Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of patient controlled epidural analgesia with sufentanil by the lumbar versus thoracic route after thoracotomy.
To compare the efficacy of patient-controlled lumbar and thoracic epidural sufentanil, 22 patients scheduled for elective thoracotomy were assigned randomly to receive sufentanil via either a lumbar or a thoracic epidural catheter. For 24 h postoperatively, the patients received analgesia only by patient-controlled epidural sufentanil. There were no significant differences in the visual analog scale (VAS) for pain between the two groups at 8 and 24 h postoperatively. ⋯ The forced vital capacity (FVC) measured at 24 h (as a percentage of baseline FVC) showed no significant difference between the lumbar and thoracic groups (44.7 +/- 3.8 and 41.7 +/- 5.5; P = 0.68). The total sufentanil used by the lumbar and thoracic groups was not significantly different (196 +/- 25.2 micrograms and 157 +/- 28.6 micrograms; P = 0.32). We conclude that there is no clinical advantage of thoracic over lumbar epidural sufentanil in the thoracotomy patient with respect to quality of analgesia, amount of sufentanil used, severity of side effects, or postoperative pulmonary function.
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Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Clinical TrialDetermination of the hemodynamics and histamine release of rocuronium (Org 9426) when administered in increased doses under N2O/O2-sufentanil anesthesia.
The cardiovascular effects, histamine release potential, and pharmacodynamics of rocuronium were determined in adult patients randomized to receive rapid (5 s) intravenous (i.v.) bolus doses of 600, 900, or 1200 micrograms/kg (2.0, 3.0, and 4.0 times the ED95) with maintenance doses of 150 micrograms/kg. There were no statistically significant hemodynamic effects (heart rate, blood pressure, mean arterial pressure [MAP] or electrocardiogram [ECG]) after administration of rocuronium. ⋯ The mean +/- SD clinical durations of 600-, 900-, and 1200-micrograms/kg intubating doses of rocuronium under N2O/O2-sufentanil anesthesia were 45 +/- 20 min, 66 +/- 16 min, and 85 +/- 22 min, respectively. We conclude that rocuronium can be administered safely over a wide range of doses (2-4 x ED95), with minimum hemodynamic effects or histamine release.
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Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Comparative Study Clinical TrialMid-latency auditory evoked potentials in humans during anesthesia with S (+) ketamine--a double-blind, randomized comparison with racemic ketamine.
Mid-latency auditory evoked potentials (MLAEP) reflect the primary cortical processing of auditory stimuli. They are suppressed widely during general anesthesia. Under ketamine, in contrast, MLAEP seem to be preserved. ⋯ After induction of general anesthesia with S (+) ketamine or racemic ketamine, there was no increase in latencies of peaks V, Na, Pa, Nb, or P1. No decrease in amplitudes Na/Pa, Pa/Nb, or Nb/P1 could be observed. There was no significant change in the power spectra.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Clinical TrialDose-response relationships for edrophonium and neostigmine antagonism of pipecuronium-induced neuromuscular block.
We have studied the dose-response relationships for neostigmine and edrophonium during antagonism of neuromuscular block induced by pipecuronium bromide. Fifty-six ASA physical status I or II adults were given pipecuronium 70 micrograms/kg during fentanylthiopental-nitrous oxide-halothane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. ⋯ Corresponding ED50 and ED80 values for endrophonium were 84.1 (72.9-96.9) and 233 (215.7-253.3) microgram/kg, respectively. These values corresponded to neostigmine:edrophonium potency ratios of 9.89 (7.4-12.3) and 13.4 (11.8-14.9) for first twitch ED50 and ED80 height, respectively. The calculated doses producing 50% (ED50) recovery of the TOF ratio at 10 min were 18.8 (17.5-20.2) and 271.3 (246.5-298.6) microgram/kg for neostigmine and edrophonium, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1994
The degradation, absorption, and solubility of volatile anesthetics in soda lime depend on water content.
Absorption of anesthetic into soda lime may delay induction of anesthesia and degradation by soda lime may produce toxic products. We determined whether the moisture content of soda lime influences the mechanisms underlying absorption (saturable uptake), degradation, and solubility (nonsaturable uptake). We placed liquid anesthetic (sevoflurane, isoflurane, halothane, enflurane, or desflurane) in 581-mL equilibration flasks containing soda lime of various water contents (0%-15.1% H2O) and sampled the vapor concentrations repeatedly for 24-35 h. ⋯ We also found that soda lime in absorbers may dry from H2O contents of 15% to 4%-8.5% in routine clinical use. Our observations suggest that during induction of anesthesia a portion of the delivered anesthetic may be lost to the soda lime, rather than delivered to the patient. In addition, the potential for production of toxic products may be increased when volatile anesthetics are used with dry soda lime.