Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1988
Randomized Controlled Trial Comparative Study Clinical TrialComparison of bupivacaine and alkalinized bupivacaine in brachial plexus anesthesia.
To define the effect of alkalinization of bupivacaine 0.5% in subclavian perivascular brachial plexus blockade, the time to onset, time to peak effect, and 6-hour regression of sensory and motor blockade were determined. Sixty physical status ASA I and II patients were randomly allocated to one of two groups and a double-blind design was used: group I (n = 30) received bupivacaine 0.5% (pH, 5.5) 3 mg/kg, while group II (n = 30) received alkalinized bupivacaine 0.5% (pH, 7.05-7.15) 3 mg/kg. Onset and regression of sensory blockade were determined by pinprick in the C4-T2 skin dermatomes, while motor blockade was assessed using a scheme of proximal to distal muscle group paralysis. ⋯ Similarly, no difference in time to onset of motor blockade (group I, 6.9 +/- 1.7 min; group II, 6.3 +/- 1.5 min) or time to peak motor effect (group I, 18.1 +/- 1.9 min; group II, 15.1 +/- 1.9 min) was observed. Regression of postoperative sensory and motor blockade was similar in both groups. It is concluded that alkalinization of bupivacaine 0.5% solutions does not confer any added clinical advantage in subclavian perivascular brachial plexus blockade when compared with commercially available bupivacaine.
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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
Comparative StudyIn vitro effect of fresh frozen plasma on the activated coagulation time in patients undergoing cardiopulmonary bypass.
The in vitro effect of fresh frozen plasma (FFP) on the whole blood activated coagulation time (ACT) was examined in 18 patients undergoing cardiopulmonary bypass (CPB) during coronary artery bypass graft surgery. The addition of FFP to whole blood in vitro, after systemic heparinization, significantly prolonged the ACT from 451 +/- 21 seconds (mean +/- SE) to 572 +/- 41 seconds (P less than 0.05). ⋯ The addition of FFP to whole blood in three of the six patients who exhibited heparin resistance (ACT less than 400 seconds after administration of 350 unit/kg heparin) did not prolong the ACT to greater than 400 seconds. These observations suggest that infusion of FFP will further prolong the ACT after heparin administration in most patients including some with initial heparin resistance.
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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.