Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1980
Obesity and the cephalad spread of analgesia following epidural administration of bupivacaine for Cesarean section.
Epidural anesthesia using 20 ml of 0.75% bupivacaine at L3-4 with the patient in the left lateral position and the table horizontal was employed for cesarean section in 147 A. S. A. class 1 or 2 parturients under the age of 35 with a single fetus. ⋯ There was no statistically significant correlation with the patients' height or age. It is concluded that higher levels of epidural block should be anticipated in obese obstetrical patients in proportion to their obesity. Twenty milliliters of 0.75% bupivacaine must frequently be augmented to provide adequate analgesia for cesarean section in thin parturients (BMI below 28) whereas it is too high a dosage for obese patients.
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Anesthesia and analgesia · Feb 1980
Nitroglycerin and the neuromuscular blockade produced by gallamine, succinylcholine, d-tubocurarine, and pancuronium.
The finding in cats of prolonged pancuronium neuromuscular blockade in conjunction with intravenous infusion of nitroglycerin was previously reported by this laboratory. To expand on this finding the present study compared the effects of nitroglycerin on neuromuscular blockade produced by gallamine, d-tubocurarine, succinylcholine, and pancuronium, and further characterized the nitroglycerin-pancuronium interaction. ⋯ In vitro pancuronium blockade was not affected by nitroglycerin, suggesting the involvement of a metabolite in the block prolongation response. Reversibility of the prolonged pancuronium block by neostigmine is not influenced by nitroglycerin.
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Anesthesia and analgesia · Feb 1980
Clinical characteristics of long-term succinylcholine neuromuscular blockade during balanced anesthesia.
Thumb adductor twitch response to train-of-four (2 Hz for 2 seconds) stimulation of the ulnar nerve was used to assess the clinical characteristics of long-term neuromuscular blockade induced with continuous infusion of succinylcholine during balanced (N2O-O2-narcotic-thiopental) anesthesia. Twitch depression of 80 to 90% was maintained for 86 to 365 minutes by continuous infusion of succinylcholine at 86 +/- 5(SEM) micrograms/kg/min. Of 32 patients, 24 developed phase II block, defined as a train-of-four ratio of less than 50%. ⋯ Of 24 patients who developed phase II block, 50% recovered spontaneously at a rate comparable to the recovery rate from a phase I block. The other 50% manifested prolonged recovery of neuromuscular function. After observing spontaneous recovery in these patients for 31 +/- 5(SEM) minutes, successful antagonism of residual phase II block with anticholinesterase agents was achieved.