Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialSmall-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.
A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. ⋯ On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.
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Anesthesia and analgesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialPrevention of spinal anesthesia-induced hypotension in the elderly: comparison between preanesthetic administration of crystalloids, colloids, and no prehydration.
The practice of routinely prehydrating patients by infusing a crystalloid or colloid solution (up to 1.0 L/70 kg) for prevention of spinal anesthesia-induced hypotension has been challenged recently, after several reports of failure to demonstrate its efficacy in young women. We compared the incidence and frequency of hypotension and vasopressor therapy after spinal anesthesia and no prehydration with crystalloid and colloid prehydration in elderly patients. Eighty-five ASA grade I or II patients (aged 60-89 yr) for elective total hip replacement were randomized to receive 500 mL crystalloid solution (Hartmanns, n = 29), 500 mL colloid (Haemaccel, n = 28), or no prehydration (n = 28) over 10 min prior to spinal anesthesia. ⋯ Although absolute systolic BP readings were significantly higher in the colloid group between 6 and 30 min (P < 0.05), the incidence of hypotension was not significantly different between the groups. The incidence of ephedrine use, incidence of nausea/vomiting, and median total dose of ephedrine were similar in all groups. We conclude that, in elderly patients undergoing elective procedures, withholding prehydration is not associated with any greater degree of hypotension or need for vasopressor therapy compared with crystalloid or colloid prehydration.
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Anesthesia and analgesia · Jan 1997
Comparative StudyComparison of end-tidal and arterial carbon dioxide in infants using laryngeal mask airway and endotracheal tube.
The laryngeal mask airway (LMA) has become a popular tool for airway management in selected adult and pediatric patients undergoing routine surgical procedures. The relationship between end-tidal and arterial carbon dioxide during controlled ventilation via the LMA in infants under 10 kg has not been reported. After induction of general anesthesia, the LMA was placed in 12 healthy infants and mechanical ventilation initiated. ⋯ The mean end-tidal carbon dioxide and arterial partial pressure of carbon dioxide obtained during ventilation were 42.2 +/- 7.9 and 47.1 +/- 11.0 (LMA) and 37.4 +/- 4.6 and 42.6 +/- 6.7 (endotracheal tube), respectively. Analysis of differences between partial pressure of carbon dioxide and end-tidal carbon dioxide using the Bland and Altman method revealed bias+/-precision of 4.9 +/- 3.9 and 5.3 +/- 3.2 with ventilation via the laryngeal mask and endotracheal tube. Our data indicate that, while ventilating infants under 10 kg with LMA, end-tidal carbon dioxide is an accurate indicator of arterial partial pressure of carbon dioxide.