Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialHemodynamic responses to an epinephrine test dose in adults during epidural or combined epidural-general anesthesia.
The efficacy of an epinephrine test dose during epidural and combined epidural-general anesthesia is unknown. Thirty-two patients were randomized to receive 2% lidocaine at either a high (25 mL) or low (12 mL) thoracic level of epidural anesthesia followed by general anesthesia with 1 minimum alveolar anesthetic concentration nitrous oxide and isoflurane. ⋯ Incidences of identification of intravascular injection from hemodynamic responses were similarly reduced for systolic blood pressure (100% vs 44%) and heart rate (100% vs 38%). The standard 15-micrograms epinephrine test dose is unaffected by low thoracic levels of epidural anesthesia, but may have decreased sensitivity for detection of intravascular injection during high thoracic levels of epidural anesthesia, especially during general anesthesia.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialSustained-release ibuprofen as an adjunct to morphine patient-controlled analgesia.
Previous studies have demonstrated reduced postoperative morphine requirements and/or improved pain relief when nonsteroidal antiinflammatory drugs are administered in conjunction with patient-controlled analgesia (PCA). This double-blind study aimed to determine whether these effects could be obtained with a sustained-release ibuprofen formulation (Brufen Retard) given preoperatively, obviating the need for oral administration during the early postoperative period. We aimed also to determine whether the anticipated reduction in morphine requirements was associated with reduced opioid side effects. ⋯ Morphine consumption was slightly but not significantly lower in the ibuprofen group (32 vs 38 mg/24 h, P = 0.096). Spo2 (P = 0.54), level of consciousness (P = 0.65), and number of antiemetic administrations (P = 0.15) did not differ significantly between groups. These results demonstrate improved efficacy with no increase in side effects when sustained-release ibuprofen is used as an adjunct to morphine PCA.
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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.