Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1987
Randomized Controlled Trial Comparative Study Clinical TrialPain relief after major abdominal surgery: a double-blind controlled comparison of sublingual buprenorphine, intramuscular buprenorphine, and intramuscular meperidine.
In a double-blind randomized study of three groups of 18 patients scheduled for major abdominal surgery the efficacy and side effects of sublingual buprenorphine were tested and compared to intramuscular meperidine and buprenorphine. Single doses of either 75 mg of meperidine, 0.4 mg of sublingual buprenorphine, or 0.3 mg of intramuscular buprenorphine were used. Patients given buprenorphine as sublingual tablets were significantly more conscious in the immediate postoperative period (Glasgow Coma Scale) than when given buprenorphine or meperidine intramuscularly. ⋯ Three cases of respiratory acidosis in the meperidine group required IPPV treatment, and one case in the intramuscular buprenorphine group required treatment. Sedation and nausea were the most common side effects in all three groups. We conclude that sublingual buprenorphine is useful for relief of postoperative pain and exhibited administrative advantages, when the patients were able to cooperate.
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Anesthesia and analgesia · Feb 1987
Randomized Controlled Trial Clinical TrialHemodynamic effects of esmolol in chronically beta-blocked patients undergoing aortocoronary bypass surgery.
The hemodynamic effects of esmolol were studied in 40 patients scheduled for elective coronary artery surgery to determine whether the administration of esmolol in chronically beta-blocked patients would result in additional attenuation of sympathetically mediated hemodynamic stress responses to noxious stimuli. Patients were randomly assigned to receive IV infusions of esmolol or 5% dextrose in water (D5W). All received their regular dose of beta-adrenergic blocker within 6 hr of surgery and were anesthetized with diazepam, pancuronium, and enflurane. ⋯ However the incidence and magnitude of SNP use in the control group was significantly (P less than 0.05) greater. Thus, the lower blood pressure, in the absence of changes in systemic vascular resistance, cardiac index, heart rate, and pulmonary capillary wedge pressure points toward a decrease in myocardial contractility, suggesting that the addition of esmolol to chronically used beta-blockers resulted in an additional negative inotropic effect. We conclude that in patients with coronary artery disease in whom chronic beta-blocker therapy is continued until the time of surgery, esmolol does not further attenuate the heart rate response but does attenuate the increase in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1987
Low-dose enflurane as adjunct to high-dose fentanyl in patients undergoing coronary artery surgery: stable hemodynamics and maintained myocardial oxygen balance.
The effects of enflurane (end-tidal concentration 0.7%) on central and coronary hemodynamics and myocardial oxygenation were studied during steady state, high-dose fentanyl anesthesia in ten patients undergoing coronary artery bypass grafting operations. Compared with the response in ten patients receiving the same fentanyl anesthesia (100 micrograms/kg) without enflurane supplementation, enflurane caused a moderate reduction in mean arterial pressure, systemic vascular resistance, and left ventricular stroke work index. No patient showed signs of myocardial ischemia, and mean coronary sinus flow and calculated coronary resistance remained unchanged. ⋯ Myocardial oxygen extraction decreased in the enflurane supplemented group although it increased in the fentanyl group after surgical stimulation. Three fentanyl group patients and one enflurane-fentanyl group patient had a low myocardial lactate extraction as a sign of myocardial ischemia during surgery. We conclude that a 0.7% enflurane supplementation of 100 micrograms/kg fentanyl anesthesia does not endanger myocardial oxygenation and effectively prevents central and coronary hemodynamic responses to skin incision and sternotomy in patients undergoing coronary artery surgery.
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Anesthesia and analgesia · Feb 1987
The neuromuscular blocking effect of vecuronium on the human diaphragm.
This study compares the neuromuscular blocking effect of vecuronium (0.1 mg/kg) on the diaphragm and the adductor pollicis in nine anesthetized patients. Monitoring of the diaphragm consisted of measurement of the transdiaphragmatic pressure after bilateral phrenic nerve stimulation. Onset time for neuromuscular blockade of the diaphragm was 1.6 +/- 0.3 min (+/-SD) compared to 2.5 +/- 0.3 min in the adductor pollicis (P less than 0.001). ⋯ The twitch height (TH) returned to 25% of its control value after 27 +/- 8 min for the diaphragm, compared to 41 +/- 11 min for the adductor pollicis (P less than 0.01). Complete TH recovery was achieved after 49 +/- 14 min for the diaphragm and after 74 +/- 22 min for the adductor pollicis (P less than 0.01). The recovery index of 12 +/- 4 min for the diaphragm was significantly shorter (P less than 0.05) than for the adductor pollicis (20 +/- 9 min.) We conclude that monitoring of peripheral muscles in anesthetized patients given vecuronium provides adequate information about the degree of paralysis of the diaphragm.
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Anesthesia and analgesia · Feb 1987
The lumbar subdural extraarachnoid space of humans: an anatomical study using spinaloscopy in autopsy cases.
The lumbar subdural extraarachnoid space was examined by spinaloscopy in 15 autopsy subjects. Special attention was paid to the ease with which the space opened up and also to the extent of view achieved. In ten cases the space opened up with ease, in four cases with difficulty, and in one case it was not possible to establish the subdural space at all. ⋯ An epidural catheter was then passed through the Tuohy needle into the subdural space in eight cases and was visualized in six of them. Although care must be exercised in drawing conclusions for clinical epidural anesthesia from autopsy cases, this study confirms the possibility of placing both the bevel of a Tuohy needle and an epidural catheter in the subdural space. The results reemphasize the need for caution suggested by other reports regarding the possibility of subdural puncture in epidural anesthesia and subsequent injection of anesthetic solution into the subdural space.