Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2003
Review GuidelineConsensus guidelines for managing postoperative nausea and vomiting.
We present evidence-based guidelines developed by an international panel of experts for the management of postoperative nausea and vomiting.
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Comparative Study Clinical TrialSubarachnoid small-dose bupivacaine versus lidocaine for cervical cerclage.
Cervical cerclage is often performed as an outpatient procedure under subarachnoid anesthesia. Lidocaine was historically the drug of choice for short procedures but has fallen out of favor because of concerns of transient neurologic symptoms (TNS). We performed this study to determine whether small-dose bupivacaine is an acceptable alternative to lidocaine for cervical cerclage. We randomized 59 women to receive either subarachnoid isobaric lidocaine 30 mg or hyperbaric bupivacaine 5.25 mg. Fentanyl 20 micro g was added to both local anesthetics, and the total volume was diluted to 3 mL with 0.9% saline. Onset and highest dermatomal level of sensory block; quality of anesthesia; hypotension; and times until T12 regression, return of lower extremity motor function, ambulation, and micturition were recorded. Symptoms of TNS were evaluated by telephone interview 24 h after surgery. We did not find any significant difference in onset or recovery times between the groups, with the exception of a longer duration until return of lower extremity motor strength in the lidocaine group. Symptoms consistent with TNS that resolved spontaneously within 48 h were reported by two women in the lidocaine group but by none in the bupivacaine group. We conclude that subarachnoid bupivacaine offers a satisfactory alternative to subarachnoid lidocaine for cervical cerclage. ⋯ We found that small-dose subarachnoid bupivacaine (5.25 mg) with fentanyl 20 micro g provides reliable anesthesia for cervical cerclage and exhibits a pharmacodynamic profile similar to that of small-dose lidocaine.
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of tracheal tube tip design and tube thickness on laryngeal pass ability during oral tube exchange with an introducer.
We compared the ease of passage through the glottis of two different tubes and two different sizes of tracheal tube exchanger (TE) during introducer-guided tracheal intubation. One tube was a polyvinyl chloride tube with a standard bevel, and the other was a newly designed tube with a hemispherical bevel. The outer diameters (OD) of the two TEs were 2.5 and 5.0 mm. After the standard induction of anesthesia, followed by vecuronium-induced paralysis, a TE was inserted into the trachea with a direct laryngoscope. By using the introducer as a guide, the tracheal tube was inserted into the trachea. The difficulty in passing the tube was assessed by a blinded observer and graded with a four-point scale. The newly designed tube was inserted more smoothly than was the conventional tube when the 2.5-mm-OD TE was used (P < 0.01). In situations such as those occurring after one-lung anesthesia, when use of a thicker TE is not applicable, this newly designed taper-tipped tube may be considered as an adjunct to oral tracheal tube exchange, using a thinner (smaller-OD) TE as the guide for tracheal intubation. ⋯ In situations such as after one-lung anesthesia, when use of a thicker tube exchanger (TE) is not applicable, a newly designed taper-tipped tube with the leading edge in the midline may be considered as an adjunct to an oral tracheal tube exchange, using a thinner TE as the guide for tracheal intubation.
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Clinical TrialSmall dose bupivacaine-fentanyl spinal analgesia combined with morphine for labor.
We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 micro g of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 micro g of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The median duration of analgesia was similar between groups (89 min versus 84 min; P = not significant), and only 20% of the MBF group experienced prolonged analgesia. During subsequent epidural analgesia, the MBF group had a significantly lesser rate of breakthrough pain (0.15 +/- 0.14 episodes per hour versus 0.26 +/- 0.18 episodes per hour; P = 0.02). Also, during the first 24 h postpartum, the MBF group required significantly fewer medications (3.3 +/- 3.7 doses versus 4.7 +/- 3.5 doses; P = 0.04). Intrathecal injection of this small dose of bupivacaine/fentanyl produced a rapid onset of labor analgesia; the addition of a small dose of morphine did not significantly prolong analgesia, but it improved subsequent pain relief, as measured by the rate of breakthrough pain and postpartum medication requirements. This may provide a clinically useful means of improving intra- and postpartum pain relief. ⋯ A small dose of intrathecal fentanyl 12.5 micro g and bupivacaine 2 mg produces effective labor analgesia lasting for approximately 85 min. The addition of a small 125- micro g dose of morphine improves pain control during subsequent epidural analgesia and reduces the requirements for postpartum pain medications.
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Clinical TrialAortocaval compression in pregnancy: the effect of changing the degree and direction of lateral tilt on maternal cardiac output.
Using thoracic bioimpedance to measure maternal cardiac output, we were unable to demonstrate any benefit from increasing the magnitude of lateral table tilt. This implies that it is unnecessary to use extremes of lateral table tilt in healthy pregnancy although this may not apply to women with cardiac compromise or regional anesthesia.