Anesthesia and analgesia
-
Vecuronium bromide, 0.045 mg X kg-1, was compared with pancuronium, 0.07 mg X kg-1, when used to provide muscle relaxation for tracheal intubation and abdominal relaxation for outpatient gynecologic laparoscopy. Both drugs provided adequate intubating conditions within 5 min and satisfactory abdominal relaxation. Because spontaneous recovery from vecuronium was more rapid, either with inhalational or nitrous oxide-narcotic techniques, pharmacological reversal with edrophonium and atropine was either not necessary or more easily accomplished after vecuronium, as shown by the train-of-four. ⋯ Tests of muscle power and coordination performed 30 and 60 min postoperatively showed no difference between the drugs. There were no postoperative complications related to muscle relaxants and all patients met our discharge criteria the day of surgery. Given the conditions observed at the end of the procedure, we would choose vecuronium for muscular relaxation in laparoscopic surgery.
-
Anesthesia and analgesia · Jan 1984
The effect of fentanyl on arginine vasopressin and cortisol secretion during anesthesia.
The effects of nitrous oxide-oxygen plus small doses of fentanyl with (N = 7) and without (N = 15) naloxone and the effects of nitrous oxide-oxygen plus halothane (N = 13) on plasma concentration of arginine vasopressin (AVP) and cortisol were studied in normal patients before and during gynecologic laparotomies. Patients given fentanyl alone received incremental doses of 0.002 mg/kg before, during, and after induction of anesthesia. Naloxone, when given, was injected in doses of 0.005 mg/kg before administration of fentanyl. ⋯ There were comparable increases in AVP and cortisol levels in both groups during surgery. Administration of naloxone before fentanyl prevented the increase of plasma AVP levels during anesthesia and surgery and blunted the elevation of plasma cortisol during surgery. Our results suggest that the increase in plasma AVP levels after induction of fentanyl anesthesia may not be induced by the stress of intubation and that small doses of fentanyl may cause AVP release during anesthesia.
-
Anesthesia and analgesia · Jan 1984
Concentrations of lactate and pyruvate in maternal and neonatal blood with different intravenous fluids used for prehydration before epidural anesthesia.
This study assesses the effects of infusion of 1200 ml of four different intravenous solutions before epidural anesthesia for cesarean section on maternal and neonatal whole blood lactate (L), pyruvate (P), excess lactate (XL), L/P ratio, and base excess (BE) in four equal groups of patients. Patients in group I (n = 15) received normal saline; those in group II, Ringer's lactate (RL); those in group III, RL with 20 g of glucose; and those in group IV, Plasma-Lyte A. Maternal venous concentrations of L increased significantly in all groups after infusion, but P increased only in group III. ⋯ However, neither neonatal Apgar scores nor maternal and neonatal BE significantly differed among the four groups. No neonate developed hypoglycemia. It is concluded that all the four intravenous fluids, despite differences in their effects on blood L and P concentrations, produce clinically satisfactory maternal and neonatal outcome.