Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1995
Comparative StudyComparison of needle deviation during regional anesthetic techniques in a laboratory model.
Although many characteristics of needles used for spinal and epidural anesthesia have been studied extensively, the amount that a needle deviates from a straight path while passing through tissue has been relatively ignored. A laboratory model was used to determine the amount of needle deviation produced when different types of new spinal needles and epidural needles were passed through porcine tissue. ⋯ Needles commonly used for epidural anesthesia (Tuohy, Hustead, Crawford) exhibited increased deviation (range 1.73-3.54 mm/50 mm tissue), although the largest amount was seen with beveled spinal needles (Quincke, Atraucan) (range 4.42-5.90 mm/50 mm tissue). The possible clinical significance of needle deviation during the performance of a regional anesthetic is discussed.
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Anesthesia and analgesia · Sep 1995
Effects of extracorporeal circulation on renal function in coronary surgical patients.
We prospectively studied perioperative changes of renal function in 12 previously normal patients (plasma creatinine < 1.5 mg/dL) scheduled for elective coronary surgery. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured with inulin and 125I-hippuran clearances before induction of anesthesia, before cardiopulmonary bypass (CPB), during hypo- and normothermic CPB, after sternal closure, and 1 h postoperatively. Renal and systemic vascular resistances were calculated. ⋯ Urine NAG, creatinine, and free water clearances were normal in all patients both pre- and postoperatively. Osmolal clearance and fractional excretion of sodium increased postoperatively from 1.54 +/- 0.06 to 12.47 4/- 11.37 mL/min, and from 0.44 +/- 0.3 to 6.07 +/- 6.27, respectively. We conclude that renal function does not seem to be adversely affected by CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe addition of epinephrine enhances postoperative analgesia by intrathecal morphine.
To investigate whether the addition of epinephrine would enhance postoperative pain relief by intrathecal morphine, we studied 36 patients scheduled to have spinal anesthesia for gynecologic surgery. Patients were randomly allocated to one of three groups: the first received epinephrine 0.12 mg, morphine 0.2 mg, and hyperbaric tetracaine 12 mg intrathecally (EMT group, n = 11); the second received morphine 0.2 mg and hyperbaric tetracaine 12 mg intrathecally (MT group, n = 13); and the third received epinephrine 0.12 mg and hyperbaric tetracaine 12 mg intrathecally (ET group, n = 12). The time to the first request for supplemental analgesics was longest (2182 +/- 251 min, mean +/- SEM) and the injection number of supplemental analgesics was least in the EMT group (P < 0.05). ⋯ The visual analog scale (VAS) pain score was larger in the ET group than the EMT group (P < 0.05), but was similar in the EMT and MT groups. There were no differences among groups in the incidence of nausea and pruritus. Our data show that the addition of epinephrine enhances postoperative analgesia by intrathecal morphine without increasing the incidence of adverse effects as compared with intrathecal morphine alone.