Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1990
Randomized Controlled Trial Clinical TrialNeuromuscular and cardiovascular effects of high-dose vecuronium.
The effects of bolus administration of large doses of vecuronium on the onset and duration of neuromuscular blockade and histamine release were studied during fentanyl-nitrous oxide anesthesia. Forty adults were randomly assigned to receive a bolus injection of either 0.1, 0.2, 0.3, or 0.4 mg/kg of vecuronium. The evoked electromyogram of thumb adduction to train-of-four stimulation was monitored. ⋯ Both time of onset and duration after doses of 0.3 or 0.4 mg/kg were significantly different from values after the lower doses. No dose-related changes in blood pressure, heart rate, or histamine release were observed. The authors conclude that large bolus doses of vecuronium can be safely used to speed the onset of blockade, but with a significantly prolonged duration of action.
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Anesthesia and analgesia · Jan 1990
Randomized Controlled Trial Clinical TrialEpidural and intravenous fentanyl infusions are clinically equivalent after knee surgery.
The management of postoperative pain with continuous epidural fentanyl infusion was compared with continuous intravenous fentanyl infusion. In a randomized, doubleblind protocol we prospectively studied 20 patients undergoing repair of the anterior cruciate ligament of the knee. The quality of analgesia and the incidence of side effects were documented. ⋯ There were no significant differences in the incidence of nausea, pruritus, or urinary retention. There was no respiratory depression in either group. We conclude that when compared with continuous intravenous fentanyl infusion, continuous epidural fentanyl infusion offers no clinical advantages for the management of postoperative pain after knee surgery.
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Anesthesia and analgesia · Jan 1990
Impaired epidural analgesia after dural puncture with and without subsequent blood patch.
We carried out a retrospective assessment of epidural analgesia in 46 parturients who had a previous dural puncture. Of 29 women who had both dural puncture and blood patch previously, only 59% had an uncomplicated successful second epidural anesthetic. Of 17 parturients who had dural puncture but no blood patch previously, only 65% had an uncomplicated successful subsequent epidural anesthetic. ⋯ The data suggest that dural puncture may lead to impaired epidural analgesia subsequently. Epidural blood patch after dural puncture did not lead to any further decrease in the rate of good analgesia with subsequent epidural anesthetics. Parturients who request epidural analgesia and who have had previous dural puncture with or without blood patch should be informed about the 35%-40% chance of poor epidural analgesia.
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Anesthesia and analgesia · Jan 1990
Labetalol and esmolol in the control of hypertension after intracranial surgery.
The postoperative course of patients emerging from general anesthesia after intracranial surgery is frequently complicated by hypertension. This study examined the comparative efficacy of esmolol and labetalol in treating increases in blood pressure during emergence and recovery from anesthesia after intracranial surgery. ⋯ However, decreases in heart rate were significantly more frequent in the immediate postoperative period in patients given labetalol. An increase in blood pressure after intracranial surgery appears to be a transitory phenomenon adequately treated with a short-acting antihypertensive agent such as esmolol.
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Anesthesia and analgesia · Jan 1990
A new local anesthetic, ropivacaine. Its epidural effects in humans.
The current study was initiated to evaluate the epidural anesthetic properties of 0.5%, 0.75%, and 1.0% ropivacaine, a new local anesthetic agent structurally similar to bupivacaine. Fifteen patients scheduled for lower limb orthopedic surgery were enrolled in the study. As the concentration of ropivacaine increased from 0.5% to 1.0%, the time to onset of sensory anesthesia decreased from 6.4 +/- 1.7 (SD) min to 2.4 +/- 0.6 min and the maximum level of sensory anesthesia increased from T6 to T1. ⋯ These initial studies in humans suggest that ropivacaine provides satisfactory sensory anesthesia with minimal motor blockade at a concentration of 0.5%. An increase in concentration resulted in a more profound motor blockade. The Cmax of ropivacaine in this study was below levels associated with toxicity in animal studies.