Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1996
Large-dose propofol alone in adult epileptic patients: electrocorticographic results.
The primary objective of this study was to evaluate the electrophysiologic effects of large-dose propofol, used as the sole anesthetic in patients with epilepsy. Nine patients with medically intractable complex partial epilepsy undergoing a three-stage approach to the surgical management of epilepsy were recruited. State I involved placement of the intracranial electrode array, while Stage II consisted of extraoperative localization of the seizure focus. ⋯ No ECoG evidence of seizure activity was detected in the seven patients completing the study. Burst suppression was attained in six patients using a mean dose of 5.7 mg/kg +/- 2.6. We conclude that large dose propofol alone does not trigger electrical epileptiform activity on the ECoG of seizure patients.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialEquivalent outcomes during postoperative patient-controlled intravenous analgesia with lidocaine plus morphine versus morphine alone.
To evaluate a possible opioid-sparing effect of intravenous lidocaine we conducted a randomized, double-blind clinical trial. Patients undergoing intraabdominal surgery under general anesthesia were treated with patient-controlled analgesia (PCA) in three groups: Group 1 (n = 100; morphine 1 mg/mL), Group 2 (n = 44; morphine 1 mg/mL plus lidocaine 10 mg/mL), and Group 3 (n = 51; morphine 1 mg/mL plus lidocaine 20 mg/mL). Pain was evaluated using a 0-10 visual analog scale in the postanesthesia care unit (PACU) during deep inhalation at 15 and 30 min, and at 1, 2, and 4 h after arrival in the PACU, and continued after PACU discharge every 4 h for 36 h. ⋯ Along with pain intensity, we assessed vital signs and side effects. Time to acceptance of oral liquids was also determined. Adding lidocaine 10 or 20 mg/mL to PCA morphine 1 mg/mL for acute pain treatment after abdominal surgery yielded no differences in opioid use, pain levels, or side effects.
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Anesthesia and analgesia · Jul 1996
Case ReportsGastropleural fistula: an unusual cause of intractable postoperative nausea and vomiting.
Gastropleural fistula is an uncommon finding (1). Gastropleural fistulae have been reported after pulmonary resection (1), perforated paraesophageal hernia (2), perforated malignant gastric ulcer at the fundus, and gastric bypass operation for morbid obesity. We present a case of gastropleural fistula that resulted acutely from intractable postoperative nausea and vomiting after ambulatory knee arthroscopic surgery under general anesthesia.
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Anesthesia and analgesia · Jul 1996
Twenty-four of twenty-seven studies show a greater incidence of emesis associated with nitrous oxide than with alternative anesthetics.
All obtainable investigations that have compared the incidence of vomiting in groups of patients who received nitrous oxide (N2O) and in patients who received anesthetics or analgesics without N2O were examined for a single, dichotomous variable: whether patients who received N2O experienced an absolutely higher incidence, as distinct from a statistically significantly higher incidence, of vomiting. The null hypothesis is that N2O has no effect on emesis, such that an increased incidence of vomiting should occur in about half of the studies examined. ⋯ The two-tailed probability that this result occurred by chance is < 0.00005. It follows that N2O increases the incidence of emesis compared to alternative anesthetics.
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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.