Anesthesia and analgesia
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Anesthesia and analgesia · May 1987
Comparative StudyThe pattern of train-of-four fade after atracurium: influence of different priming doses.
This study was designed to investigate the effect of three different priming doses of atracurium--0.06, 0.07, and 0.08 mg/kg--followed 3 min later by the remainder of a 0.5 mg/kg dose on the relationship between the depression in the first twitch of the train-of-four (T1) and train-of-four (TOF) fade. This relationship was studied after the administration of the full dose of the relaxant in all groups. ⋯ Acceleration of the onset of neuromuscular blockade was, however, evident in all groups that received atracurium in divided doses. The implication is, therefore, that prejunctional activity may not contribute significantly to the acceleration of onset of neuromuscular blockade after administration of atracurium in divided doses, as described in this study.
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Anesthesia and analgesia · May 1987
Comparative StudyBupivacaine disposition in mother, fetus, and neonate after spinal anesthesia for cesarean section.
Uptake of bupivacaine from the subarachnoid space and its placental transfer were measured in six patients undergoing elective cesarean section. Maternal plasma levels (59 +/- 32 ng/ml) were only about 5% of those found in a comparable previous study of epidural anesthesia. Mean plasma umbilical venous bupivacaine levels (20.2 +/- 21 ng/ml) were 7% of those found after epidural anesthesia. ⋯ Neonatal urine had measurable levels of both bupivacaine and its inactive metabolite, 2,6-pipecolylxylidine (PPX), for at least 36 hr after delivery. The results demonstrate that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts. This transplacental passage occurs despite injection of only small doses of a very highly protein bound drug into the subarachnoid space.
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Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialLocal analgesia without anesthesia using peripheral perineural morphine injections.
Twenty-five patients with chronic pain were treated with nerve blocks. They were divided into two groups, A and B, according to the volume of local anesthetic required for surgical anesthesia by standard nerve block techniques. The 16 patients in group A had pain in the distribution of small nerves, which could be blocked with 5 ml or less. ⋯ Morphine (6 mg) was added, in a random, double-blind fashion, to one of the injections. A second pair of injections was subsequently done, using morphine by the alternative route. Perineural morphine provided statistically longer lasting pain relief than did either intramuscular morphine or perineural bupivacaine.
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Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialEpinephrine improves the quality of spinal hyperbaric bupivacaine for cesarean section.
In a double-blind randomized study, the effects of the addition of epinephrine on hyperbaric spinal bupivacaine were studied in 63 patients having elective repeat cesarean sections. In the study group (32 patients), the addition of 0.2 mg epinephrine improved the quality of analgesia since fewer patients required supplementation of the spinal anesthetic; the motor block was more profound; and the times to two-segment regression, sensory recovery, and motor recovery were prolonged.
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Anesthesia and analgesia · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialProlongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly.
The effects of vasoconstrictors on the duration of isobaric bupivacaine spinal anesthesia are unknown. A prospective controlled study was conducted on 60 ASA class II or III patients aged 75 yr or more who were scheduled for spinal anesthesia for orthopedic hip surgery. The subjects were randomly allocated into three groups. ⋯ Mean time for regression to the L2 segment was also significantly longer in groups II and III than in group I. This time tended to increase more with the bupivacaine plus clonidine solution than with the bupivacaine plus epinephrine solution. Significant prolongation of motor block was also associated with the addition of clonidine.