Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2004
Randomized Controlled Trial Clinical TrialLower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery.
The decrease of arterial blood pressure and body temperature after epidural or spinal anesthesia is thought to be the result of sympathetic block, which could cause pooling and redistribution of blood into the lower extremities. Studies have demonstrated that leg wrapping with elastic bandages may reduce the incidence of hypotension after spinal anesthesia. We tried to extend these previous observations to epidural anesthesia by testing the hypothesis that leg wrapping with elastic bandages should decrease the incidence of hypotension in patients receiving epidural anesthesia. ⋯ Sublingual temperature decreased significantly (P < 0.001) throughout the procedure in each group. However, no differences were found between the two groups at each designated observation, even if compared by the magnitude of temperature decrease. We conclude that although leg wrapping with elastic bandages prevents maternal hypotension after epidural anesthesia, it does not reduce the incidence or magnitude of hypothermia or prevent shivering.
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Anesthesia and analgesia · Jul 2004
The recovery profile of reduced diaphragmatic contractility induced by propofol in dogs.
Propofol decreases contractility of the diaphragm, but no data are available for its effects on recovery. We studied the recovery profile of reduced diaphragmatic contractility induced by propofol in dogs. Animals were divided into 4 groups of 7 each. ⋯ After administering propofol in Group IV, Pdi at 20-Hz stimulation decreased from fatigued values (P < 0.05). At 20 min after the end of propofol administration, Pdi at 20-Hz stimulation returned to fatigued values. We conclude that reduced contractility in nonfatigued and fatigued canine diaphragm induced by propofol recovers within 20 min after the cessation of administration.
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Anesthesia and analgesia · Jul 2004
Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy.
Inguinal hernia repair is associated with a 5%-30% incidence of chronic pain, but the pathogenesis remains unknown. We therefore evaluated pain and sensory dysfunction by quantitative sensory testing 6-12 mo after open hemiorrhaphy. Before sensory testing, all patients (n = 72) completed a short-form McGill Pain Questionnaire and a functional impairment questionnaire. ⋯ Hypoesthesia, or tactile allodynia, in the incisional area was observed in 51% (37 of 72) of the patients, but the incidence did not differ significantly between the pain group and the nonpain group (14 of 20 versus 23 of 52; P > 0.3). We concluded that cutaneous hypoesthesia, or tactile allodynia, is common after inguinal hemiotomy but has a low specificity for chronic postherniotomy pain. Factors other than nerve damage may be involved in the development of chronic posthemiotomy pain.
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Anesthesia and analgesia · Jul 2004
Clinical TrialAuscultation of bilateral breath sounds does not rule out endobronchial intubation in children.
We performed orotracheal intubation in 153 consecutive pediatric patients undergoing cardiac catheterization. Auscultation of bilateral breath sounds was confirmed. By fluoroscopy, the tip of the endotracheal tube (ETT) was seen in the right mainstem bronchus in 18 patients (11.8%) and in a low position, defined as within 1 cm above the carina, in 29 patients (19.0%). ⋯ Suggested measures for preventing endobronchial intubation include maintaining increased awareness of the imperfection or lack of accuracy of the auscultatory method, assessing insertion depth by checking the length scale on the tube, and minimizing the patient's head and neck movement after intubation. When extreme flexion or extension of the neck is expected after ETT insertion, the resultant change in ETT final position must be anticipated and taken into consideration when deciding on the depth of ETT insertion. This approach resulted in a decrease in improper tube positioning from 20% when the study was initiated to 7.1% in the last 98 patients.
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Anesthesia and analgesia · Jul 2004
Case ReportsMuscle weakness and paresthesia associated with epidural analgesia in a patient with an intrathecal neurofibrolipoma as part of a tethered cord syndrome.
We report a case of a 75-yr-old female patient in whom motor deficits and paresthesias occurred after lumbar epidural analgesia. These symptoms were eventually found to be due to a tethered cord syndrome. An epidural catheter was inserted for analgesia after colon surgery. ⋯ However, our patient had denied any muscular or neurological problems or urinary incontinence during the preoperative interview. Postoperative electromyogram and electroneurography ascertained chronic neurogenic lesions of multiple lumbar and sacral nerve roots. Three months after the operation, the patient was able to walk 100 m with a crutch.