Anesthesia and analgesia
-
Anesthesia and analgesia · Jul 1983
Randomized Controlled Trial Clinical TrialEpidural morphine for the relief of postoperative pain after cesarean delivery.
To determine the safety, efficacy, and dose response of epidurally administered morphine for analgesia after cesarean delivery, 40 healthy women who underwent cesarean delivery with epidural anesthesia were randomly assigned to receive one of four regimens for relief of postoperative pain: intramuscular administration of morphine, 7.5 mg (N = 10); or epidural administration of morphine, 2 mg (N = 10), 5 mg (N = 10), or 7.5 mg (N = 10). Evaluations were made of intensity and relief of pain, time to administration of additional analgesic medications, changes in vital signs and blood-gas tensions, and adverse effects. Intramuscular administration of 7.5 mg of morphine effectively relieved pain for only a short time. ⋯ There were no significant changes in vital signs or blood-gas tensions. Side effects included pruritus and nausea, which occurred frequently but were usually mild and easily treated. We concluded that either 5 mg or 7.5 mg of morphine epidurally administered was effective and safe in providing prolonged analgesia after cesarean delivery.
-
Anesthesia and analgesia · Jul 1983
A pharmacokinetically designed etomidate infusion regimen for hypnosis.
An etomidate infusion regimen for hypnosis as part of balanced, totally intravenous anesthesia was designed to maintain plasma etomidate concentrations above the awakening concentration of 300 ng/ml while avoiding dose-related side effects. The etomidate infusion regimen of 0.1 mg/kg/min for 3 min, 0.02 mg/kg/min for 27 min, and 0.01 mg/kg/min for the remainder of the anesthesia was used together with intravenous bolus doses of fentanyl, droperidol, and pancuronium. This was evaluated in 11 patients and the kinetics of etomidate were reexamined. ⋯ The main difference between the kinetics observed in the present study and those of previous studies is in the elimination clearance. The average plasma elimination clearance of the present study was 1210 ml/min and the whole-blood clearance was estimated to be 1357 ml/min, giving an apparent hepatic extraction ratio of approximately 0.90. The negative correlation of patient mass and elimination clearance normalized for body mass suggests that the terminal infusion should not be adjusted to body mass.
-
Anesthesia and analgesia · Jul 1983
Comparative StudyMaternal and fetal effects of prophylactic hydration with crystalloids or colloids before epidural anesthesia.
Prophylactic intravenous hydration decreases the incidence and severity of hypotension due to obstetric epidural anesthesia. This study assesses whether infusion of normal serum albumin (NSA) offers any advantages over Ringer's lactate (RL) solution. Sixty patients scheduled for elective cesarean sections were divided into three equal groups. ⋯ Because low POP may predispose to postoperative pulmonary morbidity, the incidence of this complication was studied in the mothers by using a point scoring system (based on the presence of symptoms and physical signs) and also by measuring AaDO2 gradients. Neither pulmonary morbidity scores nor AaDO2 gradients differed significantly in the three groups. It is concluded that both crystalloid and colloid prehydration produce equally satisfactory maternal and fetal outcomes.
-
Anesthesia and analgesia · Jun 1983
Video stethoscope--a simple method for assuring continuous bilateral lung ventilation during anesthesia.
Complications of endotracheal intubation and mechanical ventilation are infrequent but important causes of intraoperative morbidity and mortality. We have developed a simple method of monitoring the ventilation of both lungs during general anesthesia and have evaluated this technique in 25 patients undergoing surgery under general anesthesia. ⋯ The patterns seen on the screen allowed easy identification of right mainstem intubation, esophageal intubation, or proper endotracheal tube placement. This preliminary study suggests that our technique is feasible and provides more information about the position of the endotracheal tube than presently used methods.
-
Anesthesia and analgesia · Jun 1983
Lack of arrhythmogenicity of isoflurane following administration of aminophylline in dogs.
Induction of halothane anesthesia after aminophylline administration may cause ventricular arrhythmias. Isoflurane may be as effective a bronchodilator as halothane. This study was designed to determine whether induction of isoflurane anesthesia after intravenous aminophylline is arrhythmogenic in dogs. ⋯ Three additional groups of six dogs were given intravenous aminophylline 10, 25, or 50 mg/kg, respectively, followed 3 min later by 1.5% isoflurane. No arrhythmias occurred after aminophylline and isoflurane at any time in any animal. In contrast to halothane, induction of isoflurane anesthesia after aminophylline is safe and does not cause cardiac arrhythmias.