Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1995
Meta AnalysisNeurolytic celiac plexus block for treatment of cancer pain: a meta-analysis.
We performed a meta-analysis of the efficacy and safety of neurolytic celiac plexus block (NCPB) for cancer pain. A literature search yielded 59 papers, but data on NCPB in two or more patients was available in only 24 papers. Twenty-one studies were retrospective, one was prospective, and two were randomized and controlled. ⋯ Patients with pancreatic cancer responded similarly to those with other intraabdominal malignancies. Common adverse effects were transient, including local pain (96%), diarrhea (44%), and hypotension (38%); complications occurred in 2%. This analysis suggests that: 1) NCPB has long-lasting benefit for 70%-90% of patients with pancreatic and other intraabdominal cancers, regardless of the technique used; 2) adverse effects are common but transient and mild; and 3) severe adverse effects are uncommon.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialRopivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: a double-blind comparison.
We compared the effects of continuous epidural infusion of ropivacaine 0.25% with bupivacaine 0.25% on pain relief and motor block during labor, and on the neonate. Seventy-six full-term parturients in active labor requiring epidural analgesia were randomly allocated to receive either bupivacaine 0.25% or ropivacaine 0.25%. Fifteen minutes after a loading dose of 10 mL of the study drug, an epidural infusion with the same drug was started at 6-12 mL/h to maintain an adequate block. ⋯ There was a higher proportion of the neonates in the ropivacaine group (26/31 = 84%) who had a neurologic and adaptive capacity score (NACS) > or = 35 2 h after delivery than in the bupivacaine group (18/29 = 62%). We conclude that ropivacaine 0.25% and bupivacaine 0.25% are equally effective for epidural pain relief during labor. Ropivacaine may have an advantage over bupivacaine regarding neonatal neurobehavioral performance during the first few hours after delivery, although further studies will be required to substantiate this.
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A fiberoptic bronchoscope is used to facilitate tracheal intubation in cases of difficult direct laryngoscopy. Occasionally, difficulty is encountered in advancing the endotracheal tube after the fiberoptic bronchoscope has been introduced into the trachea. This study tested the feasibility of providing jet ventilation through the suction channel of the fiberoptic bronchoscope as an interim measure under those or similar circumstances. ⋯ Jet ventilation was manually performed at the rate of 12/min for 10 min. In the mechanical test lung, the tidal volumes with 1.2-, 1.5-, and 2-mm suction channels were as follows: 280 mL, 490 mL, and 880 mL, respectively, at a compliance of 50 mL/cm H2O and normal resistance; 260 mL, 470 mL, and 820 mL, respectively, at a compliance of 50 mL/cm H2O and high resistance to simulate bronchospasm; 130 mL, 270 mL, and 890 mL, respectively, at a compliance of 20 mL/cm H2O and normal resistance; 120 mL, 220 mL, and 810 mL, respectively, at a compliance of 20 mL/cm H2O and high resistance. In anesthetized, paralyzed patients, oxygen saturation was 96% or more throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)