Anesthesia and analgesia
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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
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.