Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1990
Randomized Controlled Trial Clinical TrialEffects of duration of fasting on gastric fluid pH and volume in healthy children.
To determine the effects of duration of fasting before elective surgery on gastric fluid pH and volume in children, a prospective, randomized, blinded study of 100 unpremedicated children, aged 1-14 yr, was undertaken. Each child was given 2 mL/kg of water orally and then fasted 2, 4, or 6 h preoperatively. After induction of anesthesia and tracheal intubation, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube. ⋯ The mean (+/- SD) gastric fluid pH was 1.80 +/- 0.79 and the mean (+/- SD) gastric fluid volume was 0.56 +/- 0.39 mL/kg. Gastric fluid pH was less than 2.5 and volume greater than 0.4 mL/kg in 53% of children. We conclude that healthy children may receive 2 mL/kg of water up to 2 h before elective surgery without decreasing gastric fluid pH or increasing gastric fluid volume beyond values obtained after fasting for 6 h.
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Anesthesia and analgesia · Oct 1990
Randomized Controlled Trial Clinical TrialProphylactic oral naltrexone with intrathecal morphine for cesarean section: effects on adverse reactions and analgesia.
The influence of two different doses of oral naltrexone on the adverse effects and the analgesia associated with intrathecal morphine was compared in a double-blind, placebo-controlled study. Thirty-five patients undergoing cesarean section were provided postoperative analgesia by 0.25 mg intrathecal morphine. Sixty minutes later they were given 6 mg naltrexone, 3 mg naltrexone, or placebo as an oral solution. ⋯ The incidence of pruritus and vomiting was significantly less in the 6-mg naltrexone group than in the other two groups (P less than 0.05). Somnolence was significantly less in the 3- and 6-mg naltrexone groups than in the placebo group (P less than 0.05). Naltrexone (6 mg) is an effective oral prophylactic against the pruritus and vomiting associated with intrathecal morphine for analgesia after cesarean section, but it is associated with shorter duration of analgesia.
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Anesthesia and analgesia · Oct 1990
Randomized Controlled Trial Comparative Study Clinical TrialCerebrospinal fluid pressure in patients with brain tumors: impact of fentanyl versus alfentanil during nitrous oxide-oxygen anesthesia.
The effects on the cerebrospinal fluid pressure (CSFP) of alfentanil and fentanyl were compared during nitrous oxide-oxygen (N2O-O2) anesthesia in 24 patients who had brain tumors. Monitored variables included CSFP (lumbar subarachnoid catheter), heart rate from electrocardiographic lead II, mean radial arterial blood pressure, and arterial blood gas tensions. General anesthesia was induced with thiopental, 5 mg/kg IV in divided doses, and maintained with 70% N2O in O2; ventilation was held constant (PaCO2 = 37.4 +/- 1.6 mm Hg [mean +/- SEM]). ⋯ Cerebrospinal fluid pressure remained unchanged both in patients who received N2O-O2 alone and in those who received fentanyl-N2O-O2. By contrast, those who received alfentanil-N2O-O2 had a gradual increase in CSFP, reaching 30% above baseline values after 10 min and stabilizing thereafter. Although the absolute increase in CSFP during normocarbic alfentanil-N2O anesthesia was relatively small (9.5 +/- 1.3 mm Hg to 13.0 +/- 1.3 mm Hg [mean +/- SE], P less than 0.05), the absence of a similar effect after fentanyl administration suggests that precautionary measures such as hyperventilation are advisable if alfentanil is used for potentiating normocarbic N2O-O2 anesthesia in neurosurgical patients with intracranial mass lesions.
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Anesthesia and analgesia · Oct 1990
Randomized Controlled Trial Clinical TrialEsmolol reduces autonomic hypersensitivity and length of seizures induced by electroconvulsive therapy.
We evaluated the clinical effectiveness of esmolol, an ultra-short-acting beta 1-adrenergic receptor blocking drug, to control the sinus tachycardia and increase in arterial blood pressures induced by electroconvulsive therapy (ECT). Each of 20 patients, ASA physical status I-III, participated in a double-blind, randomized study, involving four match-pair trials (placebo versus esmolol) during ECT. Each patient acted as his or her own control (total number of ECT procedures, 160). ⋯ Finally, the length of seizures decreased, as manifested clinically from 48 +/- 18 to 39 +/- 14 s and on electroencephalogram from 86 +/- 41 to 67 +/- 28 s. We conclude that esmolol effectively controls the hyperdynamic response to ECT and reduces the length of seizures. The significance of the latter to the overall effectiveness of ECT is not known.