Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1989
Randomized Controlled Trial Clinical TrialEpidural butorphanol-bupivacaine for analgesia during labor and delivery.
A double-blind, randomized, dose-response study of a combination of 0.25% bupivacaine combined with 0, 1, 2, or 3 mg of butorphanol was studied in 40 laboring parturients. The optimal dose of butorphanol combined with 8.5 to 10 ml 0.25% bupivacaine was 2 mg; with 2 mg, the duration of analgesia was significantly greater and the time to onset of analgesia significantly shorter than when no butorphanol was added, and the amount of bupivacaine could be reduced 50%. ⋯ All neonatal observations were normal. It is concluded that epidural butorphanol can be a useful and safe adjunct to bupivacaine used for epidural analgesia during labor.
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Intraspinal narcotics have dramatically influenced the way pain of malignant origin is managed. There has been a rapid acceptance of this modality within the anesthesia community to treat a wide variety of cancer pain problems. ⋯ Factors to be considered in patient selection should include the results of the preimplantation spinal narcotic trial, infection trial, infection and local conditions, hematologic status, physiologic and behavioral abnormalities, cost, patient support systems and life expectancy. By interfacing these factors with the unique profiles that each of the five types of implantable narcotic delivery systems offer, improved results both in terms of pain relief and patient satisfaction can be expected.
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Anesthesia and analgesia · Mar 1989
Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy.
This study was undertaken to compare the effects of postoperative bupivacaine epidural analgesia with those of intermittent injections of ketobemidone (a synthetic opioid) on postoperative bowel motility in patients who had had hysterectomies. The epidural group (N = 20) received continuous epidural anesthesia with bupivacaine postoperatively for 26-30 hours and the control group (N = 20) received intermittent injections of ketobemidone for postoperative pain relief. Postoperative bowel movements and propulsive colonic motility were estimated from the first passage of flatus and feces and by following radiopaque markers by serial abdominal radiographs. ⋯ The average position of the markers was significantly more distally in the epidural group immediately after operation and the markers continued to move forward during the first postoperative day. In the control group, the markers did not move during this period. The results demonstrate that postoperative bowel peristalsis returned earlier in the patients given epidural analgesia with bupivacaine for pain relief than in patients given a narcotic.
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Anesthesia and analgesia · Mar 1989
Bunegin-Albin catheter improves air retrieval and resuscitation from lethal venous air embolism in upright dogs.
Three types of catheters, the Arrow multi-orifice catheter, the American Edwards 7 Fr Swan-Ganz catheter and the Cook Bunegin-Albin multi-orifice CVP catheter were evaluated for their ability to retrieve venous air emboli and effect on the success rate of resuscitation from venous air emboli. The catheters were inserted in dogs anesthetized with isoflurane (1.7%, inspired) and N2O (66%) in O2 and placed in the sitting position with the head 90 degrees to the horizontal. Swan-Ganz catheters were positioned with the right atrial (RA) port just above the junction of the superior vena cava (SVC) and the RA and the pulmonary artery (PA) port in the pulmonary artery. ⋯ Both RA and PA ports of the Swan-Ganz catheter were used for aspiration. The amounts of gas retrieved expressed as a percent of the injected air and the incidence of successful resuscitation were compared. Significantly greater percentages of injected venous air were retrieved with the Bunegin-Albin catheter (63 +/- 14%, mean +/- SEM) than with the Arrow multi-orifice catheter (6 +/- 2%) or the Swan-Ganz catheter (14 +/- 5%).(ABSTRACT TRUNCATED AT 250 WORDS)