Articles: anesthesia.
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Regional anesthesia · Sep 1990
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of 0.5% bupivacaine and 0.75% ropivacaine administered epidurally in humans.
In an attempt to compare equipotent doses of epidurally administered bupivacaine and ropivacaine, 44 healthy patients, aged 18-70 years, undergoing lower extremity orthopedic procedures were studied in a randomized, double-blind manner. Twenty-one patients received a single epidural injection of 20 ml 0.5% bupivacaine at the L23 or L34 interspace and 23 patients received 20 ml 0.75% ropivacaine in a similar manner. Onset of and recovery from sensory anesthesia and motor block were recorded. ⋯ Maximum block height (median (range] was T4 (T2-T8) and T5 (T2-L1) for bupivacaine and ropivacaine, respectively, and maximum motor block scores were 4 (2-6) and 4 (0-6) using the modified Bromage scale. Times to maximum height of sensory block for bupivacaine and ropivacaine, respectively, were 28 +/- 12 and 28 +/- 13 minutes; times to onset of block to T12 were 6 +/- 4 and 9 +/- 10 minutes; times to onset of maximum motor block were 32 +/- 17 and 47 +/- 29 minutes; times to two-segment regression were 2.7 +/- 0.8 and 3.4 +/- 1.0 hours (p less than 0.05); times to regression to T12 level were 4.8 +/- 0.9 and 4.7 +/- 0.95 hours; times to total recovery of sensation were 6.5 +/- 0.9 and 6.6 +/- 1.0 hours, and times to recovery of motor function were 4.4 +/- 0.9 and 4.1 +/- 0.9 hours. In two instances (both with bupivacaine), anesthesia was judged clinically inadequate.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ethyl chloride and venepuncture pain: a comparison with intradermal lidocaine.
One hundred and twenty unpremedicated patients undergoing gynaecological surgery were randomly allocated to one of three equal treatment groups to assess the effectiveness of ethyl chloride in producing instant skin anaesthesia to prevent the pain of venepuncture from a 20 G cannula. They received either no anaesthetic, 0.2 ml one per cent lidocaine plain intradermally or a ten-second spray of ethyl chloride at the cannulation site. ⋯ It had no effect on vein visualisation or ease of cannulation. Ethyl chloride can be recommended as a method of producing instant skin anaesthesia.
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Randomized Controlled Trial Clinical Trial
Test doses: optimal epinephrine content with and without acute beta-adrenergic blockade.
The authors studied the optimal epinephrine content of an epidural test dose, and determined criteria to identify intravascular injections in subjects with or without beta-adrenergic blockade. Nine healthy nonpregnant subjects 25-36 years of age were given intravenous infusions of saline or esmolol in random order. During each infusion, they received a series of five injections (3 ml each) of either saline, 1% lidocaine or 1% lidocaine containing 5, 10, or 15 micrograms of epinephrine. ⋯ During esmolol infusion, epinephrine injections increased HR by an average of 23-31 beats/min (P less than 0.05), and increased systolic blood pressure by an average of 18-30 mmHg (P less than 0.05 for 10 and 15 micrograms). After propranolol injection, epinephrine injections caused a decrease in HR by an average of 21-28 beats/min (P less than 0.05), whereas systolic blood pressure increased by an average of 22-35 mmHg (P less than 0.05 for 10 and 15 micrograms only). Without beta-adrenergic blockade, an increase in HR greater than or equal to 20 beats/min was 100% sensitive and specific for intravascular injection of 10 or 15 micrograms of epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Intravenous droperidol decreases nausea and vomiting after alfentanil anesthesia without increasing recovery time.
The frequency rate of nausea and vomiting after an alfentanil-based anesthetic is high, with reported frequencies of 38% to 68%. This study was undertaken to evaluate the efficacy of low-dose and moderate-dose droperidol in decreasing the frequency of postoperative nausea and vomiting and to evaluate whether droperidol has any effect on slowing recovery after a standard alfentanil-based anesthetic. Sixty normal adults who were scheduled to undergo short surgical procedures requiring general anesthesia were assigned randomly in a double-blind manner to one of three groups of 20: (1) control--normal saline; (2) droperidol 10 micrograms/kg; or (3) droperidol 20 micrograms/kg. ⋯ The frequency of nausea and vomiting was significantly less (p less than 0.05) for the 20 micrograms/kg group (5%) than for the 10 micrograms/kg group (25%) or the control group (40%). A dose-response relationship was evident for the antiemetic effect of droperidol. An analog scale for severity of nausea and vomiting also demonstrated a dose response effect.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Isoflurane with either 100% oxygen or 50% nitrous oxide in oxygen for caesarean section.
Two hundred mothers undergoing general anaesthesia for Caesarean section were allocated randomly to receive either 100% oxygen (group 100) or 50% nitrous oxide in oxygen (group 50), both supplemented with isoflurane. In each group the concentrations of isoflurane were chosen to deliver 1.5 MAC for the first 5 min after induction and 1.0 MAC thereafter. The mean umbilical venous PO2 was greater in group 100 for emergency sections (P = 0.001). ⋯ There were no instances of awareness, although two patients in group 100 and three in group 50 reported dreaming. This study confirms earlier findings that the use of 100% oxygen can significantly improve fetal oxygenation during Caesarean section, with particular benefit in emergency cases. This is associated with a lower incidence of neonatal resuscitation.