Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1994
Randomized Controlled Trial Clinical TrialMorphine does not affect laser induced warmth and pin prick pain thresholds.
The aim of this double-blind, placebo-controlled study was to evaluate the effect of intravenously administered morphine in humans using an argon laser to induce experimental pain. Thirty volunteers were randomised to receive a total of 0.15 mg.kg-1 morphine intravenously or saline. The argon laser was used to determine the possible change in warmth thresholds and pin prick pain thresholds. ⋯ The pinprick pain thresholds of the morphine group increased 9.4% (P < or = 0.05) from baseline (1.39 W +/- 0.7 W) while the corresponding thresholds of the placebo group was 4.6% (P > or = 0.05) (baseline: 1.73 W +/- 0.44 W). The differences seen between the morphine group and the placebo group were not statistically significant and thus it was demonstrated that morphine had no effect of either the feeling of warmth or the pain elicited by the argon laser. The present study supports other investigations and clinical experience suggesting that intermittent pain is not relieved by morphine unlike continuous pain, which can be relieved by morphine.
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Acta Anaesthesiol Scand · Feb 1994
Randomized Controlled Trial Clinical TrialThe effects of regional anaesthesia for caesarean section on maternal and fetal blood flow velocities measured by Doppler ultrasound.
We studied the effects of spinal anaesthesia (Group S), epidural anaesthesia (Group E), and combined spinal and epidural anaesthesia (Group SE), on maternal and fetal blood flow in 24 healthy parturients (n = 8/group) with uncomplicated singleton pregnancies using Doppler technique. Prior to the induction of anaesthesia, the patients were prehydrated with balanced electrolyte solution 15 ml.kg-1 over a period of 15 min. After the induction of regional anaesthesia, the systolic blood pressure was maintained within 15% limits of the preoperative values using prophylactic etilefrine infusion in Groups S and SE. ⋯ Rapid intravenous prehydration had no effects on uteroplacental or fetal circulation as indicated by unaltered uterine, umbilical, and fetal middle cerebral artery PIs. After the onset of T7 analgesia, the uterine artery PI was increased in Group S indicating increased uterine vascular resistance while no changes occurred in Groups E and SE. No adverse effects were observed on the neonates as indicated by the Apgar score and the umbilical artery and vein acid-base status in any of the groups.
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This review is an update on anesthetic agents and their excretion into breast milk; it presents the reported effects on suckling infants, and discusses the precautions which should be considered. For most anaesthetic agents, there is very sparse information about breast milk excretion and even less published knowledge about the possible effects on the suckling infant. ⋯ However, repeated administration of certain opiates and benzodiazepines has been reported to cause adverse effects in neonates, with premature neonates apparently being more susceptible. Thus, in long-term treatment with these drugs, the importance of uninterrupted breast feeding should be assessed against possible adverse drug effects in the neonate.
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Acta Anaesthesiol Scand · Feb 1994
Cardiovascular depression by isoflurane and concomitant thoracic epidural anesthesia is reversed by dopamine.
Interactive effects between exogenous dopamine (DA) and isoflurane (I) combined with thoracic epidural blockade (TEA) were studied in dogs during chloralose anesthesia. The I-TEA intervention per se decreased heart rate (HR; 28%), mean arterial pressure (MAP; 63%), cardiac output (CO; 54%), left ventricular dP/dt (LVdP/dt; 75%) and LVdP/dt/systolic arterial pressure (SAP; 42%). Prior to the I-TEA intervention, dopamine increased MAP, CO, LVdP/dt, LVdP/dt/SAP and stroke volume (SV) already at the dose 10 micrograms.kg-1.min-1 and, additionally, increased mean pulmonary artery pressure (MPAP) at the dose 20 micrograms.kg-1.min-1. ⋯ At the dose 20 micrograms.kg-1.min-1, DA also increased MAP (39%), LVdP/dt (119%), LVdP/dt/SAP (73%), SVR (28%) and MPAP (70%) above levels prior to I-TEA. To conclude, exogenous dopamine effectively and dose-dependently counters cardiovascular depression induced by the anesthetic technique of combining I and TEA. The pressor and systemic vasoconstrictor actions of dopamine are potentiated by conjoint administration of I and TEA.
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Acta Anaesthesiol Scand · Feb 1994
Randomized Controlled Trial Clinical TrialAlfentanil or fentanyl during isoflurane-based anaesthesia for day-care knee arthroscopy?
Forty patients agreed to participate in a study to compare whether fentanyl or alfentanil used as analgesic is associated with quicker recovery following anaesthesia for outpatient arthroscopy procedure. Psychomotor tests including choice reaction time (CRT), perceptive accuracy test (PAT) and finger tapping test (FTT) were done prior to induction of anaesthesia with propofol (2-3 mg.kg-1). Patients were then divided into two groups: Group F (fentanyl) received 0.1 mg fentanyl prior to start of surgery and thereafter 0.05 mg every 30 min during the procedure. ⋯ Clinical recovery and time to discharge home ("home ready") were also significantly longer in Group F. There was no difference in recovery as seen in the PAT and CRT between the groups. Also, there was no difference in the incidence of side effects and the pain intensity (VAS) scores were similar in the two groups at all time periods.(ABSTRACT TRUNCATED AT 250 WORDS)