus laryngis) is limited to the front of the epiglottis (epiglottis), laterally – arytenoid folds (plicae aryepiglottica), formed on the mucous membrane of the same name during the passage of the muscles and back - interaritenoide notch (incisura interarytenoidea). Over the entrance to the larynx (aditus laiyngis) is the cavity of the larynx (cavitas laryngis), which has three sections. Lower part of the larynx - cavitas infraglottica Figure 52 The cut at the level of the thyroid isthmus Newborn: 1 – esophagus; 2 – trachea; 3 – lobus dexter et sinister; 4 – isthmus, 5 - esophagus Adult: 1 – esophagus; 2 – trachea; 3 – lobus dexter et sinister; 4 – isthmus, 5 - esophagus Larynx consists of cricoid cartilage (cartilago cricoidea), thyroid cartilage (cartilago thyroidea), the two arytenoid cartilages (cartilago arytenoidea) and the epiglottis (epiglottis). Blood supply of the larynx is carried out at the expense of the upper and lower laryngeal artery (a. The first - a branch of superior thyroid artery, the second - the inferior thyroid artery. The innervation of the larynx occurs due to branches of the vagus nerve and sympathetic trunk of the upper node. Laiyngo-pharyngei), penetrating the larynx as part of the upper laryngeal nerve and along the laryngeal arteries. Lymph from the lower divisions of the larynx performed in front deep cervical lymph nodes (nodi lymphatici ceiyicales profundi anteriores) - prelaryngeal in the lymph nodes (nodi lymphatici prelaryngeales), thyroid lymph nodes (nodi lymphatici thyroidei), paratracheal lymph nodes (nodi lymphatici paratracheales). Lymphatic drainage of the upper sections of the larynx occurs in the lateral deep cervical lymph nodes (nodi lymphatici cervicales profundi laterals). It consists of 16-20 horseshoe-shaped cartilage (cartilagines tracheales), connected to each other annular ligament (ligamenta annularia). Behind the half-rings are connected to the mobile membranous tracheal wall (paries membranaceus). The trachea is divided into cervical (pars cervicalis) and thoracic (pars thoracica) parts. For this reason, the upper tracheostomy technically is easier than the lower tracheostomy. Supplying the cervical part of the trachea branches of the inferior thyroid arteries (aa. Thyroideae inferiores), krovoottok occurs in the veins of the same name brachiocephalic vein (v. Innervated by cervical part of the trachea branches of recurrent laryngeal nerve (nn. The lymphatic drainage from the lower larynx is carried out in the front deep cervical lymph nodes, nodi lymphatici cervicales profundi anteriores, pre-laryngeal lymph nodes, nodi lymphatici prelaryngeales, thyroid lymph nodes, nodi lymphatici thyroidei, paratracheal lymph nodes, nodi lymphatici paratracheales. Lymph outflow from the upper parts of the larynx occurs in the lateral deep cervical lymph nodes, nodi lymphatici cervicalesprofundi lateralis The esophagus (esophagus) is lined with mucous membrane muscular tube that connects the throat to the stomach.

Although the incidence of significant apnea and bradycardia is highest in the first 4 to 6 hours after surgery order voveran paypal, it can occur up to 12 hours after surgery cheap voveran 50mg line. An insightful approach to interpreting the various small studies is to stratify the risk of apnea order voveran 50 mg fast delivery, as done by Cote et al purchase voveran with visa. Using 95% confidence limits, the authors found that the probability of apnea in nonanemic infants free of recovery room apnea was not less than 5% until postconceptual age was 48 weeks with gestational age of 35 weeks. This risk was not less than 1%, until a postconceptual age of 56 weeks with a gestational age of 32 weeks or a postconceptual age of 54 weeks and gestational age of 35 weeks. This type of analysis allows the clinician to determine which patients should be admitted on not only the criteria of gestational and postconceptual ages but also the amount of risk they are willing to assume. The very preterm infant, especially those under 1,200 g of weight, are at highest risk, with an incidence of significant disease about 2%. Acute retinal changes are seen in about 45% of susceptible preterm neonates, but there is spontaneous regression in most, permitting development of normal vision. In the fetus, developing blood vessels grow gradually 2988 from the macula toward the edges of the developing retina. In full-term newborns, this process is complete at birth or in the first few weeks, but continues for a longer period in the preterm infant. These growing vessels are at risk for vasoconstriction and subsequent hemorrhage, followed by disorganized neovascularization or scarring. This scarring and lack of normal growth can eventually cause the retinal network to peel away resulting in retinal detachment. Many children who develop stage I improve with no treatment and eventually develop normal vision. The abnormal blood vessels grow toward the center of the eye instead of following their normal growth pattern along the surface of the retina. Plus disease means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease. The most common therapies involve using cryotherapy or laser therapy to destroy peripheral areas of the retina, slowing or reversing the abnormal growth of blood vessels. This is done to preserve the central vision from continuing distortion of the abnormal vessels in the periphery, although there is some loss of peripheral vision with this therapy. Cryotherapy and laser therapies, as well as advanced procedures, are usually performed under general anesthesia in the operating room, although it is occasionally done at bedside with sedation in ventilated patients. These surgical procedures do not involve blood loss or significant surgical stress, but they do depend on a still surgical field for periods ranging from 30 to 90 minutes. The primary anesthetic challenge in these patients is related to the 2989 extreme prematurity and small size of the patients. Adequate monitoring, vascular access, and thermal stability are common challenges to management. There is no direct answer to this question, but some evidence from a large collaborative study helps provide some guidance. This study demonstrates that the use of supplemental oxygen for a prolonged period of time, not just for the short duration of a general anesthetic, was not deleterious as long as the pulse oximetry readings were kept in the 96% to 99% range. Neurodevelopmental Effects of Anesthetic Agents There has been recent concern about the potential deleterious impact of anesthetic drugs on the developing brain. A variety of studies have shown that prolonged exposure of animal models to anesthetic agents can lead to neurodegenerative changes in the developing brain of neonatal rats. The collective data that are currently available in literature do not support the withdrawal of these drugs from the practice of neonatal anesthesia. The neurotoxicity data seem to be reproducible in rodents but not in other species. Future prospective trials with prospective neurocognitive testing of infants exposed to anesthesia are needed. There currently exists no conclusive evidence to demonstrate the deleterious effect of inhaled or intravenous 2990 anesthetics on neurocognitive function in neonates and infants. Prospective studies, including a current study randomizing infants to getting a spinal anesthesia versus general anesthesia should be able to provide better information on this very complex problem that may face pediatric anesthesiologists. There has been a strong trend in recent years to put an emphasis of presurgical stabilization before taking the newborn to the operating room. Exceptions to this include gastroschisis, which is usually corrected within 12 to 24 hours, airway lesions such as webs that are causing significant airway obstruction, and acute subdural/epidural hematomas from traumatic delivery. In most cases, however, a period of 1 to 3 days can be allowed for stabilization of the newborn or transport to an appropriate pediatric center for treatment. There is more to neonatal emergency surgery than just the immediate anesthetic and surgical procedures. Many of these infants require the support services of specialized nursing units, pediatric radiologists, pediatric intensive care physicians, specialized laboratory facilities, and they must have their complete care be the main consideration of where their surgery should be done. Many procedures are now performed using laparoscopic techniques which decreases postoperative morbidity and pain and facilitates early extubation. Because of the lack of expertise many hospitals have in the care of these patients, the transfer of these neonates to hospitals with greater expertise is often prudent after initial stabilization of the patient. Most hospitals that have expertise in these patients have a transport team that is well-qualified to help with stabilization and transport. Those centers that do not have transport teams often have extensive protocols and procedures to work with the sending institution to help ensure the safe transfer of the patient. Two confounding factors in neonatal surgery are prematurity and associated congenital anomalies. The presence of one congenital anomaly 2992 increases the likelihood of another one. A neonatologist should be consulted in the case of any neonate with a congenital defect who is considered for surgery. The most serious associated congenital lesion is that of the cardiovascular system. The new strategy of permissive hypercapnia and delayed surgical repair has resulted in survival rates of more than 75% in some centers. Embryology Early in fetal development, the pleuroperitoneal cavity is a single compartment. The gut is herniated or extruded to the extraembryonic coelom during the ninth to tenth weeks of fetal life. During this period, the diaphragm develops to separate the thoracic and abdominal cavities (Fig. If there is delay or incomplete closure of the diaphragm, or if the gut returns early and prevents normal closure of the diaphragm, a diaphragmatic hernia will develop, producing varying degrees of herniation of the abdominal contents into the chest. The left side of the diaphragm closes later than the right side, which results in the higher incidence of left-sided diaphragmatic hernias (foramen of Bochdalek). Approximately, 90% of hernias detected in the first week of life are on the left side. Clinical Presentation The clinical presentation and the outcome from a diaphragmatic hernia are varied. The bowel contents may compress the lung buds and prevent development, leading to bilateral hypoplastic lungs with very little chance for 2993 survival. In most instances, however, a moderately small diaphragmatic hernia may develop later in fetal life so the lung is normal but compressed by the abdominal viscera. At the mild end of the scale, the infant might have a relatively normal pulmonary vascular bed with varying degrees of persistent pulmonary hypertension that may rapidly revert to normal. In more severe defects, significant pulmonary hypoplasia and abnormal pulmonary vasculature lead to greater mortality, largely a result of ongoing pulmonary hypertension. After closure of the pleuroperitoneal membrane, muscular development of the diaphragm occurs. Incomplete muscularization of the diaphragm results in the development of a hernia sac because of intra-abdominal pressure. The condition is known as eventration of the diaphragm, and the diaphragm may extend well up into the thoracic cavity. The other possibility is that the innervation of the diaphragm is incomplete and the muscle is atonic. Eventration of the diaphragm is usually not symptomatic in the first week of life.

Effects of sevoflurane and isoflurane on electrocorticographic activities in patients with temporal lobe epilepsy cheap 50mg voveran with mastercard. Cerebral blood flow and oxygen consumption during isoflurane and halothane anesthesia in man discount voveran on line. Dynamic cerebral autoregulation during sevoflurane anesthesia: a comparison with isoflurane order cheapest voveran. Dynamic and static cerebral autoregulation during isoflurane cheapest voveran, desflurane, and propofol anesthesia. The response of the canine cerebral circulation to hyperventilation during anesthesia with desflurane. Isoflurane for neuroanesthesia: risk factors for increases in intracranial pressure. Sevoflurane increases lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy. Desflurane and isoflurane increases lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy. The effect of desflurane and isoflurane on cerebrospinal fluid pressure in humans with supratentorial mass lesions. Brain surface protrusion during enflurane, halothane, and isoflurane anesthesia in cats. Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. Cerebral oxygen tension in rats during deliberate hypotension with sodium nitroprusside, 2-chloroadenosine, or deep isoflurane anesthesia. Desflurane and isoflurane improve neurological outcome after incomplete cerebral ischaemia in rats. Sevoflurane improves neurological outcome after incomplete cerebral ischaemia in rats. Desflurane improves neurologic outcome after low-flow cardiopulmonary bypass in newborn pigs. Recovery of cognitive functions after anaesthesia with desflurane or isoflurane and nitrous oxide. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: a pilot study. Experimental nitrous oxide exposure as a model system for evaluating neurobehavioral tests. Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients. Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. The cardiovascular effects of a new inhalation anesthetic, Forane, in human volunteers at a constant arterial carbon dioxide tension. Nitrous oxide augments sympathetic outflow: direct evidence from human peroneal nerve recordings. Sympathetic hyperactivity during desflurane anesthesia in 1242 healthy volunteers: a comparison with isoflurane. Rapid increase in desflurane concentration is associated with greater transient cardiovascular stimulation than with rapid increase in isoflurane concentration in humans. Effects of fentanyl on sympathetic activation associated with the administration of desflurane. Effects of desflurane and sevoflurane on length-dependent regulation of myocardial function in coronary surgery patients. Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients. Different effects of sevoflurane, desflurane, and isoflurane on early and late left ventricular diastolic function in young healthy adults. Cardiovascular actions of desflurane with and without nitrous oxide during spontaneous ventilation in humans. Haemodynamic and organ blood flow responses to sevoflurane during spontaneous ventilation in the rat: a dose- response study. Steal-prone coronary anatomy and myocardial ischemia associated with four primary anesthetic agents in humans. Does choice of anesthetic agent significantly affect outcome after coronary artery surgery? Influence of desflurane on regional distribution of coronary blood flow in a chronically instrumented canine model of multivessel coronary artery obstruction. Steal-prone coronary circulation in chronically instrumented dogs: isoflurane versus adenosine. Myocardial ischemia and adverse cardiac outcomes in cardiac patients undergoing noncardiac surgery with sevoflurane and isoflurane. Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery. A comparison of desflurane and isoflurane in patients undergoing coronary artery surgery. The risk of myocardial ischemia in patients receiving desflurane versus sufentanil anesthesia for coronary artery bypass graft surgery. Volatile anesthetic-induced cardiac protection: molecular mechanisms, clinical aspects, and interactions with nonvolatile agents. Cardiac pharmacological preconditioning with volatile anesthetics: from bench to bedside? Cardiac preconditioning by volatile anesthetic agents: a defining role for altered mitochondrial bioenergetics. Reactive oxygen species precede the epsilon isoform of protein kinase C in the anesthetic preconditioning signaling 1244 cascade. Differential modulation of the cardiac adenosine triphosphate-sensitive potassium channel by isoflurane and halothane. Anesthetic preconditioning: effects on latency to ischemic injury in isolated hearts. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials. Differential protective effects of volatile anesthetics against renal ischemia-reperfusion injury in vivo. Effects of sevoflurane on biomechanical markers of hepatic and renal dysfunction after coronary artery surgery. A randomized, prospective comparison of halothane, isoflurane and enflurane on baroreflex control of heart rate in humans. A comparison of baroreflex sensitivity during isoflurane and desflurane anesthesia in humans. Desflurane-mediated sympathetic activation occurs in humans despite preventing hypotension and baroreceptor unloading. Desflurane-mediated neurocirculatory activation in humans: Effects of concentration and rate of change on responses. Epithelial dependence of the bronchodilatory effect of sevoflurane and desflurane in rat distal bronchi. Absence of bronchodilation during desflurane anesthesia: A comparison to sevoflurane and thiopental. Respiratory resistance during anaesthesia with isoflurane, sevoflurane, and desflurane: a randomized clinical trial. The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstructive pulmonary disease. Bronchial mucus transport velocity in patients receiving desflurane and fentanyl vs. Nitrous oxide augments the systemic and coronary haemodynamic effects of isoflurane in patients with ischaemic heart disease. Desflurane and isoflurane produce similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing one-lung ventilation during thoracotomy. The effect of sevoflurane and isoflurane on the neuromuscular block produced by vecuronium continuous infusion. Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i. Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia.