Canadian journal of anaesthesia = Journal canadien d'anesthésie
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We studied the responses of plasma epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH) during and immediately after sevoflurane-nitrous oxide anaesthesia supplemented with vecuronium in seven elderly patients (mean 76.6 +/- 1.7 SEM) who underwent major intra-abdominal surgery. The plasma concentrations of norepinephrine, ACTH, cortisol, and ADH increased in response to surgical procedures (P < 0.05). ⋯ We conclude that, in the elderly patients, the responses of stress hormones to major intra-abdominal surgery were preserved during sevoflurane-nitrous oxide anaesthesia sufficient to prevent increases in arterial pressure and heart rate. The strongest responses of epinephrine, norepinephrine, ACTH, and cortisol were elicited immediately after tracheal extubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of fentanyl, sufentanil and alfentanil during awake craniotomy for epilepsy.
Neurolept anaesthesia is used during awake craniotomy for epilepsy surgery. This study compares analgesia, sedation and the side effects of the newer opioids sufentanil and alfentanil, with those of fentanyl in patients undergoing awake craniotomy. Thirty patients were randomized into three groups, each received droperidol, dimenhydrinate and the chosen opioid as a bolus followed by an infusion. ⋯ Two patients became uncooperative requiring general anesthesia. The conditions for surgery, electrocorticography and for stimulation testing were satisfactory in all other patients. We conclude that the newer opioids did not offer any benefit over fentanyl.
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Randomized Controlled Trial Clinical Trial
Aortocaval compression in the sitting and lateral decubitus positions during extradural catheter placement in the parturient.
We prospectively studied the incidence of concealed aortocaval compression in parturients at term during identification of the extradural space. Forty ASA I or II parturients, at term and in active labour, who requested extradural analgesia were randomly allocated to one of two groups. Parturients in the first group (n = 22) were positioned in the left lateral decubitus position and those in the second group (n = 18) were in the sitting position. ⋯ In the left lateral decubitus position, 17 of 22 patients demonstrated a > 25% reduction in COTEB compared with five of 18 patients in the sitting position (chi 2, P < 0.01). The percentage change in COTEB in the lateral decubitus position (-29.8%, 95% CI -17% to -44%) was greater than the sitting position (-9.8%, 95% CI +36% to -32%) (P < 0.01). A decreased incidence of aortocaval compression during identification of the extradural space was demonstrated in the sitting position when compared with the left lateral decubitus position.
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Randomized Controlled Trial Clinical Trial
Nifedipine attenuates the hypertensive response to tracheal intubation in pregnancy-induced hypertension.
Thirty women with pregnancy-induced hypertension (PIH) scheduled for Caesarean section under general anaesthesia were studied to evaluate the efficacy of sublingual nifedipine in attenuating the pressor response to laryngoscopy and tracheal intubation. The patients were randomly given either the contents of a nifedipine capsule 10 mg or placebo sublingually 20 min before induction of anaesthesia. Blood pressure and heart rate were recorded at various time intervals. ⋯ Heart rate increased in both the groups during the laryngoscopy and tracheal intubation (P < 0.01) but the increase was higher in the nifedipine group than in the control group (P < 0.05). Neonatal Apgar scores in both the groups were comparable. These results suggest that sublingual nifedipine is effective in attenuating the hypertensive response to laryngoscopy and intubation but not the tachycardiac response in parturients with PIH.