Anesthesia and analgesia
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Some investigators have postulated a synergistic analgesic effect of local anesthetic agents and opiates when given intrathecally or epidurally, but little objective evidence has been presented to quantitate such an effect. A study was therefore undertaken to compare in mice the antinociceptive effects of intrathecal injections of mixtures of morphine with bupivacaine or lidocaine with the effects of these agents when administered alone. The antinociceptive effects (tail-flick and hotp-late tests) of morphine (0.1-1.6 micrograms) with either bupivacaine, 25 micrograms, or lidocaine, 200 micrograms, were significantly greater than the effects of morphine or the local anesthetics when administered alone. ⋯ An enhanced effect was also observed when combinations of local anesthetics and low doses of morphine were used that by themselves had no or little effect. The addition of morphine did not affect the motor block produced by the local anesthetics. The results indicate a potentiating effect of local anesthetics on spinal morphine antinociception, a finding that may have important clinical implications.
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Anesthesia and analgesia · Oct 1988
Left ventricular function during propofol and fentanyl anesthesia in patients with coronary artery disease: assessment with a radionuclide approach.
Using gated radionuclide ventriculography and invasive cardiac monitoring, the effects of propofol alone and in combination with fentanyl on left ventricular (LV) volumes and function were investigated in 10 ASA III, unpremedicated patients (51-75 years) with coronary artery disease (NYHA II-III). Anesthesia was induced with propofol (2 mg/kg) followed by an infusion (100 micrograms.kg-1.min-1). Vecuronium (0.05 mg/kg) was administered and ventilation (FIO2, 1.0) was manually controlled via a face mask (FECO2, 4-5%). ⋯ Neither global ejection fraction (EF) nor end systolic volume changed significantly at any time, nor were there changes in the ECG or in regional ejection fractions (REF). The absence of changes in REF was consistent with lack of wall motion abnormalities of the left ventricle. Propofol alone and in combination with fentanyl does not alter LV performance in patients with good LV function.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of this study was to determine the need for supplemental oxygen during recovery from general anesthesia for ambulatory surgery in healthy women without obesity or respiratory disease. Arterial oxygen saturation by pulse oximetry (SpO2) was monitored throughout the first postoperative hour in 164 patients. The patients breathed room air during recovery. ⋯ The need for supplemental oxygen increased with increasing age (P less than 0.05) but was not associated with a history of cigarette smoking, tracheal intubation, amount of opioids or sedatives given intraoperatively, anesthetic duration, or level of consciousness during recovery. Hypoxemia was neither predictable nor clinically apparent. We recommend that, unless arterial oxygenation is monitored, ambulatory patients should routinely receive supplemental oxygen during recovery from general anesthesia.