Articles: anesthesia.
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Maintenance of obstetrical analgesia by continuous perfusion into the peridural space].
Two methods of epidural analgesia were compared in two randomized groups each of 16 normal women in labour, using bolus or continuous infusion. Analgesia was provided by a mixture of bupivacaine 0.25% and fentanyl. ⋯ There was no statistical difference between the two groups concerning length of labour, number of forceps, Apgar score and patient, obstetrician and anaesthetist satisfaction score. Although continuous epidural infusion was greatly appreciated by the obstetrical team, it would seem to be of interest only when labour is long enough to require larger doses, especially when labour is induced.
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Randomized Controlled Trial Clinical Trial
Epidural ketamine for postoperative analgesia.
Thirty-four patients of ASA physical status I or II scheduled for gall bladder surgery were studied in a comparative prospective trial to evaluate the efficacy of epidural and intramuscular ketamine for postoperative pain relief. They were divided randomly into three groups. Group I (11 patients) received 30 mg intramuscular ketamine. ⋯ Four patients who received epidural ketamine complained of transient burning pain in the back during injection. No patient developed respiratory depression, psychic disturbance, cardiovascular instability, bladder dysfunction or neurologic deficit. It is concluded that 30 mg epidural ketamine is a safe and effective method for postoperative analgesia.
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Randomized Controlled Trial Clinical Trial
Hemodynamics of the legs and clinical symptoms following regional blocks for transurethral surgery.
In a prospective clinical study we compared the hemodynamics and clinical symptoms following regional blocks and general anesthesia. 115 patients undergoing transurethral resection of the prostate were randomized to spinal (n = 62) and epidural (n = 53) blocks. An additional 10 patients received general anesthesia. Calf arterial flow, determined by strain gauge plethysmography (SGP), was similar pre- and postoperatively in the regional block groups but decreased in the general anesthesia group (p less than 0.05) on the 5th postoperative day compared to the preoperative day. ⋯ Antiembolism stockings offered no hemodynamic or clinical advantages. During the hospital stay (screening by Doppler and SGP) and 3 months of follow-up, no deep vein thrombosis or pulmonary embolism was diagnosed. 3 months after the operation, unspecific pain and/or weakness in the legs were reported by 12 patients in the spinal group, while the epidural group remained asymptomatic (p less than 0.01). We conclude that the predictive value of negative Doppler and SGP findings is good and that spinal and epidural blocks are hemodynamically advantageous as compared to general anesthesia.
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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.
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Randomized Controlled Trial Clinical Trial
Effects of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation.
The effects of clonidine, a centrally acting alpha 2-adrenergic receptor agonist, on depth of fentanyl anesthesia and on cardiovascular response to laryngoscopy and intubation were studied. Twenty-four patients undergoing aortocoronary bypass surgery (ACBS) with a history of arterial hypertension, coronary artery disease (NYHA class 3-4), and well-preserved left ventricular function were assigned randomly to either Group 1 (n = 12), who received standard premedication, or Group 2 (n = 12), who received clonidine 5 micrograms X kg-1 po in addition to standard premedication 90 min before estimated induction time. Depth of anesthesia was assessed by on-line aperiodic computerized analysis of the electroencephalogram (Lifescan EEG Monitor). ⋯ By contrast, fentanyl requirements in Group 2 were significantly reduced by 45% when compared with Group 1, i.e., from 110 +/- 23 to 61 +/- 19 micrograms X kg-1 (P less than 0.001). The authors conclude that at a similar anesthetic depth, as assessed by the EEG shift into the lower frequency range (0.5-3 Hz), a markedly reduced fentanyl dose effectively prevented the hyperdynamic cardiovascular response to laryngoscopy and intubation in the group of patients premedicated with clonidine. This is likely explained by the known synergistic inhibitory action of opiates and alpha 2-adrenoceptor agonists on central sympathetic outflow.