Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural block for obstetrics: comparison of bolus injection of local anesthetic with gravity flow technique.
To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection. ⋯ Gravity flow administration of local anesthetic-opioid solution during epidural block for obstetrics was associated with fewer signs of systemic drug absorption and cardiovascular perturbations than was the traditional bolus injection. This study supports the current opinion that slow administration of local anesthetic during epidural block contributes to fewer adverse events.
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Randomized Controlled Trial Clinical Trial
Acute hemodynamic responses to electroconvulsive therapy are not related to the duration of seizure activity.
To test the hypothesis that the magnitude of the acute hemodynamic response to electroconvulsive therapy (ECT) is related to the duration of the seizure activity in patients receiving different dosages of intravenous (i.v.) lidocaine. ⋯ Despite producing dose-related decreases in the duration of both motor and EEG seizure activity, lidocaine failed to attenuate the acute hemodynamic response to ECT. Thus, the acute hemodynamic response to ECT is not related to the duration of seizure activity.
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Randomized Controlled Trial Clinical Trial
Combined hemodilution and hypotension monitored with jugular bulb oxygen saturation, EEG, and ECG decreases transfusion volume and length of ICU stay for major orthopedic surgery.
To assess the efficacy and safety of hemodilution combined with induced hypotension during surgery. ⋯ Hemodilution combined with induced hypotension was safe and may reduce the need for transfusion and ICU admission.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of 0.25% ropivacaine and bupivacaine for epidural analgesia for labor and vaginal delivery.
Part 1: To measure ropivacaine levels in the mother and infant at delivery after continuous lumbar epidural infusion. Part 2: To compare epidural ropivacaine to epidural bupivacaine for labor analgesia in regard to effectiveness, motor blockade, and maternal and neonatal effects. ⋯ Both ropivacaine and bupivacaine produced excellent analgesia for labor with no major adverse effect on the mother or neonate.
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Randomized Controlled Trial Comparative Study Clinical Trial
Remifentanil versus alfentanil in a balanced anesthetic technique for total abdominal hysterectomy.
To compare the intraoperative effects and recovery characteristics of remifentanil hydrochloride and alfentanil when administered as part of balanced anesthesia, and to assess the effects of an additional remifentanil infusion administered as analgesic pretreatment before removal of the uterus. ⋯ A mean remifentanil infusion of 0.49 microgram/kg/min is as effective as a mean alfentanil infusion of 1.99 micrograms/kg/min in suppressing intraoperative responses. Doubling of the remifentanil infusion to 0.5 microgram/kg/min before the major stress event improves suppression of responses and lowers intraoperative use of remifentanil without prolonging recovery times. Remifentanil allows faster awakening times than alfentanil, but preemptive administration of postoperative analgesics is recommended to facilitate discharge.