Articles: anesthesia.
-
Randomized Controlled Trial Clinical Trial
Effect of the trendelenberg position on spinal anaesthesia with hyperbaric bupivacaine.
In a double-blind study, the effect of the Trendelenberg position was compared with the supine, in 20 patients following intrathecal injection of 3 ml of 0.5% bupivacaine in 8% glucose. All patients had blocks suitable for abdominal surgery. ⋯ There were no differences in motor block, duration or cardiovascular changes between the groups. It is concluded that the trendelenberg position is not necessary to ensure spread of local anaesthetic solution into the mid thoracic region for abdominal surgery.
-
Randomized Controlled Trial Clinical Trial
A controlled trial of extradural fentanyl in labour.
In a double-blind trial carried out on patients in the first stage of labour, either fentanyl 80 micrograms (n = 35) or physiological saline (n = 33) was added to the test dose of bupivacaine and administered extradurally. Thereafter analgesia was maintained as necessary with 0.5% bupivacaine alone. ⋯ Analgesia was more rapid in onset and more complete in the fentanyl group, and the duration from first dose to first top-up was 2.36 h, compared with 1.66 h (supplements notwithstanding) in the control group. No serious side-effects were encountered in either group, although eight patients in the fentanyl group experienced mild itching, compared with one in the control group.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Recovery from day-case anaesthesia. Comparison between methohexitone, Althesin and etomidate.
One hundred unpremedicated patients, undergoing short gynaecological procedures, were randomly allocated to receive one of three i.v. hypnotic agents (methohexitone, Althesin and etomidate) alone or in combination with fentanyl, to supplement 66% nitrous oxide in oxygen. Recovery was assessed by the time patients took to open the eyes, to give correct date of birth, to achieve a certain level of manipulative skill with a children's post-box toy, and to perform a paper and pencil test. ⋯ Administration of fentanyl with Althesin or methohexitone did not significantly prolong the "post-box" recovery time. Side-effects were less common with Althesin, with or without fentanyl and etomidate with fentanyl was associated with the greatest frequency of complications.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative glucose tolerance during extradural analgesia.
Thirteen patients undergoing lower abdominal gynaecological surgery were allocated to general anaesthesia (halothane and nitrous oxide) or general anaesthesia plus extradural analgesia (T8-S5). I.v. glucose tolerance tests were performed on the day before surgery and 8 h after skin incision. ⋯ Extradural analgesia blocked the hyperglycaemic response to surgery but not the late postoperative cortisol response, although values were significantly less than in the group receiving general anaesthesia alone. Impairment of glucose tolerance and of insulin response to the glucose load in the period after operation were not influenced by extradural analgesia and this may have resulted from insufficient inhibition of the stress-induced release of catecholamines or cortisol, or both, or from blockade of stimulatory efferent sympathetic pathways to pancreatic islets.
-
Randomized Controlled Trial Clinical Trial
Lidocaine and bupivacaine mixtures for epidural blockade.
In a prospective double-blind clinical study, single-dose lumbar epidural blockade was instituted in 60 healthy patients undergoing lower abdominal surgery. Patients were randomly assigned to one of five groups. Each group received treatment with a different local anesthetic solution containing 1:200,000 epinephrine. ⋯ Using skin temperature as a criterion of sympathetic blockade, all three mixtures demonstrated a duration of action intermediate between the two single drugs, lidocaine (124 +/- 13 min) and bupivacaine (286 +/- 32 min). Onset of complete motor blockade was fastest and the degree of motor blockade was most profound with the mixture containing equal proportions of lidocaine and bupivacaine. Pharmacokinetics of individual drugs were unaltered in any of the mixtures.