Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1994
Randomized Controlled Trial Clinical TrialEffects of ephedrine and phenylephrine on maternal and fetal atrial natriuretic peptide levels during elective cesarean section.
The effects of ephedrine and phenylephrine on fetal and maternal plasma atrial natriuretic peptide (ANP) concentrations were studied during 30 elective cesarean sections. After induction of spinal anesthesia, reductions from baseline maternal blood pressure were corrected with one of these pressor agents administered in a double-blinded, randomized manner. Immediately following delivery, umbilical artery (UA) ANP concentrations were significantly higher than umbilical vein (UV) concentrations (pg/ml) for both groups (ephedrine, 120.8 +/- 64.0 vs. 86.8 +/- 40.8, phenylephrine, 125.0 +/- 54.2 vs. 72.4 +/- 31.7), but there were no differences between groups for UA and UV ANP levels. ⋯ Postpartum maternal (MV2), UA, and UV blood gas variables (pH, PCO2, and PO2) were also not different between groups. These data suggest that effects of pressor doses of ephedrine (beta and alpha agonist) and phenylephrine (alpha agonist) on maternal and fetal ANP levels are not different. Therefore, 1) assuming these pressor drugs stimulate ANP release, this stimulation is not solely mediated by beta receptors and 2) to the extent that fetal ANP influences feto-placental circulatory homeostasis, the effects of ephedrine and phenylephrine on this regulatory mechanism do not appear to be different.
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Acta Anaesthesiol Scand · Jan 1994
Randomized Controlled Trial Clinical TrialFlumazenil facilitates intraoperative arousal during scoliosis surgery: a randomized, double-blind, placebo-controlled study.
Intraoperative arousal was evaluated in 24 patients (median age 16.5 years), undergoing spondylodesis with Cotrel-Dubousset or Harrington-Luque instrumentation. Flumazenil and placebo groups of 12 patients each were similar with respect to age, body weight, dosage of anaesthetic drugs and surgery times. Premedication consisted of diazepam 0.2-0.3 mg kg-1 orally. ⋯ Postoperatively, motor responses were assessed after 12.0 min (5-42 min) in the flumazenil group, and after 15.2 min (4-40 min) in the placebo group (NS). Recovery from anaesthesia took 27.5 min (7-415 min) in the flumazenil group, and 25.0 min (8-160 min) in the placebo group (NS). One patient given flumazenil and one patient given placebo remembered moving their feet, but neither of them could recall anything unpleasant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialEarly and late recovery after major abdominal surgery. Comparison between propofol anaesthesia with and without nitrous oxide and isoflurane anaesthesia.
A comparison was made between early and late recovery after major abdominal surgery under intravenous anaesthesia with propofol (with and without nitrous oxide) or inhalational anaesthesia with isoflurane. Sixty patients were randomly allocated to one of three forms of anaesthesia: propofol, propofol/nitrous oxide, or isoflurane/nitrous oxide anaesthesia. All received fentanyl and vecuronium. ⋯ The difference in vegetative symptoms between groups was most obvious on day 7. Patients anaesthetised with propofol reported better subjective control (P < 0.02) and were more socially oriented (P < 0.05) than patients anaesthetised with isoflurane. We conclude that early recovery was similar in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of two fentanyl doses to improve epidural anaesthesia with 0.5% bupivacaine for caesarean section.
Ninety women undergoing elective caesarean section under epidural anaesthesia were double blindly randomised into three groups to receive either 2 ml of saline or 50 or 100 micrograms of fentanyl in 2 ml volume added to 0.5% bupivacaine. Both doses of fentanyl intensified the epidural anaesthesia and reduced patient discomfort during the operation. In both fentanyl groups the epidural blockade more often reached the 5th thoracic segment (P = 0.0258), the patients had significantly less pain (P = 0.0256), needed less intravenous diazepam medication during the operation (P = 0.0005) and the operating conditions were were better when compared to the saline group (P = 0.0416). ⋯ The postoperative time until treatment for pain was requested by the patients was more than 1 h longer in the fentanyl groups, but there was no difference in the total amount of postoperative analgesics needed during the first 24 h when compared to the saline group. Mild pruritus not requiring treatment was more common in fentanyl groups than in the saline group (P = 0.0187). The results suggest that 50 micrograms of fentanyl added to 0.5% bupivacaine increases patient comfort and improves the quality of epidural anaesthesia for caesarean section, and that adding 100 micrograms does not give further advantage.
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of cardiovascular changes during anaesthesia and recovery from propofol-alfentanil-nitrous oxide and thiopentone-halothane-nitrous oxide anaesthesia in children undergoing otolaryngological surgery.
Propofol/alfentanil anaesthesia was compared with thiopentone/halothane anaesthesia in 86 midazolam-atropine premedicated children undergoing minor otolaryngological surgery. The study was randomised, and evaluation of recovery from anaesthesia was double-blind. The children were divided into two age groups: 1-3 years and 4 years and older. ⋯ Recovery with respect to times to eye opening or response to verbal contact was significantly faster after propofol/alfentanil anaesthesia than after thiopentone/halothane anaesthesia in the older but not in the younger age group. Furthermore, in the younger age group significantly more crying occurred after propofol/alfentanil than after thiopentone/halothane anaesthesia. On the basis of this study, thiopentone/halothane anaesthesia is recommended for children aged 1-3 years and propofol/alfentanil anaesthesia for older children undergoing adenoidectomy and/or tonsillectomy.