Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1996
Multicenter StudyEpidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists.
We report the results of a prospective study on the practice of pediatric regional anesthesia by the French-Language Society of Pediatric Anesthesiologists (ADARPEF) during the period from May 1, 1993 to April 30, 1994. This study was designed to provide data concerning the epidemiology of regional anesthesia and its complications in a totally anonymous way. Data from 85,412 procedures, 61,003 pure general anesthetics and 24,409 anesthetics including a regional block, were prospectively collected. ⋯ This prospective study, based on a large and representative series of pediatric anesthetics, establishes the safety of regional anesthesia in children of all ages. It provides new insights on the practice of regional blocks and reveals that complications are rare and minor as they occur most often in the operating room and are readily managed by experienced anesthesiologists with resuscitative equipment at hand. The extremely low incidence of complications (zero in this study) after peripheral nerve blocks should encourage pediatric anesthesiologists to use them more often when they are appropriate, in the place of a central block.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialRecovery after propofol with and without intraoperative fentanyl in patients undergoing ambulatory gynecologic laparoscopy.
This prospective, randomized double-blind study was conducted to examine the effect of intraoperative opioid (fentanyl) supplementation on postoperative analgesia, emesis, and recovery in ambulatory patients receiving propofol-nitrous oxide anesthesia. Eighty patients undergoing ambulatory gynecologic laparoscopy participated. Confounding variables that could influence the incidence of postoperative emesis were controlled. ⋯ These results indicate that, in patients undergoing ambulatory gynecologic laparoscopy, the practice of administering a small dose of fentanyl at the time of anesthetic induction reduces maintenance propofol requirement, but fails to provide effective postoperative analgesia. Fentanyl administration at anesthetic induction increased the need for rescue antiemetics. The relative severity of emetic sequelae could have contributed to delay in ambulation and discharge.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block.
This study assessed the minimum dose of clonidine required to prolong the duration of both anesthesia and analgesia after axillary brachial plexus blockade. Eighty patients scheduled for elective hand surgery were divided into eight groups in a randomized, double-blind fashion. An axillary brachial plexus block was performed with 40 mL 1% mepivacaine plus 1:200,000 epinephrine. ⋯ The minimum dose of clonidine required to significantly prolong the duration of analgesia and anesthesia was, respectively, 0.1 and 0.5 microgram/kg. No side effects (sedation, drowsiness, bradycardia, arterial hypotension) were reported. We conclude that the dose of clonidine required to prolong significantly the duration of both anesthesia and analgesia after axillary brachial plexus blockade is 0.5 microgram/kg and that, at this dose, clonidine may be used without important reported side effects even in outpatients.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of cisatracurium and atracurium: onset of neuromuscular block after bolus injection and recovery after subsequent infusion.
Cisatracurium is a new nondepolarizing muscle relaxant. In patients randomized to receive either cisatracurium (n = 40) or atracurium (n = 20) we compared the time course of neuromuscular block. The initial bolus dose of cisatracurium was 0.1 mg/kg, that of atracurium 0.5 mg/kg. ⋯ The infusion rates for a 95% +/- 4% neuromuscular block were 1.5 +/- 0.4 micrograms.kg-1.min-1 for cisatracurium and 6.6 +/- 1.7 micrograms.kg-1.min-1 for atracurium, 3.3 times those of cisatracurium when referenced to the active cations. After the infusion, the spontaneous recovery intervals 25%-75% of 18 +/- 11 min and 18 +/- 8 min for cisatracurium and atracurium (P = 0.896) were shortened to 5 +/- 2 min and 4 +/- 3 min (P = 0.921) after neostigmine. While attributing different onset times also to differences in the initial doses, we conclude that time profiles for neuromuscular block of both muscle relaxants, when given in equipotent doses, are not different.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Clinical TrialA similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine.
Recent reports suggest that transient neurologic symptoms are common after spinal anesthesia with 5% lidocaine. To determine whether reducing the anesthetic concentration might decrease the incidence of symptoms, 50 ASA class I or II patients undergoing brief gynecologic procedures under spinal anesthesia were randomly allocated to receive 1 mg/kg of either 5% or 2% lidocaine in 7.5% glucose. ⋯ Symptoms suggestive of transient radicular irritation were observed in 8 patients (32%) receiving 5% lidocaine, and in 10 patients (40%) receiving 2% lidocaine (NS). These results confirm our previous findings that transient neurologic symptoms may occur in up to one third of the patients receiving 5% lidocaine, and indicate that a modest reduction in lidocaine concentration does not reduce risk.