Journal of clinical anesthesia
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Review Comparative Study
Effects of regional anesthesia on perioperative outcome.
To provide an overview of current knowledge, this article reviews experimental and clinical data from investigations examining effects of regional anesthesia on perioperative morbidity in specific physiologic systems. The issues of morbidity and mortality following general and regional anesthesia are addressed, as are the development of perioperative thromboembolism and blood loss, which are known to be increased during general anesthesia. Finally, the effects of regional anesthesia on the vascular system, the perioperative stress response, and the pulmonary function are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial.
To evaluate the efficacy of intravenous lidocaine and two doses of esmolol for attenuating the cardiovascular responses to laryngoscopy and intubation, and to assess whether a combination of both drugs is more effective than either drug alone. ⋯ Esmolol 1 to 2 mg/kg is reliably effective in attenuating HR response to tracheal intubation. Neither of the two doses of esmolol tested nor that of lidocaine affected the BP response. Only the combination of lidocaine and esmolol attenuated both HR and BP responses to tracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemodynamic effects of intrathecal sufentanil compared with epidural bupivacaine in laboring parturients.
To provide information on the central hemodynamic effects of intrathecal sufentanil after a standard intravenous preload using thoracic bioimpedance monitoring to obtain noninvasive measurements of cardiac index (CI), stroke index (SI), and systemic vascular resistance (SVR). To compare hemodynamic parameters after intrathecal sufentanil labor analgesia to those after a standard dose of epidural bupivacaine in laboring parturients. ⋯ No significant differences in CI, SI, or SVR index were seen after either method of analgesia. A few patients in both groups experienced hypotension requiring treatment with ephedrine. Both techniques of labor analgesia appear to provide effective pain relief but care must be taken with either method to monitor maternal BP.
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Randomized Controlled Trial Clinical Trial
Propofol at conscious sedation doses produces mild analgesia to cold pressor-induced pain in healthy volunteers.
To determine whether subanesthetic doses of propofol have analgesic effects in healthy volunteers. ⋯ Our laboratory results are consistent with the commonly accepted clinical practice of supplementing propofol with an opioid in conscious sedation procedures to provide a satisfactory level of pain relief.
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Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly better analgesic effects, and also fewer unwanted side effects. ⋯ Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing of analgesics and/or a reasonably large patient sample size. These data do not allow a proper meta-analysis to be performed because of the large variability in surgical procedures, dosing regimens, assessment criteria, among others.