Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 1985
Comparative StudyComparison of the effects of general and regional anesthesia for cesarean section on neonatal neurologic and adaptive capacity scores.
Fifty-two neonates delivered by elective cesarean section were evaluated using the Neonatal Neurologic and Adaptive Capacity Scores. Twenty of the mothers received general anesthesia, 14 received epidural, and 18 received spinal anesthesia. All mothers receiving regional anesthesia were prehydrated with 1000 ml of lactated Ringer's solution and were given oxygen via a transparent face mask. ⋯ Neonates delivered with general anesthesia scored significantly lower on some of the test items for adaptive capacity, passive tone, active tone, primary reflexes, and total scores at both 15 min and 2 hr of age (P less than 0.05) than those delivered with either epidural or spinal anesthesia. Neonates delivered with epidural anesthesia scored lower than those delivered with spinal anesthesia on supporting reaction and motor activity at 2 hr of age (P less than 0.05). All neonates had high scores at 24 hr, at which time there were no significant differences between the three groups.
-
Anesthesia and analgesia · Sep 1985
Randomized Controlled Trial Comparative Study Clinical TrialEtomidate versus thiopental for induction of anesthesia.
Hemodynamic changes and side effects of anesthesia induction with etomidate or thiopental were evaluated in 83 ASA class I or II patients. Patients were randomly assigned to one of 12 groups according to pretreatment drug (fentanyl, 100 micrograms, or normal saline intravenously), induction agent (etomidate, 0.4 mg/kg, or thiopental, 4 mg/kg), and maintenance anesthetic technique (isoflurane-oxygen, isoflurane-nitrous oxide-oxygen, or fentanyl-nitrous oxide-oxygen). The purpose of this experiment, of factorial design, was to evaluate the combined effects of two or more experimental variables used simultaneously and to observe interaction effects. ⋯ Patients in whom anesthesia was induced with etomidate had a greater incidence of pain on injection and myoclonus and a lesser incidence of apnea than patients in whom anesthesia was induced with thiopental. Fentanyl pretreatment significantly decreased the incidence of pain on injection and myoclonus, but it increased the incidence of apnea when anesthesia was induced with etomidate. The incidence of postoperative nausea and vomiting was similar after thiopental and etomidate and was unaffected by fentanyl pretreatment. (ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Sep 1985
Comparative Study Clinical Trial Controlled Clinical TrialComparison of morphine, meperidine, fentanyl, and sufentanil in balanced anesthesia: a double-blind study.
A double-blind study comparing four narcotic analgesics of different potencies, meperidine, morphine, fentanyl, and sufentanil, was performed on consenting patients undergoing general or orthopedic surgery under balanced anesthesia. Blood pressure, measured through an indwelling arterial catheter, was recorded continuously, as were ECG and heart rates. The narcotics, made up in equipotent concentrations, were given as indicated by hemodynamic and clinical signs. ⋯ Side effects, including histamine release accompanied by tachycardia and hypotension, were most frequent and most severe in patients who received meperidine. After extubation, marked increases in heart rate, blood pressure, and plasma norepinephrine and epinephrine occurred in some patients in each group. The incidence of postoperative respiratory depression was greatest in patients given morphine (mean dose of naloxone 8.6 micrograms/kg) and least with sufentanil (mean dose of naloxone 1.8 micrograms/kg) and fentanyl (3.2 micrograms/kg naloxone).
-
Anesthesia and analgesia · Sep 1985
Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation.
The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. ⋯ A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.