Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Clinical TrialEffect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures.
We sought to determine whether topically applied eutectic mixture of local anesthetics (EMLA) would decrease analgesic requirement during extracorporeal shock wave lithotripsy (ESWL). Fifty-nine healthy out-patients undergoing elective ESWL using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive either a topical EMLA or placebo cream applied to the skin of the flank overlying the kidney 90 min prior to the ESWL procedure. Patients were given five test shocks at each of five different energy levels: 10, 12, 15, 18, and 20 kV. ⋯ EMLA cream was significantly more effective at decreasing cutaneous pain in male than in female patients. However, during the lithotripsy procedure, EMLA cream had no significant effect on the intraoperative requirement for intravenous alfentanil, hemodynamic variables, recovery times, or postoperative side effects. Although the topical application of EMLA cream produced cutaneous analgesia, these data suggest that it failed to produce any opioid-sparing effect during the immersion lithotripsy procedure.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of eltanolone and propofol in anesthesia for termination of pregnancy.
A randomized study was designed to compare eltanolone (pregnanolone) and propofol anesthesia in 60 unpremedicated women undergoing outpatient termination of pregnancy. The initial doses for induction of anesthesia were 0.8 mg/kg for eltanolone and 2 mg/kg for propofol followed by an additional 25% increment if necessary. The doses required for successful induction were 0.82 +/- 0.06 and 2.1 +/- 0.3 (mean +/- SD) mg/kg for eltanolone and propofol, respectively. ⋯ Both clinical (opening eyes, orientation, walking, tolerating oral fluids, voiding) and psychomotor recovery (Maddox Wing test and Digit Symbol Substitution test) returned to baseline more slowly after eltanolone than after propofol. Overall home readiness was achieved later in the eltanolone group [median 57 min (range 41-190 min)] compared to the propofol [37 (32-100 min)] group. We conclude that recovery from anesthesia is more rapid from propofol as compared to eltanolone anesthesia.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Clinical TrialEffects of end-tidal gas monitoring and flow rates on hemodynamic stability and recovery profiles.
This study was designed to evaluate the impact of routine end-tidal anesthetic gas monitoring on the intraoperative hemodynamic stability and early recovery profile in 253 consenting ASA physical status I-III patients undergoing elective otolaryngologic procedures with isoflurane or enflurane anesthesia. Patients were randomly assigned to one of six treatment groups: Group I, monitored high-flow isoflurane; Group II, unmonitored high-flow isoflurane; Group III, monitored low-flow isoflurane; Group IV, unmonitored low-flow isoflurane; Group V, monitored low-flow enflurane; or Group VI, unmonitored low-flow enflurane. After a standardized induction sequence, anesthesia was maintained by administering variable concentrations of isoflurane or enflurane in an air/oxygen mixture at two different total gas flow rates (0.7 L/min or 3.5 L/min, respectively). ⋯ Intraoperative hemodynamic stability was assessed in each patient and reported as the average error from the preincisional (baseline) MAP, average absolute error from the baseline MAP, coefficients of variation for HR, systolic, diastolic, and MAP values, and ET anesthetic concentrations. Recovery times from discontinuation of the volatile drug until awakening, following commands, and postanesthesia care unit (PACU) discharge were recorded. The six study groups had similar intraoperative MAP and HR values, coefficients of variation, and numbers of episodes of hypertension, hypotension, tachycardia, and bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Sep 1994
Epidural triamcinolone suppresses the pituitary-adrenal axis in human subjects.
Epidural steroids (ESI) are often used for the treatment of low back pain but their effects on the endocrine system have not been determined. We studied the hypothalamic-pituitary adrenal (HPA) axis in 14 patients by measuring plasma adrenocorticotropin (ACTH) by sensitive two-site immunoradiometric assay and by evaluating the acute cortisol response to cosyntropin. We also evaluated the additional impact of sedation with midazolam before ESI on the degree of suppression of the HPA axis. ⋯ Median suppression was less than 1 mo, and all patients had recovered by 3 mo. Sedation with midazolam accentuated the suppression of the HPA axis. Exogenous steroid coverage during this potentially vulnerable period should be considered in patients undergoing major stress especially if the adrenocortical response to ACTH is subnormal.
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Anesthesia and analgesia · Sep 1994
Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty?
Peroneal nerve palsy is a rare complication of total knee arthroplasty (TKA). Previous studies have investigated surgical variables contributing to the development of peroneal nerve palsy after TKA, but have ignored potential medical and anesthetic risk factors. The charts of all patients undergoing TKA over a 1-yr period were retrospectively studied to identify medical, surgical, and anesthetic risk factors contributing to the development of peroneal nerve palsy after TKA; 361 TKAs were performed on 292 patients. ⋯ However, all cases of peroneal nerve palsy with motor deficits and partial neurologic recovery occurred in patients receiving postoperative epidural analgesia and were diagnosed after discontinuation of the epidural infusion. Since diagnosis of peroneal nerve palsy may be delayed in patients with postoperative epidural analgesia, these patients must be monitored closely. A dilute local anesthetic or an opioid infusion is recommended for patients at increased risk, such as those with preexisting neuropathies.