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
The pharmacokinetics and neuromuscular effects of rocuronium bromide in patients with liver disease.
To determine the effect of liver disease on the pharmacokinetics of rocuronium, the authors administered 0.6 mg/kg (twice the ED95) to 10 patients with liver disease and compared these results to values in 10 healthy surgical patients. Anesthesia was induced with thiopental and maintained with isoflurane (0.9%-1.1% end-tidal concentration) and nitrous oxide (60%). Venous blood samples were obtained for 6 h after rocuronium injection and plasma concentrations were measured using gas chromatography. ⋯ In turn, elimination half-life was longer in patients with liver disease (111 min) compared to controls (75.4 min). The authors conclude that liver disease alters the pharmacokinetics of rocuronium by increasing its volume of distribution. The longer elimination half-life might result in a longer duration of action of rocuronium in patients with liver disease, particularly after prolonged administration.
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Anesthesia and analgesia · Apr 1995
Comparative StudyThe cerebrospinal fluid and plasma pharmacokinetics of sufentanil after thoracic or lumbar epidural administration.
The cerebrospinal fluid (CSF) and plasma pharmacokinetics of sufentanil were studied in 29 adult patients undergoing thoracotomy under general anesthesia. Sufentanil, 75 micrograms, diluted in 10 mL saline, was given preoperatively in either the lumbar or thoracic epidural space to 14 and 15 patients, respectively. Lumbar CSF and plasma were frequently sampled for 10 h and analyzed for sufentanil concentration by radioimmunoassay. ⋯ In the lumbar group, the AUC and Cmax values in CSF were 19 (P < 0.01) and 45 (P < 0.01) times higher than in plasma, and 4.7 (P < 0.01) and 8.2 (P < 0.001) times higher than in CSF in the thoracic group. The decline in sufentanil concentration was more rapid in CSF than plasma; in the lumbar group the CSF/plasma concentration-ratio was eight and five at 6 and 10 h, respectively, after sufentanil administration. This study shows that after epidural administration sufentanil concentrations are higher in CSF than in plasma, and are highly localized within CSF to the site of administration.
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Anesthesia and analgesia · Apr 1995
Preventing perioperative transmission of infection: a survey of anesthesiology practice.
Given the societal and economic impact of perioperative infection, it is essential that anesthesiologists and other operating room personnel use appropriate precautions to reduce the potential for transmission of infectious agents to the patients under their care. This study, therefore, was designed to evaluate the degree to which anesthesiologists utilize appropriate hygienic techniques for the prevention of infection in the perioperative period. A total of 1149 questionnaires were mailed to anesthesiologists randomly selected from the membership of the American Society of Anesthesiologists (ASA). ⋯ The practice of reusing syringes was significantly greater among private than university practitioners (P < 0.01). On a scale of 0-10 (10 = high) anesthesiologists rated their potential for transmitting or contributing to patient potential for transmitting or contributing to patient infection as 4.7 +/- 0.12 (mean +/- SE). Results of this study suggest that, whereas most responding anesthesiologists exhibit appropriate infection control behaviors, there are several potentially hazardous practices that continue.