Anesthesia and analgesia
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Anesthesia and analgesia · May 1992
Cerebral pressure-flow velocity relationship during hypothermic cardiopulmonary bypass in neonates and infants.
To examine the effect of temperature on the relationship between cerebral perfusion pressure (CPP) and cerebral blood flow velocity (CBFV) and the effect of low-flow cardiopulmonary bypass (CPB) on cerebral perfusion, we studied 25 neonates and infants ranging from 3 to 210 days of age at three nasopharyngeal temperature (NPT) ranges during cardiopulmonary bypass. Pressure-flow velocity relationships were studied during normothermic (NPT = 36-37 degrees C), moderate hypothermic (NPT = 23-25 degrees C), and profound hypothermic (NPT = 14-20 degrees C) CPB. A transcranial Doppler monitor was used to obtain CBFV, which was measured in the M1 segment of the middle cerebral artery. ⋯ Using nonlinear regression analysis, we showed that cerebral pressure-flow velocity autoregulation was present during normothermic CPB (r2 = 0.68). Autoregulation became pressure-passive, using linear regression analysis, during moderate hypothermic CPB (r2 = 0.33) and profound hypothermic CPB (r2 = 0.69). Cerebral blood-flow velocity was not detectable at a mean (+/- SD) CPP of 9 (+/- 2) mm Hg induced by the low-flow CBP state but became apparent when CPP was increased to 13 (+/- 1) mm Hg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1992
Randomized Controlled Trial Clinical TrialInfluence of promethazine on symptom-therapy scores for nausea during patient-controlled analgesia with morphine.
We assessed whether adding promethazine to the syringe containing morphine for patient-controlled analgesia (PCA) decreases nausea after gynecologic surgery. Patients were assigned randomly to receive PCA (morphine 1.5 mg, 6-min lockout interval) with or without promethazine (0.625 mg/PCA dose, providing an average of 17.6 mg/24 h). ⋯ However, symptom-therapy scores differed significantly, with median values of 0 and 2, respectively, for the promethazine-treated and control groups. We conclude that simultaneous titration of morphine and promethazine decreases nausea associated with PCA therapy; the difference may best be appreciated with use of the combined symptom-therapy score.
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Anesthesia and analgesia · May 1992
Randomized Controlled Trial Clinical TrialDoes epidural fentanyl decrease the efficacy of epidural morphine after cesarean delivery?
Earlier studies have suggested that epidural fentanyl improves intraoperative analgesia during cesarean section, but others have suggested that it worsens postoperative analgesia from epidural morphine. The purpose of this study was to determine whether epidural fentanyl given before epidural morphine improves the quality of intraoperative epidural anesthesia without worsening postoperative analgesia provided by epidural morphine. Sixty patients having epidural anesthesia for cesarean delivery were studied. ⋯ Patients in the fentanyl group experienced significantly less nausea and vomiting between delivery and the end of surgery than did patients in the normal saline-control group (P = 0.013). Postoperatively, visual analogue scale scores for pain, pruritus, nausea, and sedation were similar at 1, 2, 4, and 8 h in the two groups. We conclude that fentanyl 100 micrograms administered epidurally during cesarean delivery did not improve intraoperative analgesia, but significantly reduced intraoperative nausea and vomiting without diminishing the efficacy of postoperative analgesia provided by epidural morphine.
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Anesthesia and analgesia · May 1992
Randomized Controlled Trial Clinical TrialClinical effects of intrathecally administered fentanyl in patients undergoing cesarean section.
The clinical effects of spinally (subarachnoid) administered, preservative-free fentanyl were assessed in 120 healthy women who underwent cesarean section with spinal anesthesia using 0.5% hyperbaric bupivacaine. Subjects were divided at random into four groups (n = 30) the first of which received 2 mL of saline containing no fentanyl (group 0); the second, 0.25 micrograms/kg (group 25); the third, 0.5 micrograms/kg (group 50); and the fourth, 0.75 micrograms/kg (group 75) of fentanyl in a blinded manner. Surgical anesthesia was excellent in 100% of treated patients and in 87% of group 0. ⋯ Neonatal status was the same in all groups. Sedation and pruritus were the main side effects. The combination of bupivacaine and a low dose of fentanyl (0.25 micrograms/kg) provides excellent surgical anesthesia with short-lasting postoperative analgesia and very few negative side effects.(ABSTRACT TRUNCATED AT 250 WORDS)