Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1987
Randomized Controlled Trial Comparative Study Clinical TrialEffect of increasing amounts of epinephrine during isobaric bupivacaine spinal anesthesia in elderly patients.
The effects of adding epinephrine to isobaric bupivacaine spinal anesthesia were investigated in 96 ASA class II-III patients aged 75 yr or more scheduled for lower extremity surgery. The subjects were randomly allocated into six groups. All patients received 15 mg bupivacaine plain solution in 4 ml, in the horizontal position. ⋯ Addition of 0.5 mg epinephrine did not result in further prolongation of anesthesia. Motor blockade was also increased by addition of epinephrine. It is concluded that addition of 0.3 mg epinephrine may be useful to increase duration of isobaric bupivacaine spinal anesthesia.
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Neurolytic celiac plexus block (NCPB) is an effective method for relief of the pain of pancreatic cancer, but many physicians are reluctant to use the technique because of the perception that the incidence of complications is high. We analyzed the incidence of complications and the quality of pain relief obtained during the use of NCPB in 136 patients with pancreatic cancer. ⋯ Radiographically guided needle placement did not affect quality of pain relief or the incidence of complications. This neurolytic pain block is effective, has a low incidence of neurologic complications, and deserves more widespread use in patients with pancreatic cancer.
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Anesthesia and analgesia · Sep 1987
Comparative StudyCerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2.
Measurement of 133Xe clearance and effluent cerebral venous blood sampling were used in 38 patients to determine the effects of cardiopulmonary bypass, and of maintaining temperature corrected or noncorrected PaCO2 at 40 mm Hg on regulation of cerebral blood flow (CBF) and flow/metabolism coupling. After induction of anesthesia with diazepam and fentanyl, mean CBF was 25 ml X 100 g-1 X min-1 and cerebral oxygen consumption, 1.67 ml X 100 g-1 X min-1. Cerebral oxygen consumption during nonpulsatile cardiopulmonary bypass at 26 degrees C was reduced to 0.42 ml X 100 g-1 X min-1 in both groups. ⋯ However, variation in CBF correlated significantly with cerebral perfusion pressure over the pressure range of 15-95 mm Hg. This study demonstrates a profound reduction in cerebral oxygen consumption during hypothermic nonpulsatile cardiopulmonary bypass. When a non-temperature-corrected PaCO2 of approximately 40 mm Hg was maintained, CBF was lower, and analysis of pooled data suggested that CBF regulation was better preserved, i.e., CBF was independent of pressure changes and dependent upon cerebral oxygen consumption.