Anesthesiology
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Comparative Study
The accuracy of Finapres noninvasive mean arterial pressure measurements in anesthetized patients.
The Finapres (FIN) is a new noninvasive blood pressure monitor that provides continuous arterial waveform display with the use of a finger cuff. The authors assessed the accuracy of FIN mean arterial pressure (MAP) measurements relative to simultaneous direct radial arterial pressures in 20 patients undergoing general anesthesia for major elective surgery. Data were collected digitally with the use of RS-232 communications over a total of 16.2 h. ⋯ However, 32.3 +/- 6.2% of all MAP comparisons differed by greater than +/- 10 mmHg, and 5.0 +/- 1.1% differed by greater than +/- 20 mmHg. Moreover, there was an average of one episode every 2 patient-hours when the FIN MAP differed by greater than +/- 20 mmHg for more than 1 min. Although the MAP measured by FIN accurately reflected direct MAPs most of the time, there were occasional discrepancies of different magnitude such that clinical usefulness may be limited in patients in whom continuous accurate blood pressure measurements are essential.
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of ropivacaine 0.5% and bupivacaine 0.5% for brachial plexus block.
This study compared the effectiveness of 0.5% ropivacaine and 0.5% bupivacaine for brachial plexus block. Forty-eight patients received a subclavian perivascular brachial plexus block for upper-extremity surgery. One group (n = 24) received ropivacaine 0.5% (175 mg) and a second group (n = 24) received bupivacaine 0.5% (175 mg), both without epinephrine. ⋯ Motor block was profound, with shoulder paralysis as well as hand paresis developing in all of the patients in both groups. Two patients in each group required supplemental blocks before surgery. Ropivacaine 0.5% and bupivacaine 0.5% appeared equally effective in providing brachial plexus anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pharmacodynamics of high-dose vecuronium in children during balanced anesthesia.
To compare the speed of onset, intubating conditions, duration of action, and recovery from neuromuscular blockade with vecuronium to those with succinylcholine, 40 ASA physical status 1 or 2 children (ages 2-9 yr) were studied during N2O-O2-opioid anesthesia. Each child was randomly assigned to receive a bolus dose of one of the following muscle relaxants: succinylcholine 2.0 mg/kg (n = 10), vecuronium 0.1 mg/kg (n = 10), vecuronium 0.2 mg/kg (n = 10), or vecuronium 0.4 mg/kg (n = 10). The evoked electromyogram of the abductor digiti minimi to train-of-four stimulation was monitored. ⋯ The intubating conditions were excellent in 100% of patients. The duration of action was least with succinylcholine (5.7 +/- 1.5 min) and increased with increasing doses of vecuronium: 0.1 mg/kg, 23.9 +/- 5.1 min; 0.2 mg/kg, 55.2 +/- 11.6 min; and 0.4 mg/kg, 74.6 +/- 9.9 min, respectively (P less than 0.001). The recovery index was most rapid with succinylcholine (1.6 +/- 0.4 min) and was slowest with vecuronium 0.4 mg/kg (22.6 +/- 2.1 min) (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination: effects on parturients.
To compare the efficacy and side effects of 0.2 mg intrathecal (IT) morphine with 0.125% epidural bupivacaine, 62 women in labor were studied. They were randomly divided into three groups: group 1 (n = 20) received IT morphine; group 2 (n = 22) received epidural bupivacaine; and group 3 (n = 20) received a combination of both using a combined spinal-epidural (CSE) technique. According to a visual analogue scale for assessing analgesia, neither IT 0.2 mg morphine nor 10 ml 0.125% epidural bupivacaine was effective in producing adequate pain relief in labor, whereas the combination produced excellent analgesia. ⋯ No serious respiratory depression occurred in any of the patients. When the course of labor was studied, the prior use of IT morphine significantly prolonged the duration of the first stage of labor and the total duration of labor. We conclude that the administration of 0.2 mg IT morphine in combination with epidural administration of 0.125% bupivacaine provides better analgesia than the administration of either drug alone.