Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1990
Randomized Controlled Trial Clinical TrialEffects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial.
Forty postpartum patients with postdural puncture headache (PDPH) were randomly assigned to receive oral caffeine (300 mg) or a placebo. Intensity of headache, quantitated using a visual analogue pain scale (VAS), was assessed immediately before drug administration and 4 and 24 h later. ⋯ Six patients (30%) whose PDPH was relieved by caffeine at 4 h had recurrence of symptoms the following day. Our study demonstrates that caffeine administered orally provides relief, albeit if sometimes transient, from PDPH with minimal side effects.
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Anesthesia and analgesia · Feb 1990
Intrathecal morphine dose-response data for pain relief after cholecystectomy.
We studied the effect of low-dose intrathecal morphine (0.00-0.20 mg) on pain relief and the incidence of side effects after cholecystectomy in 139 patients divided into eight groups according to intrathecal morphine dose: groups 1 (0.00 mg), 2 (0.04 mg), 3 (0.06 mg), 4 (0.08 mg), 5 (0.10 mg), 6 (0.12 mg), 7 (0.15 mg), and 8 (0.20 mg). Preservative-free morphine hydrochloride mixed in hyperbaric tetracaine solution was administered at the time of induction of spinal anesthesia just before surgery. Pain relief was significantly greater for the first 24 h in groups 3, 4, 5, 6, 7, and 8 than in group 1. ⋯ Vomiting occurred significantly more often in group 1 than in groups 2, 3, 4, and 5. Intraoperative cholangiography and the postoperative clinical course indicated no increase in tone of the sphincter of Oddi in any patient. We conclude that 0.06-0.12-mg intrathecal morphine is the best dose range for pain relief after cholecystectomy without respiratory depression and with the lowest incidence of vomiting or pruritus, or both.
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Anesthesia and analgesia · Feb 1990
Pediatric anesthesia morbidity and mortality in the perioperative period.
One of the most frequent questions asked of a pediatric anesthesiologist is "What are the risks of anesthesia for my child?" Unfortunately, few studies have examined the consequences of general anesthesia in children. We used data from a large pediatric anesthesia follow-up program at Winnipeg Children's Hospital (1982-1987) to determine rates of perioperative adverse events among children of different ages. A check-off form was completed by a pediatric anesthesiologist for each case (n = 29,220) and a designated follow-up reviewer examined all anesthesia forms and hospital charts to ascertain adverse effects for children less than 1 mo, 1-12 mo, 1-5 yr, 6-10 yr, and 11-16 yr of age in the intraoperative, recovery room, and postoperative periods. ⋯ When all events were considered (both major and minor), there was a risk of an adverse event in 35% of the pediatric cases. This contrasts with 17% for adults. This morbidity survey helps to focus on areas of intervention and for further study.
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Anesthesia and analgesia · Feb 1990
Comparative StudySciatic nerve blocks in children: comparison of the posterior, anterior, and lateral approaches in 180 pediatric patients.
Three techniques for blocking the sciatic nerve, differing in approach (posterior in group P; lateral in group L; and anterior in group A), were prospectively evaluated in 180 children who were also given light general anesthesia for surgery below the knee. Four anesthetic solutions with epinephrine (1% lidocaine, 0.5% bupivacaine, and two mixtures of 0.5% bupivacaine with either 1% lidocaine or 1% etidocaine) were administered to 15 patients in each group. The sciatic nerve was located by electrical stimulation or, when muscle twitches were not elicited, using a loss-of-resistance technique. ⋯ Although the spread of the anesthetic was different in the three groups, the distribution of anesthesia in the lower extremity was similar, including not only dermatomes supplied by the sciatic nerve, but also those supplied by the posterior femoral cutaneous nerve. No neurological sequelae were observed. It is concluded that the posterior and lateral approaches are the most suitable in children for blocking the sciatic nerve proximally.
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Anesthesia and analgesia · Feb 1990
Succinylcholine does not increase serum potassium levels in patients with acutely ruptured cerebral aneurysms.
Succinylcholine-induced hyperkalemia has been reported to occur in many neurological disorders including subarachnoid hemorrhage. The purpose of this study was to compare the effect of succinylcholine on serum potassium levels in patients with ruptured cerebral aneurysms undergoing either early (less than or equal to 4 days; n = 14) or delayed (5-16 days; n = 20) surgery. Thirty-four patients were classified according to the number of days from subarachnoid hemorrhage to surgery. ⋯ The electrocardiogram was continuously monitored. The mean ( +/- SD) increase in serum potassium level of 0.4 +/- 0.2 mmol/L occurred at 10 min but was not statistically significant, nor was there any statistically significant difference in serum potassium levels related to time between subarachnoid hemorrhage and administration of succinylcholine. We found no evidence of succinylcholine-induced hyperkalemia in patients undergoing either early or delayed cerebral aneurysm surgery.