Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1981
Delayed onset of epidural anesthesia in patients with back pain.
Onset and completeness of anesthesia were compared in 15 patients with back pain or sciatica and in 10 patients without back pain given lumbar epidural anesthesia with 20 to 25 ml of 1.5% mepivacaine, 80 mg of methylprednisolone, and 1:200,000 epinephrine. Sensory block was complete within 30 minutes in patients without back pain. Eleven of 15 (73%) patients with back pain had delayed onset of anesthesia ranging from 35 to 95 minutes. ⋯ Differences in time of onset between affected nerves and contralateral nerves were also significant (p less than 0.01). The nerve roots involved, as determined from the myelogram or the electromyogram, or those adjacent to them, were the roots with delayed onset of block. Any effect of the steroid on nerve blockade was ruled out as there was solid anesthesia in patients without back pain.
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Anesthesia and analgesia · Dec 1981
Effects of enflurane on release of insulin by pancreatic islets in vitro.
The effects of enflurane upon rate of insulin release from rat pancreatic islets were determined in vitro. A dose-related inhibitory effect of enflurane on glucose-stimulated insulin release was observed with almost complete inhibition being seen when the enflurane concentration in the gas phase was 3.21% (v/v), equivalent to 1.26 mM enflurane in the liquid phase. ⋯ To investigate further the metabolic integrity of islets, rates of islet incorporation of L-[4,5-3H] leucine were determined; these too were not significantly altered by concentrations of enflurane up to 1.26 mM. It is concluded that enflurane in the concentration range used clinically leads to a rapid, reversible inhibition of rat pancreatic islet insulin release, which is not attributable to interference with islet glucose metabolism or protein biosynthesis.
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Dosage of pancuronium required to produce 90% neuromuscular blockade, time of onset of action of pancuronium and changes in heart rate and arterial pressure were evaluated in 30 children with congenital cardiovascular disease during intravenous anesthesia. Neuromuscular blockade was measured using train-of-four stimulation (2 Hz for 2 seconds) and twitch count. The 90% blockade was defined as being one twitch felt on the stretched abducted thumb. ⋯ There were no significant changes in heart rate or arterial pressure. In one case bigeminy during intubation was seen. No children had tachycardia after pancuronium.
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Anesthesia and analgesia · Nov 1981
Randomized Controlled Trial Clinical TrialIsobaric tetracaine spinal anesthesia and the lithotomy position.
The extent and pattern of anesthesia produced by hyperbaric and by isobaric 0.5% tetracaine spinal anesthesia were compared in this blind-observer, randomized study of 103 spinal anesthetics performed in 98 patients having genitourinary surgery in the lithotomy position. Pinprick stimulation showed no significant differences in maximum segmental sensory levels, times to maximum level, or duration of anesthesia for isobaric as compared to hyperbaric tetracaine. No parameters were significantly altered by barbotage of isobaric tetracaine solutions. With injections given to patients in the sitting position and with patients subsequently maintained in a horizontal lithotomy position before being put in the lithotomy position, the addition of dextrose to tetracaine solutions injected at room temperature into the subarachnoid space does not significantly alter the cephalad spread of spinal anesthesia.
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Anesthesia and analgesia · Oct 1981
Adult body temperature and heated humidification of anesthetic gases during general anesthesia.
To determine the effects on body temperature of heating and humidifying inspired anesthetic gases to 37 C and 100% relative humidity, 42 men who had major surgical procedures under general anesthesia were studied. Group 1 (control) consisted of 10 patients who inspired gases from a standard semicircle absorber system with no added humidity. The mean nasopharyngeal temperature decreased significantly from 36.2 +/- 0.1 C to 34.9 +/- 0.2 C. ⋯ For groups 4 and 5, six patients each, gases were heated and humidified on alternate hours. The responses of the two groups demonstrated a causal relationship between the heating and humidifying of inspired gases and an increased mean nasopharyngeal temperature. It is concluded that heating and humidifying gases to 37 C and 100% relative humidity effectively maintains normothermia and rewarms hypothermic adults during general anesthesia.