Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Clinical TrialEffects of pH adjustment and carbonation of lidocaine during epidural anesthesia for foot or ankle surgery.
We examined the onset and the quality of sensory and motor block of the lumbosacral roots during epidural anesthesia performed for foot or ankle surgery with lidocaine HCl, pH adjusted, or carbonated lidocaine in a randomized, double-blind study. Forty-five patients received 20 mL of one of three solutions: control group (n = 15), 20 mL of 2% lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of NaCl 0.9% (pH 4.58 +/- 0.10); pH adjusted group (n = 15) 20 mL of lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of 8.4% sodium bicarbonate (pH 6.47 +/- 0.16); and carbonated group (n = 15) 20 mL of 1.73% carbonated lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of 0.9% NaCl (pH 6.42 +/- 0.04). Onset time of sensory block of the L4-S1 roots and maximum cephalad spread were similar in the three groups. ⋯ Complete motor block was observed in eight patients of the carbonated group compared to three in the pH adjusted group (P < 0.01) and one in the control group (P < 0.005). Lidocaine venous blood levels were comparable in the three groups. When compared to lidocaine HCl, only carbonated lidocaine, but not the pH adjusted solution, significantly improved epidural block of the L4-S1 roots.
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Anesthesia and analgesia · Jul 1995
Comparative StudyThe effects of differing concentrations of bupivacaine on the epidural somatosensory evoked potential after posterior tibial nerve stimulation.
The somatosensory evoked potential (SEP) recorded from the cervical epidural space in response to stimulation of the posterior tibial nerve is often used to monitor spinal cord integrity during scoliosis surgery. Epidural analgesia may be used as part of the anesthetic technique for scoliosis surgery, but the effects of the local analgesic on the evoked potential must be determined to ensure that it does not interfere with the monitoring of spinal cord function. Therefore, we compared the effects of the administration of 10 mL of 0.25% (n = 8), 0.5% (n = 8), or 0.75% (n = 8) bupivacaine injected into the L3-4 epidural space on the somatosensory evoked potential to posterior tibial nerve stimulation in patients anesthetized with a propofol infusion, nitrous oxide and oxygen, immediately before scoliosis surgery. ⋯ There were no significant differences between 0.25% bupivacaine and the control group, but both 0.5% and 0.75% bupivacaine were associated with clinically and statistically significant decreases in overall amplitude (P < 0.002, 0.5% bupivacaine; P < 0.001, 0.75% bupivacaine). Latency increased similarly in all groups. We conclude that bupivacaine in concentrations greater than 0.25% is not suitable for scoliosis surgery, if spinal somatosensory evoked potentials (SSEP) are to be measured.
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Anesthesia and analgesia · Jul 1995
Comment Letter Case ReportsLighted stylet for placement of a double-lumen endobronchial tube.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparison of the infusion requirements and recovery profiles of vecuronium and cisatracurium 51W89 in intensive care unit patients.
The selection and administration of neuromuscular blocking (NMB) drugs in intensive care unit (ICU) patients remain controversial. We compared the dose-response and recovery pharmacodynamics of a new intermediate-acting NMB drug, cisatracurium besylate, to the intermediate-acting NMB drug, vecuronium (VEC), in a prospective, randomized, double-blind, multicenter study in critically ill adults. After informed consent, 58 mechanically ventilated ICU patients from five medical centers were randomized to receive either cisatracurium or VEC. ⋯ Seven VEC and one cisatracurium patients died during the infusion of study drug or within 48 h after discontinuation of the NMB drug infusion. In summary, we found recovery of neuromuscular function after discontinuation of NMB drug infusion in ICU patients is significantly faster with cisatracurium than with VEC. In addition, routine neuromuscular monitoring was not sufficient to eliminate prolonged recovery and myopathy in ICU patients.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous regional anesthesia using lidocaine and ketorolac.
Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. ⋯ Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain.