Anesthesia and analgesia
-
Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialEpinephrine improves the quality of spinal hyperbaric bupivacaine for cesarean section.
In a double-blind randomized study, the effects of the addition of epinephrine on hyperbaric spinal bupivacaine were studied in 63 patients having elective repeat cesarean sections. In the study group (32 patients), the addition of 0.2 mg epinephrine improved the quality of analgesia since fewer patients required supplementation of the spinal anesthetic; the motor block was more profound; and the times to two-segment regression, sensory recovery, and motor recovery were prolonged.
-
Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialEpinephrine enhances analgesia produced by epidural bupivacaine during labor.
Reports on the analgesic and hemodynamic effects of epinephrine added to bupivacaine for epidural use in obstetrics are conflicting. In this study, healthy parturients received in a random manner either 10 ml of 0.25% bupivacaine (n = 50) or 10 ml of 0.25% bupivacaine with 1:300,000 epinephrine (n = 50) epidurally. ⋯ Maternal heart rate increased only after injection of the epinephrine-containing solution. The authors conclude that epinephrine 1:300,000 modestly but statistically significantly improves the analgesic efficacy of epidurally administered 0.25% bupivacaine during labor.
-
Anesthesia and analgesia · May 1987
Comparative StudyThe pattern of train-of-four fade after atracurium: influence of different priming doses.
This study was designed to investigate the effect of three different priming doses of atracurium--0.06, 0.07, and 0.08 mg/kg--followed 3 min later by the remainder of a 0.5 mg/kg dose on the relationship between the depression in the first twitch of the train-of-four (T1) and train-of-four (TOF) fade. This relationship was studied after the administration of the full dose of the relaxant in all groups. ⋯ Acceleration of the onset of neuromuscular blockade was, however, evident in all groups that received atracurium in divided doses. The implication is, therefore, that prejunctional activity may not contribute significantly to the acceleration of onset of neuromuscular blockade after administration of atracurium in divided doses, as described in this study.
-
Anesthesia and analgesia · May 1987
Comparative StudyBupivacaine disposition in mother, fetus, and neonate after spinal anesthesia for cesarean section.
Uptake of bupivacaine from the subarachnoid space and its placental transfer were measured in six patients undergoing elective cesarean section. Maternal plasma levels (59 +/- 32 ng/ml) were only about 5% of those found in a comparable previous study of epidural anesthesia. Mean plasma umbilical venous bupivacaine levels (20.2 +/- 21 ng/ml) were 7% of those found after epidural anesthesia. ⋯ Neonatal urine had measurable levels of both bupivacaine and its inactive metabolite, 2,6-pipecolylxylidine (PPX), for at least 36 hr after delivery. The results demonstrate that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts. This transplacental passage occurs despite injection of only small doses of a very highly protein bound drug into the subarachnoid space.