Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Clinical TrialUltrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus.
We prospectively studied 40 patients (ASA grades I-III) undergoing surgery of the forearm and hand, to investigate the use of ultrasonic cannula guidance for supraclavicular brachial plexus block and its effect on success rate and frequency of complications. Patients were randomized into Group S (supraclavicular paravascular approach; n = 20) and Group A (axillary approach; n = 20). Ultrasonographic study of the plexus sheath was done. ⋯ Because of the direct ultrasonic view of the cervical pleura, we had no cases of pneumothorax. An accidental puncture of subclavian or axillary vessels, as well as neurologic damage, was avoided in all cases. An ultrasonography-guided approach for supraclavicular block combines the safety of axillary block with the larger extent of block of the supraclavicular approach.
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Comparative Study Clinical TrialHigh thoracic epidural sufentanil with bupivacaine: continuous infusion of high volume versus low volume.
The purpose of the study was to investigate whether continuous infusion of a high volume of a sufentanil/bupivacaine mixture at a high thoracic level improves the analgesic effect of the mixture, compared with a dose-equivalent continuous low-volume infusion. In a prospective, observer-blind study, 60 patients scheduled for thoracic surgery received a thoracic epidural catheter for 3 days. The patients were randomly assigned by lot to one of two groups: a low-volume (LV) group (bupivacaine 0.75% with sufentanil 4 micrograms/mL, 1.0-1.3 mL/h), or a high-volume (HV) group (bupivacaine 0.125% with sufentanil 0.7 microgram/mL, 6-8 mL/h). ⋯ A difference was found between both groups in the mean preoperative PaCO2 value (P < 0.05) and also for the PaCO2 values on Day 1 versus the preoperative values within the group (P < 0.05). On the first postoperative day the analgesic effects of a sufentanil/bupivacaine mixture at a high thoracic epidural level can be improved when injected at a continuous high-volume rate compared with a dose-equivalent continuous low-volume rate. This is true for pain at rest; for pain at exercise, there were no differences.
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Clinical TrialLow dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for cesarean section--a balance block technique.
The present study was designed to develop a combined spinal/epidural anesthetic technique for cesarean section. We compared the effects of different doses of intrathecal hyperbaric bupivacaine (0.5%) combined with epidural lidocaine (2%). We attempted to interrupt somatosensory pathways with spinal anesthesia but to avoid acute high thoracic sympathetic block. ⋯ Anesthesia in Group C (7.5 mg of bupivacaine) and Group D (10 mg of bupivacaine) was mostly due to spinal block. Complications included hypotension, nausea, and dyspnea. The combined spinal/epidural technique, using 5 mg of bupivacaine and with sufficient epidural lidocaine to reach a T4 level, had the advantages of both spinal and epidural anesthesia with few of the complications of either.
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Clinical TrialOndansetron decreases emesis after tonsillectomy in children.
We performed a double-blind, randomized, placebo-controlled trial to investigate the efficacy and safety of ondansetron in preventing vomiting after tonsillectomy with or without adenoidectomy in children. Sixty children were premedicated with 0.5 mg/kg of oral midazolam and underwent inhaled induction and maintenance of anesthesia with halothane and nitrous oxide. Intravenous morphine 0.075 mg/kg, vecuronium 0.1 mg/kg, and either ondansetron 0.15 mg/kg (maximum = 8 mg), or saline placebo were administered after intravenous catheter placement. ⋯ Three children who received ondansetron and one who received placebo complained of abdominal cramping on the night of the surgery. There were no other complaints or complications. Analysis of the 51 children who did not receive dexamethasone revealed similar results.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1994
Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs.
Children and adults who develop neurologic deficits after cardiac surgery may experience cerebral ischemia during cardiopulmonary bypass. Increased intracranial pressure (ICP) may contribute to cerebral ischemia during bypass. Hypertonic saline dextran (HSD), a hyperosmotic, hyperoncotic resuscitation solution, decreases ICP in trauma resuscitation. ⋯ Brain water in the cerebrum did not differ between groups but was reduced in the cerebellum to 75.9% +/- 1.4%. We conclude that HSD prevented any significant increase in ICP during normothermic bypass, and substantially improved fluid balance during bypass. In cardiac surgery patients in whom maintaining decreased ICP and reducing isotonic fluid administration is important, HSD may be a useful addition to the bypass prime solution.