Articles: anesthesia.
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Randomized Controlled Trial Clinical Trial
Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery.
Addition of fentanyl to bupivacaine administered for spinal anesthesia for cesarean delivery was evaluated in 56 ASA physical status 1 term parturients. Preservative-free saline was added to 0, 2.5, 5, 6.25, 12.5, 25, 37.5, or 50 micrograms fentanyl to make a 1 ml total volume, which was injected intrathecally prior to bupivacaine in a double-blind, randomized fashion. Vital signs, sensory level, motor block, pain score, and side effects were recorded every 2 min for the first 12 min and then at 15, 30, 45, and 60 min and at 30-min intervals until the patient complained of pain. ⋯ None of the patients who received greater than or equal to 6.25 micrograms fentanyl required intraoperative opioids. Complete analgesia (time from injection to first report of pain) lasted 33.7 +/- 30.8 min (mean +/- SD) in the control group and increased to 130 +/- 30 min (P less than 0.05) with addition of 6.25 micrograms fentanyl. Duration of effective analgesia (time from injection to first parenteral opioid) was 71.8 +/- 43.2 min in the control group and increased (P less than 0.05) to 192 +/- 74.9 min with addition of 6.25 micrograms fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)
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Southern medical journal · Oct 1989
Randomized Controlled Trial Comparative Study Clinical TrialMetoclopramide versus droperidol for prevention of nausea and vomiting during epidural anesthesia for cesarean section.
In a randomized, double-blind study, we compared the efficacy of metoclopramide hydrochloride with that of low-dose droperidol for prevention of nausea and vomiting during and after elective cesarean section with epidural anesthesia. Immediately after the umbilical cord was clamped, each patient received fentanyl (50 micrograms) and the study drug intravenously over 30 to 60 seconds. In one study group, 40 women received metoclopramide (15 mg); in the other group, 41 women received droperidol (0.5 mg). ⋯ During the first four postoperative hours, five women (12%) in each group complained of nausea. Three women (7%) in each group had postoperative vomiting. We conclude that metoclopramide (15 mg) and droperidol (0.5 mg) were similarly effective.
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Acta Anaesthesiol Scand · Oct 1989
Randomized Controlled Trial Comparative Study Clinical TrialIsoflurane or halothane for cesarean section: comparative maternal and neonatal effects.
The maternal and neonatal effects of isoflurane and halothane combined with 50% N2O - 50% O2 were compared in 60 healthy parturients undergoing primary or repeat cesarean section. All patients had rapid sequence induction of anesthesia with sodium thiamylal 4 mg/kg followed by succinylcholine for tracheal intubation. Patients were randomly assigned to one of three groups of 20 each (inspired 0.5% isoflurane, 1% isoflurane or 0.5% halothane), combined with 50% N2O and O2. ⋯ Serum inorganic fluoride concentrations in the mother after anesthesia were not significantly above preanesthetic levels in any of the groups and there was no biochemical evidence of renal toxicity. In all neonates fluoride ion concentrations in the first voided urine sample were less than 7 mumol/l, a value well below that associated with nephrotoxicity. It is concluded that isoflurane is a safe supplement to N2O - O2 mixture for cesarean section and is a safer alternative to halothane in situations when patients receiving beta-adrenergic therapy require cesarean section since halothane might potentiate arrhythmias caused by beta adrenergic agonists.
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Regional anesthesia · Sep 1989
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of pH adjustment of 0.5% bupivacaine on the latency of epidural anesthesia.
pH adjustment of lidocaine and 2-chloroprocaine has been reported to decrease the latency of epidural anesthesia (EA). The effect of alkalinization of bupivacaine on onset of surgical anesthesia has not been adequately studied to date. To determine what effect raising the pH of 0.5% bupivacaine has on the latency of EA in patients undergoing lower extremity surgery, we performed a randomized, double-blind study. ⋯ The pH of the LA used for Group I was 6.96 +/- 0.01 and for Group II was 5.33 +/- 0.11. No statistically significant difference was found between the anesthetic parameters tested in each group. On this basis, we find no advantage of pH adjustment of 0.5% bupivacaine for EA.
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Regional anesthesia · Sep 1989
Randomized Controlled Trial Clinical TrialAlkalinization of epidural 0.5% bupivacaine for cesarean section.
Controversial results have been published in the literature concerning the efficacy of alkalinization of solutions of local anesthetics to shorten the time to onset of sensory block. Fifty-two parturients scheduled for cesarean section at term under epidural anesthesia were randomly allocated to one of four groups: group 1, 0.5% plain bupivacaine (pH = 5.38 +/- 0.05); group 2, 0.5% bupivacaine pH-adjusted with 1.4% sodium bicarbonate (pH = 6.87 +/- 0.01); group 3, 0.5% bupivacaine with 1:200,000 epinephrine (pH = 4.80 +/- 0.04); and group 4, 0.5% bupivacaine pH-adjusted with 1:200,000 epinephrine (pH = 6.68 +/- 0.01). The time to onset of the sensory block was evaluated using a nerve stimulator technique. ⋯ No differences in the characteristics of the onset of the sensory block were observed with epinephrine-containing solutions nor with pH-adjusted local anesthetics. The maximal degree of motor blockade was not significantly different in the four groups. We conclude that alkalinization of a 0.5% bupivacaine solution is not an effective way to shorten the latency of epidural block for cesarean section.