Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1985
Review Comparative StudyCroup and epiglottitis in children: the anesthesiologist as diagnostician.
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Anesthesia and analgesia · Jun 1985
Safety and efficacy of epinephrine added to bupivacaine for lumbar epidural analgesia in obstetrics.
The effects of epidural bupivacaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 32 parturients during labor and delivery. Patients in group I (n = 16) received 0.5% bupivacaine with 1:300,000 epinephrine and those in group II (n = 16) received 0.5% bupivacaine alone. Addition of epinephrine to bupivacaine had no significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate and variability, or the incidence of abnormal fetal heart rate patterns. ⋯ Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II (186.8 +/- 11.6 vs 85.3 +/- 6.1 (mean +/- SEM) min, P less than 0.001). It is concluded that adding epinephrine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother, fetus, neonate, or the progress of labor; and that it significantly prolongs the duration of anesthesia and decreases the incidence of maternal hypotension.
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The effects of intravenously administered fentanyl (25 micrograms/kg, n = 9; 50 micrograms/kg, n = 5) and alfentanil (12.5 micrograms/kg, n = 5; 25 micrograms/kg, n = 7) on the noxiously evoked, single-unit activity of cells in the nucleus reticularis gigantocellularis (NRGC) were studied in decerebrate cats. Only cells of the NRGC excited exclusively by supramaximal electrical stimulation of A delta fibers (noxious stimulation) of the superficial radial nerve were studied. ⋯ Fentanyl and alfentanil effects were antagonized by the intravenous administration of naloxone. These results indicate that opioid suppression of noxiously evoked activity is seen in neurons located in the brainstem, and thus suppression of brainstem neurons may be important in the production of fentanyl and alfentanil analgesia.
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Anesthesia and analgesia · May 1985
In vitro study of the effect of epidural blood patch on leakage through a dural puncture.
Pressure resistance of an experimental epidural blood patch was studied in vitro. Pieces of canine lumbar dura were perforated with a 19-gauge needle (n = 12) or a 25-gauge needle (n = 6) and kept between the intercommunicating chambers of a plexiglass apparatus. One chamber (epidural side) was filled with autologous blood and the other chamber (subdural side) was filled with autologous cerebrospinal fluid. ⋯ Four blood-treated specimens showed some leakage at 20 mm Hg. All dura specimens perforated with a 19-gauge needle leaked at 40 mm Hg, five of them only at the lowest score rate, 1-4 drops/5 min. One blood-patched dura perforated with a 25-gauge needle did not leak until the pressure reached 50 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · May 1985
Clinical Trial Controlled Clinical TrialAtracurium infusion requirements in children during halothane, isoflurane, and narcotic anesthesia.
We were interested in determining the dose-response relationship of atracurium in children (2-10 yr) during nitrous oxide-isoflurane anesthesia (1%) and the atracurium infusion rate required to maintain about 95% neuromuscular blockade during nitrous oxide-halothane (0.8%), nitrous oxide-isoflurane (1%), or nitrous oxide-narcotic anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 sec at 10-sec intervals. To estimate dose-response relationships, three groups of five children received 80, 100, 150 micrograms/kg atracurium, respectively. ⋯ At equipotent concentrations, halothane and isoflurane augment atracurium neuromuscular block to the same extent, compared to narcotic anesthesia. Atracurium steady-state infusion requirements averaged 6.3 +/- 0.6 micrograms . kg-1 . min-1 during halothane or isoflurane anesthesia; the requirements during balanced anesthesia were 9.3 +/- 0.8 micrograms . kg-1 . min-1 (P less than 0.05). There was no evidence of cumulation during prolonged atracurium infusion.