Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 1984
Fentanyl- and sufentanil-oxygen-pancuronium anesthesia for cardiac surgery in infants.
The safety and efficacy of fentanyl-oxygen (50 and 75 micrograms/kg) and sufentanil-oxygen (5 and 10 micrograms/kg) were studied in 40 infants undergoing repair of complex heart defects. When fentanyl or sufentanil was given simultaneously with pancuronium, induction of anesthesia was rapid and smooth with only mild and clinically insignificant hemodynamic changes. Hemodynamic responses to tracheal intubation were completely blocked, whereas hemodynamic responses to surgical incision and sternotomy were partially and variably blocked. ⋯ Transcutaneous oxygen tensions increased with induction, intubation, and surgical stimulation with both fentanyl and sufentanil, even in cyanotic patients with right to left shunts. Fentanyl- and sufentanil-oxygen-pancuronium anesthesia were both safe and effective for cardiac surgery in infants. This study raises the question of possible beneficial effects of high dose fentanyl and sufentanil in blunting stress responses in the pulmonary circulation, a critical aspect of anesthesia and intensive care in the infant and neonate.
-
Anesthesia and analgesia · Jan 1984
Concentrations of lactate and pyruvate in maternal and neonatal blood with different intravenous fluids used for prehydration before epidural anesthesia.
This study assesses the effects of infusion of 1200 ml of four different intravenous solutions before epidural anesthesia for cesarean section on maternal and neonatal whole blood lactate (L), pyruvate (P), excess lactate (XL), L/P ratio, and base excess (BE) in four equal groups of patients. Patients in group I (n = 15) received normal saline; those in group II, Ringer's lactate (RL); those in group III, RL with 20 g of glucose; and those in group IV, Plasma-Lyte A. Maternal venous concentrations of L increased significantly in all groups after infusion, but P increased only in group III. ⋯ However, neither neonatal Apgar scores nor maternal and neonatal BE significantly differed among the four groups. No neonate developed hypoglycemia. It is concluded that all the four intravenous fluids, despite differences in their effects on blood L and P concentrations, produce clinically satisfactory maternal and neonatal outcome.
-
Vecuronium bromide, 0.045 mg X kg-1, was compared with pancuronium, 0.07 mg X kg-1, when used to provide muscle relaxation for tracheal intubation and abdominal relaxation for outpatient gynecologic laparoscopy. Both drugs provided adequate intubating conditions within 5 min and satisfactory abdominal relaxation. Because spontaneous recovery from vecuronium was more rapid, either with inhalational or nitrous oxide-narcotic techniques, pharmacological reversal with edrophonium and atropine was either not necessary or more easily accomplished after vecuronium, as shown by the train-of-four. ⋯ Tests of muscle power and coordination performed 30 and 60 min postoperatively showed no difference between the drugs. There were no postoperative complications related to muscle relaxants and all patients met our discharge criteria the day of surgery. Given the conditions observed at the end of the procedure, we would choose vecuronium for muscular relaxation in laparoscopic surgery.
-
Anesthesia and analgesia · Jan 1984
High-dose hydromorphone (Dilaudid) for coronary artery bypass surgery.
The hemodynamic effects of high-dose hydromorphone hydrochloride (H), 1.25 mg/kg, were investigated in 10 patients with normal ventricular function undergoing coronary artery bypass graft (CABG) surgery. One patient with unstable angina was excluded from the study because of hypotension and facial flushing after a 6-mg test dose of H. Nine patients showed no significant change in heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR), pulmonary capillary wedge pressure (PCWP), or coronary perfusion pressure (CPP) after H; central venous pressure (CVP) increased significantly (P less than 0.05). ⋯ Vasodilators were required in eight patients before aortic cannulation and after extracorporeal circulation. Mean time to awakening was 7.6 hr after the full dose of H, and extubation was performed the morning after surgery (21 hr after H) according to our usual practice. We conclude that very large doses of H (equivalent in analgesic terms to 10 mg/kg of morphine sulfate) are well tolerated by most patients undergoing CABG surgery, but unconsciousness and complete suppression of sympathetic responses require supplementation of H with additional anesthetic agents or vasodilators.