Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialSpinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study.
In this randomized, multicenter study we compared the hemodynamic effects of spinal and epidural anesthesia for cesarean delivery in severely preeclamptic patients. The epidural group (n = 47) received 2% lidocaine with epinephrine 1:400,000, 18-23 mL, followed by 3 mg of morphine after delivery. The spinal group (n = 53) received 2.2 mL of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. ⋯ Neonatal outcomes assessed by Apgar scores and the umbilical arterial blood gas analysis were similar in both groups. Adverse neonatal outcomes (5-min Apgar score < 7 and umbilical arterial blood pH < 7.20) were found in only 2 premature newborns (weight < 1500 g) who were born without maternal hypotension after regional anesthesia. We conclude that the results of this large prospective study support the use of spinal anesthesia for cesarean delivery in severely preeclamptic patients.
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Anesthesia and analgesia · Sep 2005
Randomized Controlled Trial Comparative Study Clinical TrialMagnesium sulfate pretreatment reduces myoclonus after etomidate.
Myoclonic movements and pain on injection are common problems during induction of anesthesia with etomidate. We investigated the influence of pretreatment with magnesium and two doses of ketamine on the incidence of etomidate-induced myoclonus and pain. A prospective double-blind study was performed on 100 ASA physical status I-III patients who were randomized into 4 groups according to the pretreatment drug: ketamine 0.2 mg/kg, ketamine 0.5 mg/kg, magnesium sulfate (Mg) 2.48 mmol, or normal saline. ⋯ An anesthesiologist, blinded to group allocation, recorded the myoclonic movements, pain, and sedation on a scale between 0-3. Nineteen of the 25 patients receiving Mg (76%) did not have myoclonic movements after the administration of etomidate, whereas 18 patients (72%) in the ketamine 0.5 mg/kg, 16 patients (64%) in the ketamine 0.2 mg/kg, and 18 patients (72%) in the control group experienced myoclonic movements (P < 0.05). We conclude that Mg 2.48 mmol administered 90 s before the induction of anesthesia with etomidate is effective in reducing the severity of etomidate-induced myoclonic muscle movements and that ketamine does not reduce the incidence of myoclonic movements.
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Anesthesia and analgesia · Sep 2005
Randomized Controlled Trial Clinical TrialProlonged injection time and light smoking decrease the incidence of fentanyl-induced cough.
We designed this study to evaluate the effect of injection time and smoking on fentanyl-induced cough. Four-hundred-fifty ASA class I-II patients, aged 18-80 yr and weighing 40-90 kg, scheduled for elective surgery were included. All patients received fentanyl (100 microg for patients weighing 40-69 kg and 150 microg for patients weighing 70-90 kg for clinical convenience) via the proximal port of a peripheral IV line on the forearm. ⋯ The incidence of cough was 18% in group I, 8% in Group II, and 1.3% in Group III, significantly less (P < 0.05) with a longer injection time. Current smokers had a less frequent incidence of cough than nonsmokers; however, this effect was only significant in light smokers (<10 cigarettes per day or <10 smoking years or <10 pack-years). In conclusion, a longer injection time reduces the incidence of fentanyl-induced cough, and light smoking may be a protective factor against fentanyl-induced cough.