Acta anaesthesiologica Sinica
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Acta Anaesthesiol. Sin. · Mar 1999
Randomized Controlled Trial Clinical TrialLow dose ketamine and midazolam as supplements for spinal anesthesia.
Low dose ketamine and midazolam together were used as supplements during spinal anesthesia to provide analgesia for insertion of spinal needle and intraoperative sedation. ⋯ The use of low dose ketamine together with midazolam as supplement for spinal anesthesia is helpful in anesthetic practice.
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Selective spinal nerve block is a useful tool in today's multidisciplinary approach to the diagnosis and treatment of low back pain. The indications, sources of spinal pain, block technique, result interpretation, complications and clinical applications relevant to the subject are discussed. ⋯ In some cases, therapeutic effect including that from surgical intervention can be achieved selectively at the symptomatic root. However, controversy remains and therefore well designed clinical studies are needed to provide more information about the validity of this diagnostic and therapeutic modality.
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Acta Anaesthesiol. Sin. · Mar 1999
Case ReportsEphedrine-induced complete atrioventricular block with ventricular asystole during rapid concomitant phenytoin infusion: a case report.
Ephedrine is widely used to elevate blood pressure, however, one should be cautious to use it concomitantly with phenytoin infusion in neurosurgical procedures. A 59-year-old female was admitted for craniotomy with removal of metastatic brain tumor. During operation phenytoin infusion was given to forestall postoperative seizure. ⋯ She was successfully resuscitated. We conclude that when phenytoin is used intraoperatively it should be administered by an infusion pump at a rate of less than 25 mg/min and under continuous monitoring of cardiac rhythm, heart rate, and blood pressure. When pressure support is required, the use of a pure alpha-agonist may minimize the risk of adverse reactions in the presence of phenytoin infusion.
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It has long been understood that patients with spinal cord injury (SCI) above T6-7 may develop autonomic hyperreflexia (AH) and pose an anesthetic challenge. To date, there is no consensus regarding anesthesia management of these patients among anesthesiologists. Many anesthetic techniques have been proposed and used with varying success, but none of them is uniformly successful. ⋯ In the past fifteen years (1982-1997), we have used isobaric spinal anesthesia (ISA) in thirteen patients with SCI for various surgical procedures. Although four of these patients had previous history of AH, there was not a single incidence of AH during the perioperative period. Our favorable experiences lead us to believe that ISA is a useful anesthetic technique for SCI patients undergoing surgery.
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Acta Anaesthesiol. Sin. · Mar 1999
The dose effect of propofol on cerebrovascular reactivity to carbon dioxide in rabbits.
Propofol has several properties beneficial to intracranial operation such as reduction in cerebral metabolic rate and cerebral blood flow (CBF) in a dose-dependent manner while leaving autoregulation intact. Several studies have demonstrated that the responsiveness of CBF to changes in arterial carbon dioxide tension (PaCO2) is maintained during propofol anesthesia in both humans and animals. These studies showed a significant difference in the CBF-CO2 reactivity slope between awake and propofol anaesthetized groups, but no comparison with different doses of propofol was made. To determine the dose effect of propofol on cerebrovascular CO2 reactivity, we used laser Doppler flowmetry (LDF) to detect the changes of CBF during propofol anesthesia. ⋯ These data indicate that cerebral vasomotor responsiveness to CO2 during propofol anesthesia is preserved and that the slope of CBF-CO2 reactivity is independent of propofol doses as mean arterial blood pressure is maintained.