Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 1997
Clinical TrialPlasma concentrations of bupivacaine in neonates after continuous epidural infusion.
This study reports plasma bupivacaine concentrations in 13 neonates who received lumbar epidural anesthesia during major abdominal surgery. A bolus of 1.8 mg/kg of bupivacaine (2.5 mg/mL) was administered after induction of anesthesia, followed by a continuous infusion of 0.2 mg.kg-1.h-1 (1.25 mg/mL). Plasma concentrations of total and free bupivacaine and alpha 1-acid-glycoprotein (AAG) were determined. ⋯ However, a substantial number of patients still had increasing concentrations of total plasma bupivacaine at 48 h. Furthermore, the interindividual variation was considerable. These observations cause concern about the safety of epidural infusions longer than 48 h in the age group studied.
-
Anesthesia and analgesia · Mar 1997
The association between Doppler transmitral flow variables measured by transesophageal echocardiography and pulmonary capillary wedge pressure.
The association between Doppler transmitral flow variables, measured by transesophageal echocardiography (TEE), and pulmonary capillary wedge pressure (PCWP) was studied in 88 patients undergoing coronary artery surgery. The Doppler flow variables and PCWP were measured after sternotomy by blinded investigators. In the first part of the study, patients were divided into two groups according to left ventricular (LV) ejection fraction (EF): Group A, EF > 35% (n = 38) and Group B, EF < or = 35% (n = 34). ⋯ When the relationship between DCT-E and PCWP was tested prospectively in a third group of patients [Group C; EF < or = 35% (n = 16)], a close agreement between the calculated and measured PCWP (bias = -0.55 +/- 3.87 mm Hg) was noted. The sensitivity, specificity, and positive predictive value of DCT-E > or = 150 ms for PCWP < 10 mm Hg were 93.3%, 100%, and 100%, respectively. In summary, patients with decreased left ventricular systolic function undergoing coronary artery surgery demonstrated high, statistically significant, correlations between PCWP and the deceleration time or deceleration slope of early diastolic filling as measured by transesophageal Doppler echocardiography.
-
Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting after gynecologic surgery.
This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women undergoing gynecologic incontinence surgery with standardized general anesthesia. At the end of surgery, the patients received either tropisetron 5 mg, droperidol 1.25 mg, or 0.9% saline intravenously (i.v.). ⋯ The number of emetic episodes (retching and/or vomiting) per patient within 48 h was significantly decreased under tropisetron when compared with placebo (tropisetron 2.5 +/- 3.4, droperidol 4.2 +/- 6.1, placebo 5.9 +/- 7.1). With regard to adverse events, the patients in the droperidol group had significantly more anxiety than the placebo group (2-6 h postoperatively), more drowsiness than the tropisetron and placebo groups (0-2 h postoperatively), and more dissatisfaction than the tropisetron (0-6 h postoperatively) and placebo groups (2-6 h postoperatively). We conclude that tropisetron given 5 mg i.v. during anesthesia in gynecologic incontinence surgery effectively prevents vomiting but not nausea and retching, while 1.25 mg i.v. droperidol fails to prevent any of these emetic symptoms and results in adverse events.
-
Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of lidocaine and saline for epidural top-up during combined spinal-epidural anesthesia in volunteers.
This study was designed to determine the efficacy of saline as an epidural top-up to prolong spinal anesthesia during combined spinal-epidural anesthesia (CSEA). Eight volunteers received three separate CSEAs with intrathecal lidocaine (50 mg). After two-segment regression, each subject received either a saline (10 mL), lidocaine 1.5% (10 mL), or control sham (0.5 mL saline) epidural injection in a randomized, double-blind, triple cross-over fashion. ⋯ Instead, saline decreased the duration of tolerance to TES by 20 and 24 min at the knee and ankle (P < 0.05). Recovery from motor block at the quadriceps was prolonged by an epidural injection of lidocaine (P < 0.05). We conclude that when 10 mL of epidural saline is administered after two-segment regression, it is an ineffective top-up and may decrease the duration of spinal anesthesia during CSEA.