Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1995
Randomized Controlled Trial Clinical TrialPain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine.
Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort. Furthermore, the characteristics of postlaparoscopy pain differ considerably from those seen after laparotomy. Therefore, we investigated the time course of different pain components after laparoscopic cholecystectomy and the effects of intraperitoneal bupivacaine on these different components. ⋯ Analgesic consumption was similar in the two groups. This study demonstrates that visceral pain accounts for most of the pain experienced after laparoscopic cholecystectomy. Intraperitoneal bupivacaine is not effective for treating any type of pain after laparoscopic cholecystectomy.
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Anesthesia and analgesia · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe addition of bupivacaine to intrathecal sufentanil for labor analgesia.
We designed a prospective, randomized, double-blind study to evaluate the efficacy of the combination of intrathecal sufentanil with a low dose of local anesthetic in an attempt to prolong analgesia in labor. Fifty-two patients received one of the following intrathecal study solutions: 2.5 mg of bupivacaine; 10 micrograms of sufentanil; or 2.5 mg of bupivacaine plus 10 micrograms of sufentanil. The mean duration of analgesia (min +/- SD) was significantly different among all three groups: 70 +/- 34 min for bupivacaine, 114 +/- 26 min for sufentanil, and 148 +/- 27 min for bupivacaine-sufentanil (P < 0.001). ⋯ Hypotension was not observed in the sufentanil group but occurred transiently in the other two groups (P = 0.09). There was no evidence of motor blockade, excessive somnolence, fetal heart rate (FHR) abnormalities, or postdural puncture headache (PDPH) in any of the patients. The addition of 2.5 mg of bupivacaine to 10 micrograms of intrathecal sufentanil significantly prolonged labor analgesia without adverse maternal or fetal effects.
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Anesthesia and analgesia · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialSerum fluoride concentration and urine osmolality after enflurane and sevoflurane anesthesia in male volunteers.
The purpose of this study was to measure the serum fluoride concentration after enflurane or sevoflurane anesthesia and to compare the effects of prolonged anesthesia with these drugs on renal concentrating function in male volunteers. The study was subdivided into three stages; an ascending dose study of 3.0 and 6.0 minimum alveolar anesthetic concentration (MAC) hours of sevoflurane alone, a 6.0-MAC-hour comparison of enflurane and sevoflurane, and a 9.0-MAC-hour comparison of enflurane and sevoflurane. Renal concentrating function was assessed by an 18-h period of fluid deprivation and the serum fluoride concentration was measured at intervals until 60 h postanesthesia. ⋯ However, the rapid decrease in the serum fluoride concentration after sevoflurane was such that there was no difference between the areas under the fluoride concentration-time curves. There were no significant differences between the median maximum urine osmolalities after enflurane or sevoflurane anesthesia. Prolonged anesthesia with enflurane or sevoflurane is not associated with impaired renal concentrating function despite an increase in the serum fluoride concentration.
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Anesthesia and analgesia · Aug 1995
Randomized Controlled Trial Clinical TrialThe optimal distance that a multiorifice epidural catheter should be threaded into the epidural space.
Complications can occur during epidural placement for women in labor. As many as 23% of epidural anesthetics may not provide satisfactory analgesia. The cause of this may be technical. ⋯ Fifteen minutes later, the adequacy of the analgesia was assessed by a blinded observer. We found that catheter insertion to a depth of 7 cm was associated with the highest rate of insertion complications while insertion to a depth of 5 cm was associated with the highest incidence of satisfactory analgesia. For women in labor who require continuous lumbar epidural anesthesia, we recommend threading a multiorifice epidural catheter 5 cm into the epidural space.
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Anesthesia and analgesia · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe use of the laryngeal mask airway in children with bronchopulmonary dysplasia.
Airway maintenance with the laryngeal mask airway (LMA) was evaluated and compared to the endotracheal (ET) tube in 27 former premature infants and children with bronchopulmonary dysplasia (BPD) during second stage open-sky vitrectomy. The children were randomly assigned to a study group and anesthetized with halothane in N2O:O2. The airway was maintained with the LMA (n = 13) or the ET tube (n = 14). ⋯ The incidence of coughing, with and without desaturation, wheezing, and hoarseness in the postoperative period was higher in the ET tube group. Awakening, after discontinuation of the anesthetic (P < 0.01) was more rapid, and home discharge time (P < 0.002) was shorter in the LMA group (P < 0.0025), although our study design could not isolate the use of the LMA as the factor responsible for this. This study in patients with mild chronic lung disease demonstrated that the LMA can maintain a satisfactory airway during minor surgical procedures in children with bronchopulmonary dysplasia and result in fewer respiratory adverse effects than with the ET tube.