Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of intravenous and epidural clonidine for postoperative patient-controlled analgesia.
Both epidural and intravenous clonidine are used to provide postoperative analgesia, but in predetermined doses. This double-blind randomized study was designed to 1) determine the clonidine dose inducing pain relief after major orthopedic surgery, when controlled by patient, either intravenously or epidurally; and 2) assess whether these two administration routes are clinically equivalent. At the first complaint of pain after scoliosis correction, patients received an initial dose of 8 micrograms/kg clonidine during 30 min either intravenously (n = 12) or epidurally (n = 12). ⋯ Plasma clonidine concentrations were higher in the intravenous group than in the epidural group (2.5 +/- 0.6 vs 1.5 +/- 0.5 ng/mL after the initial dose and 2.1 +/- 0.5 vs 1.5 +/- 0.4 ng/mL during self-administration; mean +/- SD). We conclude that analgesia can be achieved postoperatively by both epidural and intravenous clonidine administration. The epidural route is associated with significant reductions in self-administered clonidine dose, and thus in the plasma clonidine concentration, and the level of sedation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 5% with dextrose, 1.5% with dextrose, and 1.5% dextrose-free lidocaine solutions for spinal anesthesia in human volunteers.
The use of lidocaine in concentrations less than 5% for spinal anesthesia may be advantageous but has not been carefully studied. Lidocaine 50 mg (1.5% with dextrose and 1.5% dextrose-free) was administered to eight volunteers in a randomized, double blind, cross-over fashion. All of these subjects had previously received 5% lidocaine with dextrose using the same experimental protocol. ⋯ Duration of motor block was increased (45 +/- 9 min) with the 5% and the 1.5% without dextrose solutions (P < 0.04). Time to void was increased (33 +/- 5 min) with the 5% solution (P < 0.03). In conclusion, the use of different solutions of lidocaine for spinal anesthesia results in significant differences in sensory and motor block and time until recovery of micturition.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Multicenter Study Clinical TrialIntravenous regional guanethidine in the treatment of reflex sympathetic dystrophy/causalgia: a randomized, double-blind study. Guanethidine Study Group.
This double-blind, randomized, multicenter study was designed to determine the short-term and long-term efficacy of intravenous regional block with guanethidine in patients with reflex sympathetic dystrophy (RSD)/causalgia. Sixty patients were enrolled to receive four intravenous regional blocks at 4-day intervals with either guanethidine or placebo in 0.5% lidocaine. Each patient was randomized to receive either one, two, or four blocks with guanethidine. ⋯ At 4 days after the initial block, the group treated with placebo experienced a greater decrease in pain scores than those treated with guanethidine, although this difference was not statistically significant. On long-term followup there was no difference in pain scores between groups receiving one, two, or four guanethidine blocks. Overall, only 35% of patients experienced clinically significant relief on long-term followup even though all were treated early in the evolution of RSD.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane for outpatient anesthesia: a comparison with propofol.
Three different anesthetic techniques were compared in 146 healthy outpatients undergoing ambulatory surgery. In Groups I and II, anesthesia was induced with propofol (1.5-2.0 mg/kg, intravenously [iv]) and maintained with nitrous oxide (N2O) 60% in oxygen and either a propofol infusion, 75-160 micrograms.kg-1.min-1 IV, or sevoflurane, 1%-2% end-tidal, respectively. In Group III, anesthesia was induced and maintained with sevoflurane, 1%-4% end-tidal and N2O 60% in oxygen. ⋯ The use of sevoflurane for induction and/or maintenance of anesthesia was associated with a higher incidence of postoperative emetic sequelae compared with propofol. Finally, the times at which patients were considered "fit for discharge" and the actual discharge times were similar in all three groups. Sevoflurane is an acceptable alternative to propofol for induction and maintenance of outpatient anesthesia.
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Anesthesia and analgesia · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialPrevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer's solution.
This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean section. Forty nonlaboring ASA class I and II women having nonurgent cesarean sections were randomized to receive either 500 mL of 6% hetastarch plus 1 L lactated Ringer's solution (LR) (n = 20), or 2 L of LR (n = 20) prior to induction of spinal anesthesia. ⋯ Neonatal outcome, as determined by Apgar scores and cord blood gas analyses, was good and similar in both groups. We conclude that 6% hetastarch plus LR is more effective than LR alone and that its routine use before spinal anesthesia for cesarean section should be considered.