Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialNalbuphine is better than naloxone for treatment of side effects after epidural morphine.
This study compared naloxone and nalbuphine when administered for treatment of side effects after epidural morphine, 5 mg, given for postcesarean analgesia. Patients requesting treatment for pruritus or nausea randomly received, in a double-blind fashion, up to three intravenous doses of either naloxone 0.2 mg (group 1; n = 20) or nalbuphine 5 mg (group 2; n = 20). The incidence of vomiting, the severity of nausea and pruritus, and the degree of sedation and pain were assessed before and 30 min after each dose. ⋯ Other than decreased pruritus after the second dose with both drugs, no further changes occurred. We conclude that nalbuphine is superior to naloxone for the treatment of side effects after epidural morphine. However, persistent symptoms may require supplemental therapy, as repeated doses proved less effective than the initial dose.
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Anesthesia and analgesia · Nov 1992
Effects of surgical stress and volatile anesthetics on left ventricular global and regional function in patients with coronary artery disease. Evaluation by computer-assisted two-dimensional quantitative transesophageal echocardiography.
We investigated the effects of halothane, enflurane, and isoflurane on central hemodynamics and left ventricular global and regional function when used to control intraoperative hypertension in 39 patients with coronary artery disease. Left ventricular short-axis, midpapillary images were obtained by transesophageal echocardiography. Using a centerline algorithm, we analyzed left ventricular images for global area ejection fraction (GAEF) and segmental area ejection fraction (SAEF). ⋯ Isoflurane induced a decrease in the SAEF/GAEF ratios of two segments corresponding to the inferolateral wall of the left ventricle that was, in one of these segments, significantly more pronounced compared with both halothane and enflurane. Halothane or enflurane did not cause any change in regional wall motion. We conclude that isoflurane is more likely to cause regional wall motion changes than halothane or enflurane in patients with coronary artery disease.
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Anesthesia and analgesia · Nov 1992
Comparative StudyTotal intravenous anesthesia: effects of opioid versus hypnotic supplementation on autonomic responses and recovery.
During radical prostatectomy procedures under total intravenous anesthesia, acute hemodynamic responses to retropubic dissection (30% +/- 8% to 36% +/- 12% [mean +/- SD] increases in mean arterial pressure) were treated with supplemental doses of either an opioid analgesic (alfentanil) or a sedative-hypnotic (propofol) to return the mean arterial pressure to within 10% of the preincision value. Although both drugs were effective, control with propofol required 10.1 +/- 2.5 min compared with 6.3 +/- 2.6 min in the alfentanil group (mean +/- SD; P < 0.01). Plasma stress hormone concentrations increased significantly in response to this surgical stimulus: epinephrine increased from 246% +/- 169% to 283% +/- 330%; norepinephrine increased from 44% +/- 33% to 83% +/- 104%; and antidiuretic hormone increased from 1300% +/- 1591% to 1700% +/- 1328%. ⋯ In addition, 36% of the alfentanil-treated patients required antihypertensive therapy in the postanesthesia care unit compared with only 9% in the propofol group (P < 0.05). Postanesthesia care unit and hospital discharge times were similar in both treatment groups. We conclude that supplemental doses of alfentanil or propofol were equally effective in controlling acute hemodynamic and hormonal responses to surgical stimuli during total intravenous anesthesia.
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Anesthesia and analgesia · Nov 1992
Comparative StudyComparison of two techniques to inflate the bronchial cuff of the Univent tube.
The Univent tube is an endotracheal tube with a movable bronchial blocker. The blocker cuff reportedly exhibits high-pressure characteristics when inflated to seal any adult bronchus. This study was aimed at measuring the cuff volume that would seal the bronchus when two different techniques of cuff inflation were used. ⋯ The bronchial cuff was then inflated until air bubbles ceased to appear in the beaker. Direct measurement of compliance of the blocker cuff confirmed its high-pressure characteristics. Bronchial sealing volume ranged from 3 to 5 mL when measured with the NPT and from 4 to 6 mL when measured with the PPT.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Nov 1992
Randomized Controlled Trial Clinical TrialAdverse effects of epidural 0.03% bupivacaine during analgesia after cesarean section.
To develop a regimen that would provide good analgesia after cesarean section with minimal side effects in the setting of prolonged (> 24 h) epidural infusion, buprenorphine or fentanyl was combined with 0.03% bupivacaine in a double-blind study of 23 parturients. Patients were randomly assigned to two groups: group I (n = 12), patient-controlled analgesia by epidural infusion of buprenorphine (3 micrograms/mL) with 0.03% bupivacaine; group II (n = 11), patient-controlled analgesia by epidural infusion of fentanyl (2 micrograms/mL) with 0.03% bupivacaine. Plasma for determination of opioid concentrations was obtained at intermittent intervals. ⋯ One patient in each group developed extensive pressure blisters on both heels. These complications led us to terminate the study. We conclude that 0.03% bupivacaine used in combination with an opioid in prolonged epidural infusions produces a high incidence of sensory loss in the lower extremities and is unsuitable for situations in which early ambulation is desired.