Anesthesiology
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Randomized Controlled Trial Clinical Trial
Potentiation of succinylcholine phase II block with isoflurane.
To determine the effect of isoflurane upon phase II block 20 patients were given succinylcholine by infusion at a rate which maintained the twitch tension of the adductor pollicis muscle at 10% of control for 2 to 4 h. The patients were assigned randomly to either nitrous-oxide-isoflurane (0.75-1.5% inspired) or nitrous-oxide-fentanyl for maintenance of anesthesia, and neuromuscular activity was monitored using train-of-four stimulation. ⋯ This decrease was related to the extent of phase II block present. It is concluded that isoflurane potentiates succinylcholine phase II block although the mechanisms involved are not necessarily the same as in the potentiation of nondepolarizing neuromuscular blocking drugs.
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Randomized Controlled Trial Clinical Trial
The role of epidural morphine in the postcesarean patient: efficacy and effects on bonding.
This study was designed to determine in postcesarean patients whether in addition to superior analgesic effects, epidural morphine administration results in secondary benefits in maternal well-being and maternal-infant interaction. Following elective cesarean section with bupivacaine epidural anesthesia, 40 healthy mothers received 5 mg preservative-free morphine sulfate in 10 ml of saline, either by the epidural (Group 1, n = 20) or the intravenous (Group 2, n = 20) route, in a randomized, double-blind fashion. Each received a simultaneous injection of saline by the alternate route. ⋯ Itching occurred in 58% of Group 1 patients and only 16% of Group 2 patients (P less than 0.01); the incidences of nausea, vomiting, and urinary retention were not statistically different between the groups. No respiratory depression was observed. Benefits of epidural morphine in this patient population appear limited to the provision of improved analgesia and earlier mobility.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of intravenous agents for rapid sequence induction--thiopental, ketamine, and midazolam.
The pharmacologic effects of ketamine, midazolam, and a midazolam-ketamine combination were compared with thiopental for rapid induction of general anesthesia. Thiopental, 4 mg/kg, 1.5 mg/kg ketamine, 0.3 mg/kg midazolam, or 0.15 mg/kg midazolam, and 0.75 mg/kg ketamine, were administered intravenously in a randomized fashion to 80 patients undergoing emergency surgery. Adequacy of induction, hemodynamic changes, and postoperative effects were assessed during and after a standardized induction-maintenance anesthetic technique. ⋯ Thus, midazolam effectively attenuated both the cardiostimulatory responses and unpleasant emergence reactions associated with ketamine. The author concludes that both midazolam and the midazolam-ketamine combination are safe and effective induction agents for emergency surgery, which may offer an advantage over thiopental in situations where hemodynamic stability is crucial. Furthermore, midazolam effectively attenuates the side effects of ketamine.
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Randomized Controlled Trial Clinical Trial
Lidocaine and bupivacaine mixtures for epidural blockade.
In a prospective double-blind clinical study, single-dose lumbar epidural blockade was instituted in 60 healthy patients undergoing lower abdominal surgery. Patients were randomly assigned to one of five groups. Each group received treatment with a different local anesthetic solution containing 1:200,000 epinephrine. ⋯ Using skin temperature as a criterion of sympathetic blockade, all three mixtures demonstrated a duration of action intermediate between the two single drugs, lidocaine (124 +/- 13 min) and bupivacaine (286 +/- 32 min). Onset of complete motor blockade was fastest and the degree of motor blockade was most profound with the mixture containing equal proportions of lidocaine and bupivacaine. Pharmacokinetics of individual drugs were unaltered in any of the mixtures.
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Randomized Controlled Trial Comparative Study Clinical Trial
The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used for pudendal block.
The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used in random sequence for pudendal block anesthesia were studied. The neurobehavioral status of 54 infants was studied 4 and 24 hours after delivery. ⋯ Mean mepivacaine levels in neonatal capillary blood at 4 hours of age were low (0.10 +/- .02 microgram/ml) compared with those in previous studies because of the short interval between maternal injection and delivery (13 +/- 3 min). Bupivacaine gave higher neonatal capillary blood levels (0.15 microgram/ml at 4 hours of age) than previously reported, but the drug still produced no detectable neonatal neurobehavioral effects.