Articles: general-anesthesia.
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J Cardiothorac Anesth · Dec 1987
Randomized Controlled TrialThe role of intrathecal morphine in the anesthetic management of patients undergoing coronary artery bypass surgery.
The study was undertaken to assess the effects of intrathecal morphine (ITM) on perioperative hemodynamics, and anesthetic and postoperative analgesic requirements in patients anesthetized with fentanyl/enflurane undergoing coronary artery bypass surgery. Forty patients were randomized in a double-blind fashion to receive either intrathecal morphine or saline. Nineteen patients received ITM, 0.02 mg/ kg, and 21 intrathecal saline (ITS) after induction of anesthesia. ⋯ No significant difference was found between ITM and ITS groups for postoperative requirements of morphine (3.5 +/- 0.5 v 4.5 +/- 0.6 mg), diazepam (5.6 +/-1.25 v 3.9 +/- 1.26 mg), and vasodilators (6 v 13 patients), respectively. Comparable and significant reductions of peak expiratory flow rates (PEFR), forced vital capacity (FVC), and forced expiratory volume (FEV1) occurred in both groups postextubation when compared with preoperative values. Intrathecal morphine at the dose of 0.02 mg/kg does not offer any clear benefit to patients anesthetized with fentanyl, 40 microg/kg, for coronary artery bypass surgery.
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The management of a 28-year-old primigravida with placenta accreta diagnosed during Caesarean section is described. A hysterectomy was required to control massive haemorrhage, and the patient made a full recovery. The increased incidence of placenta accreta over the last three decades is thought to be associated with the concomitant increased frequency of Caesarean section, resulting in an increased incidence of placenta praevia (1.9 per cent to 3.9 per cent). ⋯ Management of placenta accreta is primarily by control of haemorrhage on delivery of the placenta. Control can be assisted by infrarenal cross-clamping of the aorta and/or intra-myometrial injection of prostaglandin F2 alpha which produces myometrial and vascular contraction. Identification of patients at increased risk, preparation for treatment and effective treatment of placenta accreta will minimize maternal morbidity and mortality.
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Randomized Controlled Trial Comparative Study Clinical Trial
Maternal and neonatal responses to alfentanil administered before induction of general anaesthesia for caesarean section.
The cardiovascular response to tracheal intubation was compared in two groups of patients undergoing elective Caesarean section. Both groups received a standard technique of general anaesthesia. ⋯ No adverse effect on the neonate was seen. However, a significant increase in the incidence of postoperative nausea occurred in mothers in the alfentanil group (P less than 0.05).