Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Randomized Controlled Trial Clinical Trial
Amrinone before termination of cardiopulmonary bypass: haemodynamic variables and oxygen utilization in the postbypass period.
One hundred patients were randomly allocated to receive saline or amrinone, 0.75 mg.kg-1, ten minutes before separation from cardiopulmonary bypass (CPB) after elective coronary artery bypass grafting, in order to determine the effects of this agent on haemodynamic variables and O2 utilization. Anaesthesia and CPB were managed in a standard fashion. Before induction of anaesthesia, at pericardiotomy, then at 1, 10, 20 and 30 min after CPB, haemodynamic profiles, haematocrit, and O2 saturation of arterial and mixed venous blood were measured. ⋯ Haemodynamic measurements were similar between groups at all times; however, a higher dose of phenylephrine was given immediately before weaning from CPB in the amrinone group, and more patients in this group received phenylephrine in the first 30 min after CPB. Mixed venous saturation (SvO2) was higher in the amrinone patients at all times after CPB, leading to lower calculated oxygen consumption (VO2) (P less than 0.05). Insufficient dosage may explain the lack of haemodynamic effect, while possible reasons for the higher SvO2 and lower VO2 are either reduced whole body VO2 or peripheral shunting.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Epidural fentanyl and caesarean section: when should fentanyl be given?
Epidural fentanyl is often added to epidural local anaesthetic agents to improve the quality of anaesthesia obtained during Caesarean section. Fentanyl may be given either before or after delivery of the infant. When given before delivery, fentanyl has not been reported to cause neonatal depression, although this remains a concern. ⋯ Neonates were assessed by umbilical arterial blood pH and Apgar scores. No differences were detected in either group with respect to maternal or neonatal outcome. We recommend using only epidural local anaesthetic agents before delivery, and giving epidural fentanyl following delivery of the infant.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Supplemental maternal oxygen therapy during caesarean section under epidural anaesthesia: a comparison of nasal prongs and facemask.
Forty healthy parturients at term, undergoing elective Caesarean section, were divided into two groups to receive supplemental oxygen by either simple facemask (Group FM, 8 L.min-1) or nasal prongs (Group NP, 4 L.min-1) during the procedure. Anaesthesia was provided by epidural block to equivalent dermatomal levels in all patients. Maternal oxygen saturation was measured continuously with pulse oximetry and supplemental oxygen was provided to the mother after administration of the epidural test dose and continued until the end of the procedure. ⋯ There was no difference in the clinical condition of the neonates, as assessed by Apgar scores, or in the acid-base and oxygenation status, as assessed by blood gas analyses between the two groups. Mean umbilical vein oxygen saturation, a measure of fetal oxygen delivery, was 46 +/- 18% (95% confidence interval 39% to 54%) for Group NP and 54 +/- 17% (95% confidence interval 46% to 62%) for Group FM, again not different. We conclude that when the clinical condition, acid-base and oxygenation status of neonates, delivered by elective Caesarean section to healthy, low-risk parturients with normal placental function under epidural anaesthesia, are evaluated, it makes no difference whether the mothers received supplemental oxygen by nasal prongs or simple facemask.
-
Randomized Controlled Trial Clinical Trial
[Peridural anesthesia for surgery of the ankle and foot: effect of the sitting position].
The effects of the sitting position on the quality of both sensory and motor blockade of segments L5 and S1 and the haemodynamic consequences during epidural anaesthesia were studied on 39 patients undergoing ankle or foot surgery. After insertion of an epidural catheter with the patient in the lateral position, 19 patients were kept sitting for 15 min following the injection of the local anaesthetic and 20 remained supine for the duration of anaesthesia (control group). All patients received a dose of 20 ml of 1.73% carbonated lidocaine with epinephrine 1:200,000. ⋯ Fourteen patients of the sitting group achieved motor blockade of more than three of five myotomes compared with five patients in the supine group (P less than 0.001). The maximum decrease in mean arterial pressure occurred sooner in the sitting group (14 +/- 9 min) than in the control group (21 +/- 10 min; P less than 0.01) and was more severe (-24 +/- 10% vs -16 +/- 10% respectively; P less than 0.05). Our results indicate that placing the patient in the sitting position for 15 min after inducing epidural anaesthesia does not influence caudal sensory blockade but does increase the depth of motor blockade.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for post-thoracotomy pain.
Thirty-four patients undergoing thoracotomy were entered into a randomized, double-blind, placebo-controlled study to compare the effects of patient-controlled, lumbar epidural (PCA-E) fentanyl with patient-controlled intravenous (PCA-i.v.) fentanyl with respect to drug requirements, analgesic efficacy and respiratory function. Prior to chest closure patients received fentanyl 2 micrograms.kg-1 by the epidural or i.v. route. In the recovery room further doses of epidural or i.v. fentanyl, 50 micrograms, were administered by the patients who controlled two PCA pumps. ⋯ There were no differences between groups in respiratory rates, PaCO2, VAS pain scores or changes in pulmonary function as measured by FVC and FEV1. It is concluded that satisfactory patient-controlled analgesia can be achieved with both epidural and i.v. fentanyl after thoracotomy but that fentanyl requirements are less when given via the epidural route. This supports a direct spinal cord site of action for lumbar epidural fentanyl.