Articles: anesthesia.
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Randomized Controlled Trial Clinical Trial
The hemodynamic and cardiovascular effects of isoflurane and halothane anesthesia in children.
The hemodynamic and cardiovascular effects of isoflurane and halothane anesthesia were studied in 15 unpremedicated ASA I children using measurements of heart rate, blood pressure and M-mode echocardiography (echo). The children (ages 2 to 7.3 yr) were randomly assigned to receive either isoflurane (N = 8) or halothane (N = 7) with oxygen. End-tidal carbon dioxide concentrations (range 30-44 mmHg) were monitored throughout the study in each child. ⋯ Halothane was associated with a significant dose-dependent decrease in echo-measured left-ventricular shortening fraction and mean velocity of circumferential fiber shortening. These echo measurements were not significantly altered by isoflurane at either end-tidal anesthetic concentration. These alterations suggest halothane is associated with significant myocardial depression in normal children, while myocardial function is well preserved during isoflurane anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients.
The mortality following surgical correction of upper femoral fractures was investigated in 578 patients, over the age of 50 yr, randomly allocated to receive spinal (bupivacaine) or general (enflurane or neurolept) anaesthesia. Thirty days after surgery the mortality was 6% after spinal and 8% after general anaesthesia (ns). ⋯ The estimated blood loss was smaller (P less than 0.05) in patients receiving spinal anaesthesia. Regardless of the anaesthetic technique, a high short-term mortality was related to age, male sex, and trochanteric fracture, whereas excess long-term mortality was related to male sex and high ASA scores.
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Cahiers d'anesthésiologie · Mar 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Peridural analgesia in labor. Comparison between bupivacaine and 2-chloroprocaine].
The purpose of this study was the comparison of the effects on the labor and neonates of epidural analgesia conducted either with bupivacaine or 2-chloroprocaine. Hundred and three parturients were included in the study. They were randomly divided in two groups. ⋯ Umbilical cord blood was drawn for pH determination. Cord blood pH was slightly but significantly lower in bupivacaine (7.314 +/- 0.106) than in 2-chloroprocaine (7.345 +/- 0.06) patients (t = 1.6968, p = 0.046). Newborns extracted with forceps after maternal bupivacaine epidural analgesia had a significantly lower umbilical blood pH (7.278 +/- 0.117) than newborns who did not required forceps in the bupivacaine group (7.337 +/- 0.093) (t = 2.1986, p = 0.0159).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous infusion epidural analgesia in obstetrics. A comparison of 0.08% and 0.25% bupivacaine.
The effects of 0.08% (Group A) and 0.25% (Group B) solutions of bupivacaine were compared in a random manner, to assess continuous pump infusion epidural analgesia in labour. Both solutions were infused at a dose rate of 20 mg bupivacaine/hour. The results in all the mothers who had received infusions lasting more than 4 hours were studied. ⋯ The mean of the intervention-free intervals was significantly greater in Group A than in Group B, and significantly fewer top-up injections were required in Group A. The results show that the administration of a 0.08% solution of bupivacaine into the epidural space by continuous pump infusion is more labour saving than the infusion of a 0.25% solution. The concept that a greater volume infusion rate maintains a more extended liquid sleeve of local anaesthetic in the epidural space is supported.
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Randomized Controlled Trial Clinical Trial
Fentanyl-oxygen versus fentanyl-N2O/oxygen anaesthesia in children undergoing cardiac surgery.
Fentanyl-oxygen (fentanyl-O2) anaesthesia was compared to fentanyl-nitrous oxide/oxygen (fentanyl-N2O/O2) anaesthesia in 14 children undergoing cardiac surgery. Children were randomly assigned to one of the two techniques studied, with seven patients in each group. The mean age (mean +/- SE) was 3.9 +/- 0.75 years (0.5-8.25 years) and mean weight 14.7 +/- 2 kg (3.5-29.5 kg). ⋯ Similar phenomena were not documented in the fentanyl-N2O/O2 group. Our studies suggest that fentanyl-O2 anaesthesia in the schedule described, in children undergoing elective cardiac surgery for Tetralogy of Fallot, A-V canal, and transposition of the great arteries, is not sufficient to prevent elevation in systolic blood pressure despite fentanyl plasma concentrations in excess of 20 ng X ml-1. The addition of nitrous oxide prevents this phenomenon.