Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2000
Randomized Controlled Trial Clinical TrialSpontaneous recovery profile of rapacuronium during desflurane, sevoflurane, or propofol anesthesia for outpatient laparoscopy.
We evaluated the spontaneous recovery characteristics of rapacuronium during desflurane-, sevoflurane-, or propofol-based anesthesia in 51 consenting women undergoing laparoscopic tubal ligation procedures. After the induction of the anesthesia with standardized doses of propofol and fentanyl, 1.5 mg/kg IV rapacuronium was administered to facilitate tracheal intubation. Patients were randomized to receive either 1 minimum alveolar anesthetic concentration of desflurane, 1 minimum alveolar concentration of sevoflurane, or 100 microg. kg(-1). min(-1) propofol infusion in combination with 66% nitrous oxide in oxygen for maintenance of anesthesia. Neuromuscular blockade was monitored at the wrist by using electromyography. The degree of maximum blockade and the times for first twitch recovery (T(1)) to 5%, 25%, 50%, 75%, and 90%, as well as the recovery index, were similar in all three anesthetic groups. However, recovery times for the train-of-four ratio to achieve 0.7 and 0.8 were significantly longer with desflurane (44.4 +/- 18.9 and 53.5 +/- 22.4 min) and sevoflurane (44.8 +/- 15.1 and 53.2 +/- 15.8 min) compared with propofol (31.8 +/- 5.3 and 36.5 +/- 6.5 min). Eight patients (16%) required a maintenance dose of 0.5 mg/kg rapacuronium and reversal of rapacuronium residual block occurred in three (6%) patients. We conclude that spontaneous recovery after an intubating dose of 1.5 mg/kg rapacuronium was significantly prolonged by both desflurane and sevoflurane compared with propofol-based anesthesia. Routine monitoring of neuromuscular activity is recommended even when a single bolus dose of rapacuronium is administered during ambulatory anesthesia. ⋯ When administered for laparoscopic surgery, the duration of action of an intubating dose of rapacuronium was prolonged 40%-50% by desflurane and sevoflurane, respectively, (versus propofol). Monitoring recovery of neuromuscular blockade produced by rapacuronium is particularly important when desflurane or sevoflurane is administered to ensure that an adequate recovery (train-of-four > or = 0.8) is achieved by the end of anesthesia.
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Anesthesia and analgesia · Sep 2000
Randomized Controlled Trial Comparative Study Clinical TrialRetrobulbar versus systemic application of morphine during titratable regional anesthesia via retrobulbar catheter in intraocular surgery.
We investigated the effects of morphine on postoperative pain in patients undergoing intraocular surgery using a new indwelling catheter. Although morphine produced central analgesic effects, there was no evidence for the involvement of peripheral opioid receptors in the modulation of ocular pain.
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Anesthesia and analgesia · Sep 2000
Randomized Controlled Trial Comparative Study Clinical TrialMultiple-injection axillary brachial plexus block: A comparison of two methods of nerve localization-nerve stimulation versus paresthesia.
We conducted this prospective study to compare the onset time and the success rate of a multiple-injection axillary brachial plexus block performed by using two methods of nerve localization: paresthesia elicitation or nerve stimulation. Each of the major nerves of the plexus was located by elicitation of a paresthesia (Group PAR; n = 50) or by nerve stimulation (Group PNS; n = 50) and injected with 10 mL of local anesthetic solution. Time to perform the block, onset time of the primary block, time to achieve readiness for surgery, and total anesthetic time were significantly shorter in Group PNS than in Group PAR. The incidence of complete block was larger in Group PNS than in Group PAR (91% vs 76%; P: < 0. 05), and this was related to a larger success rate for anesthetizing the radial and the musculocutaneous nerves (P: < 0.05). The frequency of venous puncture was larger in Group PAR (P: < 0.05). For multiple-injection axillary brachial plexus block, we conclude that nerve stimulation resulted in a greater success rate and a faster onset than paresthesia elicitation, and it should be considered when the radial and musculocutaneous nerve distributions are involved in the surgical area. ⋯ Two methods of nerve localization were compared when performing an axillary brachial plexus block by the multiple-injection technique. Nerve stimulation provided a faster onset and a greater incidence of complete block, related to a better success rate for anesthetizing the radial and the musculocutaneous nerves, than paresthesia elicitation.
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Anesthesia and analgesia · Sep 2000
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study.
Recovery from anesthesia might be compromised in obese patients. Because of its pharmacological properties, desflurane might allow rapid postoperative recovery for these patients. We compared postoperative recovery for 36 obese patients randomized to receive either desflurane, propofol, or isoflurane to maintain anesthesia during laparoscopic gastroplasties. Anesthesia was induced with propofol and succinylcholine IV and was maintained with rocuronium, alfentanil, inhaled nitrous oxide, and the study drug. Immediate recovery (i.e., times from the discontinuation of anesthesia to tracheal extubation, eye opening, and the ability to state one's name) was measured. At the time of postanesthesia care unit (PACU) admission, arterial saturation and the ability of patients to move were recorded. In the PACU, intermediate recovery was measured by using sedation and psychometric evaluations, 30, 60, and 120 min postoperatively. Data were compared between groups by using the Kruskal-Wallis and chi(2) tests. Results were reported as means +/- SD. P: < 0.05, compared with desflurane, was considered significant. Immediate recovery occurred faster, and was more consistent, after desflurane than after propofol or isoflurane (times to extubation were 6 +/- 1 min, 13 +/- 8 min [P: < 0.05, compared with desflurane], and 12 +/- 6 min [P: < 0.05, compared with desflurane], respectively). At PACU admission, SpO(2) values were significantly higher and patient mobility was significantly better after desflurane than after isoflurane or propofol. Sedation was significantly less pronounced with desflurane at 30 and 120 min postoperatively. In morbidly obese patients, postoperative immediate and intermediate recoveries are more rapid after desflurane than after propofol or isoflurane anesthesia. This advantage of desflurane persists at least for 2 h after surgery and is associated with both an improvement in patient mobility and a reduced incidence of postoperative desaturation. ⋯ In morbidly obese patients, postoperative immediate and intermediate recoveries are more rapid and consistent after desflurane than after propofol or isoflurane anesthesia.
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Anesthesia and analgesia · Sep 2000
Randomized Controlled Trial Clinical TrialEvaluating hemodynamic and T wave criteria of simulated intravascular test doses using bupivacaine or isoproterenol in anesthetized children.
An increase in T wave amplitude > or =25% is a reliable indicator for detecting intravascular injection of lidocaine-epinephrine test dose in anesthetized children. We examined whether a simulated IV test dose containing bupivacaine instead of lidocaine, and isoproterenol instead of epinephrine, produces reliable changes in heart rate (HR) and T wave morphology. One hundred healthy infants and children (6-72 mo) were randomized to one of five groups (n = 20 each) during 1.0 minimum alveolar anesthetic concentration sevoflurane and 67% nitrous oxide in oxygen: atropine pretreatment (0.01 mg/kg IV) followed by 0.25% bupivacaine containing epinephrine 0.5 microg/kg IV, atropine followed by normal saline, atropine followed by 1% lidocaine containing isoproterenol 0.1 microg/kg, saline pretreatment followed by the lidocaine-isoproterenol test dose, and saline followed by saline. HR was recorded every 20 s and T wave amplitude of lead II was continuously recorded. All patients receiving the bupivacaine-epinephrine test dose and none receiving saline met the HR (positive if > or =10 bpm increase) and T wave criteria (positive if > or =25% increase in amplitude). The isoproterenol-containing test dose produced positive responses based only on the HR criterion with or without atropine pretreatment. Our results indicate that HR and T wave changes are useful if a bupivacaine-epinephrine test dose is used and that HR is the only useful indicator if an isoproterenol-containing test dose is used in sevoflurane-anesthetized children. ⋯ To determine if an epidurally administered local anesthetic has been unintentionally injected into a blood vessel, a small dose of epinephrine or isoproterenol may be added to a local anesthetic. We found that an increase in heart rate > or =10 bpm and an increase in T wave amplitude of lead II >or =25% are useful indicators for detecting accidental intravascular injection of an epinephrine-containing test dose in sevoflurane-anesthetized children, whereas only a heart rate change is a reliable diagnostic tool if an isoproterenol-containing test dose is used.