Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1994
Comparative StudyA comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain.
The aim of this study was to compare the incidence of technical complications of epidural catheters with subcutaneous injection ports to percutaneous epidural catheters without ports, fixed only by adhesive dressing. We reviewed 149 patients who received 250 epidural catheters for treatment of cancer pain during a 3 1/2-yr period from January 1, 1989, to June 30, 1992. Of the 250 catheters, 52 were provided with subcutaneous injection ports and 198 were percutaneous catheters. ⋯ No injection port became infected during the first 70 days of treatment, whereas in the percutaneous group infections occurred as early as the first week. Within the percutaneous group the complication rate in the tunneled epidural catheters was as high as in the nontunneled. We conclude that injection ports reduce the complication rate of epidural catheters, particularly catheter dislodgement and early infections.
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Anesthesia and analgesia · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialCoagulation tests, blood loss, and transfusion requirements in platelet-rich plasmapheresed versus nonpheresed cardiac surgery patients.
The results of several studies suggest that acute platelet-rich plasmapheresis decreases blood loss and allogeneic blood product transfusion requirements in cardiac surgery patients. We designed a randomized, prospective study to determine whether acute platelet-rich plasmapheresis decreases blood loss and allogeneic transfusion requirements in primary cardiac surgery patients. Forty patients were randomized to a control or pheresis group. ⋯ Chest tube drainage and transfusion requirements were recorded. There were no differences in the coagulation tests, platelet counts, chest tube drainage, or allogeneic blood product transfusion requirements between the two groups at any time. The authors conclude that the use of acute platelet-rich plasmapheresis in primary cardiac surgery patients does not decrease chest tube drainage or the need for allogeneic blood transfusions.
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Anesthesia and analgesia · Jan 1994
Randomized Controlled Trial Clinical TrialFentanyl or alfentanil decreases the minimum alveolar anesthetic concentration of isoflurane in surgical patients.
The minimum alveolar anesthetic concentration (MAC) is an accepted potency measure for inhaled anesthetics. There is no generally accepted intraoperative measure of opioid potency, partly because of the difficulty in obtaining steady state biophase concentrations. We have studied the relative potency of fentanyl and alfentanil by using computer-assisted continuous infusions (CACI), in terms of reduction of isoflurane MAC. ⋯ The maximum likelihood solution to a logistic regression model showed that fentanyl 0.5 ng/mL (95% confidence intervals [CI], 0-4.6 ng/mL) or alfentanil 28.8 ng/mL (95% CI, 0-70.9 ng/mL) resulted in a 50% isoflurane MAC reduction. In the logistic regression model, age or weight were not significant factors in the model. These results suggest that the comparative intraoperative potency ratio for alfentanil and fentanyl is 58:1, and that this methodology allows for direct intraoperative comparisons of opioid potency.
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Anesthesia and analgesia · Jan 1994
Comparative StudyCombined epidural analgesia and general anesthesia induce ischemia distal to a severe coronary artery stenosis in swine.
Epidural analgesia combined with general anesthesia may improve cardiac function and reduce the work of the heart by decreasing the rate pressure product. However, the effect of this combined technique has not been studied in the presence of severe coronary artery stenosis. Therefore, we investigated epidural analgesia combined with general anesthesia in a swine model with a tight coronary artery stenosis. ⋯ Myocardial wall thickening in the LAD bed decreased 31%, although it remained unchanged in the normal myocardium. Epidural bupivacaine added to general anesthesia resulted in moderate hypotension. Distal to the coronary stenosis was a moderate decrease in regional myocardial function and a severe reduction in blood flow.