Anesthesiology
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Randomized Controlled Trial Clinical Trial
Isoproterenol is an effective marker of intravenous injection in laboring women.
The purpose of this randomized, double-blind study was to determine if isoproterenol 5 micrograms iv produces a consistent, noticeable tachycardia in healthy, laboring women. Maternal heart rate, fetal heart rate, and uterine contractions were continuously recorded and maternal blood pressure was measured every minute for 10 min before and after each patient received either normal saline (NS group; n = 10) or isoproterenol 5 micrograms (ISO group; n = 10) iv. The data-collecting investigator and a nurse palpating the patient's radial artery determined which solution they thought had been administered. ⋯ Diastolic and mean blood pressures did not change. No fetal distress occurred. Isoproterenol 5 micrograms is an effective marker of intravascular injection in laboring women; however, the safety and efficacy of epidural isoproterenol must be demonstrated in animals before isoproterenol can be incorporated in an epidural anesthesia test dose.
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Clinical Trial Controlled Clinical Trial
Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate.
Thirty patients undergoing lidocaine spinal anesthesia for transurethral resection of the prostate (TURP) were studied to evaluate the effectiveness of low-dose intrathecal morphine (ITM) for postoperative analgesia. In a double-blinded fashion, groups of ten patients received either 0.1 mg morphine, 0.2 mg morphine, or placebo (control group) intrathecally with lidocaine 75 mg. Standard postoperative analgesics were available to all patients. ⋯ Six patients (60%) in the 0.2 mg ITM group, two patients (20%) in the 0.1 mg ITM group, and one patient (10%) in the control group experienced nausea and vomiting. No clinically evident respiratory depression occurred in any of the subjects. The authors conclude that administration of 0.1 mg or 0.2 mg of morphine intrathecally is effective in reducing postoperative pain following TURP and that 0.1 mg ITM is not associated with nausea and vomiting.
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Clinical Trial Controlled Clinical Trial
Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery.
The authors studied in a double-blind placebo-controlled study the effects of oral preoperative administration of 5 micrograms/kg clonidine upon the alfentanil and droperidol requirements, hemodynamic lability, distribution of the values of heart rate and blood pressure, and plasma noradrenaline levels, in two groups of ten normotensive patients undergoing infrarenal aortic surgery. The amounts of alfentanil supplementing a standardized continuous infusion, injected to maintain hemodynamic stability, were statistically identical between the groups (P = 0.23). The amount of droperidol, however, was significantly less (P = 0.004) in the group of patients that received clonidine. ⋯ The frequency of SBP hypertension was lower and of SBP hypotension higher in the clonidine group. After induction of anesthesia, but before surgery, there were more episodes of DBP hypotension in the clonidine group, but during dissection and vascular sutures the placebo group experienced more episodes of DBP hypotension, owing probably to the greater amount of droperidol injected. The authors conclude that the preoperative administration of clonidine decreased the need to supplement anesthetic, and modifies the profile of distribution of heart rate and blood pressure.
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Clinical Trial Controlled Clinical Trial
Pipecuronium-induced neuromuscular blockade during nitrous oxide-fentanyl, isoflurane, and halothane anesthesia in adults and children.
To determine in adults and children the dose-response relationship and the duration of action of pipecuronium bromide during fentanyl-nitrous oxide (N2O), isoflurane, and halothane anesthesia, the authors studied 30 ASA Physical Status 1-2 adults (age: 16-55 yr) and 30 ASA Physical Status 1-2 children (age: 1.7-11.5 yr) during minor elective surgery. Patients were anesthetized with N2O/O2 (60:40) supplemented with either fentanyl (4 micrograms/kg), or isoflurane (adults, 0.9%; children, 1.2%), or halothane (adults, 0.6%; children, 0.7%). Neuromuscular (NM) blockade was measured by electromyography. ⋯ In children, ED50 was 43.9 +/- 4.7 micrograms/kg during fentanyl-N2O/O2, reduced by isoflurane (23.1 +/- 1.6 micrograms/kg, P less than 0.05), and halothane (33.2 +/- 3.2 micrograms/kg, P less than 0.05). ED95 was 79.3 +/- 9.8 micrograms/kg during fentanyl-N2O/O2, and reduced by isoflurane (49.1 +/- 3.1 micrograms/kg, P less than 0.05), but not by halothane (62.5 +/- 7.3 micrograms/kg, NS). Comparison between adults and children reveals no statistically significant differences, except for ED50 during fentanyl-N2O/O2 anesthesia which was increased in children.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Correlation between bleeding times and platelet counts in women with preeclampsia undergoing cesarean section.
Platelet count and bleeding time and the correlation between these two variables in women with preeclampsia who received epidural or general anesthesia for cesarean section were evaluated. The study included 106 women with preeclampsia who were undergoing cesarean section and 94 healthy, term parturients receiving epidural anesthesia for labor analgesia or for cesarean section. Platelet counts were measured using an automated Coulter Counter, and bleeding times were measured using the modified Ivy bleeding time technique. ⋯ In addition, 34% of those women with severe preeclampsia and 13% with mild preeclampsia had prolonged bleeding time, although their platelet count was adequate. In the control group, 2% had abnormal bleeding time in the presence of a normal platelet count. There was good correlation between bleeding time and platelet count only when platelet count was lower than 100,000/mm3 (r = -0.76, P less than -0.02).