Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1993
Comparative StudyManagement of intractable pain with percutaneous epidural spinal cord stimulation: differences in pain-relieving effects among diseases and sites of pain.
This study is a survey of the overall clinical results achieved with our pain treatment method, percutaneous epidural low-frequency (1.6-8.0 Hz) spinal cord stimulation. It examines the relationship between the effectiveness of epidural spinal cord stimulation (ESCS) and diseases or sites of pain. Continuous indwelling of the catheter electrodes in the posterior epidural space ranged from 3 to 67 days, and the duration of percutaneous ESCS varied from less than 1 wk to more than 1 yr. ⋯ Alleviation of pain by ESCS was lower when the verbal pain score was high. There were no major complications in percutaneous ESCS. Thus, we have demonstrated that pain-alleviating effects of ESCS varies significantly by disease and site of pain, and that this simple percutaneous method can be used for a relatively long period.
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Anesthesia and analgesia · Jul 1993
Obstetric anesthesia in patients with idiopathic facial paralysis (Bell's palsy): a 10-year survey.
During pregnancy there is an increased incidence of idiopathic facial paralysis (Bell's palsy). During a 10-yr period, 36 patients with a diagnosis of pregnancy-associated Bell's palsy were identified retrospectively. Twenty-five patients developed symptoms during the third trimester, whereas the remaining 11 became symptomatic during the first week postpartum. ⋯ Five patients received spinal, 22 epidural, and 3 general anesthetics; 7 patients received no anesthesia. The incidence and distribution of the palsy were similar among patients delivered with and without anesthesia. We conclude that the appropriate anesthetic for a given patient may be chosen without concern for the coexisting Bell's palsy.
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Anesthesia and analgesia · Jul 1993
Comparative StudyHeat loss in humans covered with cotton hospital blankets.
We evaluated mean skin temperature, cutaneous heat loss, and perceived warmth in six volunteers covered with one or three cotton hospital blankets, warmed or unwarmed. Mean skin temperatures were significantly higher during each treatment than during the control periods preceding each blanket application. Total cutaneous heat loss during the control period was 81 +/- 11 watts. ⋯ These data indicate that increasing the number of covering blankets from one to three decreases heat loss only slightly. Similarly, warming the blankets is relatively ineffective and the benefit short-lived. The reduction in heat loss, even by three warmed blankets replaced at 10-min intervals, was small compared to that provided by available active warming systems.
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Anesthesia and analgesia · Jul 1993
Reevaluation of a maneuver to visualize the anterior larynx after intubation.
Confirmation of translaryngeal placement of the tracheal tube can be unexpectedly difficult. This study examined the usefulness of displacing the larynx posteriorly with the tracheal tube during laryngoscopy with a straight laryngoscope blade to confirm tracheal tube placement. One hundred ASA Classes I, II, or III patients presenting for elective surgery whose normal anesthetic care included placement of an orotracheal tube via direct laryngoscopy were enrolled in this institutionally approved study after giving their written, informed consent. ⋯ Thus, the tracheal tube actually was not seen to pass between these patients' vocal cords. Use of the maneuver resulted in improved visualization of the intubated larynx in 12 of these patients, and confirmed tracheal intubation. This maneuver is recommended as an aid to the anesthesiologist in the confirmation of tracheal intubation.
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Anesthesia and analgesia · Jul 1993
Psychosocial and pharmacologic predictors of satisfaction with intravenous patient-controlled analgesia.
Despite intravenous patient-controlled analgesia's (IV-PCA) increasing popularity, the psychological and pharmacological factors upon which patient satisfaction with IV-PCA are based are unknown. Sixty-eight women scheduled for abdominal hysterectomy completed a series of questionnaires measuring emotional distress, locus of control, perceived support, and optimism before their surgery. Postoperative ratings of pain intensity, emotional distress, anticipated recovery time, nightmares, and satisfaction with IV-PCA were taken 1 and 3 days after surgery. ⋯ Degree of dissatisfaction with IV-PCA was significantly correlated with pain intensity, nightmares, patient's perceptions of support, expectations of recovery, preoperative anxiety, and postoperative depression. Dose/demand ratio and hourly analgesic usage were significantly related to pre- and postoperative emotional distress factors. Perioperative management of anxiety, perceptions, and expectations may prove valuable in improving pain control and satisfaction with IV-PCA.