Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1989
Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy.
This study was undertaken to compare the effects of postoperative bupivacaine epidural analgesia with those of intermittent injections of ketobemidone (a synthetic opioid) on postoperative bowel motility in patients who had had hysterectomies. The epidural group (N = 20) received continuous epidural anesthesia with bupivacaine postoperatively for 26-30 hours and the control group (N = 20) received intermittent injections of ketobemidone for postoperative pain relief. Postoperative bowel movements and propulsive colonic motility were estimated from the first passage of flatus and feces and by following radiopaque markers by serial abdominal radiographs. ⋯ The average position of the markers was significantly more distally in the epidural group immediately after operation and the markers continued to move forward during the first postoperative day. In the control group, the markers did not move during this period. The results demonstrate that postoperative bowel peristalsis returned earlier in the patients given epidural analgesia with bupivacaine for pain relief than in patients given a narcotic.
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Intraspinal narcotics have dramatically influenced the way pain of malignant origin is managed. There has been a rapid acceptance of this modality within the anesthesia community to treat a wide variety of cancer pain problems. ⋯ Factors to be considered in patient selection should include the results of the preimplantation spinal narcotic trial, infection trial, infection and local conditions, hematologic status, physiologic and behavioral abnormalities, cost, patient support systems and life expectancy. By interfacing these factors with the unique profiles that each of the five types of implantable narcotic delivery systems offer, improved results both in terms of pain relief and patient satisfaction can be expected.
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Anesthesia and analgesia · Mar 1989
Aging: effects on minimum alveolar concentration (MAC) for halothane in Fischer-344 rats.
It is well-established that the anesthetic requirement (MAC) of volatile agents such as halothane is reduced in elderly patients. The current project was designed to determine whether a similar alteration in anesthetic requirement occurs in Fischer-344 (F-344) rats, an animal model often utilized in physiology and pharmacology to examine aging-related changes. ⋯ MAC was reduced approximately 17% in aged (25 months) versus young adult (5 months) animals. From these data, it is concluded that the F-344 rat may be an adequate model for examination of age-dependent alterations in the actions of volatile anesthetics.
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The effects of general and regional anesthesia on neonates after cesarean section have been studied mainly on elective cases. In this paper we studied infants delivered by elective and nonelective cesarean section at the Winnipeg Women's Hospital from 1975 to 1983 (n = 3940) to determine the effect of anesthetic technique on neonatal outcomes. A trained anesthesia nurse interviewed all parturients and reviewed their antepartum, labor and delivery, and anesthesia records. ⋯ Among neonates delivered after elective section, general anesthesia was associated with a higher incidence of low Apgar scores at 1 minute. In neonates delivered by nonelective section, general anesthesia was associated with higher rates of low Apgar scores at 1 and 5 minutes as well as greater requirements for intubation and artificial ventilation. There were no differences seen in neonatal death rates with general and regional anesthesia in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1989
Bunegin-Albin catheter improves air retrieval and resuscitation from lethal venous air embolism in upright dogs.
Three types of catheters, the Arrow multi-orifice catheter, the American Edwards 7 Fr Swan-Ganz catheter and the Cook Bunegin-Albin multi-orifice CVP catheter were evaluated for their ability to retrieve venous air emboli and effect on the success rate of resuscitation from venous air emboli. The catheters were inserted in dogs anesthetized with isoflurane (1.7%, inspired) and N2O (66%) in O2 and placed in the sitting position with the head 90 degrees to the horizontal. Swan-Ganz catheters were positioned with the right atrial (RA) port just above the junction of the superior vena cava (SVC) and the RA and the pulmonary artery (PA) port in the pulmonary artery. ⋯ Both RA and PA ports of the Swan-Ganz catheter were used for aspiration. The amounts of gas retrieved expressed as a percent of the injected air and the incidence of successful resuscitation were compared. Significantly greater percentages of injected venous air were retrieved with the Bunegin-Albin catheter (63 +/- 14%, mean +/- SEM) than with the Arrow multi-orifice catheter (6 +/- 2%) or the Swan-Ganz catheter (14 +/- 5%).(ABSTRACT TRUNCATED AT 250 WORDS)