Anesthesia and analgesia
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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.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialPropofol and alfentanil prevent the increase in intraocular pressure caused by succinylcholine and endotracheal intubation during a rapid sequence induction of anesthesia.
The increase in intraocular pressure (IOP) associated with succinylcholine (Sch) has made its use in patients with open globe injuries controversial. Studies that have examined techniques to prevent the increase in IOP due to Sch have shown a larger increase in IOP from the stimulus of laryngoscopy and endotracheal intubation. The purpose of our study was to examine whether the combination of propofol and alfentanil would prevent the increase in IOP due to Sch as well as endotracheal intubation during a rapid sequence induction of anesthesia. ⋯ During the entire study period, the IOP in Group III never increased above baseline. The IOP in Groups I and II had already begun to decline by 15 s postintubation, suggesting that laryngoscopy and intubation have the greatest effect on increasing IOP. We conclude that the combination of propofol and alfentanil prevents the increase in IOP from Sch as well as the increase associated with endotracheal intubation during a rapid sequence induction of anesthesia.
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Anesthesia and analgesia · Oct 1996
The efficacy of axillary block for surgical procedures about the elbow.
Surgical procedures to the distal humerus, elbow, and proximal ulna and radius are ideally suited to regional techniques. However, axillary block is usually not recommended for surgery about the elbow because blockade at this level may result in inadequate block of the terminal nerves that arise from the medial, posterior, and lateral cords, and provide sensory innervation to the upper arm. This study reports the success rates for interscalene, supraclavicular, and axillary blocks for surgery about the elbow. ⋯ In addition, axillary blocks performed with mepivacaine had a higher success rate (93%) than those performed with bupivacaine (81%) (P < 0.01). There were no patients with perioperative respiratory compromise. These results demonstrate that the axillary approach to the brachial plexus may be successfully used for surgical procedures about the elbow.
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Anesthesia and analgesia · Oct 1996
ReviewPostoperative epidural opioid analgesia: what are the choices?
The administration of hydrophilic opioids via a continuous infusion results in selective spinal analgesia with a low incidence of side effects. Lipophilic opioids may also be associated with spinal effects. However, the doses required to produce postoperative analgesia also produce plasma concentrations within the MEAC. ⋯ Regardless of the mechanism of action, epidural administration of lipophilic opioids may offer no clinical advantages over the IV route. Notwithstanding, epidural administration of small doses of lipophilic opioids in combination with local anesthetics may offer significant clinical advantages over systemic administration of opioids alone. Dose-ranging studies will be necessary to determine the ideal concentrations of opioids and local anesthetics, as well as the ratios of the two drugs to obtain optimal analgesia with minimal incidence of side effects.
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Anesthesia and analgesia · Oct 1996
Randomized Controlled Trial Clinical TrialSpinal bupivacaine in ambulatory surgery: the effect of saline dilution.
The safety of lidocaine spinal anesthesia has recently been called into question by reports of both permanent and transient neurologic toxicity. This study explored the possibility of adapting the longer acting spinal bupivacaine to ambulatory surgery. Sixty patients presenting for ambulatory arthroscopy were randomized to four groups receiving the following spinal anesthetics: Group I (15 mg bupivacaine), 3 mL of 0.5% spinal bupivacaine in 8% dextrose; Group II (10 mg bupivacaine), 2 mL of the 0.5% spinal bupivacaine+1 mL saline; Group III (7.5 mg bupivacaine), 1.5 mL of the 0.5% spinal bupivacaine%1.5 mL saline; Group IV (5 mg bupivacaine), 1 mL of the 0.5% spinal bupivacaine+2 mL saline. ⋯ The intensity of sensory block also decreased from group to group with four patients in Group IV having pain intraoperatively that required further treatment. Therefore, Group III provided the optimum combination of adequate depth of anesthesia and rapid recovery. The results of this study indicate that spinal anesthesia with 7.5 mg of 0.5% bupivacaine in 8% dextrose diluted with an equal volume of saline provides an acceptable spinal anesthetic for ambulatory arthroscopy with a recovery profile appropriate to the ambulatory setting.