Anesthesia and analgesia
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The neuromuscular effect of neostigmine, 1.25 mg/70 kg, was assessed in 40 adult patients 10 min after cessation of a succinylcholine infusion. The patients had received a thiopental-nitrous oxide anesthetic supplemented by halothane or fentanyl during which they were given at least 5 mg/kg succinylcholine over more than 90 min. Train-of-four monitoring was used. ⋯ The degree of recovery was directly related to the train-of-four ratio, and the results in patients who had received halothane were no different from those who had received fentanyl. The findings are compatible with the hypothesis that phase I block depends upon the presence of circulating succinylcholine and decreases as the latter is cleared, whereas phase II block decreases more slowly. Thus succinylcholine block can be antagonized by neostigmine if enough time is allowed for phase I block to disappear and for a pure phase II block to be present.
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Questionnaires were sent to all anesthesia departments in Denmark to determine the total number of anesthetics given per year, and the distribution of different types of anesthesia. All cases of suspected malignant hyperthermia forwarded to the Danish Malignant Hyperthermia Register during a 6.5 yr period were reviewed and divided into subgroups according to clinical criteria. The incidence of suspected malignant hyperthermia in these subgroups was calculated in relation to type of anesthesia. ⋯ The incidence of fulminant malignant hyperthermia was low: 1 in 250,000 total anesthetic procedures, but 1 in 62,000 anesthetic procedures with a combination of potent inhalation agents and succinylcholine. Masseter spasm occurred in 1 of 12,000 anesthetic procedures in which succinylcholine was administered. Suspicion of malignant hyperthermia was raised in 1 of 16,000 anesthetics total, but in 1 of 4,200 anesthetics with the above-mentioned combination of agents.
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Anesthesia and analgesia · Jul 1985
The effects of naloxone associated with the intrathecal use of morphine in labor.
The efficacy of naloxone in reducing the incidence of side effects after intrathecal injection of morphine and the effects of maternal naloxone administration on the condition of the newborn were evaluated in 40 patients. Patients in labor were given a 1-mg intrathecal injection of morphine and, 1 hr later, either a 0.4-mg bolus of naloxone, followed by a 0.4-0.6 mg/hr intravenous infusion of naloxone, or an intravenous bolus of saline, followed by an intravenous infusion of saline. Intrathecal morphine provided at least 50% pain relief in 78% of patients given naloxone, and in 82% given saline. ⋯ Despite placental transfer of naloxone, neonatal outcome was not adversely affected. For both groups, maternal beta-endorphin levels decreased significantly with the onset of analgesia and returned to control levels at delivery. We conclude that intravenous infusion of naloxone reduced pruritus after intrathecal injection of 1 mg of morphine for labor pain without lessening analgesia or adversely affecting maternal or neonatal status.
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Anesthesia and analgesia · Jul 1985
A retrospective study of the incidence and causes of failed spinal anesthetics in a university hospital.
One hundred sequential spinal anesthetic procedures were reviewed retrospectively to study specifically the incidence and causes of spinal anesthesia. Variables examined included the patient population, the technical aspects of performing subarachnoid tap and subsequent blockade, and the level of training of the anesthetists. We found a 17% incidence of spinal failure, defined as the need to use general anesthesia during the surgical procedure. ⋯ We attribute the high incidence of failed spinal anesthesia mainly to technical reasons, most of them avoidable. The use of local and regional anesthesia requires considerable technical skills and demands a precise and total understanding of regional anatomic relationships. With the decreasing use of regional anesthesia in our operating rooms, only those regional anesthesia techniques that require minimum dexterity, such as spinal and epidural anesthesia, continue to be utilized widely; and even these techniques, safe as they are, are being poorly taught.