Journal of clinical anesthesia
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Two cases of inadvertent dural puncture in patients at high risk for dural puncture headache are presented. These patients were managed with an immediate epidural blood patch through a catheter placed at another level with placement of this catheter occurring immediately following the dural puncture. Following the blood patch, the patients were anesthetized with the epidural catheter being used for supplementation of the general anesthetic and for postoperative pain management. Neither patient required further management of a dural puncture headache nor did it appear that the blood interfered with the patients receiving adequate postoperative analgesia through the use of this epidural catheter.
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Randomized Controlled Trial Comparative Study Clinical Trial
Rocuronium versus succinylcholine-atracurium for tracheal intubation and maintenance relaxation during propofol anesthesia.
To compare the onset and offset time (clinical duration), and intubating conditions obtained with rocuronium bromide 0.6 mg/kg and succinylcholine 1.0 mg/kg after induction with propofol and fentanyl; and to compare rocuronium with atracurium for maintenance during propofol anesthesia. ⋯ Rocuronium bromide at a dose of 0.6 mg/kg, when used with propofol and fentanyl for induction, provides intubating conditions similar to succinylcholine 1.0 mg/kg at 1 minute. The actual onset time and offset time, however, are significantly longer with rocuronium. There was no difference between atracurium and rocuronium as a maintenance drug. Rocuronium is suitable for surgical procedures greater than 30 minutes, eliminating the need for an additional relaxant to succinylcholine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery.
To determine if remifentanil would offer a superior hemodynamic and recovery profile compared to the current standard of care, which implements a fentanyl-based technique. ⋯ Remifentanil, a new short-acting opioid, offers excellent hemodynamic control for brief, intense outpatient procedures performed in high-risk patients; however, its use was not associated with any improvement in recovery profiles.
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Randomized Controlled Trial Clinical Trial
Postoperative analgesia by intraarticular and epidural neostigmine following knee surgery.
To define the analgesic efficacy, and to identify a possible site of action, of epidural and intraarticular neostigmine. ⋯ Although peripheral neostigmine 1 microg/kg did not result in postoperative analgesia, the same dose applied epidurally resulted in over 5 hours of analgesia, similar to a fivefold dose applied peripherally. The results suggest that epidural neostigmine has a greater analgesic efficacy than peripherally applied neostigmine.