Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1984
Randomized Controlled Trial Comparative Study Clinical TrialComparison of four opioid analgesics as supplements to nitrous oxide anesthesia.
The hemodynamic changes, plasma norepinephrine levels, pupil size, and rapidity of postoperative mental recovery were measured and compared in 72 patients randomly assigned in a double-blind manner to receive either morphine, meperidine, fentanyl, or sufentanil as supplements to nitrous oxide anesthesia. Meperidine, unlike the other opioids, which did not change heart rate, consistently increased it. Hemodynamic responses to laryngoscopy and intubation were suppressed by fentanyl and sufentanil, but not by morphine or meperidine. ⋯ Meperidine caused deleterious effects on objective tests of psychomotor and cognitive skills that were not reflected by subjective evaluation of rate of recovery from anesthesia. The authors conclude that moderate doses of fentanyl and sufentanil are better supplements to nitrous oxide anesthesia than morphine or meperidine and that fentanyl and sufentanil are equally satisfactory. Subjective effects of the opioids correlated well with changes in pupil diameter.
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Anesthesia and analgesia · Apr 1984
Neonatal neurobehavioral responses after epidural anesthesia for cesarean section using lidocaine and bupivacaine.
We compared the early neonatal neurobehavioral responses after lumbar epidural anesthesia for elective cesarean section using 2% lidocaine (n = 10) and 0.5% bupivacaine (n = 21). We tested the infants at 4 and 24 hr after birth and found that the neonates in the lidocaine group scored as well as those in the bupivacaine group on all parameters of the early neonatal neurobehavioral score (ENNS). ⋯ We concluded that 2% lidocaine does not compromise newborn outcome when compared to 0.5% bupivacaine and that it provides a satisfactory choice for use during elective cesarean section in healthy pregnancies. This conclusion is important in the light of the current concern over the safety of the use of chloroprocaine and bupivacaine in obstetric anesthesia.
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Anesthesia and analgesia · Apr 1984
Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine--maternal, fetal, and neonatal effects.
The effects of epidural analgesia for labor and delivery using a continuous infusion technique on fetal heart rate, uterine activity, maternal blood pressure, Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System were studied in 61 parturients. Group I (n = 23) received initial test and therapeutic doses of 2 and 6 ml of 0.5% bupivacaine followed by an infusion of 0.125% at a rate of 14 ml/hr. Group II (n = 19) received 2 and 6 ml of 2% chloroprocaine followed by an infusion of 0.75% at a rate of 27 ml/hr. ⋯ The incidence was significantly higher in group I than in groups II or III (P less than 0.05). Apgar scores and neonatal acid-base status were equally good in all three groups. Neurologic and adaptive capacity scores 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 19 neonates whose mothers did not receive any analgesia or medications for labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1984
EEGs during high-dose fentanyl-, sufentanil-, or morphine-oxygen anesthesia.
In 49 patients undergoing open-heart surgery we compared the electroencephalographic (EEG) effects of high-dose morphine, fentanyl, or sufentanil with O2, using two computerized analysis and display techniques: a period analysis (the Klein method) and an aperiodic analysis (the Neurometrics monitor). During fentanyl or sufentanil anesthesia, both techniques revealed a general decrease in frequency, shown by the aperiodic analysis primarily as a marked increase in the very low frequency range: an increase in the 1-Hz bin (TP1, in muv2) from 2.80 X 10(4) +/- 3.20 X 10(4) (SD) to 45.1 X 10(4) +/- 27.2 X 10(4) for fentanyl and from 3.11 X 10(4) +/- 2.83 X 10(4) to 52.8 X 10(4) for sufentanil. ⋯ The changes with morphine were less obvious, with some attenuation of high-frequency power shown by the Klein method, and an increase from 24.1 +/- 8.6 to 59.3 +/- 20.7 with CP3, but no change in TP1. Low-frequency power with the period analysis and TP1 with the aperiodic analysis decreased between laryngoscopy and the incisions with fentanyl and sufentanil.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1984
Chronic neurological deficits and Nesacaine-CE--an effect of the anesthetic, 2-chloroprocaine, or the antioxidant, sodium bisulfite?
Chronic neurological deficits have been described in patients after presumed accidental subarachnoid injection of 2-chloroprocaine-CE (Nesacaine-CE; N-CE) intended for epidural block. This study investigated the possible role of pure 2-chloroprocaine (2-CP) and sodium bisulfite, two components of Nesacaine-CE, in causing these complications when injected separately into the lumbar subarachnoid space of neurologically intact awake rabbits. ⋯ This amount of bisulfite is contained in 12-24 mg of 2% N-CE. The demonstration that persistent paralysis resulted from low dosages of sodium bisulfite contained in commercially available 2-CP requires reevaluation of the suitability of this antioxidant for products prepared for intrathecal use.