Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine.
The purpose of this study was to compare meperidine to meperidine with bupivacaine when used for patient-controlled epidural analgesia (PCEA) after thoracotomy. For 3 days after thoracotomy patients received thoracic PCEA with meperidine 0.1% plain or with added bupivacaine 0.1% or 0.01%. No background infusion was used. ⋯ The addition of bupivacaine 0.1% reduced the incidence of pruritus (P = 0.036), but 5 of 23 patients in this group were with-drawn from the study because of significant hypotension, oliguria, and/or motor or sensory block (P = 0.006). We conclude that the addition of bupivacaine 0.1% or 0.01% to thoracic PCEA meperidine 0.1% does not affect meperidine requirements or analgesia after thoracotomy. The addition of bupivacaine 0.1% may reduce pruritus, but is associated with signs of excessive sensory, motor, or autonomic blockade in a significant number of patients.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous tramadol versus epidural morphine for postthoracotomy pain relief: a placebo-controlled double-blind trial.
Tramadol, an analgesic deriving only part of its effect via opioid agonist activity, might provide postoperative pain relief with minimal risk of respiratory depression. We, therefore, evaluated it for the control of postthoracotomy pain. In this randomized, double-blind study, a single intravenous (IV) bolus dose of 150 mg tramadol (Group T) was compared to epidural morphine administered as an initial 2-mg bolus and subsequent continuous infusion at a rate of 0.2 mg/h (Group M). ⋯ Pao2 was significantly higher in Group T at 2 h and Paco2 significantly higher in Group M at 4 h postoperatively. There were no other significant respiratory differences. We conclude that a single dose of 150 mg tramadol given at the end of surgery provided postoperative analgesia equivalent to that provided by this dosage regimen of epidural morphine for the initial postoperative period.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialTranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery.
The administration of tranexamic acid (TA) prior to cardiopulmonary bypass (CPB) has been associated with reduced bleeding during and after cardiac surgery. In a prospective, randomized, controlled, double-blind clinical trial, adult patients undergoing repeat open heart surgery received TA (n = 17) or an equal volume of saline placebo (n = 13). In the TA group, a 20-mg/kg intravenous (IV) initial dose of TA at akin incision was followed by an infusion of 2 mg.kg-1.h-1, which continued for the duration of the surgical procedure. ⋯ Sternal closure occurred in 41 +/- 21 min in the TA group and 61 +/- 49 min in the placebo group (P = 0.14), and the subjective bleeding score was less in the TA group than in the placebo group (2.38 +/- 0.78 vs 3.08 +/- 1.04; P = 0.045). The data from the current study support the prophylactic use of TA in patients undergoing repeat cardiac surgery. TA administered prior to CPB reduced the incidence of allogeneic transfusions and postoperative mediastinal tube drainage, and improved the subjective assessment of post-CPB hemostasis in a group of patients at moderately high risk for perioperative bleeding.
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Anesthesia and analgesia · Jul 1996
Case ReportsTransient compartment syndrome of the forearm after attempted radial artery cannulation.
Radial artery cannulation for continuous intraoperative monitoring of arterial blood pressure is considered a safe procedure. One complication of arterial cannulation is hematoma formation at the time of insertion or removal of the catheter. Bleeding is usually self-limited or will stop with compression without significant sequelae, even in the anticoagulated patient. We describe a case of hematoma with a transient compartment syndrome of the forearm after attempts to cannulate the radial artery for intraoperative monitoring purposes.
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Anesthesia and analgesia · Jul 1996
The effects of intrathecally administered FK480, a cholecystokinin-A receptor antagonist, and YM022, a cholecystokinin-B receptor antagonist, on the formalin test in the rat.
Cholecystokinin (CCK) is located in the brain and the spinal cord, and CCK antagonist is reported to enhance the analgesic effect of morphine. It has been suggested that, during inflammation, the level of endogenous opioid peptides increases in the spinal cord. Intrathecally administered CCK antagonist may have some analgesic effect during inflammation via the activated spinal opioid system. ⋯ Pretreatment, but not posttreatment, with YM022 depressed the Phase 1 and Phase 2 flinching behavior in a dose-dependent manner, and this YM022 effect was stereospecific and was not antagonized by naloxone. These data indicate that a CCK-B receptor antagonist, but not a CCK-A receptor antagonist, produces an antinociceptive effect in the rat formalin test. This effect of a CCK-B receptor antagonist was not mediated by the spinal opioid receptor activation.