CRNA : the clinical forum for nurse anesthetists
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intraoperative morphine sulfate and methadone hydrochloride on postoperative visual analogue scale pain scores and narcotic requirements.
Morphine sulfate and methadone hydrochloride exhibit very different half-lives but are described as having an analgesic potency of one. The use of a drug like methadone may provide prolonged and constant analgesia in the perioperative setting. This double-blinded investigation used methadone and morphine intraoperatively and measured pain scores and narcotic requirements in the first 24 hours postoperatively. ⋯ Fifteen patients received morphine and fifteen patients received methadone. There was no significant difference between the two groups in terms of age, height, weight, and ASA status. No statistically significant difference was observed among the two groups between the amount of analgesic requirements postoperatively or in the visual analogue scale pain score.
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Randomized Controlled Trial Clinical Trial
Comparison of sufentanil versus fentanyl with 0.125% bupivacaine for continuous labor epidural anesthesia.
The search for an ideal combination of agents for labor epidural anesthesia has become a focus of current research studies. This study was performed to determine if a combination of sufentanil with bupivacaine would show superior analgesia and fewer side effects when compared with an equipotent combination of fentanyl with bupivacaine in continuous labor epidurals. After the approval of the Human Investigations Committee and written consent from the subjects, 54 parturients were assigned to receive one of two epidural drug combinations in a randomized double-blind design. ⋯ There were no statistically significant differences found in VAS scores or requirement for epidural top-up injections between the two groups. Demographics, side effects, apgar scores, and maternal satisfaction scores were also comparable. Both sufentanil and fentanyl with bupivacaine provide comparably safe and satisfactory analgesia for labor epidural anesthesia.
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Pipecuronium Bromide (Arduan, Organon, Inc, West Orange) is a long-acting, nondepolarizing neuromuscular blocking agent. The efficacy of pyridostigmine 170 micrograms/kg intravenously (approximately 10 mg/70 kg) for reversing pipecuronium has not been reported. This study was performed to determine the time required to obtain a train-of-four (TOF) ratio of 0.7 after administration of pyridostigmine 140 micrograms/kg at 25% recovery of T1 after pipecuronium-induced neuromuscular blockade. ⋯ Anesthesia was maintained with a nitrous oxide/narcotic technique and the use of potent inhalational anesthetics was avoided. The mean reversal time was found to be 16.14 minutes, with a minimum of 10.3 minutes and a maximum of 24.3 minutes. The standard error was +/- 1.05 minutes with a variance of 17.68 minutes.
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The purpose of this study was to determine the correlation between patient controlled analgesia and continuous epidural analgesia after total knee or total hip replacement on the length of hospital stay. Stress responses to postoperative pain, including decreased mobility, compromised respiratory function, increased catecholamine release, and hypercoagulation, may adversely affect patient recovery, thus lengthening hospital stay. A retrospective chart review of 127 adult, American Society of Anesthesiology (ASA) I, II, or III, patients who had undergone total knee arthroplasty (TKA) or total hip replacement (THR) was obtained. ⋯ These findings were not statistically significant at P = 0.054. LOS did not correlate with age, weight, height, type or surgery, or the ASA classification. Further research into the effectiveness of continuous infusion of epidural bupivacaine and epidural morphine and their impact on LOS may be warranted.
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Throughout its pharmacological history in anesthesia practice, succinylcholine has been notorious for its role in causing life-threatening hyperkalemia. Normally the serum potassium level will increase .5 to 1.0 mEq/L because of a sustained opening of the receptors in the neuromuscular junction and release of myoplasmic potassium. However, in certain patients the drug will result in a much higher level of serum potassium. ⋯ The patient recovered without complications and was later discharged to home. Succinylcholine definitely has its use in anesthesia, but it is imperative for the provider to be discriminatory in its administration. An all-encompassing history is paramount to discover any hidden rationale not to use succinylcholine.(ABSTRACT TRUNCATED AT 250 WORDS)