Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialExcitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol.
Excitatory movements have been observed during induction of anesthesia with etomidate, thiopental, methohexital, and propofol. We studied the frequency of these excitatory effects and correlated movements with electroencephalographic (EEG) findings in 67 unpremedicated patients (mean age 66.1 yr, range 45-82 yr). Excitatory effects, including myoclonus, tremor, and dystonic posturing, occurred in 86.6% of patients receiving etomidate; 69.2% of the patient responses were myoclonic. ⋯ In most patients, the excitatory movements were coincident with the early slow phase of the EEG which corresponds to the beginning of deep anesthesia. We conclude that perhaps caution should be exercised when administering etomidate to patients with a history of seizures as the myoclonic activity is associated with seizure activity. The incidence of excitatory movements after administration of propofol is very low.
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialPreliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B).
Remifentanil is a newly synthesized 4-anilido-piperidine with an ester side chain susceptible to esterase metabolism. We evaluated the safety, analgesic efficacy, and pharmacokinetics of remifentanil in 48 male volunteers. Volunteers were randomized to receive increasing doses of remifentanil, alfentanil, or placebo. ⋯ Remifentanil had a small volume of distribution of 0.39 (SD, +/- 0.25) L/kg (alfentanil, 0.52 +/- 2 L/kg), with a rapid distribution phase of 0.94 (SD, +/- 0.57) min and an extremely short elimination half-life of 9.5 (SD, +/- 4) min compared with an elimination half-life of alfentanil of 58 (SD, +/- 7.6) min. The t1/2 ke0 (half-time for equilibration between plasma and the effect compartment) of remifentanil for analgesia was calculated as 1.3 min. Thus, remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short-lasting pharmacokinetics, which is likely to make it a very useful opioid for clinical practice.
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Clinical TrialEstablishing intravenous access: a study of local anesthetic efficacy.
We performed a double-blind, randomized, prospective study to determine the local anesthetic that provided the best analgesia for insertion of an 18-gauge intravenous (i.v.) catheter and to determine whether alkalinization of lidocaine decreases the pain of intradermal injection. There were 280 healthy adult patients assigned randomly to seven different groups: benzyl alcohol 0.9% in normal saline, 2-chloroprocaine 3%, lidocaine 1%, lidocaine 1% with preservative, alkalinized lidocaine 1% with preservative, normal saline, and a control group that received i.v. catheter placement without previous drug injection. A 10-cm visual analog pain scale (VAPS) was used to obtain pain scores after pre-i.v. drug injection and after iv catheter insertion. ⋯ We conclude that alkalinized lidocaine decreased the pain associated with its injection. Alkalinized lidocaine was the best local anesthetic for i.v. catheter placement. Benzyl alcohol in normal saline was also effective.
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialEpidural anesthesia for labor in an ambulatory patient.
The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. ⋯ Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialOpioid antagonist adjuncts to epidural morphine for postcesarean analgesia: maternal outcomes.
This prospective, randomized, controlled investigation compared the effects of three prophylactic mu-opioid antagonists, epidural butorphanol (BU) 3 mg, epidural nalbuphine (NB) 10 mg, and oral naltrexone (NX) 6 mg, on postcesarean epidural morphine analgesia. After randomization, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. ⋯ Through the first 12 h postpartum, the BU group achieved significantly greater analgesia than the morphine sulfate (control) (MS), NB, and NX groups, a significantly lower incidence of severe pruritus than the MS group, and significantly greater satisfaction than MS and NX groups. Epidural morphine and BU promoted better analgesia and satisfaction than any previously documented postcesarean regimen.