Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1992
Randomized Controlled Trial Comparative Study Clinical TrialCombination of low-dose epidural morphine and intramuscular diclofenac sodium in postcesarean analgesia.
Epidural morphine is used for postcesarean analgesia, and nonsteroidal antiinflammatory drugs are frequently administered to relieve uterine cramps after vaginal delivery. To assess the efficacy of a combination of low-dose epidural morphine and intramuscular diclofenac sodium in postcesarean analgesia, a double-blind, randomized study was conducted. Epidural anesthesia was given to 120 parturients who were randomly allocated into four treatment groups: group A received normal saline solution, 10 mL epidurally and 3 mL intramuscularly (IM); group B received 10 mL of epidural saline solution and 75 mg (3 mL) of diclofenac IM; group C received 2 mg of morphine in 10 mL of epidural saline solution and 3 mL of saline solution IM; and group D received 2 mg of morphine in 10 mL of epidural saline solution and 75 mg of diclofenac IM. ⋯ Incidence of nausea or vomiting, or both, and pruritus occurred more frequently in groups C and D compared with group A or B (P less than 0.05). No bradypnea was observed during the study period. Diclofenac alone was not effective in postcesarean analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Jul 1992
Comparative Study Clinical TrialVasopressor therapy for hypotension during epidural anesthesia for cesarean section: effects on maternal and fetal flow velocity ratios.
The purpose of this study was to identify the influence of hypotension as a result of epidural anesthesia and of its treatment with either ephedrine or methoxamine on uteroplacental and umbilical flow velocity ratios and fetal acid-base status. Fifty healthy women with an uncomplicated full-term pregnancy were studied during elective cesarean section under epidural anesthesia. A method of continuously recording flow velocity waveforms was used that allowed the identification of simultaneous values of maternal and fetal Doppler indices related to events during the induction of anesthesia. ⋯ Treatment with ephedrine had no influence on either the UtPI or UmPI, but treatment with methoxamine resulted in brief increases in the UtPI of 0.47 (0.24-0.69) during the first 5 min after its administration; the increases were brief and resolved within 2 min. The choice of vasopressor drug had no influence on the UtPI recorded just before surgery commenced (final UtPI), but those patients who experienced hypotension had significantly larger final UtPIs (1.02 (0.91-1.10)) than those who never became hypotensive (0.86 (0.72-0.99)), and this was associated with significantly increased placental hydrogen ion gradients. The choice of vasopressor drug appears to be of minor importance compared with the avoidance of hypotension.
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Anesthesia and analgesia · Jul 1992
Oxygen consumption and carbon dioxide elimination after release of unilateral lower limb pneumatic tourniquets.
Oxygen consumption (VO2), carbon dioxide elimination (VCO2), and respiratory exchange ratio (RQ) were continuously measured in 15 male and 15 female adults during knee surgery, with the leg exsanguinated by an inflatable tourniquet around the thigh. Arterial blood was also intermittently sampled for blood gas analysis, electrolytes, and lactate content before and after tourniquet deflation. There was a significant increase in VO2 and VCO2 after tourniquet deflation, which was more pronounced in the male (aged 29.5 +/- 14.8 yr, mean +/- SD) than the female (aged 56.9 +/- 15.6 yr) patients, both in terms of maximal increase (P less than 0.001) and percent of increase from values before deflation (P less than 0.001 and P = 0.01). ⋯ There was no correlation between the duration of tourniquet inflation time and peak increase in VO2, peak increase in VCO2, and O2 debt over 12 min after deflation of the tourniquet; however, tourniquet time was weakly correlated with excess VCO2 over 12 min after tourniquet deflation (r = 0.55, P = 0.002). There was a significant decrease in pHa (P less than 0.001) from release of PaCO2 and lactate after tourniquet deflation. Plasma potassium levels also increased significantly after tourniquet release (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)