Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 1988
Comparative Study Clinical Trial Controlled Clinical TrialComparison of buprenorphine with morphine in the treatment of postoperative pain in children.
The safety and efficacy of buprenorphine and morphine as postoperative analgesics for children were compared in 60 boys and girls 4 to 14 years old having elective orthopedic operations on upper or lower extremities. The drugs were given in a double-blind manner initially intravenously and thereafter by sublingual buprenorphine or intramuscular morphine administered as required to relieve pain until the third postoperative morning. ⋯ The most common side effects were nausea and vomiting (28 and 16%) and urinary retention (21 and 19%) in the buprenorphine and morphine groups, respectively. Analgesia with sublingual buprenorphine was as effective and reliable as with intramuscular morphine but a longer duration of action could not be demonstrated.
-
Anesthesia and analgesia · Mar 1988
Randomized Controlled Trial Clinical TrialPostoperative effects of intrathecal morphine in coronary artery bypass surgery.
To determine whether intrathecal morphine is effective in decreasing analgesic and antihypertensive drug requirements after coronary artery bypass (CAB) surgery, a prospective, randomized, double-blind study was designed. Approximately 30 minutes before induction of anesthesia with IV sufentanil and diazepam, and 2 hours before heparinization, one group of patients (n = 16) were given morphine 0.5 mg, while the control group (n = 14) were given placebo intrathecal injections through 22- or 25-gauge lumbar puncture needles. Intraoperatively, there were no differences in the numbers of patients requiring vasodilator drugs or volatile agent titration. ⋯ There were no differences in pain scores, and the only complications (itching, nausea and vomiting) were infrequent. It is concluded that an intrathecal dose of 0.5 mg of morphine is efficacious in reducing analgesic and antihypertensive drug requirements after CAB surgery. Whether these results are clinically important enough to warrant the theoretical risks of postheparinization lumbar hematoma is a topic for further investigation.
-
Anesthesia and analgesia · Mar 1988
The temperature of bupivacaine 0.5% affects the sensory level of spinal anesthesia.
Three milliliters of plain bupivacaine 0.5% was injected intrathecally in two groups of 20 patients. Group 1 received a solution that had been equilibrated to 37 degrees C, group 2 received a solution that had been equilibrated to 4 degrees C. ⋯ The differences between segmental levels of sensory loss between groups 1 and 2 (T4 and T9, respectively) and of temperature loss (T3 and T8, respectively) 10 and 20 minutes after injection of bupivacaine were statistically significant. It is concluded that the time needed for thermal equilibration in the cerebrospinal fluid and hence temperature of the injected solution plays an important role in the sensory spread of plain bupivacaine 0.5%.
-
Anesthesia and analgesia · Mar 1988
Regional hemodynamics and oxygen supply during isovolemic hemodilution alone and in combination with adenosine-induced controlled hypotension.
Studies were performed in ten pentobarbital-anesthetized, open chest dogs to evaluate regional circulatory effects of isovolemic hemodilution alone, and in combination with adenosine-induced controlled hypotension. Regional blood flow measured with 15-microns radioactive microspheres was used to calculate regional oxygen supply. Hemodilution with 5% dextran (40,000 molecular weight) reduced arterial hematocrit and oxygen content by approximately one-half and caused heterogeneous changes in regional blood flows; flow decreased in the spleen, was unchanged in the renal cortex, liver, skeletal muscle and skin, and increased in the duodenum, pancreas, brain and myocardium; however, only in the brain and myocardium were increases in flow sufficient to preserve oxygen supply. ⋯ In the myocardium, direct coronary vasodilation by adenosine caused parallel increases in blood flow and oxygen supply to levels exceeding prevailing metabolic requirements. It is concluded that 1) during isovolemic hemodilution alone, oxygen supply to the brain and myocardium is maintained at the expense of oxygen supply to less critical organs and, 2) during combined isovolemic hemodilution and adenosine-induced hypotension, oxygen is oversupplied to the myocardium but undersupplied to the brain and kidney. These latter effects suggest the need for extensive clinical monitoring of patients in whom combined isovolemic hemodilution and adenosine-induced hypotension is utilized.