Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1987
Comparative StudyCerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2.
Measurement of 133Xe clearance and effluent cerebral venous blood sampling were used in 38 patients to determine the effects of cardiopulmonary bypass, and of maintaining temperature corrected or noncorrected PaCO2 at 40 mm Hg on regulation of cerebral blood flow (CBF) and flow/metabolism coupling. After induction of anesthesia with diazepam and fentanyl, mean CBF was 25 ml X 100 g-1 X min-1 and cerebral oxygen consumption, 1.67 ml X 100 g-1 X min-1. Cerebral oxygen consumption during nonpulsatile cardiopulmonary bypass at 26 degrees C was reduced to 0.42 ml X 100 g-1 X min-1 in both groups. ⋯ However, variation in CBF correlated significantly with cerebral perfusion pressure over the pressure range of 15-95 mm Hg. This study demonstrates a profound reduction in cerebral oxygen consumption during hypothermic nonpulsatile cardiopulmonary bypass. When a non-temperature-corrected PaCO2 of approximately 40 mm Hg was maintained, CBF was lower, and analysis of pooled data suggested that CBF regulation was better preserved, i.e., CBF was independent of pressure changes and dependent upon cerebral oxygen consumption.
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Anesthesia and analgesia · Aug 1987
Randomized Controlled Trial Comparative Study Clinical TrialEpidural ketamine for postoperative pain relief after gynecologic operations: a double-blind study and comparison with epidural morphine.
This double-blind study evaluates whether ketamine given epidurally is effective for postoperative pain relief, and compares the effects of epidural ketamine with those of epidural morphine. Sixty-eight patients undergoing abdominal gynecologic surgery were randomly assigned into six groups (control; ketamine 4, 6, and 8 mg in saline; 6 mg in 10% glucose; morphine 3 mg). ⋯ Significantly, none of the patients in the morphine group needed additional analgesics within 24 hr, whereas 85% in the other five groups did. We conclude that ketamine administered epidurally is inadequate for postoperative pain relief after gynecologic operations.