Anesthesiology
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Fifty attempted central venous cannulations via the antecubital route were studied with fluoroscopy to determine catheter tip location. Only "catheter through needle" devices were employed. Successful central placement occurred on the first attempt in 27 cases. ⋯ All of these problems were avoided by two maneuvers: 1) turning the patient's head toward the side of cannulation and applying digital pressure to the ipsilateral supraclavicular fossa, and 2) withdrawing the catheter stylet and injecting 5-10 ml of physiologic saline solution while the catheter was advanced. The only cause of unsuccessful central placement in this study was inability to pass the catheter tip past the axillary venous plexus (two patients). It is concluded that the head-turn-supraclavicular fossa pressure maneuver in combination with the stylet withdrawal-saline injection maneuver can result in greater than a 90% rate of successful central venous catheter placement.
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Clinical Trial Controlled Clinical Trial
Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate.
Thirty patients undergoing lidocaine spinal anesthesia for transurethral resection of the prostate (TURP) were studied to evaluate the effectiveness of low-dose intrathecal morphine (ITM) for postoperative analgesia. In a double-blinded fashion, groups of ten patients received either 0.1 mg morphine, 0.2 mg morphine, or placebo (control group) intrathecally with lidocaine 75 mg. Standard postoperative analgesics were available to all patients. ⋯ Six patients (60%) in the 0.2 mg ITM group, two patients (20%) in the 0.1 mg ITM group, and one patient (10%) in the control group experienced nausea and vomiting. No clinically evident respiratory depression occurred in any of the subjects. The authors conclude that administration of 0.1 mg or 0.2 mg of morphine intrathecally is effective in reducing postoperative pain following TURP and that 0.1 mg ITM is not associated with nausea and vomiting.
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Clinical Trial Controlled Clinical Trial
Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery.
The authors studied in a double-blind placebo-controlled study the effects of oral preoperative administration of 5 micrograms/kg clonidine upon the alfentanil and droperidol requirements, hemodynamic lability, distribution of the values of heart rate and blood pressure, and plasma noradrenaline levels, in two groups of ten normotensive patients undergoing infrarenal aortic surgery. The amounts of alfentanil supplementing a standardized continuous infusion, injected to maintain hemodynamic stability, were statistically identical between the groups (P = 0.23). The amount of droperidol, however, was significantly less (P = 0.004) in the group of patients that received clonidine. ⋯ The frequency of SBP hypertension was lower and of SBP hypotension higher in the clonidine group. After induction of anesthesia, but before surgery, there were more episodes of DBP hypotension in the clonidine group, but during dissection and vascular sutures the placebo group experienced more episodes of DBP hypotension, owing probably to the greater amount of droperidol injected. The authors conclude that the preoperative administration of clonidine decreased the need to supplement anesthetic, and modifies the profile of distribution of heart rate and blood pressure.