Articles: anesthetics.
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Anesthesia and analgesia · Feb 1988
Randomized Controlled Trial Comparative Study Clinical TrialLaser-induced pain for evaluation of local analgesia: a comparison of topical application (EMLA) and local injection (lidocaine).
High-energy lasers are suitable for experimental pain stimulation because they selectively activate the polymodal nociceptors. Argon laser light penetrates deep into the skin and makes this laser type preferable for simulating pain arising from surgical skin incisions. Short argon laser pulses were applied to the skin and three parameters were quantified before and during analgesia; sensory threshold, pain threshold, and the pain-related cortical response (latency and amplitude). ⋯ During the next 30 minutes after removal of the cream, the thresholds increased further. The increase in analgetic effect after removal of the cream was studied using different times (15, 30, 60, 80, 100, and 120 minutes) for topical EMLA cream application. Total sensory block was reached 20 minutes after removal of application for 80 minutes or immediately after removal of the cream after it was applied for 100 or 120 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Cardiothorac Anesth · Feb 1988
Comparative StudyComparison of sufentanil-oxygen and fentanyl-oxygen anesthesia for mitral and aortic valvular surgery.
The cardiovascular responses, speed of anesthetic induction, incidence of chest wall rigidity, need for anesthetic supplements (phentolamine, N2O, and nitroprusside) to control intraoperative hypertension, and speed of postoperative recovery were measured and compared in 44 patients undergoing aortic and mitral valvular replacement with fentanyl-O2 or sufentanil-O2 anesthesia. After a lorazepamatropine premedication and pancuronium pretreatment, fentanyl was administered intravenously at a rate of 400 micrograms/min and sufentanil at 200 micrograms/min until patients were unconscious; at this time they were given succinylcholine and their tracheas were intubated. After intubation, an amount of fentanyl or sufentanil equal to the dose producing unconsciousness was infused over the next 30 minutes, at which time the operation began. ⋯ Total doses of fentanyl and sufentanil required for the entire operation were 113 +/- 11 and 9.0 +/- 0.4 micrograms/kg (mean +/- SD), respectively. Heart rate, cardiac output, and mean right atrial pressure remained unchanged throughout the study in both groups. Mean arterial blood pressure (MBP) and SBP were significantly decreased during induction and after intubation in patients receiving sufentanil, but not fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain reduction in local anesthetic administration through pH buffering.
The effects of pH buffering on the pain of administration and efficacy of three local anesthetics (1% lidocaine, 1% lidocaine with 1:100,000 epinephrine, and 1% mepivacaine) were investigated in a randomized, prospective, double-blind study of 25 adult volunteers. Plain and buffered solutions of the three local anesthetics were prepared, and a 0.5 intradermal injection of each was administered. Pain of anesthetic infiltration was rated from zero to ten. ⋯ Onset, extent, and duration of skin anesthesia were not statistically altered by pH buffering. The pain of local anesthetic administration can be dramatically reduced by buffering the local anesthetic prior to its infiltration. Anesthetic efficacy is not compromised, and patient acceptance may be significantly increased.
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J Cardiothorac Anesth · Feb 1988
Randomized Controlled Trial Clinical TrialCatecholamine responses to anesthetic induction with fentanyl and sufentanil.
In a randomized study, the authors examined the changes in plasma epinephrine and norepinephrine concentrations associated with induction of anesthesia and surgery in 33 patients with good ventricular function undergoing elective coronary artery surgery. After premedication with morphine and scopolamine, patients received either fentanyl, 100 micrograms/kg (n = 16), or sufentanil, 15 micrograms/kg, (n = 17), intravenously (IV), over 10 minutes to induce anesthesia. Metocurine, 0.42 mg/kg, IV, produced muscle relaxation. ⋯ Induction-related changes in arterial pressure and pulmonary capillary wedge pressure were significantly correlated with changes in the logarithm of plasma norepinephrine concentration. Similar degrees of endogenous norepinephrine release appear to accompany induction with equipotent doses of fentanyl and sufentanil in patients premedicated with morphine and scopolamine. Norepinephrine release may influence the hemodynamic response to induction with narcotics.
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A prospective evaluation of 103 consecutive children who received TAC (tetracaine, epinephrine [adrenaline], cocaine) liquid topical anesthetic for the repair of their minor dermal lacerations was performed. A unique method of TAC application was used that consisted of applying the medication to the inner margins of the wound cavity and allowing it to stand for several minutes prior to the application of a TAC-saturated gauze pad to the wound surface. Of 670 sutures placed, 637 (95%) were done without eliciting pain. ⋯ A single wound healing complication occurred in 103 patients. TAC is a safe, effective method for anesthetizing minor lacerations of the skin in children. Its painless method of application relieves patient discomfort and maximizes patient compliance during the repair procedure, both of which enhance the accurate approximation of lacerated tissue.