Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialThe effects of adding sufentanil to bupivacaine for postoperative patient-controlled epidural analgesia.
We tested the hypothesis that postoperative patient-controlled epidural analgesia was more effective with the combination of sufentanil and bupivacaine (Group 2) than with bupivacaine alone (Group 1). One hundred patients undergoing thoracic, upper abdominal, and aortic surgery were provided with an epidural catheter and randomly allocated to one of the two groups. Postoperatively, patients were monitored in a postanesthetic care unit for at least 1 day before they were transferred to a ward. ⋯ Motor block was only seen in patients with lumbar epidural catheters. There was no difference between groups, and all patients with thoracic catheters could be mobilized beginning on the first postoperative day. We conclude that 1) the addition of sufentanil to a small-dose bupivacaine augments epidural analgesia and 2) thoracic epidural catheters should be used for postoperative analgesia after abdominal or thoracic surgery.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialThe effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass.
Although milrinone effectively increases cardiac function, few studies have specifically evaluated its efficacy during cardiac surgery. We investigated the effects of milrinone on hemodynamics and left ventricular function in cardiac surgical patients who were already treated with catecholamines. Thirty-seven patients undergoing cardiac surgery were studied. ⋯ In all three milrinone groups, cardiac index and velocity of circumferential fiber shortening (Vcfc) significantly increased from the baseline, and both were significantly higher at 5 and 10 min than those in the control group. The plasma concentration of milrinone with half of maximum increase in Vcfc was 139.3 ng/mL based on the dose-response curve. Thus, milrinone improves hemodynamics and left ventricular function when constant loading conditions are maintained.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialMidlatency auditory evoked potentials predict movements during anesthesia with isoflurane or propofol.
To determine threshold values, sensitivity, and specificity of midlatency auditory evoked potentials (MLAEP) for prediction of spontaneous intraoperative movements, 40 patients undergoing elective laparotomy were studied. Continuous epidural analgesia was used in all patients. To maintain general anesthesia, the patients in Group 1 (n = 20) received isoflurane (0.4-1.2 vol%), and the patients in Group 2 (n = 20) received propofol (3-5 mg x kg(-1) x h(-1) intravenously). ⋯ Before and during spontaneous movement observed intraoperatively or during emergence from anesthesia, the latencies of the peaks Na, Pa, Nb, and P1 decreased, and the amplitudes Na/Pa, Pa/Nb, Nb/P1 increased significantly. A threshold value of 60 ms of Nb proved to be most predictive of movement during anesthesia. MLAEP recording seems to be a promising method to monitor the level of anesthesia as defined by spontaneous movement during anesthesia.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialPreemptive epidural morphine for postoperative pain relief after lumbar laminectomy.
This study was designed to evaluate the efficacy of preemptive epidural morphine for postoperative analgesia after lumbar laminectomy. Thirty ASA physical status I adults undergoing elective lumbar laminectomy under general anesthesia were randomly allocated to one of two groups. Group 1 (study group) received 3 mg epidural morphine preemptively 60 min before surgery, followed by epidural placebo at the end of surgery. ⋯ The demand for supplementary analgesia and postoperative morphine consumption in the preemptive group was significantly lower than that in control group (P < 0.05). Patients in the control group were significantly sedated after 12 h and had a high incidence of nausea and vomiting (P < 0.05). The study shows that preemptive epidural morphine is superior to epidural morphine given postoperatively for pain relief after lumbar laminectomy.