Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1995
Risk of catheter migration during combined spinal epidural block: percutaneous epiduroscopy study.
Combined spinal epidural (CSE) block with the needle-through-needle technique has become increasingly popular during recent years. However, the risk of epidural catheter penetrating dura mater through the hole made by the spinal needle (migration) is a major concern. In 15 fresh cadavers a percutaneous epiduroscopy technique with a rigid epiduroscope and video recording was used to assess the risk of catheter migration when a CSE block is performed. ⋯ After multiple (five) dural punctures with the spinal needle, the epidural catheter penetrated the perforated dura in 1 of 20 cases. The epidural catheter penetrated the dural hole made by the Tuohy needle in 9 of 20 cases. The distribution of fat, rather than any dorso median connective tissue band, influences the course of epidural catheter in epidural space.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1995
Randomized Controlled Trial Clinical TrialA prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery.
This study investigated the impact of perioperative fluid status on adverse clinical outcomes in ambulatory surgery. Two hundred ASA grade I-III ambulatory surgical patients were prospectively randomized into two groups to receive high (20 mL/kg) or low (2 mL/kg) infusions of isotonic electrolyte solution over 30 min preoperatively. A standardized balanced anesthetic was used. ⋯ Adverse outcomes were assessed by an investigator blinded to the fluid treatment group at 30 and 60 min after surgery, at discharge, and the first postoperative day. The incidence of thirst, drowsiness, and dizziness was significantly lower in the high-infusion group at all intervals. We recommend perioperative hydration of 20 mL/kg for patients undergoing general anesthesia for short ambulatory surgery.
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Anesthesia and analgesia · Apr 1995
Randomized Controlled Trial Clinical TrialThe effects of clonidine on desflurane-mediated sympathoexcitation in humans.
This study explored the effectiveness of oral clonidine premedication in attenuating sympathetic activation, tachycardia, and hypertension triggered by desflurane. After institutional review board approval, informed consent was obtained from 15 young, healthy male volunteers. Heart rate (HR, electrocardiogram), mean arterial pressure (MAP, radial artery catheter), and central venous pressure (CVP, jugular vein) were monitored. ⋯ In both groups propofol decreased SNA and MAP, and increased HR. The administration of desflurane via a mask resulted in significant increases in SNA, HR, and MAP. Clonidine reduced the HR and MAP responses by approximately 30%-40% during induction and transition periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialEffect of interpleural administration of bupivacaine or lidocaine on pain and morphine requirement after esophagectomy with thoracotomy: a randomized, double-blind and controlled study.
The purpose of the present study was to investigate the efficacy of interpleural (IP) analgesia with bupivacaine or lidocaine after esophageal surgery and to measure the plasma concentrations of bupivacaine and lidocaine after intermittent IP administrations. Two IP catheters were inserted percutaneously in the seventh intercostal space during operation. Patients in the bupivacaine group (Gr B) received 1 mg/kg of 0.5% bupivacaine with epinephrine 1:200000 in 20 mL of saline 0.9%, patients in the lidocaine group (Gr L) received 3 mg/kg of 2% lidocaine with epinephrine in 20 mL of saline 0.9%, and patients in the placebo group (Gr P) received 20 mL of saline 0.9% every 4 h during 2 days. ⋯ VAST scores were significantly lower in Gr B at 12, 16, 28, and 32 h when compared with Gr P and Gr L (P < 0.05). There was no statistical difference in mean VAST between Gr L and Gr P. Total consumption of morphine was lower in Gr B than in Gr P and Gr L (41.2 +/- 13 mg vs 66.1 +/- 21 mg in Gr P (P < 0.02) and 75.5 +/- 27 mg in Gr L (P < 0.01)), but were similar in Gr L when compared with Gr P.(ABSTRACT TRUNCATED AT 250 WORDS)