Articles: anesthesia.
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Randomized Controlled Trial Clinical Trial
Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation.
Thirty patients scheduled for elective cardiopulmonary bypass surgery were interviewed pre-operatively and postoperatively to assess changes in their emotional state and recollections, both aware and unaware, of intra-operative events. A random selection of patients heard a prerecorded audio tape towards the end of bypass after they were rewarmed to 37 degrees C. The tape contained suggestions for patients to touch their chin during the postoperative interview, to remember three sentences and to recover quickly. ⋯ Seven patients (23%) recalled intraoperative events, five with the aid of hypnosis. Three reports (10%) were corroborated. Pre-operative medication (p less than 0.01) and postoperative anxiety (p less than 0.05) were significant predictors of those patients who reported recall.
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Randomized Controlled Trial Clinical Trial
The influence of continuous epidural bupivacaine analgesia on the second stage of labor and method of delivery in nulliparous women.
A randomized, double blind, placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.125% bupivacaine beyond a cervical dilatation of 8 cm in nulliparous women. When the cervix was greater than or equal to 8 cm dilated, coded study solution was substituted for the known 0.125% bupivacaine solution. The study solution for 46 patients was 0.125% bupivacaine; 46 patients received saline. ⋯ Twenty-one of 40 (53%) women in the bupivacaine group, versus 11 of 40 (28%) in the saline group, underwent instrumental vaginal delivery (P less than .05). Twenty-eight of 40 (70%) women in the bupivacaine group, versus six of 40 (15%) in the saline group; had surgical perineal anesthesia for vaginal delivery (P less than .0001). There were no significant differences between groups in Apgar scores or umbilical cord blood acid-base values.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Quantitative EEG analysis during anaesthesia with isoflurane in nitrous oxide at 1.3 and 1.5 MAC.
In 14 patients undergoing elective surgery the EEG was studied during anaesthesia with isoflurane and nitrous oxide (in oxygen) at 1.3 and 1.5 MAC. The distribution of spectral EEG indices of the baseline EEG, during the intraoperative and recovery periods were established and compared. Median frequency exhibited the most clear separation between the distributions during recovery and the intraoperative period. ⋯ Burst suppression was observed during the loading period in all patients treated with 1.5 MAC and in five patients out of seven receiving 1.3 MAC. The average duration of the period of burst suppression was markedly greater in the group receiving 1.5 MAC than in the group receiving 1.3 MAC. It is concluded that devices designed for EEG trend monitoring during anaesthesia should preferably depict a frequency measure, and allow for burst suppression recognition before spectral analysis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural anesthesia and analgesia in high-risk surgical patients.
The authors conducted a randomized controlled clinical trial to evaluate the effect of epidural anesthesia and postoperative analgesia (EAA) on postoperative morbidity in a group of high-risk surgical patients. A total of 53 patients were admitted to the study, 28 received EAA, and 25 received standard anesthetic and analgesic techniques without EAA. Surgical "risk" was evaluated preoperatively and found to be comparable in the two groups. ⋯ Urinary cortisol excretion, a marker of the stress response, was significantly diminished during the first 24 postoperative hours in the group receiving EAA (P = 0.025). Finally, hospital costs were significantly reduced for patients who received EAA (P = 0.02). The authors conclude that EAA exerted a significant beneficial effect on operative outcome in a group of high risk surgical patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of three anesthetic techniques on emetic symptoms using sufentanil for outpatient surgery.