Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1989
Ketamine potentiates nondepolarizing neuromuscular relaxants in a primate.
Ketamine has many neuromuscular effects in vitro. Its neuromuscular effects in vivo have been controversial and inconsistent. To systematically examine its neuromuscular effects over a wide dose range and its interaction with all popular nondepolarizing neuromuscular relaxants, the effects of ketamine 2, 5, and 10 mg/kg IV were studied on a continuous but incomplete (50%) neuromuscular block preestablished by an IV infusion of d-tubocurarine, atracurium, vecuronium, and pancuronium. ⋯ Ketamine 2 mg/kg potentiated the neuromuscular relaxants in the following order of magnitude: vecuronium greater than atracurium greater than d-tubocurarine greater than pancuronium. However, with a 10 mg/kg dose of ketamine, pancuronium became as potentiated as was vecuronium, i.e., pancuronium = vecuronium greater than atracurium greater than d-tubocurarine. It is concluded that in the primate, ketamine potentiates all nondepolarizing muscle relaxants in a dose-dependent manner.
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Anesthesia and analgesia · Dec 1988
Comparative Study Clinical Trial Controlled Clinical TrialInfluence of bupivacaine as an adjuvant to epidural morphine for analgesia after cesarean section.
The effect of the addition of bupivacaine to epidural morphine (EM) on postoperative analgesia was evaluated in 150 patients after cesarean section performed under epidural anesthesia with carbonated lidocaine. Fifty patients received 3 mg EM without bupivacaine, 50 received 3 mg EM with 0.125% bupivacaine, 25 received 5 mg EM without bupivacaine, and 25 patients received 5 mg EM with 0.125% bupivacaine. ⋯ The addition of bupivacaine did not affect the quality or duration of analgesia afforded by EM and did not influence the incidence or severity of side effects. Furthermore, there was no statistically significant difference in the analgesia obtained by patients receiving 3- and 5-mg doses of EM with or without bupivacaine.
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Anesthesia and analgesia · Dec 1988
Epidural morphine delivered by a percutaneous epidural catheter for outpatient treatment of cancer pain.
Twenty-three outpatients with cancer pain refractory to other methods of pain control were treated with epidural morphine (EM) delivered through a chronically placed percutaneous lumbar epidural catheter. Patients and their families were taught to administer EM at home. ⋯ There were no catheter-related infections or cases of respiratory depression. After 2500 patient treatment days, we have found this method to be a safe and effective method of cancer pain management in outpatients.
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Anesthesia and analgesia · Nov 1988
Clinical Trial Controlled Clinical TrialA dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects.
We performed a double-blind study of the dose-response relationship of intrathecal morphine (0, 0.3, 1, and 2.5 mg) for postoperative pain relief in 33 subjects who underwent total knee or hip replacement surgery. Assessments commenced 1 hour after the opioid injection, which was given at the end of surgery, and continued for 24 hours. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. ⋯ Pruritus was unique to intrathecal morphine administration, but nausea, vomiting, and urinary retention were common in all the groups. We conclude that no ideal dose of intrathecal morphine exists because, even with small quantities, minor adverse effects are evident. Doses between 0.3 and 1 mg, however, should provide good analgesia free from the major complication, respiratory depression.