Journal of anesthesia
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Journal of anesthesia · Jun 1997
Oral clonidine premedication does not alter the efficacy of epidural test doses in adult patients anesthetized with isoflurane.
Clonidine premedication has been increasingly used in clinical anesthesia. Though clonidine was found to alter pressor responses to various sympathomimetics, its effect on epidural test dose efficacy to detect intravascular injection has never been evaluated. Eighty healthy patients were randomly assigned to one of four groups, each of which was anesthetized with 1% end-tidal isoflurane and 67% nitrous oxide in oxygen after endotracheal intubation. ⋯ On the other hand, all of 20 patients in the control-epinephrine and the clonidine-epinephrine groups exhibited positive SBP responses (SBP increment ≥15 mmHg). Therefore, based on the SBP criterion, sensitivities, specificities, and positive and negative predictive values were all found to be 100% regardless of the presence of clonidine. We conclude that oral clonidine 5μg·kg(-1) premedication alters neither (a) hemodynamic responses to the intravenously administered epidural test dose containing 15 μg epinephrine, nor (b) the efficacy for detecting intravascular injection based on either criterion in adult patients under stable isoflurane anesthesia.
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Journal of anesthesia · Jun 1997
Simple pain relief score by observers (PRSO) for assessing chronic pain.
In 56 patients with severe chronic pain, pain relief was evaluated by observation of changes in activities of daily life (ADL), drug intake, and patients' mood. The degree of pain relief was scored on the basis of these evaluations by a pain clinic physician, a nurse, and a member of the patient's family. The resulting score was termed "pain relief score by observers" (PRSO). ⋯ Although a significant correlation (rS=0.755,P<0.001) was demonstrated between the mean PRSO and VAS values, there was some dissociation between the two values in patients with underlying personal problems such as compensation lawsuits or job loss. The results suggest that an objective evaluation of pain relief is possible by PRSO alone without subjective assessment, and that PRSO can be used for patients with various types of pain. Combined assessment of pain relief by the VAS and PRSO methods may be useful to detect the influence of personal background factors in patients with chronic pain.
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Journal of anesthesia · Jun 1997
Normothermic cardiopulmonary bypass: effect on the incidence of persistent postoperative neurological dysfunction following coronary artery bypass graft surgery.
We retrospectively reviewed the records of 250 consecutive patients undergoing coronary artery bypass graft surgery (CABG) from January 1994 through January 1996 to determine the incidence of persistent postoperative neurological dysfunction after CABG and to compare normothermic and moderate hypothermic cardiopulmonary bypass (CPB). Normothermic CPB was used in 128 patients (36°-37°C) and hypothermic CPB (27°-28°C) in 122 patients. Postoperative neurological dysfunction included focal motor deficits, delayed recovery of consciousness (>24h) after surgery, and seizures within 1 week postoperatively. ⋯ The incidence of persistent postoperative neurological dysfunction was 4.1% in the hypothermic CPB group and 2.3% in the normothermic CPB group. There were no statistically significant differences between the two groups (P=NS). These results suggest that normothermic CPB did not increase the incidence of persistent postoperative neurological dysfunction compared to hypothermic CPB.
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Journal of anesthesia · Jun 1997
Comparison of circulatory and respiratory responses between supplementary epidural buprenorphine and eptazocine administration during and immediately after total intravenous anesthesia.
Opioid supplements are often required in total intravenous anesthesia (TIVA). Most ϰ-opiate receptors are found in the spinal cord, wherea μ-opiate receptors are widespread throughout the brain and spinal cord. Buprenorphine has a strong μ-action with a minute ϰ-action, while eptazocine stimulates ϰ-receptors only. ⋯ A significant analgesic effect (P<0.01) of epidural eptazocine without circulatory and respiratory depression was observed. With epidural buprenorphine, circulatory and respiratory depression during and immediately after anesthesia were significant (P<0.05). These results suggest that medullary μ-stimulation by an epidural opioid induces circulatory (hypervagotonicity and hypervagosensitivity) and respiratory depression, while ϰ-stimulation produces only minimal effects on circulatory and respiratory systems.