Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Clinical TrialThe efficacy of prophylactic ondansetron, droperidol, perphenazine, and metoclopramide in the prevention of nausea and vomiting after major gynecologic surgery.
The prophylactic antiemetic efficacy of intravenous (i.v.) ondansetron, droperidol, perphenazine, and metoclopramide was evaluated in a prospective, double-blind study of 360 ASA physical status I-III patients undergoing total abdominal hysterectomy (TAH). Subjects were randomized to receive i.v., one of ondansetron 4 mg, droperidol 1.25 mg, perphenazine 5 mg, metoclopramide 10 mg, or placebo prior to induction of anesthesia. Hypotension immediately after administration of metoclopramide was observed in two patients and four patients given ondansetron developed profound systolic hypotension at induction of anesthesia. ⋯ Metoclopramide was ineffective. Although ondansetron, droperidol, and perphenazine were effective in providing antiemetic prophylaxis, only i.v. perphenazine was free of side effects. Hence, we conclude that perphenazine is the best choice for antiemetic prophylaxis after TAH.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Clinical TrialEffects of pH adjustment and carbonation of lidocaine during epidural anesthesia for foot or ankle surgery.
We examined the onset and the quality of sensory and motor block of the lumbosacral roots during epidural anesthesia performed for foot or ankle surgery with lidocaine HCl, pH adjusted, or carbonated lidocaine in a randomized, double-blind study. Forty-five patients received 20 mL of one of three solutions: control group (n = 15), 20 mL of 2% lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of NaCl 0.9% (pH 4.58 +/- 0.10); pH adjusted group (n = 15) 20 mL of lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of 8.4% sodium bicarbonate (pH 6.47 +/- 0.16); and carbonated group (n = 15) 20 mL of 1.73% carbonated lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of 0.9% NaCl (pH 6.42 +/- 0.04). Onset time of sensory block of the L4-S1 roots and maximum cephalad spread were similar in the three groups. ⋯ Complete motor block was observed in eight patients of the carbonated group compared to three in the pH adjusted group (P < 0.01) and one in the control group (P < 0.005). Lidocaine venous blood levels were comparable in the three groups. When compared to lidocaine HCl, only carbonated lidocaine, but not the pH adjusted solution, significantly improved epidural block of the L4-S1 roots.
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Anesthesia and analgesia · Jul 1995
Comparative StudyThe effects of differing concentrations of bupivacaine on the epidural somatosensory evoked potential after posterior tibial nerve stimulation.
The somatosensory evoked potential (SEP) recorded from the cervical epidural space in response to stimulation of the posterior tibial nerve is often used to monitor spinal cord integrity during scoliosis surgery. Epidural analgesia may be used as part of the anesthetic technique for scoliosis surgery, but the effects of the local analgesic on the evoked potential must be determined to ensure that it does not interfere with the monitoring of spinal cord function. Therefore, we compared the effects of the administration of 10 mL of 0.25% (n = 8), 0.5% (n = 8), or 0.75% (n = 8) bupivacaine injected into the L3-4 epidural space on the somatosensory evoked potential to posterior tibial nerve stimulation in patients anesthetized with a propofol infusion, nitrous oxide and oxygen, immediately before scoliosis surgery. ⋯ There were no significant differences between 0.25% bupivacaine and the control group, but both 0.5% and 0.75% bupivacaine were associated with clinically and statistically significant decreases in overall amplitude (P < 0.002, 0.5% bupivacaine; P < 0.001, 0.75% bupivacaine). Latency increased similarly in all groups. We conclude that bupivacaine in concentrations greater than 0.25% is not suitable for scoliosis surgery, if spinal somatosensory evoked potentials (SSEP) are to be measured.