Anesthesia and analgesia
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Anesthesia and analgesia · May 1993
Randomized Controlled Trial Clinical TrialAccelerated onset and delayed recovery of neuromuscular block induced by mivacurium preceded by pancuronium in children.
The goal of this study was to describe a technique which could shorten the time from mivacurium administration to peak neuromuscular block (NMB) after administration of the maximum recommended dose of mivacurium. Forty-eight pediatric patients were randomized into three groups and studied during nitrous oxide-alfentanil-thiopental anesthesia. Every patient received two blinded injections 3 min apart: either 15 micrograms/kg of pancuronium in 1 mL of saline followed by 170 or 200 micrograms/kg of mivacurium or saline followed by 200 micrograms/kg of mivacurium. ⋯ Time from injection to 90% NMB averaged 116 (SEM 11) s after administration of 200 micrograms/kg of mivacurium, and 71 (7) s and 94 (11) s when 200 micrograms/kg or 170 micrograms/kg of mivacurium, respectively, was preceded by pancuronium (P = 0.0095). Mean times from injection to recovery of neuromuscular function to > 25% of baseline (T25) and to train-of-four ratio of 0.75 were 9.1 (0.7) and 15.8 (1.2) min, respectively, after administration of 200 micrograms/kg of mivacurium alone. T25 and train-of-four of 0.75 occurred significantly later at 21.9 (1.8) and 35.0 (2.8) min, respectively (P = 0.0001), when 200 micrograms/kg of mivacurium was preceded by 15 micrograms/kg of pancuronium.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia.
This study was designed to compare the efficacy of an ephedrine infusion with crystalloid administration for reducing the incidence of hypotension during spinal anesthesia. Fifty-four ASA I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 15 mL/kg of crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 70-90 mg of hyperbaric 5% lidocaine. ⋯ The incidence of hypotension was 15/27 (55%) in the crystalloid group and 6/27 (22%) in the infusion group (P < 0.05). There was no significant difference between the groups in relation to the level of anesthesia or maximal heart rate, and hypertension did not occur in either group. We conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia and compares favorably with crystalloid administration in this patient population in terms of efficacy and incidence of side effects.
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The purpose of this study was to investigate the incidence of technical problems encountered when performing continuous spinal anesthesia and the influence of catheter tip position on block height following injection of a hypobaric spinal anesthetic. Twenty-nine elderly patients undergoing hip surgery were studied. Lumbar puncture was performed with an 18-gauge Tuohy needle at the L3-4 (or L2-3) interspace. ⋯ Although threading difficulties were encountered in 4/28 cases, there was a 100% success rate in catheter insertion. One catheter displacement into the epidural space was noted. Twenty of twenty-eight catheters took a cephalad direction, 6 remained coiled in a horizontal position, and 2 took a caudal direction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1993
Randomized Controlled Trial Comparative Study Clinical TrialDesflurane versus propofol anesthesia: a comparative analysis in outpatients.
This study compares the induction, hemodynamic, and recovery characteristics of a general anesthetic with desflurane to one with propofol. Sixty outpatients presenting for orthopedic surgery received either a propofol induction of anesthesia followed by desflurane and nitrous oxide (Group 1), a propofol induction followed by propofol infusion and nitrous oxide (Group 2), a desflurane and nitrous oxide induction and maintenance (Group 3), or a desflurane induction and maintenance (Group 4). The quality of induction was inferior in Groups 3 and 4 with more breath-holding and excitation than in Groups 1 and 2. ⋯ Although there was no difference between the groups in postoperative narcotic requirement, more patients in Group 3 vomited (50%) than in either Group 2 (0%) or Group 4 (12.5%). Hemodynamically, the anesthetics were very similar. Although desflurane was a difficult drug to use for induction of anesthesia, this study demonstrates that desflurane is a suitable maintenance anesthetic for ambulatory surgery because it provides a rapid awakening and an intermediate recovery similar to propofol.