Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1992
Randomized Controlled Trial Clinical TrialSystemic piroxicam as an adjunct to combined epidural bupivacaine and morphine for postoperative pain relief--a double-blind study.
In a randomized, double-blind, placebo-controlled trial, we assessed the value of adding rectal piroxicam to a low-dose epidural regimen for postoperative pain relief. Forty-four patients scheduled for major upper abdominal surgery during combined thoracic epidural (bupivacaine + morphine) and general anesthesia were studied. Postoperative analgesia was achieved by using epidural bupivacaine (10 mg/h) plus morphine (0.2 mg/h) for 72 h. ⋯ The sensory level of analgesia was evaluated by pinprick. We found no significant difference between piroxicam and placebo with regard to postoperative pain scores or need for supplementary analgesics. Thus, we were unable to demonstrate enhanced analgesia by adding piroxicam to an otherwise very effective low-dose epidural bupivacaine and morphine treatment after upper abdominal surgery.
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Anesthesia and analgesia · Mar 1992
Accuracy of the FEF CO2 detector in the assessment of endotracheal tube placement.
The sensitivity and reliability of the FEF end-tidal CO2 detector were investigated for its suitability in the assessment of correct placement of an endotracheal tube. Sensitivity was determined by having eight blinded volunteers observe the color change in the FEF detector with the administration of different volumes and varying CO2 concentrations of gas mixture. The color change in the FEF detector was also assessed during esophageal ventilations before and after administration of carbonated beverage into the stomach of swine and during cardiopulmonary resuscitation in swine. ⋯ The "C" color was displayed during the initial six ventilations in one swine, and esophageal intubation would have been missed. The FEF detector could (by displaying a "C" color) identify one of six correctly intubated swine during cardiopulmonary resuscitation. In conclusion, the FEF CO2 detector does not have the characteristics to reliably assess the correct placement of an endotracheal tube.
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Anesthesia and analgesia · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialUse of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration.
Fentanyl, unlike morphine, is highly lipophilic and rapidly diffuses out of the epidural space. Respiratory depression is, therefore, unlikely when fentanyl is given epidurally. However, much of fentanyl's analgesic effect is mediated by systemic rather than spinal receptor binding. ⋯ There were also no significant differences in the cumulative dosage of fentanyl within each group (epidural vs IV) or between the groups. Thus, the analgesic effects of epidural fentanyl appear largely mediated by systemic absorption. Intravenous fentanyl achieves a similar degree of analgesia and a more rapid onset of effect without the need for epidural catheterization.