Anesthesia and analgesia
-
Anesthesia and analgesia · Jul 1993
Randomized Controlled Trial Comparative Study Clinical TrialForced-air warming maintains intraoperative normothermia better than circulating-water mattresses.
The hypothesis that forced-air warming preserves core temperature better than circulating-water mattresses was tested in: (a) 16 adults undergoing major maxillofacial surgery, including radical node resection and flap reconstruction; (b) 53 adults undergoing hip arthroplasty, having approximately 25% of their body surface area available for warming; (c) 20 infants undergoing minor maxillofacial surgery; and (d) 10 young children undergoing pelvic or femoral osteotomies. Patients having each type of surgery were randomly assigned to forced-air warming (approximately 40 degrees C) or conductive warming using a full-length circulating-water mattress at 40 degrees C. Forced-air warming was applied to the legs of the adults undergoing maxillofacial surgery and to one arm, the shoulders, and the neck in the adults undergoing hip arthroplasty; a U-shaped, tubular forced-air cover was positioned around the pediatric patients. ⋯ Furthermore, we needed to decrease the temperature of the warmer from high to medium (approximately 37 degrees C) in most patients assigned to forced-air warming to prevent hyperthermia. After 15 h of anesthesia, rectal temperatures in the adults undergoing maxillofacial surgery were 3.4 degrees C higher in the forced-air group (P < 0.01). After 4 h of anesthesia, esophageal temperatures had increased 0.8 +/- 0.5 degrees C in the patients warmed with forced-air and decreased 0.8 +/- 0.3 degrees C in those warmed by circulating-water mattresses (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Jul 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of intrathecal fentanyl infusion with intrathecal morphine infusion or bolus for postoperative pain relief after hip arthroplasty.
The purpose of this study was to compare an intrathecal fentanyl infusion with intrathecal morphine infusion or bolus for postoperative pain relief after hip arthroplasty. Sixty patients scheduled to undergo hip joint replacement were studied. A 28-gauge (n = 12) or a 22-gauge (n = 48) spinal catheter was introduced through the L3-4 interspace, 3-4 cm into the subarachnoid space. ⋯ In Group I, supplementary intramuscular (IM) opioid was required more often (46 doses) than in Group II (18 doses) in 24 h (P < 0.01). The number of patients given IM administered opioid was larger in Group I (18 patients) than in Group II (8 patients) (P < 0.01). The IM opioid was requested sooner in Group I (18 patients, mean 480 min) after the intrathecal injection than in Group III (13 patients, mean 786 min) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
-
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.
-
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.
-
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.