Regional anesthesia
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Regional anesthesia · Mar 1995
Comparative Study Clinical TrialPostoperative myocardial ischemia: epidural versus intravenous patient-controlled analgesia. A pilot project.
Continuous postoperative epidural analgesia with bupivacaine (BUP) and morphine (MS) may be associated with a decreased incidence of postoperative myocardial ischemia (ISCH) and infarction (MI). This study evaluated the incidence of ISCH and MI in patients with two or more risk factors for coronary artery disease (CAD) who were admitted to the ICU after upper abdominal surgery for cancer. ⋯ These preliminary results suggest that epidural anesthesia and analgesia may decrease the incidence of postoperative tachycardia, ischemia, and possibly infarction in patients undergoing upper abdominal procedures.
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Regional anesthesia · Mar 1995
Case ReportsUnintentional subdural block during labor epidural in a parturient with prior Harrington rod insertion for scoliosis. Case report.
The authors report a case of unintentional subdural block in a parturient with prior Harrington rod insertion. ⋯ Lumbar epidural anesthesia is not always an easily performed technique and is known to be associated with a higher incidence of complications in patients with prior Harrington rod insertion. Prompt recognition and proper management of subdurally placed needle and catheter avoided more serious complications.
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Regional anesthesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialSpinal anesthesia for cesarean delivery. A comparison of two doses of hyperbaric bupivacaine.
Hyperbaric local anesthetic pools in the thoracic spinal curvature in supine patients. The authors hypothesized that patients receiving 12 or 15 mg of hyperbaric bupivacaine would achieve similar levels of sensory block but the spinal anesthetic would be denser and longer lasting in patients receiving the 15 mg dose. ⋯ Parturients receiving 15 mg of hyperbaric bupivacaine developed a higher mean level and longer duration of sensory analgesia than those receiving 12 mg.
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Regional anesthesia · Mar 1995
Randomized Controlled Trial Comparative Study Clinical TrialAddition of bicarbonate to plain bupivacaine does not significantly alter the onset or duration of plexus anesthesia.
In an effort to elucidate further the effect of alkalinization of bupivacaine on its anesthetic effect, a study was undertaken using alkalinized and non-alkalinized bupivacaine for lumbar plexus block and comparing the results with those obtained previously with brachial plexus block. ⋯ The data obtained in the present study indicate that alkalinization of non-epinephrine-containing bupivacaine does not reduce the latency or increase the duration of analgesia or anesthesia after lumbar plexus block. Since most of the studies that do show such an effect of alkalinization were carried out using epinephrine-containing bupivacaine, it is postulated that in those studies alkalinization contributed to the decrease in latency and increase in duration, not so much by providing an increased amount of local anesthetic in the free base form, but by reactivating epinephrine's vasoconstrictor activity, which is inactivated by a low pH.
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Regional anesthesia · Mar 1995
Clinical TrialEpidural air injection assessed by transesophageal echocardiography.
The object of this study, using transesophageal echocardiography (TEE) in anesthetized patients, was to investigate the occurrence of venous air embolism (VAE) when air is injected into the epidural space. ⋯ No evidence of clinically significant VAE was seen in any patient. The results suggest that drugs injected into the epidural space may have unexpectedly easy access to the venous circulation with a potential to produce unwanted systemic effects. Clinicians should be alert to the possibility that local anesthetics, or any other drug placed epidurally, may rapidly enter the systemic circulation even without the intravenous placement of an epidural catheter.