Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe hemodynamic and renal effects of sevoflurane and isoflurane in patients with coronary artery disease and chronic hypertension. Sevoflurane Ischemia Study Group.
In patients without significant cardiovascular disease, the hemodynamic effects of sevoflurane and isoflurane are similar; however, the hemodynamic effects of sevoflurane in patients with hypertension and ischemic heart disease are unknown. To examine the effects of sevoflurane in comparison to isoflurane in this high-risk population, 214 patients scheduled for elective surgery were enrolled if they had evidence of ischemic heart disease or multiple risk factors for ischemic heart disease. Patients were randomly assigned to receive sevoflurane (n = 106) or isoflurane (n = 108) for anesthetic maintenance in conjunction with fentanyl and nitrous oxide in oxygen. ⋯ The incidence of post-operative proteinuria was similar in the sevoflurane and isoflurane groups. We conclude that hemodynamic stability in patients with hypertension and ischemic heart disease is similar with sevoflurane and isoflurane. No differences in renal function were observed between the sevoflurane and isoflurane groups.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia.
Ketorolac prolongs bleeding time and inhibits platelet aggregation and platelet thromboxane production in healthy, awake volunteers. However, platelet function was recently shown not to worsen after ketorolac was given during general anesthesia. The purpose of this study was to investigate platelet function changes during a standardized spinal anesthetic and surgery, as well as after a single intraoperative dose of intravenous (IV) ketorolac. ⋯ Platelet TxB2 production decreased dramatically in the ketorolac group from preoperative to poststudy drug data points (157.2 +/- 129.4 to 0.3 +/- 0.3 ng/mL; P < 0.01). Platelet function does not appear to be accentuated during spinal anesthesia as it is during general anesthesia. Unlike during general anesthesia, platelet function during spinal anesthesia is impaired, with respect to bleeding time and platelet aggregometry to collagen, by a single intraoperative dose of IV ketorolac.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Clinical TrialThe effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain.
The purpose of this study is to determine the effect of postoperative analgesia on the amount of breast feeding and infant weight gain. Thirty parturients undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive postoperative pain management with (S-E group, n = 15) or without epidural bupivacaine (S group, n = 15). Epidural analgesia was performed for 3 days with a continuous epidural infusion (0.7 mL/h) of 0.25% bupivacaine. ⋯ In the S-E group, the visual analog pain score after surgery was significantly lower and both the weight of milk fed by breast and the infant weight during the study were significantly more than the respective values in the S group. The S group required a larger dose of diclofenac after the operation than did the S-E group. We suggest that satisfactory postoperative pain relief with continuous epidural bupivacaine for 3 days after cesarean section improved the amount of breast feeding and the gain of infant weight.
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Anesthesia and analgesia · Jun 1996
Comparative Study Clinical TrialTransesophageal echocardiography in myocardial revascularization: II. Influence on intraoperative decision making.
This study was conducted to determine how transesophageal echocardiography (TEE) guides intraoperative decision making during myocardial revascularization. Although its usefulness in influencing clinical decision making during cardiac valvular surgery is well documented, the clinical utility of TEE in patients undergoing myocardial revascularization is less clear. We studied the performance of five community-based, full-time cardiac anesthesiologists during 75 surgical procedures. ⋯ TEE is often influential in guiding decision making in myocardial revascularization when incorporated as a routine monitor in the intraoperative setting. Information from TEE has been most commonly used to guide the management of fluid administration and institution of antiischemic therapy. In a small subset of patients, TEE appears to be useful in guiding critical surgical interventions.