Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Clinical TrialEmergence of elderly patients from prolonged desflurane, isoflurane, or propofol anesthesia.
Recovery from prolonged anesthesia might be compromised in elderly patients. Desflurane (DES) may be particularly well suited to achieve a rapid postoperative recovery because of its low lipid solubility. Postoperative recovery was compared in 45 elderly patients randomized to receive either DES, isoflurane (ISO), or propofol (PRO) to maintain anesthesia. Anesthesia was induced with PRO, vecuronium, and fentanyl and maintained with N2O, fentanyl, and the study drug. Times from end of anesthesia to tracheal extubation, eye opening and hand squeezing on command, and ability to state name and date of birth were recorded. Sedation and psychometric evaluation were tested 0.5, 1, 1.5, 2, and 24 h postoperatively. Results are given as means +/- SD. Differences among were analyzed by chi2 or analysis of variance. P < 0.05 compared with DES was considered significant. After a prolonged anesthesia (199 +/- 57 min with DES), immediate recovery times were significantly shorter with DES than with ISO or PRO (times to eye opening: 5.6 +/- 3.4 min, 11.5 +/- 8.4 min, and 11.9 +/- 7.6 min; times to extubation: 6.9 +/- 3 min, 13.1 +/- 8.9 min, 9.9 +/- 6.5 min for DES, ISO, and PRO, respectively). Intermediate recovery, as measured by psychometric testing, sedation levels, and time to discharge from the postanesthesia care unit, was similar in the three groups. In this study, DES provided a transient advantage compared with ISO or PRO with respect to early recovery after prolonged general anesthesia in elderly patients. ⋯ Recovery from prolonged anesthesia can sometimes be problematic in elderly patients. We evaluated 45 elderly patients who received either desflurane, isoflurane, or propofol for anesthesia. We found that desflurane provided a transient advantage in terms of postoperative recovery, but whether this difference is clinically important remains to be demonstrated.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Clinical TrialMaternal experience during epidural or combined spinal-epidural anesthesia for cesarean section: a prospective, randomized trial.
Epidural anesthesia (EA) and combined spinal-epidural anesthesia (CSEA) are popular anesthetic techniques for elective cesarean section. A randomized, blind study was conducted to compare maternal experiences during these regional anesthetics. EA was established using alkalinized 2% lidocaine with epinephrine and fentanyl, whereas spinal anesthesia was performed using 2.5 mL hyperbaric 0.5% bupivacaine and fentanyl via a single-space CSEA approach. Both patients and observers were blinded to the anesthetic technique allocation. One hundred twenty patients were enrolled; 6 were withdrawn (Group EA, n = 55; Group CSEA, n = 59). Of the two techniques, CSEA was associated with earlier onset times (P < 0.001), more intense motor block (P < 0.05), and greater ephedrine use (P < 0.01). Anxiety was significantly lower (P < 0.05) and satisfaction was higher (P < 0.05) before starting surgery with CSEA. Pain scores were lower pre- and intraoperatively with CSEA, a difference that became significant during block placement and at delivery (P < 0.05). There were no differences between groups in the incidence or severity of hypotension and nausea or analgesic supplementation rate; or for postoperative assessments of intraoperative pain, anxiety and satisfaction, and postpartum backache and headache. We conclude that maternal conditions and experience were good with both methods, although CSEA conferred several minor advantages. ⋯ Epidural and combined spinal-epidural anesthesia are often used for elective cesarean sections. Although the combined spinal-epidural anesthetic technique conferred minor advantages, both techniques were associated with low anesthetic failure rates, good operative conditions, and high maternal satisfaction levels.
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Anesthesia and analgesia · Sep 1997
Comparative StudyA comparative study of the vasodilator effects of prostaglandin E1 in patients with pulmonary hypertension after mitral valve replacement and with adult respiratory distress syndrome.
To determine whether the vasodilator effects of prostaglandin E1 (PGE1) differ according to the etiology and pathophysiology of pulmonary hypertension, we studied 30 patients with pulmonary hypertension after mitral valve replacement (MVR) (n = 16) or with the adult respiratory distress syndrome (ARDS) (n = 14). PGE1 was administered to decrease the mean pulmonary artery pressure to below 30 mm Hg in both groups. Cardiac index and oxygen delivery tended to increase, whereas mean systemic artery pressure, mean pulmonary artery pressure, systemic vascular resistance index (SVRI), and pulmonary vascular resistance index (PVRI) significantly decreased in both groups. A vasodilatory index was defined in this study to allow evaluation of vasodilation relative to PGE1 dose: systemic vasodilatory index (VIs) = SVRI change/PGE1 dose; and pulmonary vasodilatory index (VIp) = PVRI change/PGE1 dose. The VIp was similar in both groups, but the VIs was significantly greater in the ARDS group compared with the MVR group (13.3 +/- 7.8 vs 4.8 +/- 5.1, P < 0.01). A good correlation was found between the pretreatment intrapulmonary shunt fraction (Qs/Qt [%]) value and PGE1 extraction rate in the lung (r = 0.60), and between the pretreatment Qs/Qt value and PGE1 concentration in the radial artery (r = 0.65) in an additional 15 patients. We conclude that the vasodilator effects of PGE1 on the pulmonary circulation are similar in the two groups, whereas the vasodilator effects on the systemic circulation are significantly greater in the ARDS group and that significant reduction in VIs in the ARDS group was associated with decreased PGE1 extraction in the lung. ⋯ Pulmonary hypertension after mitral valve replacement, or with adult respiratory distress syndrome, is a major medical problem. The authors found that administration of prostaglandin E1 significantly dilated the pulmonary circulation with a concomitant decrease in pulmonary artery pressure. Because the systemic vasodilatory effect was greater in the adult respiratory distress syndrome group, the authors concluded that prostaglandin E1 concentrations in the systemic circulation depend on the severity of lung injury.
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Anesthesia and analgesia · Sep 1997
Letter Case ReportsAn uncommon leak in the anesthesia breathing circuit.