Articles: anesthesia.
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Anasth Intensivther Notfallmed · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Intravenous regional anesthesia of the arm and foot using 0.5, 0.75 and 1.0 percent prilocaine].
Quality of anaesthesia and risk of intoxication are competing principles in IVRA. To evaluate the optimal prilocaine concentration with injection of 40 ml, 300 patients were randomly allocated to receive either a 0.5 (PRI 0.5), 0.75 (PRI 0.5) or a 1.0 (PRI 1.0) per cent solution. Using PRI 0.5, fifteen patients required supplementary fentanyl, with PRI 0.75 one, and with PRI 1.0 two (p less than or equal to 0.05). ⋯ Objective symptoms of local anaesthetic toxicity were not observed. The incidence of tourniquet-related pain was 25-30% in all three groups and not related to the prilocaine concentration. In conclusion, with 40 ml injection volume the 0.75% solution of prilocaine offers the optimal relation between incidence of anaesthesia and risk of intoxication.
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Anasth Intensivther Notfallmed · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery].
Anaesthesia for neurosurgical patients should provide haemodynamic stability, reduce cerebral metabolism, preserve cerebral autoregulation, avoid increases of intracranial pressure and guarantee rapid recovery without respiratory depression. A commonly used Balanced Anaesthesia (BA, n = 20) (thiopental and fentanyl bolus induction and maintenance with repetition boluses of fentanyl and droperidol, thiopental infusion, and isoflurane in N2O/O2) was compared to Total Intravenous Anaesthesia (TIVA, n = 20) with propofol and alfentanil infusion. Pancuronium was employed for muscle relaxation in both groups. ⋯ Quality of recovery after the procedure was determined by standardised psychometric tests. The time span between awakening of patients to orientation and concentration was significantly shorter in the TIVA group compared to the BA group. There was also a smaller deviation of these parameters in the TIVA group indicating a more predictable recovery.
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Randomized Controlled Trial Clinical Trial
Peroperative nitrous oxide delays bowel function after colonic surgery.
Forty patients scheduled for elective colonic surgery were allocated at random to receive either nitrous oxide or air during surgery. Preoperative management, surgery, parenteral therapy and postoperative analgesics were similar in both groups. Anaesthetic management included isoflurane, vecuronium by infusion and fentanyl 3 micrograms kg-1 h-1. ⋯ No differences were found in duration of operation, blood loss, need for postoperative analgesia or postoperative nausea. Patients in the air group had less gas in the small bowel (P less than 0.005) and in the large bowel (P less than 0.001), and operating conditions were better than in the nitrous oxide group (P less than 0.01). After operation, the air group had significantly earlier bowel function than the nitrous oxide group, with earlier passing of flatus (3.4 (1.2) vs 4.7 (1.4) days) (P less than 0.05) and faeces (4.7 (1.5) vs 6.3 (2.2) days) (P less than 0.05) and required a shorter postoperative hospital stay (10.0 (1.3) vs 11.7 (2.5) days) (P less than 0.05).
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Regional anesthesia · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialChloroprocaine and lidocaine decrease hospital stay and admission rate after outpatient epidural anesthesia.
Lumbar epidural anesthesia with 20 ml of either 3% 2-chloroprocaine (C), 1.5% lidocaine (L), or 1.5% mepivacaine (M) with epinephrine was studied in 84 outpatients undergoing surgery (extracorporeal shock wave lithotripsy (ESWL]. The average duration of the procedure was 31.9 minutes. The total duration of sensory anesthesia was 133 +/- 28 minutes (C), 182 +/- 38 (L), and 247 +/- 42 (M) (p less than 0.05). ⋯ There was a trend to an increasing rate of unplanned overnight hospital admission with increasing duration of the local anesthetic drug employed. Continuous epidural anesthesia with C, L or M appears safe and effective for outpatient surgical procedures such as ESWL. In contrast to previous understanding, mepivacaine produces significantly longer anesthesia and recovery times and may not be optimal for outpatient epidural use.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
A jet nebuliser for delivery of topical anesthesia to the respiratory tract. A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy.
Topical anesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single-blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a 'spray-as-you-go technique'. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl-droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. ⋯ The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for 'awake' intubation.