Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1975
The effects of ketamine on cardiovascular dynamics during halothane and enflurane anesthesia.
The cardiovascular effects of a single dose of ketamine administered during halothane or enflurane anesthesia were studied in 24 patients. During halothane anesthesia, ketamine caused a rapid and significant increase in arteriolar peripheral resistance (p less than 0.01) and a decrease in cardiac output, stroke volume, and systolic diastolic, and mean arterial blood pressures. ⋯ These results demonstrate that general anesthesia blocks the cardiovascular-stimulating properties of ketamine. They also indicate that ketamine has significant cardiovascular-depressant qualities when used during halothane or enflurane anesthesia.
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Two adult patients suffered postoperative delirium following administration of lorazepam, a new benzodiazepine sedative. Physostigmine was found effective in reversing all untoward central nervous system effects.
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During the period November 1972 through October 1974, 118 epidural blood patch procedures were performed for severe postlumbar-puncture cephalgia. Subsequently, in a period varying from 105 to 380 days, three patients, two of whom had twice undergone epidural blood patch, were readmitted for either surgical operation or delivery. Either epidural, caudal, or spinal block was successfully accomplished. ⋯ During the spinal block, ligmentum flavum was distinctly felt from the dura. The extent of the blocks, the onset and duration of action ofpivacaine, mepivacaine, and lidocaine were within normal limits. It is, therefore, concluded that epidural blood patch does not obliterate the epidural space and should not preclude the use of regional block for later surgical or obstetric procedures.
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A modified low-dose paratracheal approach to stellate ganglion block at the C6 level prevents the possible complications of subarachnoid introduction of large quantities of local anesthetic, brachial plexus block, and toxic reaction to local anesthetics. It is a technically simple procedure with readily identifiable landmarks and can be performed on an outpatient basis with short recovery periods. Successful block can be readily evaluated. It is emphasized that a series of blocks is required to "disorganize" the reflex activity triggered in the internuncial pools of the spinal cord as well as in the sympathetic ganglia themselves.