Articles: anesthetics.
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J Cardiothorac Anesth · Jun 1990
Sufentanil and succinylcholine for rapid-sequence anesthetic induction and tracheal intubation: hemodynamic and hormonal responses.
Rapid-sequence induction and tracheal intubation are used in the management of patients at risk of aspiration. Patients with coronary artery disease (CAD) are at additional risk of adverse hemodynamic responses to intubation. The hemodynamic and hormonal responses to intubation with sufentanil, 7 micrograms/kg, and succinylcholine, 1.5 mg/kg, were studied in patients with CAD and good left ventricular function (ejection fraction greater than or equal to 0.4) who were undergoing elective coronary artery bypass grafting. ⋯ Rapid-sequence administration of sufentanil and succinylcholine resulted in a moderate decrease (24%) in mean arterial pressure from 95 to 72 mm Hg, and the mean arterial pressure remained less than the control value at 1, 3, and 5 minutes after intubation. Systemic vascular resistance also decreased (23%) after administration of sufentanil and returned to control values 5 minutes after intubation. There were no changes in cardiac index until 5 minutes after intubation, at which time it decreased (18%) from 2.8 to 2.3 L/min/m2.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional anesthesia · May 1990
Randomized Controlled Trial Clinical TrialLocal anesthetic efficacy of ropivacaine (LEA 103) in ulnar nerve block.
Ropivacaine (LEA 103) is a new long-acting local anesthetic that in animal experiments has proved to be equally potent but less toxic than bupivacaine. In this controlled double-blind study in man, the dose-response relation of ropivacaine was examined in peripheral nerve block and its potency was compared to that of bupivacaine. Nerve functions during bilateral ulnar nerve block were monitored in 70 normal subjects by a computer-controlled method. ⋯ Its profile of action is uniform for the different fiber groups and resembles that of bupivacaine. Addition of epinephrine does not improve latency or duration of ropivacaine nerve block. Adverse effects attributable to ropivacaine have not been observed.
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Regional-Anaesthesie · May 1990
Comparative Study Clinical Trial Controlled Clinical Trial[Ropivacaine in epidural anesthesia. Dose-response relationship and a comparison with bupivacaine].
Ropivacaine is a new long-acting local anesthetic with a pharmacodynamic profile resembling that of bupivacaine; in addition, ropivacaine has been shown to be less cardiotoxic than bupivacaine in dogs and pigs. To test the dose-response relationship of ropivacaine 0.75% (epinephrine 1:200,000) given epidurally, 47 patients were divided into three groups; the first group received 15 ml (n = 16), the second 20 ml (n = 15), and the third group, 25 ml (n = 16) ropivacaine. Further, to compare bupivacaine 0.75%, bupivacaine 0.5% and ropivacaine 0.75% for epidural anesthesia, 15 ml bupivacaine 0.75% (n = 15) or bupivacaine 0.5% (n = 15) or ropivacaine 0.75% (n = 16) was given epidurally, all with epinephrine added to the solution (1:200,000). ⋯ A total of 77 patients with ASA I or II were enrolled in a non-randomized open-label study. All patients were scheduled for varicose vein stripping. Male and female patients aged 18-70 and weighing 50-100 kg were included in the study. Patients were all placed in a sitting position and the epidural space was identified by the "loss of resistance" technique using a midline approach at the L 3/4 interspace; a test dose of 3 ml local anesthetic was then given, followed by injection of the remainder of the local anesthetic at the rate of 10 ml/min 1 min later. Following injection patients were immediately positioned supine. Upward and downward spread of analgesia were determined bilaterally by the pin-prick method, motor blockade was assessed by use of the Bromage scale following each determination of analgesia. Heart rate and blood pressure were obtained immediately before blockade and every 5 min until 3 h after the injection. RESULTS. The different volumes of ropivacaine 0.75% (15, 20, and 25 ml) brought about adequate analgesia in the sacral and lumbar regions in all patients. In the thoracic region T 6, T 5 and T 4 were reached. The time of onset of analgesia (segment L-1 in all three groups) was 6.4 +/- 2.9 min, 7.7 +/- 2.3 min, and 5.6 +/- 2.9 min for the 15-, 20- and 25-ml groups, respectively. The highest thoracic dermatome was reached after 20 +/- 6 min, 26 +/- 11 min, and 18 +/- 5 min. The duration of sensory anesthesia at the T 10 dermatomal level was 250 +/- 68, 249 +/- 77, and 278 +/- 51 min. Two-segment regression time was 160 +/- 67 min for bupivacaine 0.75%, 140 +/- 60 min for bupivacaine 0.5%, and 124 +/- 29 min for ropivacaine 0.75%. The total duration of sensory block was 303 +/- 58, 290 +/- 70, and 343 +/- 55 min for 15-, 20- and 25-ml groups, respectively. The degree of motor block achieved was 1.6, 1.8, and 2.0 (Bromage), respectively. Sensory anesthesia was considered adequate for surgery in all patients, and no signs of systemic toxicity were observed in any of the patients. The comparison of bupivacaine 0.75%, bupivacaine 0.5% and ropivacaine 0.75% revealed the same latency period of analgesia for bupivacaine 0.75% and ropivacaine 0.75%. This was shorter than for bupivacaine 0.5% (bupivacaine 0.75%: 6.4 +/- 2.1, bupivacaine 0.5%: 7.8 +/- 4...
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Regional-Anaesthesie · May 1990
Case Reports[Subdural spread of a local anesthetic following installation of a peridural catheter].
We report 4 cases of inadvertent subdural injection of local anesthetics among 640 patients receiving epidural anesthesia. In contrast to subarachnoid injection a typical sign was the development of patchy anesthesia in cervical segments and with late onset of symptoms. The case of a 63 year old woman scheduled for aortofemoral bypass surgery in epidural anesthesia is reported. ⋯ Her trachea was therefore intubated; 30 min later the level of anesthesia was below T5 and she could be extubated. Uneventful cesarean section was then performed. These cases demonstrate that as well as subarachnoid injection, inadvertent subdural injection of local anesthetic agents is a potential hazard of epidural anesthesia, not only in patients in an advanced state of pregnancy but also in nonpregnant patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Local anesthesia in pediatric patients: topical TAC versus lidocaine.
Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. ⋯ TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.