Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The effects of dobutamine (DOB) on diaphragmatic fatigue were examined in 20 anaesthetized, mechanically ventilated dogs. Animals were divided into two groups: the DOB group (n = 10) and the control group (n = 10). Diaphragmatic fatigue was induced by intermittent supramaximal electric stimulation applied to bilateral phrenic nerves at a frequency of 20 Hz for 30 min. ⋯ In the control group, the speed of recovery from fatigue was much slower at low-frequency stimulation. The integrated diaphragmatic electric activity (Edi) in the two groups did not change throughout the experiment at any frequency of stimulation. We conclude that dobutamine improves contractility in fatigued diaphragm.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between patient-controlled analgesia and intramuscular meperidine after thoracotomy.
A prospective randomized controlled study was performed to assess the efficacy and safety of patient-controlled analgesia (PCA) in patients undergoing thoracotomy. This method was compared with a conventional pain management technique consisting of regularly scheduled im injections of analgesics. Forty adult patients were randomly assigned to receive intravenous PCA or im meperidine treatment over a 48-hr period after surgery. ⋯ Meperidine intake was similar in both groups but considerable interpatient variation was seen. In conclusion, PCA is a safe, effective and individualized treatment method for controlling pain after thoracotomy. There appears to be some clinical advantages of PCA over im dosing regimens for analgesia after thoracotomy.
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Randomized Controlled Trial Clinical Trial
Alkalinization improves the quality of lidocaine-fentanyl epidural anaesthesia for caesarean section.
This double-blind randomized study of 116 healthy women was undertaken to evaluate whether alkalinization potentiated the analgesic effects of epidural fentanyl-lidocaine for elective Caesarean section. After a test-dose of 3 ml, lidocaine 2% with adrenaline 1:200,000, all patients received 100 micrograms, fentanyl in 5 ml saline and they were then divided into two groups, to receive incremental doses of 5 ml lidocaine 2% with adrenaline 1:200,000 with or without 0.1 mEq.ml-1 sodium bicarbonate, to obtain anaesthesia to T4. The addition of bicarbonate to lidocaine resulted in a mean (SD) pH increase from 6.58 (0.01) to 7.14 (0.02) and in a mean PCO2 increase from 3.8 (0.8) to 345.1 (5.9) mmHg. ⋯ The percentage of patients experiencing pain during surgery and requiring intravenous analgesics was higher in the group which did not receive bicarbonate (3% vs 16%; P < 0.05). There were no differences in intraoperative maternal side-effects, neonatal outcome or in maternal venous and umbilical venous and arterial lidocaine concentrations between the groups. The concentrations of fentanyl in maternal plasma, umbilical artery, and the umbilical artery to maternal vein ratio were greater in the alkalinized group (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of patient-controlled epidural fentanyl and single dose epidural morphine for post-caesarean analgesia.
In a prospective, randomized, double-blinded study, 23 patients who had undergone Caesarean delivery under epidural anaesthesia were assessed to evaluate the effectiveness of patient-controlled epidural analgesia (PCEA) with fentanyl compared with a single dose of epidural morphine for postoperative analgesia. Group A (n = 11) received epidural fentanyl 100 micrograms intraoperatively then self-administered a maximum of two epidural fentanyl boluses 50 micrograms (10 micrograms.ml-1) with a lockout period of five minutes for a maximum of two doses per hour. Group B (n = 11) received a single bolus of epidural morphine 3 mg (0.5 mg.ml-1) intraoperatively and received the same instructions as Group A but had their PCA devices filled with 0.9% NaCl. ⋯ Pruritus was less common in Group A patients at the 8 and 24 hr observation periods (P < 0.0125). Both groups experienced the same degree of nausea and clinically unimportant respiratory depression. We conclude that PCEA with fentanyl provides analgesia equal to a single dose of epidural morphine and may be suitable for patients who have experienced considerable pruritus after epidural morphine administration.