Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2001
Randomized Controlled Trial Clinical TrialThe enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block.
Clonidine added to local anesthetics results in an increased duration of anesthesia or analgesia after brachial plexus block. We investigated the effect of selective application of clonidine to the median and musculocutaneous nerves during midhumeral block, a technique allowing selective nerve blocks with the use of different local anesthetics. Initially, 58 patients scheduled for hand surgery were prospectively enrolled to receive a midhumeral block. ⋯ Adding 50 microg clonidine to the median and musculocutaneous nerves resulted in a significant increase in the duration of sensory block in these nerves (P < 0.0001). Recovery of motor block was not different between the two groups. No significant difference was found between the two groups in the mean plasma mepivacaine concentration.
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Anesthesia and analgesia · Sep 2001
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting.
We performed an open, prospective, randomized, controlled study of the incidence of major organ complications in 420 patients undergoing routine coronary artery bypass graft surgery with or without thoracic epidural anesthesia and analgesia (TEA). All patients received a standardized general anesthetic. Group TEA received TEA for 96 h. ⋯ The incidence of stroke was insignificantly less in the TEA group (GA = 6 of 202, TEA = 2 of 206; P = 0.17). There were no neurologic complications associated with the use of TEA. We conclude that continuous TEA significantly improves the quality of recovery after coronary artery bypass graft surgery compared with conventional narcotic analgesia.
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Anesthesia and analgesia · Sep 2001
Randomized Controlled Trial Clinical TrialNeither nalbuphine nor atropine possess special antishivering activity.
The special antishivering action of meperidine may be mediated by its kappa or anticholinergic actions. We therefore tested the hypotheses that nalbuphine or atropine decreases the shivering threshold more than the vasoconstriction threshold. Eight volunteers were each evaluated on four separate study days: 1) control (no drug), 2) small-dose nalbuphine (0.2 microg/mL), 3) large-dose nalbuphine (0.4 microg/mL), and 4) atropine (1-mg bolus and 0.5 mg/h). ⋯ This differs markedly from meperidine, which impairs shivering twice as much as vasoconstriction. Atropine increased all thresholds and would thus be expected to facilitate shivering. Our results thus fail to support the theory that activation of kappa-opioid or central anticholinergic receptors contribute to meperidine's special antishivering action.
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Anesthesia and analgesia · Sep 2001
Randomized Controlled Trial Clinical TrialMetaraminol infusion for maintenance of arterial blood pressure during spinal anesthesia for cesarean delivery: the effect of a crystalloid bolus.
We randomly allocated women having elective cesarean delivery to receive either no bolus (Control Group, n = 31) or 20 mL/kg lactated Ringer's solution (Bolus Group, n = 35) IV before spinal anesthesia. An infusion of metaraminol started at 0.25 mg/min was titrated to maintain systolic arterial blood pressure in the target range 90%-100% of baseline. ⋯ There was no difference between groups in regards to changes in systolic arterial blood pressure or heart rate over time, or maternal or neonatal outcome. We conclude that when metaraminol is used to maintain arterial pressure during spinal anesthesia for cesarean delivery, crystalloid bolus is not essential provided that sufficient vasopressor is given in the immediate postspinal period.
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Anesthesia and analgesia · Sep 2001
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural levobupivacaine 0.5% with or without epinephrine for lumbar spine surgery.
Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, we compared the onset, extent, and duration of sensory and motor blockade produced by plain 0.5% levobupivacaine (15 mL, 75 mg) with that of 0.5% levobupivacaine with the addition of 1:400,000 or 1:200,000 epinephrine in 117 patients undergoing elective spine surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in all groups (12.4 +/- 6.6 min for plain levobupivacaine, 13.9 +/- 7.9 min for levobupivacaine with 1:400,000 epinephrine, and 12.7 +/- 4.9 min for levobupivacaine with 1:200,000 epinephrine), with an average peak block height of T5. ⋯ Peak serum levobupivacaine levels were reduced in each of the epinephrine-containing groups. We conclude that 0.5% levobupivacaine with or without 1:200,000 or 1:400,000 epinephrine produced effective epidural anesthesia in patients having lumbar spine surgery. Epinephrine 1:400,000 is as effective as 1:200,000 in reducing the resultant serum levobupivacaine levels after epidural anesthesia.