Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1984
Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine--maternal, fetal, and neonatal effects.
The effects of epidural analgesia for labor and delivery using a continuous infusion technique on fetal heart rate, uterine activity, maternal blood pressure, Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System were studied in 61 parturients. Group I (n = 23) received initial test and therapeutic doses of 2 and 6 ml of 0.5% bupivacaine followed by an infusion of 0.125% at a rate of 14 ml/hr. Group II (n = 19) received 2 and 6 ml of 2% chloroprocaine followed by an infusion of 0.75% at a rate of 27 ml/hr. ⋯ The incidence was significantly higher in group I than in groups II or III (P less than 0.05). Apgar scores and neonatal acid-base status were equally good in all three groups. Neurologic and adaptive capacity scores did not differ among the three groups of neonates, nor did any of the neonates in the three groups score lower than a control group of 19 neonates whose mothers did not receive any analgesia or medications for labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1984
Alpha-adrenergic responsiveness correlates with epinephrine dose for arrhythmias during halothane anesthesia in dogs.
The dose of epinephrine required to elicit ventricular arrhythmias during halothane anesthesia may depend on end-organ sensitivity. We determined whether the arrhythmogenic dose for epinephrine (ADE) could be correlated with either alpha- or beta-adrenergic responsiveness. After ADE was determined in 26 dogs anesthetized with 1.2 MAC halothane, an in vivo assessment of adrenergic responsiveness was made. ⋯ The correlation coefficients for alpha 75 and beta 75 vs ADE then were determined by multiple linear regression analysis. There was a highly significant correlation with the alpha 75 (F = 9.06; P less than 0.01), while no relationship existed with beta 75 (F = 0.52; P greater than 0.05). Thus the alpha-adrenergic responsiveness in individual patients may be used to predict the threshold for epinephrine-induced arrhythmias during halothane anesthesia.
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Anesthesia and analgesia · Mar 1984
Comparative StudyClinical pharmacology of atracurium in infants.
The neuromuscular effects of atracurium were studied in 25 infants anesthetized with 1.0% end-tidal halothane and N2O-O2. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 sec at 10-sec intervals. To estimate dose-response relationships, three groups of five infants received 60, 80, and 100 micrograms/kg atracurium, respectively; another ten infants received 300 micrograms/kg (2 X ED95). ⋯ The ED50 and ED95 (estimated from linear regression plots of log dose vs probit of effect) were 85 micrograms/kg and 150 micrograms/kg, respectively. Neuromuscular blockade lasted 23 +/- 1.6 min at 1 X ED95 and 32.5 +/- 5.2 min at 2 X ED95. Changes in heart rate and mean arterial pressure were clinically insignificant.
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Anesthesia and analgesia · Mar 1984
Comparative StudyAlfentanil as an anesthetic induction agent--a comparison with thiopental-lidocaine.
Alfentanil (0.175 mg/kg) and a combination of thiopental (3-4 mg/kg) and lidocaine (1.5 mg/kg) during anesthetic induction were compared. Each was administered rapidly to eight patients with cardiovascular disease (average age, 64 yr), followed by succinylcholine (1.5 mg/kg) for laryngoscopy and intubation. Chest wall rigidity or flexor spasm of arm and jaw were seen transiently in 7 of 8 patients receiving alfentanil. ⋯ In patients given alfentanil, after intubation arterial pressure returned to levels no different from control and the heart rate remained stable. Five of the patients given alfentanil required a single dose of naloxone (0.08-0.15 mg) to achieve a PCO2 less than 50 torr at the end of surgery. Rapidly administered alfentanil blunted the cardiovascular response to intubation but decreased arterial pressure as much as thiopental-lidocaine.
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Anesthesia and analgesia · Mar 1984
Randomized Controlled Trial Comparative Study Clinical TrialMaternal and neonatal effects of epidural morphine for labor and delivery.
To determine the efficacy of epidural morphine during labor and delivery, 40 healthy parturients who requested epidural analgesia were randomly given either a single injection of morphine sulfate (2 mg, n = 9; 5 mg, n = 10; or 7.5 mg, n = 11) or 0.5% bupivacaine (n = 10). Bupivacaine provided excellent analgesia in all patients. Morphine (2 or 5 mg) did not produce adequate analgesia and needed to be supplemented by local anesthesia. ⋯ Epidural morphine did not produce neonatal depression, as evidenced by Apgar scores and neurologic and adaptive capacity scores. We conclude that 7.5 mg of epidural morphine can give satisfactory pain relief during labor but not delivery, and that 2 or 5 mg of morphine is ineffective. Although 0.5% bupivacaine provided better anesthesia, epidural morphine might prove useful for selected patients.