Anesthesiology review
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Anesthesiology review · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled and nurse-administered analgesia using intravenous fentanyl during labor.
Preliminary observations have shown that fentanyl citrate, a potent narcotic, is helpful during labor without undue side effects. This randomized prospective investigation compared the patient-controlled administration of fentanyl with that of administration by nurses on request. Eighty healthy women beginning active labor (cervical dilation 4 cm) at term were assigned to receive fentanyl intravenously by either patient-controlled administration (n=37) or nurse administration on demand (n=43). ⋯ Maternal oversedation and vomiting did not occur. Neonatal naloxone therapy was used infrequently, umbilical serum levels of fentanyl were the same in both groups, and postnatal neuroadaptive testing revealed comparable results in both groups. Despite the usefulness of fentanyl during labor, administration by the patient had no advantages over administration by the nurses in significantly reducing drug use, improving pain relief, or avoiding drowsiness.
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Anesthesiology review · Sep 1990
Combined continuous and demand narcotic dosing for patient-controlled analgesia after cesarean section.
New patient-controlled analgesia devices can deliver an analgesic by continuous infusion along with demand dosing. This prospective investigation involving postcesarean-section patients was undertaken to determine whether a combination of continuous infusion and demand dosing of meperidine would provide more effective analgesia than would demand dosing alone during the first 24 hours. During a 12-month period, 171 patients were prescribed meperidine postoperatively, using a 5- to 10-mg demand dose no more frequently than every 10 minutes. ⋯ All patients were able to understand the nurse, became ambulatory, and tolerated liquids on the first postoperative day. The infusion rate of 20 mg/h was most acceptable in requiring fewer demand doses while providing satisfactory pain relief without undesired sedation. In conclusion, a system combining continuous infusion and demand dosing was preferable to demand dosing alone, and added no apparent hazards.
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A kit for difficult intubation can be assembled quickly from vascular catheters and sheaths commonly available in surgical facilities. The kit provides for continuous oxygen administration throughout all phases of its application in difficult upper airway management. Such applications include stylet-guided endotracheal intubation, cricothyroid puncture, transtracheal ventilation, and translaryngeal catheter-guided retrograde tracheal intubation. A technical description of the Difficult Intubation Kit and guidelines for its use in difficult airway management are presented.