Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialTranscutaneous cranial electrical stimulation (Limoge's currents) decreases early buprenorphine analgesic requirements after abdominal surgery.
Transcutaneous cranial electrical stimulation with Limoge's currents (TCES) consists of high frequency, low intensity currents which decreased anesthetic requirements during elective surgery. This action is likely to be mediated by the release of central endogenous opioids. In the present study, we hypothesized that TCES applied intraoperatively may decrease early postoperative narcotic requirements. ⋯ Intraoperative isoflurane anesthetic requirements, as well as hourly postoperative scores for pain and sedation, were the same for the two groups. These data indicate that TCES reduces narcotic requirements for early postoperative analgesia. This technique might have potential to facilitate early postoperative analgesia in patients undergoing elective abdominal surgery.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia after peripheral nerve block for podiatric surgery: clinical efficacy and chemical stability of lidocaine alone versus lidocaine plus clonidine.
Postoperative analgesia may be prolonged by the addition of clonidine to local anesthetic solutions used for regional anesthesia. The purpose of this study was to test this hypothesis in a clinical trial of patients undergoing podiatric surgery. The study design was prospective, double-blinded, and randomized. ⋯ Group C20 results suggested no statistically significant improvement over plain lidocaine. One patient in Group C20 experienced significant hypotension postoperatively. pH determinations and chemical analysis by capillary electrophoresis showed no significant change in composition of the solutions when clonidine was mixed with lidocaine and stored at 4 degrees C for 1 wk. Compared to 1.73% lidocaine, combining clonidine (10 micrograms/mL) with lidocaine for local anesthetic block for foot surgery significantly increases the duration and quality of postoperative analgesia.
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Anesthesia and analgesia · Oct 1996
Comparative Study Clinical Trial Controlled Clinical TrialFetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labor analgesia: incidence and clinical significance.
The objective of this study was to compare the incidence of intrapartum fetal heart tracing (FHT) abnormalities and the obstetric outcome after intrathecal sufentanil (ITS) versus epidural bupivacaine (EB). During the period from April to September 1994, 129 patients who met inclusion criteria were prospectively identified during labor at a single university-affiliated hospital. Inclusion criteria included: singleton, gestational age > or = 36 wk, and cephalic presentation. ⋯ This increased risk was associated with an increase in cesarean section for nonreassuring FHT in both groups (ITS 14.3% [2/14] versus 0% [0/51], P = 0.04; EB 13.3% [2/15] versus 0% [0/49], P = 0.05). These results support the conclusion that the incidence of clinically significant FHT abnormalities and hypotension is equivalent in patients receiving ITS when compared to EB within the first hour of administration. During this period, patients should have continuous FHT monitoring since a new onset FHT abnormality unveils and alerts the physicians to a possible compromised fetal condition and a corresponding increased risk of cesarean section.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialClonidine for major vascular surgery in hypertensive patients: a double-blind, controlled, randomized study.
The utility of clonidine for hypertensive patients presenting for major vascular procedures remains debatable. Twenty-one hypertensive patients presenting for aortic surgery were given clonidine (n = 11) or placebo (n = 10) in a double-blind, randomized manner. Clonidine was administered 6 micrograms/kg per os 120 min before induction of anesthesia and 3 micrograms/kg intravenously (i.v.) over 60 min from aortic declamping to skin closure. ⋯ Plasma concentrations of clonidine, alfentanil, and vasoactive hormones were measured. When the clonidine group was compared with the placebo group, (a) isoflurane, alfentanil, and midazolam requirements were reduced by 38%, 42%, and 41%, respectively (P = 0.04, 0.03, 0.0002, respectively); (b) supplemental circulatory and anesthetic adjustments were reduced by 51% (P = 0.0006); (c) interventions with vasopressors were not significantly increased (placebo: two; clonidine: five); (d) systolic and mean arterial pressures and heart rate were reduced; (e) increases in norepinephrine, epinephrine, and plasma renin activity were suppressed, whereas vasopressin surge was attenuated; and (f) chronotropic response to isoproterenol was unaffected. Clonidine was effective in reducing anesthetic requirements and in improving circulatory stability in hypertensive patients presenting for major vascular procedures.
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Anesthesia and analgesia · Oct 1996
Comparative StudyA comparative study of early postoperative hypoxemia in infants, children, and adults undergoing elective plastic surgery.
To determine the influence of age on postoperative hypoxemia, we studied postoperative hypoxemia in 1152 patients, from infants to adults, ASA physical status I, undergoing elective plastic surgery. Subjects were divided into four groups on the basis of age: Group 1, infants aged 1 yr or less (n = 108); Group 2, children aged 1-3 yr (n = 240); Group 3, children aged 3-14 yr (n = 482); and Group 4, adults aged 14-58 yr (n = 322). Arterial oxygen saturation (Spo2) levels were recorded while patients were breathing room air in the postanesthesia recovery room shortly after arrival (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120, and 180 min thereafter. ⋯ Hypoxemia occurred most commonly within 1 h after anesthesia, particularly during the first 40 min in infants and during the first 15 min in older children and adults. A significant correlation was found by linear regression analysis between low Spo2 levels on admission to the recovery room and children's age. Thereafter, Spo2 levels and the incidence of hypoxemia during the early postoperative period were related only to infants' recovery scores.