Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialLidocaine hydrocarbonate and lidocaine hydrochloride for cesarean section: transplacental passage and neonatal effects.
Twenty-six patients, ASA physical status 1, scheduled for elective cesarean section, were divided at random into two groups and received via an epidural catheter 20 ml of 2.2% lidocaine hydrocarbonate (17.3 mg.ml-1 lidocaine base) with 5 micrograms.ml-1 epinephrine freshly added (Group CO2 = 13 patients) or 20 ml of 2% lidocaine hydrochloride (17.3 mg.ml-1 lidocaine base) also with 5 micrograms.ml-1 epinephrine freshly added. Following clampage of the umbilical cord (at 40.1 +/- 4.9 min after the injection of lidocaine for the CO2 group and at 41.0 +/- 5.4 min for the HCl group), serum concentrations of lidocaine were measured both in the mother and in the umbilical vein. ⋯ The ratio of umbilical vein to maternal vein concentrations of lidocaine was also similar in both groups: 0.45 +/- 0.07 for the CO2 group vs 0.54 +/- 0.24 for the HCl group. The percentage of newborns with a normal NACS (score > or = 35/40) was equal in both groups, i.e. 91% at 15 min and 2 h of life and 100% at 24 h of life.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialA two-dose epidural morphine regimen for cesarean section patients: therapeutic efficacy.
A single dose of epidural morphine (EM) usually produces 24 h of post-cesarean section (CS) analgesia and patients require supplemental analgesics beyond this period. This study assesses if a second dose of EM administered 24 h after the first one offers superior therapeutic efficacy compared to conventional analgesics. Patients (n = 100) were randomized to receive one or two doses of epidural morphine. ⋯ No serious complications were noted. In summary, the use of a second dose of EM for post-CS analgesia produces better analgesia and reduces the need for oral analgesics. The second dose produced fewer side-effects, probably due to acute tolerance to morphine.
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Acta Anaesthesiol Scand · Aug 1992
Randomized Controlled Trial Comparative Study Clinical TrialIntramuscular low-dose ketamine versus pethidine for postoperative pain treatment after thoracic surgery.
In a double-blind prospective study the effects of low-dose intramuscular ketamine (1 mg/kg) were compared to pethidine (1 mg/kg) in the treatment of pain after pulmonary surgery. Thirty patients were admitted to the study and postoperatively randomized to either a ketamine or a pethidine group. The analgesic effect was evaluated using a scale ranging from 0 to 10, where 0 denoted no pain and 10 severe pain. ⋯ Mean arterial pressures remained unchanged and the respiratory frequencies were similar in the two groups. The incidence of adverse reactions was low and not significantly different between the groups. The findings indicate that low-dose intramuscular ketamine is a potent analgesic for postoperative analgesia following thoracic surgery and that it has no respiratory depressive effect.
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Acta Anaesthesiol Scand · Aug 1992
Randomized Controlled Trial Clinical TrialOxygen consumption after flumazenil reversal.
The effect of flumazenil reversal of midazolam-induced anesthesia on whole body oxygen uptake (VO2) was investigated in a double-blind trial in 48 patients (ASA, 1 or 2) undergoing elective surgery under general anesthesia. VO2 was measured in spontaneously breathing patients during recovery from anaesthesia induced with midazolam 0.25 mg.kg-1 and maintained with nitrous oxide 60% in oxygen and halothane. The level of sedation was evaluated by a subjective score. ⋯ No significant changes in VO2 (160 +/- 53 vs 150 +/- 39 ml.min-1.m-2 or sedation score (2.5 +/- 1.0 vs 2.1 +/- 0.9) were observed in the placebo group. After flumazenil administration, the sedation score significantly (P less than 0.05) improved (2.9 +/- 1.0 vs 1.3 +/- 0.8) whereas no significant change in VO2 was observed (158 +/- 67 vs 157 +/- 61 ml O2.min-1.m-2). These data show that reversal of benzodiazepine effects with flumazenil resulted in no significant change in oxygen uptake.
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Acta Anaesthesiol Scand · Aug 1992
Randomized Controlled Trial Clinical TrialInjection pain, cardiovascular changes and recovery following induction of anaesthesia with propofol in combination with alfentanil or lignocaine in children.
The effect of pretreatment with alfentanil 10 (Alf10), 15 (Alf15) or 20 (Alf20) micrograms.kg-1 on reducing injection pain caused by propofol was compared with lignocaine 10 mg mixed with propofol (Lign). This double-blind, double-dummy and randomized study included 100 children with a mean age of 4.3 +/- 0.6 years, 25 children in each group, undergoing minor otolaryngological surgery. The children were premedicated orally with midazolam 0.5 mg.kg-1 and atropine 0.03 mg.kg-1. ⋯ Both 1% lignocaine 10 mg and alfentanil 15 micrograms.kg-1 reduced injection pain significantly compared with alfentanil 10 micrograms.kg-1. Pretreatment with alfentanil significantly diminished haemodynamic responses to tracheal intubation. Furthermore, the concomitant use of alfentanil and propofol caused transient severe bradycardia and a significant decrease in heart rate after laryngoscopy.