Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1997
Do not resuscitate orders in the perioperative period: patient perspectives.
The purpose of this study was to determine the perspectives and opinions of terminally ill patients regarding the management of their do not resuscitate (DNR) orders in the perioperative period. Eighteen patients who had DNR orders and were willing to discuss those orders and their intentions were identified by hospital nurses or hospice workers. An in-depth interview was conducted with each patient. ⋯ Others were satisfied with discussing the intent of their orders. For various reasons and for various procedures, many patients with DNR orders are willing to undergo anesthesia and surgery. Anesthesiologists' awareness of the variety of opinions and perspectives held by patients regarding their DNR orders will enhance their preoperative discussion.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Multicenter Study Clinical TrialA multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect.
Bispectral analysis (BIS) of the electroencephalogram (EEG) has been shown in retrospective studies to predict whether patients will move in response to skin incision. This prospective multicenter study was designed to evaluate the real-time utility of BIS in predicting movement response to skin incision using a variety of general anesthetic techniques. Three hundred patients from seven study sites received an anesthetic regimen expected to give an approximately 50% movement response at skin incision. ⋯ When drugs such as propofol or isoflurane are used as the primary anesthetic, changes in BIS correlate with the probability of response to skin incision. When opioid analgesics are used, the correlation to patient movement becomes much less significant, so that patients with apparently "light" EEG profiles may not move or otherwise respond to incision. Therefore, the adjunctive use of opioid analgesics confounds the use of BIS as a measure of anesthetic adequacy when movement response to skin incision is used as the primary end point.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialContinuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery.
The purpose of this study was to determine whether a lumbar epidural infusion of ropivacaine 0.2% would provide effective analgesia with an acceptably low incidence of motor blockade and side effects after lower abdominal surgery. After combined general and epidural anesthesia and surgery, 125 patients were randomly assigned to receive either saline or ropivacaine 0.2% at a rate of 6, 8, 10, 12, or 14 mL/h (Groups R6, R8, R10, R12, and R14, respectively) for 21 h. Supplemental analgesia, if required, was provided with intravenous patient-controlled analgesia with morphine. ⋯ Sensory blockade at 8 and 21 h was greater in the ropivacaine groups compared with the saline group. Approximately 30% of R8, R10, and R12 patients, and 63% of R14 patients had demonstrable motor block of the lower limbs at 21 hours. We conclude that lumbar epidural ropivacaine 0.2% reduces parenteral morphine requirements but has little effect on pain scores and may be associated with motor blockade.