Articles: anesthesia.
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Cahiers d'anesthésiologie · Sep 1989
Randomized Controlled Trial Multicenter Study Clinical Trial[Dobutamine during anesthesia of patients at risk for heart failure. A controlled prospective multicenter study of 93 surgical patients over 64 years of age].
Most anaesthetic agents cause cardiac depression possibly hazardous in the elderly, especially in presence of a poor cardiac reserve. Ninety-three patients undergoing non cardiac surgery lasting more than 90 min. were entered in a double-blind multicentre randomized trial. They were 65 year old or more and unaffected by evolutive angina pectoris. ⋯ More arrhythmias and hypertensive episodes but less hypotensions occurred in group D. Substantial haemodynamic changes occur during anaesthesia and surgery in elderly patients. Dobutamine corrects the peroperative decrease in cardiac output and blood pressure, and might prevent postoperative neurological disorders.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of bupivacaine and bupivacaine with fentanyl in continuous extradural analgesia during labour.
In a randomized, double-blind study of 39 mothers in labour, we have compared a loading dose of 0.5% bupivacaine 6.0 ml and fentanyl 100 micrograms given extradurally, followed by an infusion of 0.08% bupivacaine 15 ml h-1 plus fentanyl 37.5 micrograms h-1, with a loading dose of 0.5% bupivacaine 6.0 ml and saline 2.0 ml, followed by an extradural infusion of 0.08% bupivacaine alone, per hour. Analgesic levels were more consistent and sustained in mothers who received fentanyl in addition to bupivacaine, and the duration from the time of the loading dose to the first top-up was extended considerably in this group. The only significant side effect was a high incidence of mild pruritus in the fentanyl group. The addition of fentanyl to the extradural loading dose and subsequent infusion of local anaesthetic is a satisfactory alternative to giving higher doses of local anaesthetic alone.
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Randomized Controlled Trial Clinical Trial
Prophylactic ephedrine during spinal anaesthesia: double-blind study in patients in ASA groups I-III.
Forty-eight patients scheduled to undergo spinal anaesthesia were allocated to three groups of 16 each according to ASA classification I-II-III. Each patient received a fluid load of 7 ml kg-1 and either ephedrine 12.5 mg i.v. and 37.5 mg i.m., or placebo. ⋯ In ASA risk group III, all patients in the placebo group had a decrease in mean arterial pressure exceeding 20%; in 50% of these patients, the decrease exceeded 33%. We conclude that prophylactic ephedrine is desirable for spinal anaesthesia, especially in ASA III patients.
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Anesthesia and analgesia · Sep 1989
Randomized Controlled Trial Comparative Study Clinical TrialEffects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship.
The effects of thoracic epidural anesthesia (TEA) on total body oxygen supply-demand ratio are complex due to potential influences on both O2 delivery (QO2) and consumption (VO2). One hundred and five patients undergoing abdominal aortic surgery were randomly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with (1) thoracic epidural anesthesia plus light general anesthesia (group TEA); (2) general anesthesia with halothane (group H); and (3) neuroleptanalgesia (group NLA). Values of cardiac index (CI) and QO2 were less intraoperatively in the TEA group than in the H or NLA groups, while VO2 values were similar. ⋯ Heart rate was slowest intraoperatively during TEA, and stroke work was less with TEA than with NLA. As cardiac filling pressure and systemic vascular resistance did not differ among the three groups, reduced adaptation of CI to tissue O2 needs during TEA was attributed to negative inotropic and chronotropic effects of the sympathetic blockade. We conclude that in patients undergoing abdominal aortic surgery, TEA has no apparent advantage over general anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthesia for surgery of the forearm and hand. A technique of combined supraclavicular and discrete blocks.
Eighty patients who presented for surgery of the forearm or hand were allocated randomly to one of two groups. In Group A, surgery was performed under supraclavicular brachial plexus block only; a mixture of equal parts of prilocaine 1% and bupivacaine 0.5% without adrenaline was used. In Group B, supraclavicular brachial plexus block was performed using prilocaine 1% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline. Patients in Group B had a significantly shorter duration of unwanted postoperative motor blockade and a significantly longer duration of postoperative analgesia (p less than 0.005).