Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a chloroprocaine--bupivacaine mixture with chloroprocaine and bupivacaine used individually for obstetric epidural analgesia.
Continuous lumbar epidural anesthesia was instituted in 49 healthy parturients who were randomly assigned to three treatment groups: 14 patients received chloroprocaine, 3 per cent; 19 received bupivacaine, 0.5 per cent, and 16 received a mixture containing chloroprocaine, 1.5 per cent, and bupivacaine, 0.375 per cent. Observations relating to the characteristics of the anesthetic block and to maternal and fetal well-being were made by a trained nurse observer. ⋯ No clinical superiority could be demonstrate for the mixture as compared with bupivacaine or chloroprocaine used individually. There was no sign of material or fetal toxicity with any of the three treatment regimens.
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Randomized Controlled Trial Clinical Trial
Epidural anesthesia with bupivacaine for Cesarean section: neonatal blood levels and neurobehavioral responses.
A recent study found no neurobehavioral change in infants whose mothers received bupivacaine epidural anesthesia (112 +/- 7 mg) for labor and vaginal delivery. The present study was undertaken to examine the possibility that the larger doses of bupivicaine necessary for cesarean section might cause neurobehavioral changes in the neonate. Ten infants delivered by cesarean section with bupivacaine epidural anesthesia (168 +/- 7 mg) was assessed by Scanlon's neonatal neurobehavioral examination. ⋯ By 24 hours of age bupivacaine was no longer detectable in newborn blood samples. Infants in the experimental group were indistinguishable from control infants in terms of their motor organization, responsiveness to external stimuli, and habituation to repetitive stimuli. Detectable neurobehavioral effects were absent despite the fact that 1.5 times the dose of bupivacaine used for labor and vaginal delivery was employed in this study.
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Randomized Controlled Trial Clinical Trial
Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney).
The authors attempted to determine whether hypotensive anesthesia or the method of inducing hypotension has any effect on postoperative brain, liver, or kidney function and myocardial status following total hip arthroplasty. Thirty patients were anesthestized with halothane-nitrous oxide for total hip arthroplasty and randomly assigned to one of three groups. In two groups mean arterial blood pressure was decreased to 50 torr by high inspired concentrations of halothane (n = 90) or sodium nitroprusside (n = 12). ⋯ Neither method of inducing hypotension nor hypertensive technique affected the results of postoperative tests of cerebral, hepatic, or renal function and myocardial status. These tests were performed before anesthesia and operation and at intervals in the postoperative course. In this small group of patients, deliberate hypotension for total hip arthroplasty added no morbidity and significantly shortened operating time, decreased blood loss, and decreased the number of blood transfusions needed.