Anesthesia and analgesia
-
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.
-
Anesthesia and analgesia · Oct 1996
Comparative StudyIntravenous ketamine or fentanyl prolongs postoperative analgesia after intrathecal neostigmine.
The purpose of this study was to determine whether intravenous (i.v.) ketamine would enhance analgesia from intrathecal (IT) neostigmine compared with combining i.v. fentanyl with IT neostigmine. Sixty patients undergoing vaginoplasty under spinal anesthesia were assigned to one of six groups (n = 10). Patients were premedicated with midazolam plus the i.v. test drug. ⋯ The time to first rescue analgesic was longer for the FNG and KNG compared with the CG, with less rescue analgesic consumption (P < 0.02 and P < 0.01, respectively). Only the FNG had significantly intraoperative nausea/vomiting (P < 0.02). In conclusion, the combination of i.v. ketamine and IT neostigmine results in prolonged postoperative analgesia and less intraoperative nausea and vomiting than the combination of i.v. fentanyl and IT neostigmine.
-
Anesthesia and analgesia · Oct 1996
Comparative StudyModerate primary pulmonary hypertension in patients undergoing liver transplantation.
Primary pulmonary hypertension (PPH) in patients with hepatic cirrhosis is often considered an unacceptable condition for liver transplantation because of increased morbidity and mortality during the procedure. We studied the incidence, characteristics, and final outcome of patients with PPH undergoing liver transplantation in our institution. Among the 226 patients undergoing 257 liver transplantations, eight (3.5%) fulfilled the conditions of PPH and responded to vasodilator therapy. ⋯ All patients with PPH required pulmonary vasodilator therapy after reperfusion of the new liver, while none in the group of patients without PPH required this therapy. Furthermore, after graft reperfusion, patients with PPH in which venovenous bypass was not used (n = 3), had a more compromised right ventricular function with a greater increase of central venous pressure (CVP) (90%) and MPAP (140%) when compared with patients with bypass or preservation of the recipient's vena cava (n = 5) in whom the increase of CVP and MPAP was 50% and 60%, respectively. Moderate PPH without a fixed level of pulmonary hypertension in patients undergoing liver transplantation is not related to an adverse outcome.
-
Anesthesia and analgesia · Oct 1996
Comparative StudyPlasma potassium response after tromethamine (THAM) or sodium bicarbonate in the acidotic rabbit.
The purpose of this study was to evaluate the plasma potassium (K+) response after administration of tromethamine (THAM) or sodium bicarbonate (NaHCO3) in an acidotic rabbit model. Eighteen healthy, adult female New Zealand White rabbits were subjected to severe hypoxia until a base deficit of -10 mEq/L resulted. Rabbits were then randomized to receive THAM solution, NaHCO3, or no drug (control). ⋯ In contrast, THAM resulted in significantly lower Na+ concentrations when compared to the NaHCO3 or the control group (P < 0.05). In this rabbit model, alkalinization after THAM administration results in K+ changes similar to those after NaHCO3. THAM should be considered when treating acidosis in patients where hypernatremia is a concern.