Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Sep 2008
Comparative StudyComparison of three different concentrations of ropivacaine for postoperative patient-controlled thoracic epidural analgesia after upper abdominal surgery.
Previous studies have reported the comparable efficacy of ropivacaine/fentanyl for patient-controlled epidural analgesia (PCEA). In our hospital, three different concentrations of ropivacaine solution (0.1%, 0.15%, 0.2%) in combination with 1 microg/mL fentanyl were available for PCEA. As some studies have reported a much higher incidence of motor block and opioid-related side effects with 0.2% ropivacaine in combination with 4 microg/mL fentanyl, it was our intent to analyze the data of our patients who had received PCEA after upper abdominal surgery. In addition to comparing the analgesic effects and the incidence of motor block and opioid-related side effects of these three different ropivacaine/fentanyl solutions, we also evaluated the workload of our pain staff. The main purpose of our study was to determine which of these three regimens of ropivacaine was most satisfactory with the least workload for the pain service staff. ⋯ Both thoracic epidural 0.15% and 0.2% ropivacaine provide effective postoperative pain control in combination with fentanyl without motor block. A 0.15% ropivacaine-1 microg/mL fentanyl solution is preferable considering the lower incidence of adverse events.
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Acta Anaesthesiol Taiwan · Sep 2008
The relationship between lockout interval and requirement for patient-controlled epidural analgesia.
Patient-controlled epidural analgesia (PCEA) with background infusion provides better analgesia than the use of a demand dose alone but might be associated with more consumption of PCEA solution and adverse effects. Therefore, we conducted this retrospective study to evaluate the influence of parameters of the drug delivery system on the PCEA requirements of patients receiving thoracic or upper abdominal surgeries. ⋯ Patients receiving PCEA with a 30-minute lockout and background infusion used the least amount of PCEA infusate and the differences increased over time. Further investigations are recommended to evaluate potential benefits and drawbacks of a longer lockout interval.
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Acta Anaesthesiol Taiwan · Sep 2008
Case ReportsAphonia and quadriplegia---a rare complication following epidural labor analgesia.
We report an obstetric patient who developed unusual neurological complications after an epidural injection of a local anesthetic and a narcotic in a seemingly faultless manner. Ten minutes after receiving a loading dose, the patient developed aphonia, quadriplegia, and facial palsy while retaining normal consciousness and stable hemodynamics. ⋯ We wish to draw attention to anesthesiologists of the possibility that even in the presence of a negative aspiration test or without noticeable dural puncture, the injected drugs may enter the intrathecal or subdural space instead of pooling entirely in the epidural compartment. Once an unexpected high block and unusual symptoms or signs are noted, a prompt differential diagnosis must be made and treatment initiated as soon as possible.
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Acta Anaesthesiol Taiwan · Jun 2008
Randomized Controlled TrialSingle vital-capacity and successive tidal-volume breathing of sevoflurane in induction of anesthesia for tracheal intubation in gynecologic patients.
The optimal end-tidal concentrations of sevoflurane in induction of anesthesia for tracheal intubation have been widely studied and discussed. Single vital-capacity breathing of a high concentration of inspiratory sevoflurane rapidly elevates the end-tidal concentration to cause loss of consciousness, although it does not bear relation to proportional body or brain uptake. This study was designed to investigate the time effect of fast wash-in of alveolar sevoflurane in induction of anesthesia for tracheal intubation with single vital-capacity and ensuing tidal-volume breathing in gynecologic patients. ⋯ This study demonstrated that vital-capacity induction with a high concentration of sevoflurane is a safe and feasible technique for our female patients. The end-tidal 1.5 minimum alveolar concentration sevoflurane following 4.5 minutes of tidal-volume ventilation did not suppress intubation-induced hemodynamic responses. Pretreatment with fentanyl helped to shorten the induction time and provide better hemodynamic control for tracheal intubation.
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Acta Anaesthesiol Taiwan · Jun 2008
Hemodynamic changes during spinal surgery in the prone position.
Hypertension and fluctuations in blood pressure (BP) during lumbar spinal surgery in the prone position under anesthesia are not unusual. The purpose of this study was to investigate the causes of the decrease in BP during lumbar spinal surgery in the prone position using a noninvasive monitor of cardiac output. ⋯ Decreases in SV and CI are the main causes of a decrease in BP in the prone position during lumbar spinal surgery.