Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Classification of malignant hyperthermia-equivocal patients by 4-chloro-M-cresol.
To clarify the contracture response to 4-chloro-m-cresol (4-CmC) in malignant hyperthermia (MH) equivocal (MHE) muscle, we studied the effect of cumulative concentrations of 4-CmC. In vitro contracture test (IVCT) was performed in 35 probands according to the European MH test protocol. Surplus muscle bundles were exposed to 4-CmC (25-200 micromol/L), maintaining each concentration for 4 and 8 min. ⋯ Therefore, 4-CmC might reduce the frequency of MHEh diagnosis based on standard halothane-caffeine IVCT. However, since MHE individuals may also represent an aberrant genetic status, with MH causing defects linked to unknown mutations, it is premature to consider 4-CmC as a solution to the diagnostic uncertainty of the true status of MHE probands. Presently, 4-CmC may provide supplementary information for a more precise phenotypic categorization of MHE individuals.
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We describe a novel supraclavicular approach to the brachial plexus. Designated as the intersternocleidomastoid technique, this new approach was tested in unembalmed cadavers. It was then applied for evaluation to 150 ASA grade I or II patients scheduled for elective surgery or physiotherapy of the upper limb or for treatment of reflex sympathetic dystrophy associated with painful shoulder. ⋯ Postoperative analgesia was provided for 48 h or more in 45 patients and for 24 h in 18 patients. Only minor complications were observed: asymptomatic phrenic nerve block in 89 patients (60%), transient Horner's syndrome in 15 (10%), transient recurrent laryngeal nerve blockade in 2, and misplacement of the catheter into the subclavian vein in 1 patient. No pneumothorax was observed.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA comparison of oral ketorolac and hydrocodone-acetaminophen for analgesia after ambulatory surgery: arthroscopy versus laparoscopic tubal ligation.
This multicenter study compared the analgesic efficacy and side effects of ketorolac and hydrocodone-acetaminophen when administered orally after ambulatory arthroscopic or laparoscopic tubal ligation procedures. After awakening from general anesthesia, 252 patients experiencing moderate or severe postoperative pain were randomly assigned to receive one of three analgesic treatments according to a placebo-controlled, double-blind protocol. Group 1 (n = 83) received oral ketorolac 10 mg every 6 h for up to 3 days, Group 2 (n = 82) received hydrocodone 7.5 mg plus acetaminophen 750 mg every 6 h for up to 3 days, and Group 3 (n = 87) received placebo capsules followed by ketorolac 10 mg every 6 h for up to 3 days. ⋯ However, the ketorolac group scored higher in terms of overall tolerability than the hydrocodone-acetaminophen group. In conclusion, there was no difference in the efficacy between oral ketorolac and hydrocodone-acetaminophen combination in controlling pain after outpatient arthroscopic surgery procedures. Neither oral analgesic proved to be very effective after laparoscopic tubal ligation.
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Anesthesia and analgesia · Jul 1997
Comparative StudyComparative pharmacokinetics of ropivacaine and bupivacaine in nonpregnant and pregnant ewes.
We determined the pharmacokinetics and protein binding of ropivacaine and bupivacaine after intravenous administration to nonpregnant and pregnant sheep. All animals were in good condition throughout the study. The highest mean total serum drug concentrations were found at the end of infusion. ⋯ In conclusion, the pharmacokinetics of ropivacaine and bupivacaine are altered by ovine pregnancy in a similar way. If these data are applicable to humans, an unintended intravascular injection of either drug could be expected to result in higher total serum concentrations in the pregnant than in the nonpregnant patient, but drug levels would decline at similar rates in both groups of individuals. However, differences between the two drugs, particularly in T(1/2)beta and MRT, may make ropivacaine preferable for use in obstetric anesthesia.
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Anesthesia and analgesia · Jul 1997
Laryngeal mask airway and the incidence of regurgitation during gynecological laparoscopies.
We studied the incidence of regurgitation in 100 patients undergoing elective gynecological laparoscopies under general anesthesia with intermittent positive pressure ventilation using a laryngeal mask airway (LMA). Patients ingested methylene blue capsules 10-15 min before induction of anesthesia. After induction and insertion of an LMA using the recommended insertion technique, a fiberoptic examination of the larynx was made for traces of dye and to site a pH probe in the bowl of the LMA for continuous monitoring. ⋯ The 95% confidence limit for a true probability of regurgitation in this study is 0.041 or a true rate of regurgitation of less than 4.1%. A larger study would be required to possibly demonstrate a lower incidence of regurgitation. This study confirms the clinical impression that the incidence of regurgitation during laparoscopies with a LMA is extremely low.