Articles: anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind study of motor blockade in the lower limbs. Studies during spinal anaesthesia with hyperbaric and glucose-free 0.5% bupivacaine.
Sensory and motor blockade were studied double-blind during spinal anaesthesia in 20 urology patients who received 0.5% bupivacaine solution 4 ml with or without glucose. Using a new method for determining muscle strength, motor blockade during anaesthesia was recorded quantitatively for flexion of the hip, extension of the knee and plantar flexion of the big toe. Movements of the lower part of the thoracic cage were recorded at the same time. ⋯ Thoracic movements (maximal inspiration to normal expiration) did not appear to be notably influenced by the level of analgesia. Complete regression of motor blockade was not observed for any of the movements at grade O of a modified Bromage scale. Not until 1.5-2 h after the attainment of this grade was the muscle strength of all movements restored (90% of control value).
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with 0.75% bupivacaine and 0.5% amethocaine in 5% glucose.
Three millititre of 0.75% plain bupivacaine and 0.5% amethocaine 3 ml in 5% glucose were used for spinal anaesthesia and compared in a double-blind study of 20 patients undergoing urological surgery. The onset time to maximum cephalad spread of sensory analgesia was approximately 45 min for bupivacaine and approximately 30 min in the amethocaine group (ns). The mean maximum spread of sensory analgesia was similar for both agents: T6-7 180 min after injection, although the cephalad spread of sensory analgesia with bupivacaine persisted for longer at a significantly higher level than that of amethocaine. ⋯ Onset time to complete motor blockade of the lower limbs was similar for both agents. Nine of 10 bupivacaine patients and seven of the 10 patients receiving amethocaine had complete motor blockade of the lower limbs. Duration of motor blockade was significantly longer for all degrees in the bupivacaine group.
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Anesthesia and analgesia · Sep 1985
Randomized Controlled Trial Comparative Study Clinical TrialEtomidate versus thiopental for induction of anesthesia.
Hemodynamic changes and side effects of anesthesia induction with etomidate or thiopental were evaluated in 83 ASA class I or II patients. Patients were randomly assigned to one of 12 groups according to pretreatment drug (fentanyl, 100 micrograms, or normal saline intravenously), induction agent (etomidate, 0.4 mg/kg, or thiopental, 4 mg/kg), and maintenance anesthetic technique (isoflurane-oxygen, isoflurane-nitrous oxide-oxygen, or fentanyl-nitrous oxide-oxygen). The purpose of this experiment, of factorial design, was to evaluate the combined effects of two or more experimental variables used simultaneously and to observe interaction effects. ⋯ Patients in whom anesthesia was induced with etomidate had a greater incidence of pain on injection and myoclonus and a lesser incidence of apnea than patients in whom anesthesia was induced with thiopental. Fentanyl pretreatment significantly decreased the incidence of pain on injection and myoclonus, but it increased the incidence of apnea when anesthesia was induced with etomidate. The incidence of postoperative nausea and vomiting was similar after thiopental and etomidate and was unaffected by fentanyl pretreatment. (ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Etomidate versus methohexital for intravenous anesthesia with alfentanyl and nitrous oxide-oxygen. A double-blind study of circulatory behavior and postoperative course].
This study compared both etomidate and methohexitone for intravenous anaesthesia with alfentanil and nitrous oxide/oxygen in 2 X 20 patients scheduled for ENT-surgery, in a double blind, random fashion. Apart from the alternative use of etomidate and methohexitone the anaesthetic procedure did not differ: After a small dose of alfentanil anaesthesia was induced by a bolus dose of the hypnotic followed by a continuous infusion of the drug. In case of inadequate analgesia alfentanil was injected. ⋯ The dosage of etomidate and methohexitone was lowe than that reported in the literature. It proved to be impossible for the anaesthetist to decide which drug he was using. Hence both anaesthetic techniques compare favourably with each other.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural fentanyl in labour. An evaluation of the systemic contribution to analgesia.
In a randomized double-blind trial in the first stage of labour, 20 patients given fentanyl 80 micrograms in the epidural test dose of bupivacaine, were compared with 20 patients receiving an intravenous infusion designed to produce comparable plasma fentanyl concentrations, at the same time as their epidural test dose. Despite slightly higher plasma fentanyl concentrations in the intravenous fentanyl group, epidural fentanyl produced analgesia which was more complete, more rapid in onset and slightly longer lasting. Supplementary doses of bupivacaine were needed to produce analgesia in 75% of the intravenous and 30% of the epidural fentanyl group. It is clear that epidural fentanyl produces satisfactory pain relief when added to the epidural test dose, but that the presence of fentanyl in the systemic circulation makes a negligible contribution to analgesia.