Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1986
Epidural analgesic techniques in the management of cervical pain.
The injection of depot steroids into the cervical epidural space can maximize the conservative management of patients with cervical radiculopathy. We retrospectively studied 25 patients with cervical radiculopathy who received a total of 45 epidural injections of steroids. ⋯ The patient's history and a description of the pain and the corresponding neurological abnormalities present were of value in the selection of patients who were most likely to respond favorably to epidural steroids, whereas laboratory studies were not as useful. Anesthesiologists, many already familiar with the use of epidural steroid injection in the treatment of low back pain, should add to their armamentarium the use of such techniques in the management of patients with acute and chronic cervical radiculopathy.
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Anesthesia and analgesia · Sep 1986
Plasma and cerebrospinal fluid progesterone concentrations in pregnant and nonpregnant women.
Pregnancy is associated with a wider dermatomal spread of local anesthetics after epidural and spinal anesthesia. This phenomenon also exists in the immediate postpartum period. The mechanism of this observation is unresolved. ⋯ The CSF progesterone concentrations in term parturients (3 +/- 0.28 (SEM) ng/ml) and postpartum patients (1.03 +/- 0.16 ng/ml) were eight and three times greater than that of nonpregnant women (0.39 +/- 0.01 ng/ml). Significantly less lidocaine was needed (P less than 0.05) for comparable segmental levels of spinal anesthesia in term and postpartum patients than in nonpregnant individuals. These data suggest that high CSF, plasma progesterone concentrations, or both may augment the anesthetic spread of lidocaine.
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Anesthesia and analgesia · Sep 1986
Cardiopulmonary effects of oleic acid-induced pulmonary edema and mechanical ventilation.
In order to define the mechanisms whereby cardiac output and arterial oxygen transport are reduced by acute permeability pulmonary edema and by positive end-expiratory pressure (PEEP), hemodynamic, respiratory, and lung water changes were measured in 12 mechanically ventilated dogs prior to the injection of oleic acid and at 1, 2.5, and 4 hr after the injection. Measurements were performed at each interval before and after the addition of 20 cm H2O PEEP. Positive end-expiratory pressure was not continued between measurements. ⋯ However, PEEP also significantly increased the lung water content and pulmonary vascular resistance, and decreased the RV volume and stroke volume by 33%. The extravasation of fluid from the intravascular to the interstitial and alveolar spaces of the lung with oleic acid pulmonary edema is associated with substantial decreases in right ventricular volume and stroke volume and significant increases in the pulmonary vascular resistance. Treatment with 20 cm H2O PEEP further increases the lung water content and pulmonary vascular resistance and substantially reduces the right ventricular volume and stroke volume.