Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1984
Cerebral and cardiopulmonary responses to high-frequency jet ventilation and conventional mechanical ventilation in a model of brain and lung injury.
The cardiopulmonary and intracranial effects of high-frequency jet ventilation (HFJV) were evaluated in four groups of 10 mongrel dogs and compared to conventional mechanical ventilation with and without positive and expiratory pressure (PEEP). Each group of animals was studied with various combinations of normal and abnormal brain and lung function. Experimental brain injury (abnormal cerebral elastance) was produced by infusion of saline into the subarachnoid space to increase intracranial pressure (ICP), while lung injury resulted from intratracheal instillation of 0.1N HCl. ⋯ ICP responses did not vary significantly with the different modes of ventilation and were not influenced by the status of lung or brain function. However, significant reductions in cerebral perfusion pressure were noted with 20 cm H2O PEEP compared to HFJV. We conclude that unless high levels of PEEP (15-20 cm H2O) are required for adequate oxygenation, the cardiovascular and cerebral effects of HFJV do not differ significantly from those of conventional mechanical ventilation.
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Anesthesia and analgesia · Nov 1984
Hyperbaric bupivacaine for spinal anesthesia in cesarean section.
The efficacy and safety of 0.5% hyperbaric bupivacaine (Sensorcaine, Astra) was evaluated in 22 patients undergoing elective cesarean section under spinal anesthesia. The dose varied from 7.5 to 10 mg, (depending on the patient's height) which was significantly lower than previously reported. Patients were placed in head-down tilt immediately after subarachnoid injection. ⋯ All infants were vigorous at birth and there were no serious maternal complications. The incidence of hypotension was 4.5%, the lowest reported as a consequence of spinal anesthesia in this group of patients. A technique involving the use of reduced doses of hyperbaric bupivacaine (0.5%) in conjunction with head-down tilt appears to be useful for spinal anesthesia for cesarean section.
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Anesthesia and analgesia · Nov 1984
Clinical Trial Controlled Clinical TrialMetoclopramide and cimetidine to reduce gastric fluid pH and volume.
Eighty female patients undergoing outpatient laparoscopy were divided into four equal groups to investigate the effect of cimetidine and metoclopramide on the gastric fluid volume and pH. Group I patients received two placebo tablets. Group II patients were given metoclopramide, 10 mg, and one placebo tablet. ⋯ Gastric fluid volume was significantly less (P less than 0.0001) in groups II and IV than in groups I and III. Gastric fluid pH was significantly higher (P less than 0.0001) in groups III and IV than in groups I and II. It is concluded that administration of metoclopramide and cimetidine two hours prior to induction of anesthesia significantly decreases the gastric fluid volume and increases gastric fluid pH, thereby decreasing both the likelihood of aspiration of gastric contents and the likelihood of severe pulmonary reaction, should aspiration occur.
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Anesthesia and analgesia · Nov 1984
Maternal, fetal, and neonatal effects of lidocaine with and without epinephrine for epidural anesthesia in obstetrics.
The effects of epidural lidocaine 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 the Neurologic and Adaptive Capacity Scoring System were compared in 30 parturients during labor and delivery. Patients in group I (n = 16) received 1.5% lidocaine with 1:300,000 epinephrine and those in group II (n = 14) 1.5% lidocaine alone. Addition of epinephrine to lidocaine did not have any significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate variability, or the incidence of abnormal fetal heart rate patterns. ⋯ Duration of analgesia was significantly longer in group I as compared to group II patients (106.9 +/- 6.6 vs 66.2 +/- 4.4 min, P less than 0.001). Umbilical venous concentrations of lidocaine and umbilical vein to maternal vein ratios of lidocaine were significantly higher in group II patients (P less than 0.05). It is concluded that addition of epinephrine to lidocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and it significantly prolongs the duration of anesthesia and limits the placental transfer of lidocaine.