Articles: anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled epidural analgesia during labor: a comparison of three solutions with a continuous infusion control.
This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of three different PCEA solutions. After establishing effective epidural analgesia with 12 ml of 0.25% bupivacaine, 72 parturients in active labor were randomly assigned to one of four groups: physician-controlled continuous epidural infusion using 0.125% bupivacaine (CEI); PCEA using 0.125% bupivacaine (B); PCEA using 0.125% bupivacaine with fentanyl 1 micrograms/ml (BF); and PCEA using 0.125% bupivacaine with fentanyl 1 micrograms/ml and 1:400,000 epinephrine (BFE). The CEI infusion was begun at 12-16 ml/h and adjusted to maintain a T10 sensory level and adequate pain relief. ⋯ Average hourly infusion rates were 13.0 +/- 1.1 ml/h (B), 10.6 +/- 0.6 ml/h (BF), and 9.6 +/- 0.5 ml/h (BFE); group B differs from others (P less than 0.05). No instance of respiratory depression or complication secondary to PCEA was observed. Mild pruritus occurred only with fentanyl-containing solutions, whereas dense motor block developed more frequently with the epinephrine-containing solution.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Dose-related effects of succinylcholine on the adductor pollicis and masseter muscles in children.
This study was performed to determine the effects of various doses of succinylcholine on resting tension and evoked twitch height at the masseter and adductor pollicis muscles in children. Twenty patients, aged 3-10 yr, ASA physical status I or II, were randomly assigned to receive succinylcholine 0.15, 0.25, 0.50 or 1.00 mg.kg-1, during halothane-nitrous oxide anaesthesia. Supramaximal train-of-four stimulation was applied simultaneously to the ulnar nerve and the nerve to the masseter. ⋯ A dose-related increase in resting tension was observed in both muscles, but its magnitude was five times greater at the masseter. With succinylcholine, 1 mg.kg-1, this increase was 51.6 +/- 16.8 g at the masseter and 9.1 +/- 2.3 g at the adductor pollicis. Tension returned to baseline within 1-2 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional anesthesia · Jan 1990
Randomized Controlled Trial Clinical TrialEphedrine as a marker of intravascular injection in laboring parturients.
Thirty healthy laboring parturients were randomly chosen to receive either normal saline (NS), ephedrine 10 mg (EPH-10), or ephedrine 15 mg (EPH-15) intravenously. Changes in maternal heart rate and blood pressure and fetal heart rate were monitored. ⋯ There was no adverse fetal outcome. Transient fetal tachycardia was seen in three fetuses in the EPH-15 group.
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Rev Esp Anestesiol Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Localization of lumbar epidural space by loss of resistance and using the Episensor: a comparative study].
Since the existence of negative pressure in the epidural space was reported, its technique of localization has undergone changes directed to improve objectivity, reliability and safety. The aim of the present study was to evaluate a new electronic divide to localize the epidural space, i.e. the Episensor (Palex, Spain). To this end, 71 patients, both males and females, undergoing elective urological surgery and in whom catheterization of the lumbar epidural space had been planned, were prospectively evaluated and randomly assigned to two homogeneous groups. ⋯ There was no correlation between the qualification of the operator and the development of complications. It was concluded that the use of Episensor to localize lumbar epidural space did not improve the effectiveness of blockade but increased the iatrogenic effects of the puncture. Our lack of experience with this new technique and the low negative pressure of lumbar epidural space might have been the causes of the poor results, that we consider as initial in the evaluation of this new method.
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Acta Anaesthesiol Scand · Jan 1990
Randomized Controlled Trial Clinical TrialDoes ephedrine influence newborn neurobehavioural responses and spectral EEG when used to prevent maternal hypotension during caesarean section?
The recovery of 16 infants born by elective caesarean section with spinal anaesthesia, in which either ephedrine or fluid load was used to prevent maternal hypotension, were studied using Scanlon's neurobehavioural tests and a computerized EEG. Neurobehavioural testing showed no differences between the ephedrine and the non-ephedrine groups of infants at ages of 3 h, 1 day, 2 days and 4-5 days, whereas the spectral EEG showed significant differences between the two groups during the first 2 h after delivery, which had disappeared 24 h later. It is suggested that small doses of ephedrine given to the mother i.v. to prevent hypotension during spinal anaesthesia have short-lived effects on the neonate's central nervous system, which will be detected in the spectral EEG, but not in neurobehavioural tests.