Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1988
Randomized Controlled Trial Comparative Study Clinical TrialAwakening concentrations of isoflurane are not affected by analgesic doses of morphine.
A randomized, double-blind study was performed to determine how morphine 0.1 mg/kg IV, or placebo administered 80 +/- 11 (means +/- SE) minutes before the end of surgery affect recovery from isoflurane/oxygen anesthesia. End-tidal isoflurane remained constant at 1.10 +/- 0.02% (means +/- SE) in both groups intraoperatively, and no other anesthetics were given after the administration of the morphine or placebo. ⋯ At the time of eye-opening, end-tidal isoflurane concentrations did not differ between subjects receiving morphine (0.20 +/- 0.02%) and placebo (0.18 +/- 0.01%). It is concluded that the awakening concentration (MAC-awake) during recovery from isoflurane anesthesia is approximately 0.19% and is not affected by analgesic doses or morphine.
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Anesthesia and analgesia · Jan 1988
Comparative StudyNeonatal neurobehavior after epidural anesthesia for cesarean section: a comparison of bupivacaine and chloroprocaine.
Reports of whether or not bupivacaine affects neonatal neurobehavior have been contradictory. The purpose of this study was to test the hypothesis that scores on the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) after epidural anesthesia with bupivacaine for cesarean section would not be different than those after chloroprocaine. Furthermore, if there were any effects, it was hypothesized that they would be related to cord blood levels of the drug. ⋯ The results indicate that infants in the bupivacaine group do significantly better than those in the chloroprocaine group in the orientation cluster of the BNBAS (F[1,49] = 22, P less than 0.001); this cluster reflects higher cortical functioning. Furthermore, there was improvement in the bupivacaine group in the regulation of state cluster with age, whereas there was no improvement in the chloroprocaine group (F[1,53] = 4.34, P less than 0.01). This study suggests that performance on the BNBAS after exposure to bupivacaine is better than that after exposure to chloroprocaine.
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Anesthesia and analgesia · Jan 1988
Recovery scores do not correlate with postoperative hypoxemia in children.
The correlation between the degree of postanesthetic recovery (PAR) in children as measured by a modified Aldrete scoring system and oxygen saturation (SaO2) was studied. Eighty-one ASA PS I unpremedicated infants and children were studied. Oxygen saturation and PAR scores were recorded on arrival in the recovery room, then at 5-minute-intervals. ⋯ It is concluded that children recovering from anesthesia can become hypoxemic in the recovery room. The degree of wakefulness as measured by a PAR score cannot be used to establish an end point for oxygen supplementation. Oxygen supplementation and/or SaO2 monitoring are recommended in all children recovering from anesthesia.
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Anesthesia and analgesia · Jan 1988
Potentiation of neuromuscular blocking agents by calcium channel blockers in rats.
The effect of calcium channel blockers (Ca-antagonists) on the potency and reversibility of muscle relaxants (MR) was investigated in the in vitro phrenic nerve-hemidiaphragm and in vivo sciatic nerve-tibialis anterior preparation of rats. To increase the relevance of the experimental findings to the clinical situation, the [Ca++] and [Mg++] in vitro were the same as in the plasma of rats and humans and the stimulation parameters used in vitro and in vivo were similar to those that elicit voluntary movements of the muscles used. Both verapamil and nifedipine significantly decreased the I50 and I90 of d-tubocurarine (d-Tc), pancuronium, vecuronium, and atracurium in vitro and those of the first three MR in vivo (P less than 0.001). ⋯ Under these circumstances the decrease of P caused by all Ca-antagonist-MR combinations recovered spontaneously close to control levels. This study indicates that acute administration of verapamil during anesthesia may increase MR potency, but it is unlikely that spontaneous recovery or reversibility of the residual neuromuscular (NM) block at the end of anesthesia will be significantly affected. However, long-term administration of Ca-antagonists may make difficult the reversal of the residual NM block.
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Anesthesia and analgesia · Dec 1987
Comparative Study Clinical Trial Controlled Clinical TrialClinical pharmacokinetics of carbonated local anesthetics. II: Interscalene brachial block model.
A double-blind comparison of 1.1% lidocaine carbonate and 1.0% lidocaine hydrochloride was carried out in 30 healthy adult patients undergoing upper-extremity surgery under interscalene brachial plexus block. Epinephrine (1:200,000) was added to both solutions just before injection. As compared to lidocaine hydrochloride, lidocaine carbonate produced, in addition to a 38% reduction in onset time, a remarkable increase in the extent of anesthesia: lidocaine carbonate produced surgical anesthesia of the entire upper extremity including the hand in 87% of the patients, whereas lidocaine hydrochloride produced similar anesthesia in only 53% of the patients. Thus, supplemental blocks were required in 66% of the patients who received lidocaine hydrochloride, whereas they were required in only 25% of those who received lidocaine carbonate.