Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of propofol with a propofol-ketamine combination for sedation during spinal anesthesia.
Propofol (P) is increasingly used as a sedative during regional anesthesia. Providing titratable sedation and rapid recovery, it can compromise hemodynamic stability. However, in combination with ketamine (K), it provides stable hemodynamics during total intravenous anesthesia, avoiding emergence phenomena. ⋯ Mean arterial pressure was significantly higher in the P + K group, e.g., 91 mm Hg (86-94) vs 75 mm Hg (69-83) at 30 min (mean +/- SD). Administration of vasopressors and fluids as well as recovery and emergence phenomena were similar between groups. Although the described additive effect of propofol and ketamine was not confirmed, the combination conferred hemodynamic stability during spinal anesthesia.
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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
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of multiport and uniport epidural catheters in laboring patients.
The relative incidence of technical difficulties associated with multiport (three lateral ports) and uniport (single distal port) epidural catheters remains controversial. As part of a continuing institutional evaluation of epidural catheter insertion, 500 parturients were randomized to have either a multiport or a uniport epidural catheter inserted 6 cm into the epidural space. ⋯ No multiport epidural catheter was associated with multicompartment placement. We conclude that multiport epidural catheters are preferable for use in laboring patients since they reduce the incidence of inadequate epidural analgesia.
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Anesthesia and analgesia · Jun 1997
Clinical TrialDynamic ventilatory characteristics during weaning in postoperative critically ill patients.
Postoperative patients occasionally require more than 48 h of mechanical ventilation. This study examined whether there were distinct differences in dynamic respiratory variables between patients who successfully weaned from mechanical ventilation and those who failed. Forty general and thoracic surgery patients underwent a standardized weaning sequence: 25 min of synchronous intermittent mandatory ventilation (SIMV) at 8 bpm plus 5 cm H2O pressure support ventilation (PSV), then SIMV at 4 bpm plus 5 cm H2O PSV, followed by continuous positive airway pressure (CPAP) plus 5 cm H2O PSV and, finally, CPAP without PSV. ⋯ P0.1 (threshold 4.5 cm H2O, sensitivity 1.00, specificity 1.00), patient work of breathing (threshold 1.3 J/L, sensitivity 0.92, and specificity 0.98), and the sRR/sV(T) ratio (threshold 65 bpm/L, sensitivity 0.90, specificity 0.80) were distinctive. Most unique was the analysis of spontaneous breaths during low SIMV rates. This appears to permit an early determination of whether weaning would succeed.