Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialIntrathecal sufentanil for labor analgesia: do sensory changes predict better analgesia and greater hypotension?
Sensory changes and hypotension occur after intrathecal sufentanil (ITS) is given during labor. The goal of this study was to determine whether sensory changes are predictive of hemodynamic changes or duration of pain relief. We also examined whether sensory and hemodynamic changes relate to the concentration of ITS administered. ⋯ Systolic blood pressure decreased 23 +/- 2 mm Hg (P < 0.05) during the first 30 min after ITS, and six patients were given ephedrine. The magnitude of blood pressure change was not affected by the diluent volume or the presence of sensory changes. Because sensory changes were not predictive of the duration or quality of analgesia or the degree of hemodynamic change, we conclude that analgesia with ITS is predominantly mediated via spinal cord opioid receptors rather than by a local anesthetic-type conduction blockade.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Multicenter Study Clinical TrialIntravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery.
The newer 5-hydroxytryptamine type 3 (5-HT3) antagonists are sometimes considered for routine prophylaxis of postoperative nausea and vomiting (PONV) in high-risk patients. This multicenter, randomized, double-blind, placebo-controlled study compared the efficacy and safety of three single intravenous (IV) doses of dolasetron mesylate salt (12.5, 25, or 50 mg) for the prevention of PONV in 635 females undergoing outpatient laparoscopic gynecologic surgery. Antiemetic efficacy was evaluated over a 24-h postoperative period by recording the number and timing of emetic episodes; effects on nausea were evaluated by a visual analog scale (VAS). ⋯ Dolasetron-treated patients had significantly (P < 0.0357) lower median postdose maximum nausea VAS scores compared with placebo-treated patients. Patient satisfaction with dolasetron was high and, overall, was significantly (P = 0.0131) greater than that with placebo. Dolasetron was an effective and well tolerated preventive treatment for PONV resulting from laparoscopic gynecologic surgery.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialHands-up positioning during asymmetric sternal retraction for internal mammary artery harvest: a possible method to reduce brachial plexus injury.
This study compares the hands-up (HU) with the arms at side (AAS) position to determine whether one is beneficial in reducing brachial plexus stress during asymmetric sternal retraction. Eighty patients undergoing cardiac surgery were assigned to either Group 1 (AAS) or Group 2 (HU). Perioperative neurologic evaluations of the brachial plexus were performed and somatosensory evoked potentials (SSEPs) were collected during internal mammary artery harvest using asymmetric sternal retraction. ⋯ During asymmetric sternal retraction, HU positioning offered minimal benefit in reducing brachial plexus stress as measured by SSEP. Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury. However, none of the four patients with plexus symptoms in the HU group had ulnar nerve problems, suggesting that the higher incidence of postoperative symptoms observed with AAS positioning may occur from ulnar nerve compression.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialThe direction of the Whitacre needle aperture affects the extent and duration of isobaric spinal anesthesia.
The use of Whitacre spinal needles results in directional flow out of the needle aperture, diverting local anesthetic from the longitudinal axis of the needle. Thus, a change in orientation of the needle aperture would be expected to result in a different local anesthetic distribution in the subarachnoid space. We studied 40 outpatients undergoing elective knee arthroscopy under spinal anesthesia with 60 mg plain lidocaine 2% in a prospective, double-blinded manner. ⋯ Group I had significantly shorter duration of lumbar sensory anesthesia (149.2 +/- 30.6 min vs 177.8 +/- 23.5 min, P < 0.01) and motor blockade (117.6 +/- 26.1 min vs 150.0 +/- 22.8 min, P < 0.001). Mean time to outpatient discharge was approximately 32 min shorter in Group I. The orientation of the Whitacre needle aperture exerts a major influence on sensory level, as well as the duration of isobaric lidocaine spinal anesthesia.
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Anesthesia and analgesia · Feb 1997
Immediate tracheal extubation after liver transplantation: experience of two transplant centers.
Early tracheal extubation has been safely performed after large operative procedures, questioning the need for routine postoperative ventilation. Because immediate postoperative tracheal extubation of liver transplantation patients has not been previously reported, we performed preliminary studies at two institutions to evaluate potential risk and cost benefit. At the University of Colorado (UC), extubation criteria were derived from the retrospective analysis of patients who were ventilated less than 8 h and experienced an intensive care unit stay less than 48 h in 1994. ⋯ Wider limits on age and severity of illness did not preclude successful extubation. Cost analysis at UC showed a significant reduction in intensive care unit services and associated cost for extubated patients. We conclude that immediate postoperative tracheal extubation of selected liver transplantation patients is safe and cost effective.