Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1984
The effect of fentanyl on arginine vasopressin and cortisol secretion during anesthesia.
The effects of nitrous oxide-oxygen plus small doses of fentanyl with (N = 7) and without (N = 15) naloxone and the effects of nitrous oxide-oxygen plus halothane (N = 13) on plasma concentration of arginine vasopressin (AVP) and cortisol were studied in normal patients before and during gynecologic laparotomies. Patients given fentanyl alone received incremental doses of 0.002 mg/kg before, during, and after induction of anesthesia. Naloxone, when given, was injected in doses of 0.005 mg/kg before administration of fentanyl. ⋯ There were comparable increases in AVP and cortisol levels in both groups during surgery. Administration of naloxone before fentanyl prevented the increase of plasma AVP levels during anesthesia and surgery and blunted the elevation of plasma cortisol during surgery. Our results suggest that the increase in plasma AVP levels after induction of fentanyl anesthesia may not be induced by the stress of intubation and that small doses of fentanyl may cause AVP release during anesthesia.
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Anesthesia and analgesia · Jan 1984
High-dose hydromorphone (Dilaudid) for coronary artery bypass surgery.
The hemodynamic effects of high-dose hydromorphone hydrochloride (H), 1.25 mg/kg, were investigated in 10 patients with normal ventricular function undergoing coronary artery bypass graft (CABG) surgery. One patient with unstable angina was excluded from the study because of hypotension and facial flushing after a 6-mg test dose of H. Nine patients showed no significant change in heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR), pulmonary capillary wedge pressure (PCWP), or coronary perfusion pressure (CPP) after H; central venous pressure (CVP) increased significantly (P less than 0.05). ⋯ Vasodilators were required in eight patients before aortic cannulation and after extracorporeal circulation. Mean time to awakening was 7.6 hr after the full dose of H, and extubation was performed the morning after surgery (21 hr after H) according to our usual practice. We conclude that very large doses of H (equivalent in analgesic terms to 10 mg/kg of morphine sulfate) are well tolerated by most patients undergoing CABG surgery, but unconsciousness and complete suppression of sympathetic responses require supplementation of H with additional anesthetic agents or vasodilators.