Articles: anesthesia.
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Randomized Controlled Trial Clinical Trial
The effect of thoracic epidural analgesia on postoperative stress and morbidity.
A hundred patients scheduled for cholecystectomy were randomized to either thoracic epidural anaesthesia and analgesia for 24 h with bupivacaine intraoperatively about 100 mg and 15 mg/h thereafter (TEA) for postoperative analgesia, TEA combined with general anaesthesia (low dose fentanyl) (TEA + GA) and general anaesthesia (GA) (low dose fentanyl). During TEA and TEA + GA the arterial pressure was significantly decreased as compared with GA. TEA was associated by an intense haemodilution in comparison with GA. ⋯ The postoperative alleviation of the alteration of the above mentioned parameters by TEA was slightly diminished in the TEA + GA group. However, we found no significant reduction in cardiac dysrhythmias (TEA 7%, TEA + GA 7% and GA 10%), ST-segment depression (TEA 17%), TEA + GA 3.3% and GA 12.5%), wound complication (TEA 3%, TEA + GA 0%, GA 0%), pneumonia (TEA 3%, TEA + GA 3% and GA 0%), subphrenic abscess (TEA 6%, TEA + GA 0%, GA 3%), mortality (TEA 0%, TEA + GA 3%, GA 0%), and urinary tract infect (TEA 17%, TEA + GA 7% and GA 2.5%). Since an equal number of patients in each group, about 30%, suffered one or more of the postoperative complications this epidural analgesia was not effective in reducing postoperative morbidity albeit the significant alleviation of the postoperative stress response.
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Ann Fr Anesth Reanim · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial[Use of isoflurane in a closed-circuit. Economic advantages].
The present study was designed to assess whether isoflurane requirement was significantly affected by fresh gas flow in a closed-circuit system. Sixty patients scheduled for orthopaedic procedures were randomly assigned into three groups. In group A (n = 20), anaesthesia was conducted with a fresh gas flow of 482.5 +/- 186.6 ml X min-1, corresponding to the patient's metabolic demand. ⋯ Alveolar concentration of isoflurane was set at 0.92 vol. % according to Lowe and Ernst. Statistical analysis was carried out using Student's test for means. Anaesthesia lasted 138 +/- 88.3 min in group A, 125.5 +/- 45.1 min in group B and 146.5 +/- 50 min in group C, no difference being significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraoperative local anesthetic injection of the carotid sinus nerve. A prospective, randomized study.
One hundred patients undergoing carotid endarterectomy under general anesthesia were prospectively randomized to receive either a local anesthetic injection of their carotid sinus nerve with bupivacaine (Marcaine) or no injection. Systolic blood pressure and pulse rate were recorded before injection and at 5 and 30 minutes after injection. The need for intraoperative and postoperative use of systemic vasopressor and vasodilator medications was recorded for each group as was the incidence of arrhythmias, neurologic complications, and myocardial infarctions. ⋯ The incidence of postoperative hypotension (6 percent of patients), hypertension (34 percent), arrhythmias (6 percent), cerebrovascular accidents (1 percent), transient ischemic attacks (3.1 percent), and myocardial infarctions (2 percent) were not significantly influenced by intraoperative local anesthetic injection of the carotid sinus nerve. Intraoperative and postoperative hypotension did not cause morbidity in this series, however, local anesthetic injection was associated with a significant incidence of perioperative hypertension. Routine prophylactic local anesthetic injection of the carotid sinus nerve cannot be recommended in view of its detrimental effects in relation to the development of hypertension.
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Randomized Controlled Trial Comparative Study Clinical Trial
Left ventricular ejection fraction during anaesthetic induction: comparison of rapid-sequence and elective induction.
A randomized clinical trial was conducted in 14 women, aged 24-60 years, to compare the effects of rapid-sequence induction of anaesthesia and elective induction on heart rate, blood pressure and left ventricular ejection fraction (LVEF). None of the patients suffered from heart or lung diseases, and all were scheduled for hysterectomy. Cuff blood pressure was measured repeatedly by an automatic recording device, and heart rate and LVEF were monitored by a portable nonimaging nuclear probe. ⋯ Similar decreases in LVEF was observed in both groups, from 0.60 to 0.42 in the elective induction group, and from 0.60 to 0.41 in the rapid-sequence induction group. The equal depression of LVEF indicates that laryngoscopy and intubation produce, with both induction regimens, sudden impairment of cardiac function. The more pronounced hypertension and tachycardia observed during rapid-sequence induction suggests a higher myocardial oxygen consumption which may represent a serious additional burden for the poorly perfused heart.
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Randomized Controlled Trial Clinical Trial
Double-blind evaluation of a lignocaine-prilocaine cream (EMLA) in children. Effect on the pain associated with venous cannulation.
The effect of the topical application of a lignocaine-prilocaine cream (EMLA) on the pain of venous cannulation was tested in a double-blind manner. Sixty boys and girls between the ages of 4 and 10 yr who were to undergo surgery participated in the study. No analgesic premedication was given and the venous cannulation was performed during the preparation for general anaesthesia. ⋯ The effect of EMLA in the alleviation of the pain of venous cannulation was considered significantly better than placebo by both anaesthetist (P less than 0.001) and patient (P less than 0.05) (verbal scales). One conventional pictorial scale showed a statistically significant difference (P less than 0.05), but the other, based on facial expressions, did not. Local reactions to the cream were minor and transient in both groups.