Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1997
Comparative StudyThe effect of xenon on spinal dorsal horn neurons: a comparison with nitrous oxide.
We compared the effects of xenon (Xe) on the spinal cord dorsal horn neurons with those of nitrous oxide (N2O) in cats anesthetized with chrolarose and urethane. We assessed the potency of both anesthetics by the inhibition of wide dynamic range neuron responses evoked by cutaneous noxious (pinch) stimulation to a hindpaw. During 70% Xe inhalation, the responses of 7 of 11 neurons to pinch stimulation were suppressed. ⋯ After 20 min of Xe inhalation, the response to pinch was suppressed to 49.5% +/- 8.2% (mean +/- SE), while N2O, 70% in oxygen, suppressed it to 45.9% +/- 7.9%. The difference between N2O and Xe was not significant. We conclude that Xe and N2O suppress the spinal cord dorsal horn neurons to a similar degree.
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Anesthesia and analgesia · Jun 1997
Clinical TrialDisplacement of the double-lumen endobronchial tube can be detected by bronchial cuff pressure change.
We measured the bronchial cuff pressure of left-sided double-lumen endobronchial tubes (DLTs) in 54 patients to confirm the effect of DLT displacement on cuff pressure. After positioning the cephalad surface of the bronchial cuff of the DLT 2.5 cm distal to the carina (23 patients in the first part of the study) or just below the carina (23 patients in the second part), the cuff was withdrawn in 0.5-cm steps during right-sided, one-lung ventilation. The bronchial cuff pressure was measured, and the capnogram and pressure-volume loop, displayed by a side-stream spirometer, was evaluated. ⋯ The bronchial cuff pressure decreased significantly by 28.4 cm H2O (P < 0.01) and 21.3 cm H2O (P < 0.01) in the first and second parts, respectively, before the pressure-volume loop or the capnogram changed. The bronchial cuff pressure in the third part showed no significant change. We conclude that bronchial cuff pressure monitoring was very helpful in detecting displacement of the DLT during right-sided, one-lung ventilation.
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Clinical TrialSuprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?
Arthroscopic shoulder surgery has a 45% incidence of severe postoperative pain. Opiates and interscalene nerve blocks have a high incidence of side effects, and intraarticular local anesthetic has been shown to be ineffective when used for postoperative pain relief. The suprascapular nerve supplies 70% of the sensory nerve supply to the shoulder joint, and local anesthetic block of this nerve is effective in certain shoulder pain disorders. ⋯ A 24-h phone call interview revealed a 40% reduction in analgesic consumption and a reduction in verbal pain scores at rest and on abduction. There were no complications from the suprascapular nerve block. This study demonstrates that a suprascapular nerve block for pain relief in arthroscopic shoulder surgery is an effective and safe modality of postoperative pain relief.
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of skull-pin insertion on cerebrospinal fluid pressure and cerebral perfusion pressure: influence of sufentanil and fentanyl.
This randomized prospective study measured the effects of an intravenous opioid bolus on cerebrospinal fluid pressure (CSFP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) during skull-pin insertion. Twenty-two adult patients scheduled for elective craniotomy for supratentorial lesions were studied. Outcome variables were MAP, heart rate (HR), and lumbar CSFP. ⋯ In the sufentanil group, HR decreased approximately 10 bpm after opioid injection and remained decreased throughout the study. In fentanyl-treated patients, HR decreased 8 bpm after opioid injection but returned to preopioid rates after skull-pin insertion. In conclusion, in anesthetized patients, an intravenous bolus of fentanyl or sufentanil prior to skull-pin insertion results in stable values of CSFP, CPP, BP, and HR when the hemodynamic effects of the opioid are modified with phenylephrine and atropine.