Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2005
Clinical TrialIsobaric ropivacaine 5 mg/ml for spinal anesthesia in children.
In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1-17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. ⋯ One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.
-
Anesthesia and analgesia · Jan 2005
Comparative StudyA comparison of patients' and health care professionals' preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting.
In this study we sought to examine the differences in patients' and health care professionals' preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting (PONV). The key differences between symptoms during immediate postoperative recovery (PONV, sedation, and pain) and management of PONV (prophylaxis, efficacy of antiemetic, and extra cost) were used to develop 14 scenarios in a questionnaire. Fifty-two health care professionals (anesthesiologists and recovery room nurses) and 200 women undergoing elective gynecological surgery were recruited (overall response rate, 97%). ⋯ They were more concerned about the cost of the antiemetic to the patient than the patients were themselves. There was no preference for a policy of effective treatment versus routine prophylaxis. This study shows that there were small differences in the importance of pain, sedation, efficacy of the antiemetic, and extra cost of treatment between patients and health care professionals.
-
Anesthesia and analgesia · Jan 2005
Clinical TrialA real-time method for estimating the concentrations of isoflurane in mixed venous blood by a derived Fick's equation.
We propose an equation derived from Fick's laws and Lin's concept of effective blood concentration to calculate the blood concentration of inhaled anesthetics in mixed venous blood (MVBC) without direct blood sampling. We investigated the relationship between the calculated concentrations and the actual blood sample concentrations in mixed venous blood of patients undergoing cardiac surgery during isoflurane anesthesia in this study. Sixteen patients were recruited for Experiment 1. ⋯ We have demonstrated that MVBC could represent the actual pulmonary blood concentrations of isoflurane during cardiac surgery. The results suggest that MVBC could be a useful method of estimating the real-time pulmonary blood concentration of isoflurane. The clinical significance and importance of the method merit further investigation.
-
Anesthesia and analgesia · Jan 2005
Comparative Study Clinical TrialTrain-of-four stimulation for adductor pollicis neuromuscular monitoring can be applied at the wrist or over the hand.
Adductor pollicis stimulation over the ulnar nerve at the wrist is the standard method of monitoring neuromuscular function. Stimulation over a muscle is believed to cause direct muscle contraction, but evidence for this is lacking. In this study we sought to determine whether direct muscle stimulation occurred during stimulation of the adductor pollicis in the hand and whether the responses were comparable to those observed with stimulation at the wrist. ⋯ With a Bland and Altman analysis, TOF ratios during recovery at the hand showed a bias of 0.5% and limits of agreement of +/-11.8% as compared with the wrist. Stimulation in the hand causes no direct muscle stimulation because the response is no more than that produced by stimulation at the wrist. Both sites yield comparable TOF ratios.
-
Anesthesia and analgesia · Jan 2005
Clinical TrialA modified coracoid approach to infraclavicular brachial plexus blocks using a double-stimulation technique in 300 patients.
Infraclavicular brachial plexus block is used less than other techniques of regional anesthesia for upper-limb surgery. We describe a modified coracoid approach to the infraclavicular brachial plexus using a double-stimulation technique and assess its efficacy. Patients undergoing orthopedic surgery of the upper limb were included in this prospective study. ⋯ Five patients required general anesthesia. No major complications were observed. This modified infraclavicular brachial plexus block using a double-stimulation technique was easy to perform, had frequent success, and was safe in this cohort.