Articles: general-anesthesia.
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Randomized Controlled Trial Clinical Trial
The effect of clonidine on intra-operative requirements of fentanyl during combined epidural/general anaesthesia.
The study evaluates the analgesic effects of epidural clonidine in patients undergoing abdominal hysterectomy under combined epidural/general anaesthesia. Forty ASA 1-2 patients were divided into two groups who received epidurally either clonidine 300 micrograms (group 1) or placebo (group 2). Anaesthesia was maintained with oxygen/nitrous oxide, a midazolam infusion, vecuronium, and boluses of fentanyl 100 micrograms administered as needed to maintain cardiovascular stability. ⋯ Patients in Group 1 had a lower heart rate after tracheal intubation and surgical incision (p < 0.02). In the recovery room, pain intensity was lower in group 1 (p < 0.003) and the mean (SD) time until analgesia request was increased from 48.5 (8.4) min in group 2 to 235.7 (33.2) min in group 1 (p < 0.001). Our results demonstrate that epidural clonidine produces decreased fentanyl requirements, improved cardiovascular stability, reduced pain intensity and effective postoperative analgesia in the recovery room.
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Acta Anaesthesiol Scand · Nov 1994
Randomized Controlled Trial Clinical TrialPlatelet activation in major surgical stress: influence of combined epidural and general anaesthesia.
Platelets are activated in surgery releasing vasoactive substances such as serotonin and thromboxane. Platelets become temporarily hypoaggregable during surgery followed by a postoperative hyperaggregability. Local anaesthetics are known to inhibit platelet function but earlier reports are conflicting. ⋯ Postoperatively both groups showed significant hyperaggregability. The release products were not significantly influenced by regional anaesthesia. In conclusion epidural as combined with general anaesthesia affects platelet responses to major abdominal surgery only to a minor extent, although it may attenuate the haemodynamic response.
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Review Randomized Controlled Trial Clinical Trial
[Medical therapy for coronary heart disease. Perioperative relevance].
The aim of our review is to summarize relevant data on the perioperative use of anti-ischaemic drugs in patients at risk for or with proven coronary heart disease. ⋯ Beta-blockers, calcium channel blockers, nitrates, and possibly alpha 2-agonists lead to reduced rates of PMI and other cardiac complications in risk patients. Current anti-anginal medications, with the exception of anti-platelet agents, should be maintained to the day of surgery and continued as soon as possible thereafter. All of these drugs except anti-platelet agents may also be used intra-operatively, however, possible interactions with anaesthetic agents should be carefully considered.
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Randomized Controlled Trial Clinical Trial
Assessment of intubating conditions in children after induction with propofol and varying doses of alfentanil.
We have assessed tracheal intubating conditions in 60 ASA I or II children, aged 3-12 yr, after induction of anaesthesia with alfentanil 5, 10 or 15 micrograms kg-1, followed by an induction dose of propofol. Neuromuscular blocking agents were not given. ⋯ Intubation was successful in 70%, 95% and 95% of patients after alfentanil 5, 10 or 15 micrograms kg-1, respectively, and conditions were considered to be excellent in 20%, 70% and 80% of patients, respectively. Side effects included pain on injection of propofol (27%), excitatory movements (5%) and bradycardia (1.7%).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1994
[Effects of propofol and fentanyl on the baroreceptor reflex in geriatric patients].
Increasing age and anaesthetics diminish the baroreflex response to acute changes in blood pressure. This study was designed to investigate the effects of propofol and the combination of propofol with fentanyl on the baroreflex activity in geriatric patients. ⋯ Our data demonstrate that in geriatric patients the baroreflex control of heart rate already is attenuated in the awake state. Propofol produces a further reduction in reflex sensitivity to an acute decrease in blood pressure; this effect is more pronounced in elderly patients as compared to younger individuals. Acute changes in posture or circulating blood volume during propofol anaesthesia may result in greater cardiovascular instability in older patients due to the greater impairment of circulatory control mechanisms.