Regional anesthesia
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Regional anesthesia · Nov 1991
Comparative StudyThe effects of epinephrine on the anesthetic and hemodynamic properties of ropivacaine and bupivacaine after epidural administration in the dog.
Ropivacaine is a new local anesthetic that is chemically related to mepivacaine and bupivacaine. Previous laboratory studies have demonstrated that ropivacaine possesses an anesthetic profile similar to that of bupivacaine and has less arrhythmogenic potential. The current study was initiated to compare the hemodynamic and anesthetic effects of epidurally administered 0.75% bupivacaine and 1% ropivacaine, with and without epinephrine (1:200,000), in the dog. ⋯ The addition of epinephrine did not alter onset or duration of sensory or motor block in this animal model. Epinephrine reduced the average anesthetic blood concentration observed in both treatment groups at the various time intervals, but not the time to achieve the mean maximum blood level. No residual adverse effects were observed in any animal.
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Regional anesthesia · Nov 1991
Temperature monitoring during epidural anesthesia for cesarean delivery.
Tympanic, rectal, and axillary temperatures were measured and compared in 12 ASA Physical Status I and II parturients during epidural anesthesia for cesarean delivery. Measurements were performed before (T0) and at 15 (T1), 30 (T2), 45 (T3), and 60 (T4) minutes after epidural anesthesia. At birth, rectal neonatal and maternal temperatures were measured. ⋯ The relative hypothermia observed in the newborns at birth after regional anesthesia was well correlated with the decrease in maternal temperature. A decrease in tympanic temperature of 1.4 degrees C developed during the course of epidural anesthesia for cesarean delivery. This decrease was underestimated by the measurement of rectal and axillary temperatures.
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Regional anesthesia · Sep 1991
Case ReportsPost dural puncture headache after lumbar sympathetic block: a report of two cases.
Dural puncture during lumbar sympathetic block (LSB) is a recognized but apparently uncommon complication. Interestingly, post dural puncture headache (PDPH) has not been reported as a complication of LSB. ⋯ In the second case the patient developed PDPH and a subdural block during separate LSBs. Possible anatomic explanations for these complications are discussed.
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Regional anesthesia · Sep 1991
Case ReportsBlood pressure, not heart rate, as a marker of intravascular injection of epinephrine in an epidural test dose.
Investigators have generally examined the heart rate response after injection of a test dose containing a beta-adrenergic agonist as an indicator of intravascular placement of an epidural catheter. Some have reported an increase in blood pressure accompanying the increase in heart rate after an intravascular injection. ⋯ As far as we know, this phenomenon previously has been described only in patients receiving beta-adrenergic blocking drugs. In these patients it may be related to decreased beta-adrenergic receptor responsiveness in elderly patients; this and other possible mechanisms are discussed.