Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 1995
Randomized Controlled Trial Clinical TrialDesflurane: a new volatile anesthetic for cesarean section. Maternal and neonatal effects.
Desflurane, a new volatile anesthetic agent with low blood/gas solubility, has recently been studied in clinical and animal trials but its use in obstetrics has not been adequately evaluated. This prospective study was undertaken to evaluate the maternal and neonatal effects of desflurane in obstetrical patients. Seventy-five healthy parturients undergoing primary or repeat cesarean section were randomly assigned to one of three groups of 25 each, end-tidal 3% desflurane, 6% desflurane or 0.6% enflurane, combined with 50% N2O and O2. ⋯ Patients in all three groups developed transient hypertension and tachycardia during induction of anesthesia which returned to baseline values in approximately 5 min. Neonatal outcome was equally good in the three groups. More neonates in the 6% desflurane group had TSR > 90 s compared to the 3% desflurane group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialQT interval of the ECG, heart rate and arterial pressure during anaesthetic induction: comparative effects of alfentanil and esmolol.
In a double-blind study the effect of esmolol and alfentanil on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during anaesthetic induction was studied in 59 oxycodone- and atropine-premedicated ASA class I-(II) patients with a mean age of 26 yr (range 15-50 yr). The patients were randomly allocated to one of the four groups: saline, esmolol 2 mg.kg-1, esmolol 3 mg.kg-1 or alfentanil 0.03 mg.kg-1. Both doses of esmolol prevented the prolongation of the QTc interval after thiopental and suxamethonium, but not after laryngoscopy and intubation. ⋯ Esmolol did not prevent the increase in the heart rate and arterial pressure in response to laryngoscopy and intubation. No cardiovascular responses to laryngoscopy and intubation occurred in the patients treated with alfentanil. No cardiac arrhythmias occurred in the esmolol 3 mg.kg-1 group, whereas the frequency of ventricular ectopic beats was 40% in the saline group and 13-20% in the other groups.
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Acta Anaesthesiol Scand · Aug 1995
Randomized Controlled Trial Clinical TrialPerioperative monitoring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium.
The frequency of postoperative residual neuromuscular block following the use of the long-acting non-depolarizing muscle relaxants is high, and manual evaluation of the response to nerve stimulation does not eliminate the problem. In this prospective and randomized study we evaluated the hypothesis that perioperative use of acceleromyography would allow for a more rational and precise administration of the long-acting muscle relaxant pancuronium resulting in a decrease in 1) the incidence and severity of postoperative residual neuromuscular block, 2) the amount of pancuronium used, and 3) the time from end of surgery to tracheal extubation. Forty adult patients were randomized into two groups, one managed without the use of a nerve stimulator, the other monitored using train-of-four (TOF) nerve stimulation and acceleromyography. ⋯ In the patients managed without a nerve stimulator, the trachea was extubated when the anaesthetist judged the neuromuscular function to have recovered adequately for upper airway protection and spontaneous ventilation. In patients monitored with acceleromyography, the trachea was extubated when the TOF ratio was above 0.70. In all 40 patients, TOF ratio was measured using mechanomyography immediately after tracheal extubation and the patients were evaluated for clinical signs of residual neuromuscular block.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialParavascular lumbar plexus block: block extension after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml.
The goal of this prospective randomized study was to assess the extension of the "three-in-one" paravascular lumbar plexus block after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml. Three-in-one blocks were achieved in 12 of 39 (31%) patients given 20 ml of 1% mepivacine (group 1), and 17 of 41 (41%) patients given 40 ml (Group 2) of the same solution (n.s.). ⋯ We conclude that femoral nerve stimulation is effective in faciliating blockade in the femoral nerve but not the obturator or lateral cutaneous femoral nerve with the tested solution and volumes, and therefore not particularly effective for achieving complete 3-in-1 blockade. Within the clinically relevant range of 20-40 ml, the volume of mepivacaine 10 mg/ml does not appear to influence the extent of blockade.
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Acta Anaesthesiol Scand · Aug 1995
Randomized Controlled Trial Clinical TrialRespiratory changes during treatment of postoperative pain with high dose transdermal fentanyl.
This study made a longterm (72 hours) evaluation of the efficacy and possible side-effects of transdermal delivery of fentanyl (TTS-system) for post-operative pain relief. The study was double-blind, placebo-controlled with either a TTS-system delivering fentanyl 100 micrograms.h-1 and rescue analgesic on demand or a placebo system and analgesic on demand. Analgesic consumption, pain, general satisfaction, respiratory rate, and levels of SpO2 and tcCO2 (pulse oximetry and transcutaneous CO2 measuring) were evaluated. ⋯ These findings terminated the study. The 100 micrograms transdermal fentanyl system is agreeable to the patients, but apparently too potent for routine postoperative pain relief due to a risk of respiratory depression. Respiratory frequency can not be relied upon as sole indicator of insufficient respiration.