Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1989
Randomized Controlled Trial Clinical TrialIncidence of visceral pain during cesarean section: the effect of varying doses of spinal bupivacaine.
The safety of 0.5% hyperbaric bupivacaine, as well as the incidence and severity of visceral pain, were evaluated in 36 women undergoing elective cesarean section under spinal anesthesia who, randomly divided into two groups, received different dose ranges according to height, 7.5-10 mg in group A and 10-12.5 mg in group B. When sensory block to at least the fourth thoracic dermatome was established, surgery was begun and the occurrence and severity of visceral pain recorded (visual analog scale) by an observer unaware of patient data. The level of analgesia to pinprick was determined when and if there was onset of pain intraoperatively, and supplementary medication was administered as needed. ⋯ In patients experiencing moderate to severe pain, the mean time between induction of anesthesia and onset of pain was similar in both groups, as was the amount of systemic narcotic given. Total time for regression of sensory analgesia to L5 was longer in patients in group B (243.9 versus 195.4 min), and the incidence of complete motor blockade was greater in group B. Increasing the amount of 0.5% hyperbaric bupivacaine per spinal segment reduces the occurrence of moderate to severe visceral pain during elective cesarean section without jeopardizing mother or fetus.
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Anesthesia and analgesia · Jul 1989
Comparative StudyComparison of viscoelastic measures of coagulation after cardiopulmonary bypass.
Postoperative hemorrhage remains a major cause of morbidity after cardiopulmonary bypass (CPB). Treatment remains empiric because of the need for immediate correction and the lack of availability of rapid intraoperative coagulation monitoring (except for ACT) at most institutions. Thrombelastography (TEG) and Sonoclot analysis (SCT) are measures of viscoelastic properties of blood which allow rapid intraoperative evaluation of coagulation factor and platelet activity as well as overall clot integrity from a single blood sample. ⋯ After CPB, mean values for RCT were normal, but there were abnormalities in TEG and SCT parameters that reflect platelet-fibrin interaction. Both TEG and SCT were 100% accurate in predicting bleeding in these nine patients and, overall, both tests were significantly better predictors of postoperative hemorrhage than RCT. We conclude that viscoelastic determinants of clot strength may be abnormal after CPB and that SCT and TEG are, therefore, more useful than RCT for the detection and management of coagulation defects associated with CPB.
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A technique for blocking the dorsal nerves of the penis was designed after reevaluation of the gross anatomy of the subpubic space and penis in children. The technique consists of inserting a short bevel needle in the two compartments of the subpubic space, where the nerves run before entering the base of the penis, and of injecting a small volume (0.1 mL/kg of body weight) of local anesthetic. This two-puncture procedure was prospectively evaluated in 100 children undergoing surgery of the penis under light general anesthesia. ⋯ No complications occurred and anesthesia was satisfactory for completion of surgery. The duration of postoperative pain relief was significantly longer in patients given bupivacaine than in those given lidocaine. It is concluded that the subpubic approach to the dorsal nerves of the penis is easy, safe, and reliable, and that 0.5% plain bupivacaine provides long-lasting postoperative pain relief.