Articles: analgesia.
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Southern medical journal · Apr 1992
Pediatric analgesia with epidural fentanyl citrate administered by nursing staff.
Even though epidural analgesia is effective and has advantages over conventional postoperative analgesia, it is also labor intensive, requiring 24-hour supervision by an anesthesiologist. In an effort to decrease the manpower requirements, some hospitals allow the nursing staff to administer epidural narcotics to adult patients. In children, however, this practice has been limited. ⋯ No intravascular or intrathecal injections were noted, nor did any inadvertent epidural injections of medications occur. No patient had respiratory depression (respiratory rate less than 10% for age). We believe epidural administration of fentanyl by a carefully educated nursing staff is safe and effective in children.
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In order to find out the effectiveness of continuous epidural infusion with a portable disposable pump (Baxter Infusor) in management of post-operative pain, a comparative study was made on a continuous epidural infusion method with a syringe pump versus a twice-a-day intermittent epidural infusion method. Study 1: With 41 patients who underwent thoracic/abdominal surgery between June, 1991 and September, 1991, researches were conducted on the effects of pain relief, methods for postoperative pain relief and weaning course from confinement to bed. The degree of pain examined at five points--at 4 hours, 12 hours, 16 hours, 24 hours and 28 hours postoperatively--indicated a significantly lower level in the Infusor group, compared with the intermittent infusion group (P less than 0.05). ⋯ When the syringe pump method and the intermittent method were compared, the evaluation of the syringe pump method was significantly higher (P less than 0.05). The evaluation by nurses, on the other hand, was remarkably higher on the infusion method than on the other two methods (P = 0.0001). Based on the results of the two studies summarized above, the Infusor method is considered to be most effective for pain control among the three methods.
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J. Cardiothorac. Vasc. Anesth. · Apr 1992
Randomized Controlled Trial Comparative Study Clinical TrialCoronary artery bypass grafting using two different anesthetic techniques: Part I: Hemodynamic results.
Hemodynamic changes were studied during two different anesthetic techniques in 54 patients undergoing coronary artery bypass grafting (CABG). All patients had normal to moderately impaired left ventricular function and were randomly assigned to two groups. In 27 patients, high thoracic epidural analgesia (TEA) with bupivacaine 0.375% plus sufentanil 1:200,000 (ie, 5 micrograms/mL) was used in combination with general anesthesia with midazolam/N2O; in the other 27 patients, general anesthesia (GA) with midazolam and sufentanil was used. ⋯ Four GA patients developed electrocardiographic evidence of prebypass ischemia and, therefore, more nitroglycerin was needed for treating myocardial ischemia. More sodium nitroprusside was needed in the GA group during cardiopulmonary bypass (CPB) and the post-bypass period to treat hypertension with a high SVR. In conclusion, hemodynamic stability was more pronounced in the TEA than the GA group before and after CPB.
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A disposable patient-controlled analgesia (PCA) device was evaluated in 20 children after major abdominal, urological and orthopaedic surgery. All patients were given a high dependency level of nursing care in general wards. ⋯ Morphine consumption was similar with the two techniques, but varied widely between patients. The disposable device has a complementary role to play in the provision of a comprehensive pain relief service for children.