Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialA randomized, double-blind, dose-response comparison of epidural fentanyl versus sufentanil analgesia after cesarean section.
This study was designed to determine and compare the dose-response characteristics, speed of onset, and relative potency of single-dose epidural fentanyl (F) and sufentanil (S) for postoperative pain relief. Eighty women undergoing cesarean section (C/S) with epidural 2% lidocaine with epinephrine (1:200,000) were randomly assigned to receive double-blind epidural administration of F (25, 50, 100, or 200 microg) or S (5, 10, 20, or 30 microg) (n = 10 per group) upon complaint of pain postoperatively. Visual analog scales (VAS, 0-100 mm) were used to assess pain and sedation at baseline; at 3, 6, 9, 12, 15, 20, 25, 30, 45, and 60 min; and every 30 min until further analgesia was requested. ⋯ The 50% and 95% effective dose values for each opioid to achieve a VAS score <10 mm were F 33 microg and 92 microg and S 6.7 microg and 17.5 microg. There were no differences among groups in sedation scores or side effects. Our data suggest that the relative analgesic potency of epidural S:F is approximately 5 and that there are no differences between the opioids in the onset, duration, and effectiveness of analgesia when equianalgesic doses are administered postoperatively after lidocaine anesthesia for C/S.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of epidural fentanyl on hemodynamic responses during emergence from isoflurane anesthesia and tracheal extubation: a comparison with intravenous fentanyl.
To investigate the effects of epidural fentanyl infusion on hemodynamic responses to recovery of consciousness and tracheal extubation, we studied 50 unpremedicated patients scheduled for abdominal hysterectomy. All patients underwent epidural catheterization and blind infusion of placebo and study drug. Patients were assigned randomly to three groups: Group I received epidural and intravenous (i.v.) bolus injections and infusion of saline at the rate of 0.2 mL x kg(-1) x h(-1); Group II received an i.v. injection of fentanyl 2 microg/kg for 30 s followed by 25 ng x kg(-1) x min(-1), and Group III received epidural injection and infusion using the same administration regimen as Group II. ⋯ The incidence of coughing during and after extubation was also lower with Group III. Suppression of respiratory rate prior to tracheal extubation was similar in the two groups receiving fentanyl. These findings suggest that the significant reduction in arterial pressures responses to tracheal extubation due to epidural fentanyl infusion may arise from more suppression of cough reflex than i.v. fentanyl infusion, which could be provided by the spinal action of epidural fentanyl as well as the supraspinal action.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialEffect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement.
Given the inherent side effects associated with both opioid and nonopioid analgesic drugs, a nonpharmacologic therapy that could decrease the need for analgesic medication would be valuable. We designed a sham-controlled study to assess the effect of the intensity of transcutaneous acupoint electrical stimulation (TAES) on postoperative patient-controlled analgesia (PCA) requirement for hydromorphone (HM), the incidence of opioid-related side effects, and the recovery profile after lower abdominal surgery. One hundred one healthy consenting women undergoing lower abdominal procedures with a standardized general anesthetic technique were randomly assigned to one of four postoperative analgesic treatment regimens: Group I (n = 26) PCA only; Group II (n = 25), PCA + sham-TAES (no electrical stimulation); Group III (n = 25), PCA + low-TAES (4-5 mA of electrical stimulation); Group IV (n = 25), PCA + high-TAES (9-12 mA of electrical stimulation). ⋯ High-TAES decreased the HM requirement by 65% and reduced the duration of PCA therapy, as well as the incidence of nausea, dizziness, and pruritus. Low-TAES produced a 34% decrease in the HM requirement compared with only 23% in the "sham" TAES group. We conclude that high-TAES produced a significant decrease in the PCA opioid requirement and opioid-related side effects after low intraabdominal surgery.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Clinical TrialThe effect of ephedrine on the onset time of rocuronium.
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Anesthesia and analgesia · Aug 1997
epsilon-Aminocaproic acid plasma levels during cardiopulmonary bypass.
epsilon-Aminocaproic acid (EACA) concentrations achieved during cardiopulmonary bypass (CPB) have not been previously reported. It is unknown whether plasma concentrations reported to inhibit fibrinolysis in vitro (130 microg/mL) are achieved or whether differences in these levels relate to variability in postoperative bleeding. EACA (total intraoperative dose 270 mg/kg) was administered to 27 patients undergoing cardiac reoperation. ⋯ Twenty-four-hour postoperative thoracic drainage and allogeneic red blood cell transfusions were not associated with plasma levels at any time. Although plasma EACA concentrations greater than 130 microg/mL were consistently achieved, we observed a marked variability (more than sixfold) in plasma concentrations and bleeding outcomes despite the use of a weight-based dosing regimen. This variability in drug levels appears to have little relevance to bleeding outcomes, possibly since mean plasma levels exceeded 130 microg/mL during CPB, and nearly all patients (26 of 27) achieved that target level.