Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1987
Randomized Controlled Trial Comparative Study Clinical TrialEpidural butorphanol or morphine for the relief of post-cesarean section pain: ventilatory responses to carbon dioxide.
To determine the safety, efficacy, and the ventilatory responses to carbon dioxide (CO2) of epidurally administered butorphanol or morphine, 122 healthy women who underwent cesarean section with epidural anesthesia were studied. Patients were randomly assigned to receive one of four epidural regimens for the relief of postoperative pain: 5 mg morphine (n = 32), 4 mg butorphanol (n = 30), 2 mg butorphanol (n = 29), or 1 mg butorphanol (n = 31). Epidural morphine provided satisfactory analgesia with slow onset and long duration of approximately 21 hr. ⋯ The ventilatory response to CO2 was depressed after morphine and after 2 and 4 mg butorphanol, but the duration of depression was more prolonged after morphine. It is concluded that epidural butorphanol is effective in providing pain relief after cesarean section with minor side effects. However, patients must be observed closely because of possible respiratory depression.
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Anesthesia and analgesia · Sep 1987
Randomized Controlled Trial Comparative Study Clinical TrialEffect of increasing amounts of epinephrine during isobaric bupivacaine spinal anesthesia in elderly patients.
The effects of adding epinephrine to isobaric bupivacaine spinal anesthesia were investigated in 96 ASA class II-III patients aged 75 yr or more scheduled for lower extremity surgery. The subjects were randomly allocated into six groups. All patients received 15 mg bupivacaine plain solution in 4 ml, in the horizontal position. ⋯ Addition of 0.5 mg epinephrine did not result in further prolongation of anesthesia. Motor blockade was also increased by addition of epinephrine. It is concluded that addition of 0.3 mg epinephrine may be useful to increase duration of isobaric bupivacaine spinal anesthesia.
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Anesthesia and analgesia · Sep 1987
Randomized Controlled Trial Comparative Study Clinical TrialComparison of high-frequency jet ventilation with conventional mechanical ventilation for bronchopleural fistula.
In seven patients with acute respiratory failure and a bronchopleural fistula, the authors compared gas exchange and volume of gas lost via the chest tube during conventional mechanical ventilation (CV) and high-frequency jet ventilation (HFJV). After the initial comparison, patients were randomized to HFJV or CV, unless one mode of ventilation was clearly superior based on preestablished criteria. In six of the seven patients, oxygenation deteriorated after the switch from CV to HFJV. ⋯ The mean chest tube leak did not change significantly. Randomization of the mode of ventilation was not performed in any patient because CV was superior by a priori criteria. We conclude that when acute respiratory failure is complicated by a bronchopleural fistula, HFJV with mean airway pressures comparable to those provided during conventional ventilation does not provide satisfactory gas exchange.