Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2007
Randomized Controlled Trial Comparative StudyA comparison of minimum local anesthetic volumes and doses of epidural bupivacaine (0.125% w/v and 0.25% w/v) for analgesia in labor.
In this study we sought to determine and compare the minimum local anesthetic volumes (MLAV) and doses (MLAD) of two concentrations of bupivacaine for epidural pain relief in labor, and to quantify the effect on dose. ⋯ Bupivacaine 0.125% (w/v) when compared with 0.25% (w/v) produced equivalent analgesia with a 50% increase in volume, but with a 25% reduction in dose. Any reduction in dose, without loss of efficacy, reduces risk of toxicity and improves safety.
-
Anesthesia and analgesia · Feb 2007
Randomized Controlled Trial Comparative StudyGlycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections.
Two recent studies have identified copious secretions as an independent risk factor for perioperative adverse events in children who present for elective surgery in the presence of an upper respiratory tract infection (URI). We designed this study, therefore, to determine whether the administration of the anticholinergic drug, glycopyrrolate, to children with URIs would reduce the incidence of adverse perioperative respiratory events. One hundred thirty children (1 mo to 18 yr of age) who presented for elective surgery with a URI were randomized to receive either 0.01 mg/kg glycopyrrolate or placebo and were followed for the appearance and severity of any perioperative respiratory adverse events. ⋯ Furthermore, there were no differences in outcome between the two groups when children with congestion and secretions were analyzed separately (45.0% vs 37.0%, respectively). However, compared with the placebo group, children in the glycopyrrolate group had significantly shorter discharge times (83.9 min vs 111.4 min, P = 0.024), and significantly less postoperative nausea and vomiting (10.7% vs 33.3%, P = 0.005). These results suggest that glycopyrrolate, administered after induction of anesthesia to children with URIs, does not reduce the incidence of perioperative respiratory adverse events, and thus may not be clinically indicated for routine use in this population.
-
Anesthesia and analgesia · Feb 2007
Randomized Controlled Trial Comparative StudyDoes ondansetron or granisetron prevent subarachnoid morphine-induced pruritus after cesarean delivery?
We compared the efficacy of granisetron and ondansetron for the prevention of subarachnoid morphine-induced pruritus after cesarean delivery. ⋯ Neither prophylactic ondansetron nor granisetron reduced the incidence of subarachnoid morphine-induced pruritus when compared with the saline group.
-
Anesthesia and analgesia · Feb 2007
Comparative StudyA new plasma-adapted hydroxyethylstarch preparation: in vitro coagulation studies using thrombelastography and whole blood aggregometry.
The lack of acceptance of hydroxyethylstarch (HES) for intravascular volume replacement is most likely due to reports of abnormal coagulation. In a blinded in vitro study, we compared the effects on hemostasis of a new HES, prepared in a balanced solution, with a conventional HES preparation and Ringer's lactate solution. ⋯ A balanced HES preparation showed fewer negative effects on thrombelastographic data and platelet aggregation than a nonbalanced HES preparation, especially when using higher degrees of dilution. Future clinical studies may show a decreased influence of balanced HES solutions on coagulation.
-
Anesthesia and analgesia · Feb 2007
Comparative StudyMeasurements of optical pathlength using phase-resolved spectroscopy in patients undergoing cardiopulmonary bypass.
Near infrared spectroscopy (NIRS) has been used during cardiac surgery to monitor cerebral oxygenation although the validity of this technique has yet to be established. Although optical pathlength included in the algorithm for calculating NIRS values is supposed to be constant, recent evidence has suggested that optical pathlength could be affected by acute hemodilution in animals. We conducted the present study to investigate whether optical pathlength changes during cardiopulmonary bypass (CPB), and whether these changes affect NIRS values in adult patients. ⋯ The results indicate that optical pathlength can change during CPB and its changes may affect DeltaO2Hb.