Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1997
Clinical Trial Controlled Clinical TrialIntrathecal neostigmine for post-cesarean section analgesia: dose response.
Intrathecal (IT) neostigmine produces analgesia in animals and humans and enhances systemic opioid analgesia. To examine the safety of IT neostigmine for eventual use in obstetrics, we studied 24 healthy, term pregnant patients scheduled to receive elective cesarean section using a combined spinal-epidural anesthetic. Using an open-label, dose-ranging design, patients received either IT placebo or neostigmine 10, 30, or 100 microg in a 1-mL solution of 5% glucose in normal saline followed in 15 min by 2% epidural lidocaine for cesarean section. ⋯ Cumulative average 24-h morphine use was 82 +/- 7 mg for women receiving IT placebo and 50 +/- 8 mg for women receiving IT neostigmine (P < 0.003). Hourly morphine use was significantly reduced in the neostigmine groups for 10 h postoperatively. These data indicate that IT neostigmine can produce 10 h of post-cesarean section analgesia without adverse fetal effects and support cautious further prospective study.
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Anesthesia and analgesia · Jun 1997
Comparative StudyThe effect of xenon on spinal dorsal horn neurons: a comparison with nitrous oxide.
We compared the effects of xenon (Xe) on the spinal cord dorsal horn neurons with those of nitrous oxide (N2O) in cats anesthetized with chrolarose and urethane. We assessed the potency of both anesthetics by the inhibition of wide dynamic range neuron responses evoked by cutaneous noxious (pinch) stimulation to a hindpaw. During 70% Xe inhalation, the responses of 7 of 11 neurons to pinch stimulation were suppressed. ⋯ After 20 min of Xe inhalation, the response to pinch was suppressed to 49.5% +/- 8.2% (mean +/- SE), while N2O, 70% in oxygen, suppressed it to 45.9% +/- 7.9%. The difference between N2O and Xe was not significant. We conclude that Xe and N2O suppress the spinal cord dorsal horn neurons to a similar degree.
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Anesthesia and analgesia · Jun 1997
Clinical TrialDisplacement of the double-lumen endobronchial tube can be detected by bronchial cuff pressure change.
We measured the bronchial cuff pressure of left-sided double-lumen endobronchial tubes (DLTs) in 54 patients to confirm the effect of DLT displacement on cuff pressure. After positioning the cephalad surface of the bronchial cuff of the DLT 2.5 cm distal to the carina (23 patients in the first part of the study) or just below the carina (23 patients in the second part), the cuff was withdrawn in 0.5-cm steps during right-sided, one-lung ventilation. The bronchial cuff pressure was measured, and the capnogram and pressure-volume loop, displayed by a side-stream spirometer, was evaluated. ⋯ The bronchial cuff pressure decreased significantly by 28.4 cm H2O (P < 0.01) and 21.3 cm H2O (P < 0.01) in the first and second parts, respectively, before the pressure-volume loop or the capnogram changed. The bronchial cuff pressure in the third part showed no significant change. We conclude that bronchial cuff pressure monitoring was very helpful in detecting displacement of the DLT during right-sided, one-lung ventilation.