Anesthesia and analgesia
-
Anesthesia and analgesia · May 2000
Randomized Controlled Trial Clinical TrialA prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients.
Organ dysfunction and multiple organ failure are the main causes of prolonged hospital stay after cardiac surgery, which increases resource use and health care costs. Increased levels of oxygen delivery and consumption are associated with improved outcome in different groups of postoperative patients. Cardiac surgical patients are at risk of inadequate perioperative oxygen delivery caused by extracorporeal circulation and limited cardiovascular reserves. The purpose of our study was to test whether increasing oxygen delivery immediately after cardiac surgery would shorten hospital and intensive care unit (ICU) stay. Four hundred three elective cardiac surgical patients were enrolled in the study and randomly assigned to either the control or the protocol group. Goals of the protocol group were to maintain SvO(2) >70% and lactate concentration < or =2.0 mmol/L from admission to the ICU and up to 8 h thereafter. Hemodynamics, oxygen transport data, and organ dysfunctions were recorded. The median hospital stay was shorter in the protocol group (6 vs 7 days, P < 0.05), and patients were discharged faster from the hospital than those in the control group (P < 0.05). Discharge from the ICU was similar between groups (P = 0. 8). Morbidity was less frequent at the time of hospital discharge in the protocol group (1.1% vs 6.1%, P < 0.01). Increasing oxygen delivery to achieve normal SvO(2) values and lactate concentration during the immediate postoperative period after cardiac surgery can shorten the length of hospital stay. ⋯ Health care economics has challenged clinicians to reduce costs and improve resource use in cardiac surgery and anesthesia in a patient population increasing in age and in severity of disease. Optimizing cardiovascular function to maintain adequate oxygen delivery during the immediate postoperative period after cardiac surgery can decrease morbidity and reduce length of hospital stay.
-
Anesthesia and analgesia · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialDoes the addition of fentanyl to bupivacaine in caudal epidural block have an effect on the plasma level of catecholamines in children?
We evaluated the effect of adding fentanyl to bupivacaine, compared with bupivacaine alone, on the stress response. The effect was evaluated by determining blood levels of epinephrine (E) and norepinephrine (NE) in pediatric patients receiving caudal epidural blocks. Sixty children, 1-8 yr of age, scheduled for elective herniorrhaphy, were randomly allocated to two groups of 30 patients each. ⋯ There were no significant differences in the E and NE plasma levels between the two groups at H(0), H(1), and H(2) (P = 0.5, P = 0.12, P = 0.5, respectively). Pain scores (modified Children's Hospital of Eastern Ontario Pain Score) were also similar in both groups (P = 0. 19). This study suggests that adding fentanyl 1 microg/kg to bupivacaine in the caudal epidural block in children does not influence plasma levels of E and NE, nor does it improve the analgesic intensity of the caudal block.
-
Anesthesia and analgesia · May 2000
Randomized Controlled Trial Clinical TrialAlfentanil given immediately before the induction of anesthesia for elective cesarean delivery.
Opioids are routinely omitted at the induction of general anesthesia for cesarean delivery because of concerns about neonatal respiratory depression. The subsequent unmodified maternal stress response to tracheal intubation reduces placental perfusion. The short-acting opioid alfentanil may afford advantages at the induction, without subsequent neonatal depression. ⋯ One neonate in the alfentanil group required naloxone. The maternal stress response was attenuated in the alfentanil group but at the cost of early neonatal depression. However, all neonates should be monitored for possible immediate, but transient, respiratory depression.
-
Anesthesia and analgesia · May 2000
Randomized Controlled Trial Clinical TrialThe onset time of rocuronium is slowed by esmolol and accelerated by ephedrine.
Administration of ephedrine prior to rocuronium decreases the onset time of neuromuscular blockade from rocuronium by 26%. This effect was attributed to a increased cardiac output. If so, beta adrenergic-blocking drugs, which decrease cardiac output, should prolong the onset time of rocuronium. ⋯ The onset time of rocuronium was significantly shorter after ephedrine (22%) and longer after esmolol (26%), as compared to placebo. No differences were observed among the three groups with regard to heart rate, systolic, diastolic or mean blood pressure. We concluded that a dose of 0.5 mg. kg(-1) of esmolol significantly prolongs the onset time of rocuronium with minimal hemodynamic changes.
-
The most useful qualities of a NMBD for pediatric anesthesia are: rapid, reliable onset of laryngeal muscle block after IV or IM administration, duration of < or =20 min, and lack of side effects. Until recently, no nondepolarizer met all these criteria. However, 2 mg/kg rapacuronium produces rapid laryngeal block that can be easily reversed to restore neuromuscular function within 20 min in most pediatric patients.