Anesthesia and analgesia
-
Anesthesia and analgesia · Sep 2000
Clinical TrialThe safety and efficacy of parent-/nurse-controlled analgesia in patients less than six years of age.
Over the past 5 yr, we have treated nonsurgical and postoperative pain in children <6 yr of age by using a patient-controlled analgesia pump to deliver small-dose continuous IV opioid infusions supplemented by parent- and nurse-controlled opioid bolus dosing. We call this technique parent-/nurse-controlled analgesia (PNCA). Because the safety and efficacy of PNCA have not been previously evaluated, we have undertaken a prospective, 1-yr observational study to determine patient demographics, effectiveness of analgesia, and the incidence of complications (pruritus, vomiting, and respiratory depression) in patients receiving PNCA. Data were collected on 212 children (98 female) who were treated on 240 occasions with PNCA for episodes of pain. Patients averaged 2.3 +/- 1.7 yr of age and 11 +/- 5 kg, and received a median of 4 (range 2-54) days of PNCA therapy. Maximum daily pain scores were < or =3/10 (objective pain scale) or < or =2/5 (objective or self-report pain scale) in more than 80% of all occasions of PNCA use. PNCA usage was associated with an 8% incidence of pruritus and a 15% incidence of vomiting on the first day of treatment. Nine children studied received naloxone, four (1.7%) for treatment of PNCA-related apnea or desaturation. All had improvement in their symptoms after naloxone administration. ⋯ Parent-/nurse-controlled analgesia provided effective pain relief in most children <6 yr of age experiencing nonsurgical or postoperative pain. The observed incidence of vomiting and pruritus was similar to that seen in older patients treated with patient-controlled analgesia. However, significant respiratory depression, although uncommon, did occur, thus reinforcing the need for close patient monitoring.
-
Anesthesia and analgesia · Sep 2000
Comparative Study Clinical TrialArterial blood pressure and heart rate discrepancies between handwritten and computerized anesthesia records.
Previous publications suggest that handwritten anesthesia records are less accurate when compared with computer-generated records, but these studies were limited by small sample size, unblinded study design, and unpaired statistical comparisons. Eighty-one pairs of handwritten and computer-generated neurosurgical anesthesia records were retrospectively compared by using a matched sample design. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate (HR) data for each 5-min interval were transcribed from handwritten records. In computerized records, the median of up to 20 values was calculated for SAP, DAP, and HR for each consecutive 5-min epoch. The peak, trough, standard deviation, median, and absolute value of the fractional rate of change between adjacent 5-min epochs were calculated for each case. Pairwise comparisons were performed by using Wilcoxon tests. For SAP, DAP, and HR, the handwritten record peak, standard deviation, and fractional rate of change were less than, and the trough and median were larger than, those in corresponding computer records (all with P: < 0.05, except DAP median and HR peak). Considering together all the recorded measurements from all cases, extreme values were recorded more frequently in computerized records than in the handwritten records. ⋯ The discrepancies between handwritten and computerized anesthesia records suggest that some of the data in handwritten records are inaccurate. The potential for inaccuracy should be considered when handwritten records are used as source material for research, quality assurance, and medicolegal purposes.
-
Anesthesia and analgesia · Sep 2000
Clinical TrialA preliminary investigation of remifentanil as a labor analgesic.
In this preliminary investigation, we evaluated the safety and analgesic efficacy of IV remifentanil for labor pain. Four women were studied, and then the trial was terminated because administration of this novel synthetic opioid produced significant maternal side effects in the absence of effective pain control.
-
Anesthesia and analgesia · Sep 2000
Case ReportsRecurring brachial plexus neuropathy in a diabetic patient after shoulder surgery and continuous interscalene block.
The performance of regional blockade on a patient with a preexisting neurologic condition or a history of neurologic complications after regional anesthesia is controversial. We present a case of recurring brachial plexus neuropathy in a diabetic patient after two shoulder procedures performed 4 mo apart. In both cases, the patient underwent intensive physical therapy with continuous postoperative interscalene analgesia.
-
Anesthesia and analgesia · Sep 2000
Case ReportsCortical blindness in a preeclamptic patient after a cesarean delivery complicated by hypotension.
Visual strokes can occur after prolonged hypotension or as a complication of preeclampsia-eclampsia. This case describes the diagnostic dilemma posed by a patient who developed transient blindness after a hypotensive episode during cesarean delivery for severe preeclampsia-eclampsia.