Regional anesthesia
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Regional anesthesia · Jul 1996
Review Case ReportsLabor analgesia and anesthesia in a patient with spinal muscular atrophy and vocal cord paralysis. A rare and unusual case report.
A case of labor analgesia and anesthesia in a 23-year-old woman with spinal muscular atrophy and vocal cord paralysis is reported. As spinal muscular atrophy is a progressive degenerative disorder of spinal anterior horn cells, with generalized neuromuscular weakness as a common sequela, the goal of anesthetic management is to provide satisfactory labor analgesia and anesthesia with minimal compromise of respiratory function. ⋯ It is believed that labor analgesia and anesthesia can be provided adequately with lumbar epidural techniques. An understanding of the physiology underlying spinal muscular atrophy is essential to safe anesthetic management of the laboring parturient.
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Regional anesthesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison between hemodynamic changes after single-dose and incremental subarachnoid anesthesia.
The depressant activity on sympathetic tone of subarachnoid anesthetic block is well known. The aim of this study was to compare cardiovascular response to an incremental dose of subarachnoid anesthesia administered through a small-bore microcatheter with the response to single-dose spinal anesthesia. ⋯ In well-hydrated, healthy patients incremental local anesthetics offer adequate subarachnoid anesthesia with minimal hemodynamic effects.
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Regional anesthesia · Jul 1996
Case ReportsPressure sores as a complication of patient-controlled epidural analgesia after cesarean delivery. Case report.
Postoperative epidural analgesia using mixtures of bupivacaine and opioids has become common practice following abdominal surgery. Side effects such as hypotension, motor block, respiratory depression, pruritus, and urinary retention are well known. Pressure sores occurring within the first 24 hours are extremely rare. ⋯ Pressure sores following postoperative epidural analgesia may occur even in young patients. Although bupivacaine may induce a motor block, its combination with other drugs in the analgesic mixture or other contributing factors may explain the occurrence of pressure sores. Prophylaxis and increased alertness should eliminate this complication.
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Regional anesthesia · Jul 1996
Antinociceptive and motor-blocking efficacy of ropivacaine and bupivacaine after epidural administration in the dog.
This study was initiated to evaluate the antinociceptive and motor blocking capabilities of epidurally administered 0.5% and 0.75% ropivacaine and bupivacaine using a blinded, random crossover design in the dog. Additionally, serum drug concentrations and serum protein binding were determined. ⋯ The 0.5% solutions produced similar sensory block of the vertebral dermatomes. Duration of dermatomal block with 0.75% bupivacaine was longer than with the corresponding ropivacaine concentration. Ropivacaine produced motor block of shorter duration as compared with bupivacaine. Serum concentrations of the two drugs were similar after injection of the same doses. In this animal model, ropivacaine produced shorter durations of sensory and motor block than corresponding concentrations of bupivacaine. These data are consistent with previously published data in animals and humans.
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Regional anesthesia · Jul 1996
Editorial Comment Comparative StudyIs an ounce of preoperative local anesthetic better than a pound of postoperative analgesic?