Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1991
Randomized Controlled Trial Clinical TrialContinuous infusion of interpleural bupivacaine maintains effective analgesia after cholecystectomy.
Twenty-five patients who had undergone elective cholecystectomy were prospectively randomized to receive via an interpleural catheter either a continuous infusion of 0.25% bupivacaine at 0.125 mL.kg-1.h-1 (n = 13) or repeated bolus injections (n = 12) of 0.5% bupivacaine with epinephrine 1:200,000 at 0.4 mL/kg every sixth hour. Adequacy of pain relief was measured by the amount of patient-controlled analgesia morphine required postoperatively and by patient scores on a visual analog scale obtained every sixth hour. Two venous blood samples for measurements of serum bupivacaine levels were obtained from patients in the continuous group at hours 6 and 24; four blood samples were obtained from patients in the bolus group, both immediately before and 30 min after injections at hours 6 and 24. ⋯ The difference was not, however, statistically significant, but when activity during the 2-h time periods immediately before reinjection were examined, patients in the bolus group required and received significantly more morphine than did those in the continuous group (P less than 0.05). Patients in the continuous group had visual analog scale scores that averaged 2.9 +/- 0.6 over the 24-h study period. Patients within the bolus group had visual analog scale scores before and again 30 min after injection that averaged 5.8 +/- 0.8 and 1.8 +/- 0.5, respectively (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1991
Randomized Controlled Trial Clinical TrialEffects of clear liquids on gastric volume and pH in healthy volunteers.
The effects of clear liquids on gastric volume and pH were examined in 30 healthy ASA physical status I volunteers. After overnight fasting, a Salem-sump nasogastric tube was inserted and gastric contents were removed for measurement of volume and pH. Gastric contents were then reinserted through the nasogastric tube into the stomach. ⋯ Gastric contents were then again aspirated, measured for volume and pH, and reinserted through the nasogastric tube every half hour until gastric volume was less than 25 mL. All volunteers had gastric volumes less than 25 mL with a slight decrease in pH within 2 h of orally taking one of the three 240-mL liquids. These data suggest that if patients have ingested a moderate amount of clear liquids it is safe to conduct general anesthesia after a 2-h fast in healthy surgical patients.
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Anesthesia and analgesia · Apr 1991
Biography Historical ArticleThe development of academic anesthesiology at the Roswell Park Memorial Institute: James O. Elam, MD, and Elwyn S. Brown, MD.
In the early 1950s, Drs. James Elam and Elwyn Brown were recruited to establish the department of anesthesiology at the Roswell Park Memorial Institute. ⋯ Their work on carbon dioxide elimination led to a redesigning of the soda lime canisters that is still in clinical use. By popularizing mouth-to-mouth rescue breathing, these two anesthesiologists changed the manner in which emergency aid was given and won international acclaim.
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Anesthesia and analgesia · Apr 1991
Potentiation of atracurium neuromuscular blockade by enflurane: time-course of effect.
This study was designed to determine the time required for potentiation of atracurium neuromuscular blockade after the introduction of enflurane. Ten ASA physical status I and II adults anesthetized with thiopental, nitrous oxide, and alfentanil were given 0.4 mg/kg atracurium besylate. The force of contraction of the adductor pollicis muscle in response to train-of-four stimulation of the ulnar nerve was recorded. ⋯ During the first 30 min, no significant decrease in plasma levels occurred; but at 45 min, concentrations were only 67% +/- 8% of their initial value (P less than 0.01) and 48% +/- 2% at 120 min (P less than 0.01). This suggests that the interaction between enflurane and atracurium is time-dependent. Clinically, the interaction between atracurium and enflurane is negligible during procedures of less than 45 min.
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Anesthesia and analgesia · Apr 1991
One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography.
Interscalene brachial plexus anesthesia for shoulder surgery routinely includes sensory anesthesia of the fourth and fifth cervical nerves. The authors reasoned that some degree of diaphragm paralysis should result from interscalene blocks that produce surgical C3-C5 sensory anesthesia. In this investigation, ultrasonography was used to study the incidence of ipsilateral hemidiaphragmatic paresis during routine interscalene block, as it is a practical, sensitive, and low-risk method for diagnosing hemidiaphragmatic function without radiation exposure. ⋯ Changes from normal to paradoxical motion of the ipsilateral hemidiaphragm were seen in all 13 patients during sniff and Mueller maneuvers within 5 min (in 11 of 13 patients at 2 min). Diaphragmatic motion returned to normal in 10 of 11 patients between 3 and 4 h after injection and in the remaining patient by the fifth hour after injection. Diaphragmatic paresis appears to be an inevitable consequence of interscalene brachial plexus block when providing anesthesia sufficient for shoulder surgery.