Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialAttenuation of cardiovascular responses to tracheal extubation: verapamil versus diltiazem.
We studied the effect of intravenous injection of verapamil (0.05 mg/kg or 0.1 mg/kg) on cardiovascular changes during tracheal extubation and emergence from anesthesia and compared the efficacy of the drug with that of diltiazem (0.2 mg/kg). Eighty patients (ASA physical status I) who were to undergo elective gynecological surgery were randomly assigned to one of four groups (n = 20 each): saline (control), 0.05 mg/kg and 0.1 mg/kg verapamil, and 0.2 mg/kg diltiazem. These medications were given 2 min before tracheal extubation. ⋯ Both calcium channel blockers attenuated the increases in these variables. The inhibitory effect was greatest with verapamil 0.1 mg/kg, while the alleviative effect of verapamil 0.05 mg/kg was inferior to that of diltiazem 0.2 mg/kg. These findings suggest that a bolus injection of verapamil 0.1 mg/kg given 2 min before tracheal extubation is a more effective prophylactic for attenuating the cardiovascular changes associated with extubation than is diltiazem 0.2 mg/kg.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialContinuous small-dose aprotinin controls fibrinolysis during orthotopic liver transplantation.
Large doses of aprotinin (1,000,000-2,000,000 kallikrein inhibitor units [KIU] initial dose and a 500,000 KIU/h infusion) have been used during orthotopic liver transplantation (OLT) to reduce the incidence and severity of fibrinolysis. This double-blinded study was designed to investigate whether a small-dose infusion of aprotinin (200,000 KIU/h) would control fibrinolysis. A controlled study was undertaken to compare small-dose aprotinin with a placebo in patients undergoing OLT with veno-venous bypass. ⋯ Blood levels of fibrin degradation products (FDP) were significantly higher in the control group (95% > 20 micrograms/mL) at the end of surgery compared to the aprotinin group (53% > 20 micrograms/mL, P < 0.01). The transfusion of cryoprecipitate units was more in the control group versus the aprotinin (12.6 +/- 12.8 vs 5.7 +/- 7.5; P < 0.04), as was the number of fresh frozen plasma units (6.6 +/- 3.5 vs 3.6 +/- 6.1; P < 0.05). We conclude that an infusion of a small dose of aprotinin can safely control fibrinolysis during liver transplantation with a concomitant reduction in transfusion of blood products.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe hemodynamic and renal effects of sevoflurane and isoflurane in patients with coronary artery disease and chronic hypertension. Sevoflurane Ischemia Study Group.
In patients without significant cardiovascular disease, the hemodynamic effects of sevoflurane and isoflurane are similar; however, the hemodynamic effects of sevoflurane in patients with hypertension and ischemic heart disease are unknown. To examine the effects of sevoflurane in comparison to isoflurane in this high-risk population, 214 patients scheduled for elective surgery were enrolled if they had evidence of ischemic heart disease or multiple risk factors for ischemic heart disease. Patients were randomly assigned to receive sevoflurane (n = 106) or isoflurane (n = 108) for anesthetic maintenance in conjunction with fentanyl and nitrous oxide in oxygen. ⋯ The incidence of post-operative proteinuria was similar in the sevoflurane and isoflurane groups. We conclude that hemodynamic stability in patients with hypertension and ischemic heart disease is similar with sevoflurane and isoflurane. No differences in renal function were observed between the sevoflurane and isoflurane groups.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Clinical TrialThe effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain.
The purpose of this study is to determine the effect of postoperative analgesia on the amount of breast feeding and infant weight gain. Thirty parturients undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive postoperative pain management with (S-E group, n = 15) or without epidural bupivacaine (S group, n = 15). Epidural analgesia was performed for 3 days with a continuous epidural infusion (0.7 mL/h) of 0.25% bupivacaine. ⋯ In the S-E group, the visual analog pain score after surgery was significantly lower and both the weight of milk fed by breast and the infant weight during the study were significantly more than the respective values in the S group. The S group required a larger dose of diclofenac after the operation than did the S-E group. We suggest that satisfactory postoperative pain relief with continuous epidural bupivacaine for 3 days after cesarean section improved the amount of breast feeding and the gain of infant weight.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane versus isoflurane for maintenance of anesthesia: are serum inorganic fluoride ion concentrations of concern?
Sevoflurane administration can result in increased serum inorganic fluoride ion concentrations, which have been associated with inhibition of renal concentrating ability. We measured serum fluoride levels, renal function, and recovery variables as a function of time in ASA grade I-III patients administered general anesthesia with isoflurane or sevoflurane for at least 1 h. Fifty patients were exposed to sevoflurane (< or = 2.4% inspired concentration) or isoflurane (< or = 1.9% inspired concentration) for maintenance of anesthesia as part of a multicenter trial. ⋯ Those two patients also demonstrated an increase in serum blood urea nitrogen and creatinine at 24 h after sevoflurane administration compared with baseline. The elimination half-life of serum fluoride ion was 21.6 h. The results of this study suggest the possibility of sevoflurane induced nephrotoxicity.