Masui. The Japanese journal of anesthesiology
-
A 26-yr-old morbidly obese parturient with a body mass index of 62 kg.m-2 underwent elective cesarean section for preeclampsia under epidural anesthesia. The distance between the skin and the epidural space was about 9 cm at the L3-4 interspace via mid approach. Epidural catheter was inserted 5 cm cephalad in the sitting position and a bolus of 17 ml of mepivacaine 1.5% was given in the supine position. ⋯ Both maternal and neonatal postpartum courses were uneventful. In conclusion, elective cesarean section in a morbidly obese parturient was successfully managed with epidural anesthesia. This indicates that an elective cesarean section under epidural anesthesia reduce the risk of perioperative complications in a morbidly obese parturient.
-
A great deal of new information on alpha 2-adrenoceptor agonists has recently been accumulated in humans; alpha 2-agonists have several beneficial actions in clinical anesthesia including sedative, anxiolytic as well as analgesic effects, improved hemodynamic stability, and etc. In the first part of this review, we summarized the structure, signal transmission and basic pharmacology of alpha 2-adrenoceptor agonists (clonidine and dexamedetomidine), and evaluated their usefulness for premedication, and as anesthetic adjuvants as well as agents for stabilizing circulation in the clinical settings. In addition, we referred to practical problems associated with their use.
-
Randomized Controlled Trial Clinical Trial
[Effects of continuous epidural administration of fentanyl and morphine on postcesarean pain].
We studied the effects of continuous epidural administration of fentanyl and morphine with bupivacaine for management of postcesarean pain. Eighteen patients received either bolus epidural administration of fentanyl 100 micrograms or morphine 3 mg with 0.5% bupivacaine 4 ml, followed by continuous infusion of fentanyl 33 micrograms.ml-1 with 0.17% bupivacaine or morphine 0.21 mg.ml-1 with 0.17% bupivacaine for 48 hours, respectively. Pain score was assessed at 0 h, 12h, 24h and 48h after leaving the operating room. ⋯ In all cases pruritus was noted. Severe pruritus was observed in the morphine group significantly more than in the fentanyl group. The current results indicate that morphine may be preferable to fentanyl for postcesarean pain control using the present opioid doses.