Anesthesiology
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Randomized Controlled Trial Clinical Trial
Intrathecal clonidine as a sole analgesic for pain relief after cesarean section.
In a small number of studies and isolated case reports, intrathecally administered clonidine has been reported to relieve intractable cancer pain and to prolong spinal anesthesia induced by various local anesthetics. A double-blind placebo-controlled clinical trial was carried out in order to evaluate the effect of intrathecal clonidine on pain following cesarean section. Twenty patients who underwent elective cesarean section received, 45 min after general anesthesia, either 150 micrograms (n = 10) clonidine or saline (control group, n = 10) intrathecally. ⋯ Maximal reduction of systolic arterial pressure was 15 +/- 9%, of diastolic arterial pressure 22 +/- 12%, and of mean arterial pressure 18 +/- 12%. Clonidine did not affect arterial hemoglobin oxygen saturation or PaCO2. Patients in the clonidine group were significantly more sedated (P less than 0.05) and more frequently reported a dry mouth (P less than 0.01) compared to the normal saline group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy.
Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. This study sought to compare the effects of morphine with those of bupivacaine administered intraarticularly upon pain following arthroscopic knee surgery. In a double-blind, randomized manner, 33 patients received either morphine (1 mg in 20 ml NaCl; n = 11), bupivacaine (20 ml, 0.25%; n = 11), or a combination of the two (n = 11) intraarticularly at the completion of surgery. ⋯ Analgesic requirements were significantly greater in the morphine group than in the other groups at 1 h but were significantly greater in the bupivacaine group than in the other groups throughout the remainder of the study period. We conclude that intraarticular morphine produces an analgesic effect of delayed onset but of remarkably long duration. The combination of these two drugs results in satisfactory analgesia throughout the entire observation period.
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Randomized Controlled Trial Clinical Trial
Fifty percent nitrous oxide does not increase the risk of venous air embolism in neurosurgical patients operated upon in the sitting position.
Although nitrous oxide (N2O) should theoretically increase the severity of venous air embolism (VAE), data confirming this hazard in clinical situations are not available. The effect of 50% N2O on the incidence and severity of VAE and on the emergence time from anesthesia was evaluated in 300 neurosurgical patients operated upon while in the sitting position. Of these, 110 patients underwent craniectomy for posterior fossa pathology and 190 patients underwent cervical spine surgery (CSS). ⋯ Emergence time was significantly longer in the craniectomy group than in the CSS group (5 vs. 1 min, respectively; P less than 0.001). Within the craniectomy group, the incidence of Doppler-detected VAE was significantly less in patients with previous surgery at the operative site (21%) compared to patients without previous surgery at the operative site (47%). Postoperatively, no complications could be related to the use of N2O or directly attributed to the occurrence of VAE.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
The influence of atropine dose on recovery from vecuronium-induced neuromuscular blockade.
To determine whether the dose of atropine affects the rate of neostigmine-induced recovery from vecuronium-induced neuromuscular blockade, the authors monitored isometric adductor pollicis mechanical activity in 36 anesthetized (thiopental, fentanyl, nitrous oxide) adult patients (ASA physical status 1 or 2). Once surgery was completed and twitch height had spontaneously regained 25% of its initial value, the patients were randomly allocated into three groups (A10, A15, A20; n = 12 in each group) according to the dose of atropine (10, 15, or 20 micrograms/kg) that was mixed with 40 micrograms/kg neostigmine. Twitch height, train-of-four, and 50- and 100-Hz tetanic fade were recorded for 15 min after the administration of the reversal agents. ⋯ Fifteen minutes after reversal, fade in response to 100-Hz tetanus was statistically greater in the A10 group than in the two other groups (70% +/- 3% of control versus 84% +/- 4% and 81% +/- 2%) (mean +/- SEM, P less than 0.05). The present results demonstrate that larger doses of atropine facilitate neostigmine's reversal of vecuronium neuromuscular blockade. The clinical implications of the differences observed in this study remain to be determined.
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Randomized Controlled Trial Clinical Trial
The role of desmopressin acetate in patients undergoing coronary artery bypass surgery. A controlled clinical trial with thromboelastographic risk stratification.
The role of desmopressin acetate in attenuating blood loss and reducing homologous blood component therapy after cardiopulmonary bypass is unclear. The purpose of this investigation was to identify a subgroup of patients that may benefit from desmopressin acetate therapy. One hundred fifteen patients completed a prospective randomized double-blind, placebo-controlled trial designed to evaluate the effect of desmopressin acetate (0.3 microgram.kg-1) on mediastinal chest tube drainage after elective coronary artery bypass grafting surgery in patients with normal and abnormal platelet-fibrinogen function as diagnosed by the maximal amplitude (MA) on thromboelastographic (TEG) evaluation. ⋯ During the first 24 h after cardiopulmonary bypass, the placebo-treated patients in group 2 had significantly greater mediastinal chest tube drainage when compared to placebo patients in group 1 (1,352.6 +/- 773.1 ml vs. 865.3 +/- 384.4 ml, P = 0.002). In addition to increases in blood loss, group 2 placebo patients also were administered an increased number of blood products (P less than 0.05). The desmopressin-treated patients in group 2 neither experienced increased mediastinal chest tube drainage nor received increased amounts of homologous blood products when compared to those in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)