Anesthesiology
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Intrathecally administered clonidine has been reported to produce analgesia in cancer patients tolerant to intrathecal opiates. To assess the efficacy, safety, and appropriate dose of epidurally administered clonidine for the treatment of cancer pain, clonidine (range, 100-900 micrograms in 100-micrograms increments) was injected in nine patients with severe, intractable cancer pain. Clonidine produced analgesia, as measured by change in verbal pain scores, lasting more than 6 h. ⋯ Clonidine was absorbed in a dose-dependent manner into the systemic circulation, although absorption and elimination kinetics were highly variable. Following study seven patients received epidural clonidine/morphine infusions at home for periods of up to 5 months with sustained analgesia. These results suggest that epidurally administered clonidine may offer effective analgesia in patients with severe, intractable cancer pain.
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A series of infusions of mock cerebrospinal fluid (CSF) was used to determine intracranial volume-pressure relationships in 18 anesthetized dogs. Measures of intracranial volume-pressure relationships included 1) CSF pressure prior to volume infusion (P0), 2) peak CSF pressure (Pp) caused by volume injection, 3) intracranial compliance (C, calculated as the ratio of change of intracranial volume [delta V] to change of CSF pressure [delta P]), 4) the volume-pressure response (VPR, a measure of elastance, calculated as the ratio of delta P to delta V), 5) the pressure volume index (PVI, calculated as the ratio of delta V to log Pp/P0), and 6) estimated intracranial compliance (Ce, calculated from PVI as 0.4343 PVI/P0). ⋯ Thiopental decreased P0 (by 2-3 +/- 1 cmH2O) and Pp (by 2-4 +/- 2 cmH2O), increased Ce (by 0.02-0.03 +/- 0.01 ml/cmH2O), and did not change C, VPR, or PVI. Etomidate decreased P0 (by 3-4 +/- 1 cmH2O) and Pp (by 4-6 +/- 2 cmH2O), increased Ce (by 0.03-0.04 +/- 0.01 ml/cmH2O) and did not change C, VPR, or PVI.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical Trial Controlled Clinical Trial
Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine.
The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. ⋯ Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.
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Epidurally administered clonidine has been reported to produce postoperative analgesia. To assess the efficacy, safety, and appropriate dose of epidural clonidine for postoperative analgesia, clonidine (range, 100-900 micrograms in 100-micrograms increments) was injected in 22 patients following abdominal surgery or total knee arthroplasty (TKA). Clonidine produced analgesia, as measured by change in verbal pain scores and supplemental iv morphine usage. ⋯ Oxyhemoglobin saturation, serum glucose, and arterial blood gas tensions were not altered by clonidine, whereas there was a small (28%) dose-independent decrease in serum cortisol following clonidine injection. Clonidine was absorbed in a dose-dependent manner into the systemic circulation, with plasma concentrations 0.1-3.3 ng/ml 1 h following injection. These results suggest that hemodynamic depression and short-lasting analgesia may limit the usefulness of bolus epidural clonidine analgesia in the postoperative setting.