Articles: anesthetics.
-
Anesthesia and analgesia · Oct 1980
Age and the spread of local anesthetic solutions in the epidural space.
Sensory level of anesthesia following the injection of 20 ml of 1.5% lidocaine with epinephrine (1:200,000) in 238 adult males averaged T7.7, T5.6, and T5.1 at 10, 20, and 30 minutes, respectively. Patient age had no significant effect on local anesthetic requirements per spinal segment per unit height until age 40 years, which age the calculated amount of local anesthetic decreased significantly to 0.62 ml from 0.69 ml/segment/meter of height. ⋯ Patient height was inversely related to sensory level (p < 0.001). Time required for anesthesia ro recede to T12 averaged 164 minutes and was slightly but significantly (p < 0.05) prolonged with advancing age.
-
The use of inflammable anesthetics in the United States has been debated widely over the past several years. Those in favor of continued use of these agents argue for educational use, professional freedom, pharmacologic safety, and the need to retain an option. Those in favor of a ban on such agents cite the lack of demonstrated pharmacologic advantage, diminishing physician expertise, risk of fire, and cost. ⋯ As their use declines further, the cost per patient increases because most of the costs are fixed. We advocate a ban on inflammable anesthetics. Without definitive action on the part of policy makers, the use of these agents is likely to continue at a very low, and hence a relatively expensive, rate.
-
Experiments were performed in a rat sciatic nerve preparation to determine the characteristics of nerve blocks produced by a combination of commercially available solutions of bupivacaine and chloroprocaine. A mixture of equal parts of commercially available chloroprocaine 2% and bupivacaine 0.5% resulted in a nerve blockade with characteristics of a chloroprocaine block. Changing the pH value of this mixture from 3.60 to 5.56 changed these characteristics to a blockade resembling that produced by bupivacaine. It is concluded that the nerve blockades obtained by mixing commercially available solutions of local anesthetics are unpredictable and may depend on a number of factors which include not only the types of drugs but the pH of the mixture.
-
A 61-year-old woman experienced a cardiopulmonary arrest immediately after the retrobulbar injection of a mixture of 2 ml of 0.5% bupivacaine HCl, 2% mepivacaine HCl, and hyaluronidase. The patient was immediately resuscitated but remained unconscious for a total of 20 minutes. All neurologic deficits resolved completely over the two hours following the cardiopulmonary arrest and no adverse sequelae were noted. We assumed that this cardiopulmonary arrest was precipitated by the local anesthetic being transported via retrograde flow through the ophthalmic artery and then by antegrade flow through the internal carotid artery to the thalamus and other midbrain structures.