Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1989
Randomized Controlled Trial Clinical TrialProphylactic transdermal scopolamine patches reduce nausea in postoperative patients receiving epidural morphine.
To evaluate the efficacy of prophylactic transdermal scopolamine in reducing nausea associated with postoperative epidural analgesia, we studied 32 healthy adult women undergoing major gynecologic surgery. The patients were randomized in a double blind fashion to receive either a cutaneous scopolamine patch or a visually identical cutaneous placebo patch. Postoperative analgesia was provided solely with epidural morphine. ⋯ The number of patients reporting "zero nausea" was significantly greater with scopolamine patches than with placebo patches (13 vs 1, P less than 0.01). The mean number of times antiemetic drugs were administered per patient was lower with scopolamine than with placebo patches (0.2 +/- 0.4 vs 2.8 +/- 2.6, P less than 0.05). It is concluded that prophylactic transdermal scopolamine patches reduce nausea in postoperative patients receiving epidural morphine.
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Anesthesia and analgesia · Feb 1989
The lumbar epidural space in patients examined with epiduroscopy.
Percutaneous epiduroscopy was performed in 10 patients with the aim of comparing the lumbar epidural space of the patients with the findings made earlier in autopsy subjects. The patients were scheduled for partial laminectomy for a herniated lumbar disc. A complete examination was possible in eight subjects. ⋯ Smaller bleeding occurred in three other subjects. The partial laminectomy performed one to two interspaces caudad to the level of endoscopy did not reveal any evidence of epidural bleeding in any subject. The postoperative course of all patients was uneventful.
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Anesthesia and analgesia · Feb 1989
ReviewClinical uses of intravenous anesthetic and analgesic infusions.
Renewed interest in i.v. anesthetic techniques has resulted from the availability of more rapid and shorter-acting i.v. drugs. With recent advances in the area of infusion pump technology, it has become easier to administer i.v. anesthetics and analgesics by continuous infusion techniques. The newer sedative-hypnotic (midazolam, propofol) and analgesic (sufentanil, alfentanil) drugs are better suited pharmacologically to continuous administration techniques than the traditional i.v. agents because they can be more accurately titrated to meet the unique and changing anesthetic needs of the individual patient. ⋯ Improved delivery systems for administering i.v. drugs will make it easier to use continuous infusion techniques in the future. With continued progress in the development of infusion devices and i.v. drugs designed for continuous administration, the use of intravenous anesthetic techniques will become more widespread. In the near future, infusion pumps will likely become standard equipment on all anesthesia machines and anesthesiologists should find these techniques easier to use in their clinical practices.
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This study determined the priming dose of vecuronium (V), pancuronium (P) and atracurium (A) that resulted in the most rapid onset of neuromuscular blockade (NMB) in 150 patients given either V 0.08 mg/kg, P 0.1 mg/kg or A 0.6 mg/kg. Patients were further divided (n = 10 per group) to receive no prime or 5%, 10%, 15% or 20% of the total dose as a prime followed 5-7 minutes later by the remaining (intubating) dose. A further 10 patients received 0.04 mg/kg d-tubocurarine followed by 1.5 mg/kg succinylcholine (S). ⋯ Increasing the intubating dose did not improve onset of NMB. The "optimal" priming dose, however, resulted in a high incidence of symptoms of muscle weakness. We conclude that priming shortens the onset of NMB similarly between V, P and A but the priming dose producing the most rapid onset of NMB also results in a high incidence of side effects and therefore the priming principle should be used with caution.