Anesthesia and analgesia
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Anesthesia and analgesia · May 1991
Randomized Controlled Trial Clinical TrialPentamorphone for management of postoperative pain.
The efficacy, duration, and safety of the synthetic opioid pentamorphone in the treatment of acute postoperative pain were evaluated in a randomized, double-blind study of 72 patients given 0.08, 0.16, or 0.24 micrograms/kg of pentamorphone or a placebo intravenously in the recovery room after major abdominal or orthopedic surgery. Only patients given 0.24 micrograms/kg of pentamorphone experienced decreased pain intensity and increased sedation, both transient in duration. ⋯ No acute cardiorespiratory changes were observed. Pentamorphone (0.08-0.24 micrograms/kg) was ineffective for treating acute postoperative pain after major surgery.
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Anesthesia and analgesia · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialDeliberate hypotension in patients with intracranial arteriovenous malformations: esmolol compared with isoflurane and sodium nitroprusside.
Thirty patients undergoing resection of arteriovenous malformations with deliberate hypotension were randomized to receive 1 of 3 hypotensive agents. Anesthesia was maintained with isoflurane and nitrous oxide in all patients. Mean arterial pressure was reduced 20% to 60-65 mm Hg with use of either isoflurane (less than or equal to 4%), sodium nitroprusside (less than or equal to 8 micrograms.kg-1.min-1), or esmolol (less than or equal to 24 mg/min). ⋯ Heart rate increased 13% with sodium nitroprusside, remained unchanged with isoflurane, and decreased 23% with esmolol. Although esmolol may be used as a primary hypotensive agent, the potential for marked myocardial depression must be recognized. The differences in pharmacologic properties for the different hypotensive agents suggest that combinations of these agents may provide a pharmacologic profile superior to either agent alone.
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Anesthesia and analgesia · May 1991
Comparative StudyComparison of intravenous sedative-analgesic techniques for outpatient immersion lithotripsy.
Fifty-three unpremedicated outpatients undergoing elective extracorporeal shock wave lithotripsy using an unmodified Dornier HM-3 lithotriptor received one of two different intravenous sedation-analgesia techniques. Both intravenous midazolam-alfentanil and fentanyl-propofol techniques produced conditions comparable to those achieved with epidural anesthesia during immersion lithotripsy. ⋯ Compared with a standard epidural anesthesia technique, the mean anesthesia and recovery times were significantly shorter with the two intravenous sedation-analgesia techniques (57-62 min vs 105 min and 143-147 min vs 199 min, respectively). These data suggest that combinations of either midazolam and alfentanil or fentanyl and propofol are viable alternatives to epidural anesthesia for outpatient immersion lithotripsy.