Regional anesthesia
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Regional anesthesia · May 1994
Comment Clinical Trial Controlled Clinical TrialEvaluation of brachial plexus anesthesia for upper extremity surgery.
Brachial plexus anesthesia is the preferred anesthetic at the authors' institution for upper extremity surgery. The article is a prospective observational evaluation of brachial plexus anesthesia for surgical success of the block and immediate and postoperative complications. ⋯ Both interscalene and axillary blocks are safe and effective techniques for upper extremity surgery.
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Regional anesthesia · May 1994
Clinical TrialAnalysis of heart rate dynamics as a measure of autonomic tone in obstetrical patients undergoing epidural or spinal anesthesia.
The purpose of this study is to determine if spectral analysis of beat-to-beat heart rate variability will provide important data on autonomic nervous system function during either spinal or epidural anesthesia that is not apparent from the monitoring of mean heart rate and blood pressure. ⋯ These data suggest that autonomic tone decreased with spinal and epidural anesthesia but the sympathetic-parasympathetic balance (expressed as PLF/PHF) did not change. Spectral measures, as well as approximate entropy, provide an independent evaluation of the integrity of the autonomic nervous system and cardiovascular control mechanisms that cannot be discerned from mean heart rate and blood pressure.
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Regional anesthesia · May 1994
Randomized Controlled Trial Clinical TrialPlasma concentration profile of epidural alfentanil. Bolus followed by continuous infusion technique in the parturient: effect of epidural alfentanil and fentanyl on fetal heart rate.
A combined bolus and continuous epidural infusion technique of opioid and bupivacaine mixture has been described, although no pharmacokinetic data for this technique exists. The study documents the plasma concentration profile of epidural alfentanil in parturients using this technique, and evaluates the fetal heart rate tracing for associated changes following opioid administration. ⋯ With the dosage regimen used in this study, an initial epidural bolus with continuous infusion technique generates a steady state plasma concentration of alfentanil that is below levels associated with direct respiratory depression.
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Regional anesthesia · May 1994
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of combined spinal-epidural anesthesia using two different techniques.
This investigation was designed to evaluate combined spinal-epidural anesthesia with a needle-through-needle technique using two different needle sets. One kit has a standard 16-gauge Tuohy needle and a 26-gauge spinal needle that extends 13 mm beyond the tip of the Tuohy needle (set A). The other kit consists of a 16-gauge Tuohy needle with an aperture in its curve (back hole) for the insertion of a 26-gauge spinal needle that protrudes 10 mm beyond the tip of the epidural needle (set B). ⋯ Combined spinal-epidural provides satisfactory surgical and postoperative analgesia for total knee arthroplasty. An improved needle set for the needle-through-needle technique would be one with a modified Tuohy needle having an aperture at the back and a spinal needle protruding more than 13 mm beyond the Tuohy needle.