Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1982
Maternal, fetal, and neonatal responses after epidural anesthesia with bupivacaine, 2-chloroprocaine, or lidocaine.
The effects of epidural analgesia on fetal heart rate, fetal heart rate variability, uterine activity, maternal blood pressure, newborn Apgar scores, neonatal acid base status, and the early neonatal neurobehavioral status were studied in 150 parturients during labor and delivery. Group I (n = 50) received 0.5% bupivacaine, group II (n = 50) received 2% 2-chloroprocaine, and in group III (n = 50) received 1.5% lidocaine. None of the three local anesthetics used had any significant effect on either base line fetal heart rate, beat-to-beat variability, or uterine activity. ⋯ The difference in incidence of late deceleration patterns between groups I and II was statistically significant (p less than 0.025). Early neonatal neurobehavioral status did not differ among the three groups of neonates nor did any of the neonates in the three groups score lower than a control group of 20 neonates whose mothers did not receive any analgesia or medications for labor or delivery. It is concluded that epidural anesthesia as administered in this study has no significant effect on the base line fetal heart rate, uterine activity, or neurobehavioral status of the neonate, and that bupivacaine is associated with a higher incidence of what appears to be transient abnormalities of fetal heart rate.
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In 13 full-term primipara in active labor an initial single dose of preservative-free meperidine (100 mg) diluted in 10 ml of saline was injected epidurally (L2-3). In another 13 full-term parturients in active labor, 10 ml of bupivacaine 0.25% was used. Pain was scored by the linear analog scale. ⋯ All parturients delivered vaginally, 288 +/- 212.6 minutes following meperidine and 348 +/- 195.8 minutes following bupivacaine administration (p greater than 0.05); the neonates showed normal Apgar scores and neurobehavioral responses. Epidural meperidine, supplemented by subsequent bupivacaine as indicated, provides maternal sedation and satisfactory analgesia, and it diminishes the requirements of bupivacaine supplementation. The technique is advantageous in the parturient primipara.
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Anesthesia and analgesia · Aug 1982
Randomized Controlled Trial Clinical TrialLow-dose fentanyl blunts circulatory responses to tracheal intubation.
The effect of fentanyl, 8 micrograms/kg, used as an adjunct to thiopental for induction of anesthesia, on the circulatory response to tracheal intubation was investigated in 36 patients undergoing major vascular surgery. Patients were randomly assigned to receive either thiopental, 6 mg/kg, alone (N = 18), or thiopental, 3 mg/kg, along with fentanyl, 8 micrograms/kg (N = 18), for induction of anesthesia. ⋯ Increases in systolic blood pressure, diastolic blood pressure, and pulmonary capillary wedge pressure with intubation were also significantly greater following administration of thiopental than following fentanyl-thiopental. Doses of fentanyl that are low enough to cause little postoperative respiratory depression significantly blunt postintubation hypertension when used as an adjunct to thiopental.
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Anesthesia and analgesia · Aug 1982
Cardiopulmonary resuscitation with interposed abdominal compression in dogs.
This study was conducted to evaluate the hemodynamic effectiveness of a new modification of cardiopulmonary resuscitation (CPR), termed interposed abdominal compression-CPR (IAC-CPR). IAC-CPR utilizes all the steps of standard CPR with the addition of abdominal compressions interposed during the release phase of chest compression. Ventricular fibrillation was induced electrically in 10 anesthetized dogs, and either IAC-CPR or standard CPR was initiated while arterial and venous blood pressures and cardiac output were monitored. ⋯ Brachial arterial blood pressure averaged 87/32 mm Hg during IAC-CPR vs 58/16 mm Hg during standard CPR. Cardiac output (+/- SE) averaged 24.2 +/- 5.7 ml/min/kg during IAC-CPR vs 13.8 +/- 2.6 ml/min/kg during standard CPR. IAC-SPR requires no extra mechanical equipment, and, if proven effective in human trials, may improve resuscitation success in the field and in the hospital.
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Anesthesia and analgesia · Aug 1982
Acid-base status of diabetic mothers and their infants following spinal anesthesia for cesarean section.
Acid-base status and Apgar scores were evaluated in 10 rigidly controlled insulin-dependent diabetic mothers and 10 healthy nondiabetic control women having spinal anesthesia for cesarean section. Dextrose-free intravenous solutions were used for volume expansion before induction of anesthesia, and hypotension was prevented in all cases by prompt treatment with ephedrine. ⋯ Apgar scores were also similar in the two groups. If maternal diabetes is well controlled, if dextrose-containing solutions are not used for maternal intravascular volume expansion before delivery, and if maternal hypotension is avoided, spinal anesthesia can be used safely for diabetic mothers having cesarean section.