Articles: anesthetics.
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Physiologic and pathologic changes due to ageing should be taken in account for the preoperative evaluation and peroperative management of geriatric patients. Pharmacokinetic changes ed to reduce the doses of intravenous agents by 50%. ⋯ Pharmacodynamic deleterious effects are limitative in the choice of some drugs. Cardiocirculatory and pulmonary functions need specific, if possible non invasive monitoring, during surgery, recovery and the early postoperative days.
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Ann Fr Anesth Reanim · Jan 1990
[Intrathecal and epidural administration of alpha adrenergic receptor agonists].
Alpha-agonists are frequently added to local anaesthetic agents to prolong the duration of spinal or extradural anaesthesia. Adrenaline and phenylephrine have been employed most commonly for this purpose. Recent controlled studies indicated that the alpha-adrenoceptor agonist clonidine, when administered spinally, has a dose-dependent antinociceptive effect. ⋯ However, spinally administered alpha-agonists have side effects, which include vasoconstriction in the spinal cord, hypotension, bradycardia or tachycardia, somnolence and respiratory depression. To minimize such complications, great care may be needed, which is described in this review, assessing the minimal required amount of alpha-agonists and effective clinical monitoring. The development of this technique in the management of subarachnoid and extradural anaesthesia and of chronic pain is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tetracaine, adrenaline, and cocaine with cocaine alone for topical anesthesia.
A mixture of tetracaine, adrenaline, and cocaine (TAC) has been used extensively in the repair of small lacerations, especially in children. The purpose of this study was to determine whether cocaine alone would provide anesthesia equal to that of TAC, thus eliminating the risk of tetracaine toxicity and the theoretic risk of side effects from the combination of cocaine and adrenaline and simplifying preparation. One hundred thirty-nine patients were enrolled in a randomized, double-blind study comparing TAC with cocaine. ⋯ The percentage of patients having good anesthesia in the TAC-treated group was approximately 72%, which is equivalent to the efficacy found in other studies. Good anesthesia was obtained in 52% of the cocaine-treated group. No side effects or increased rates of infection were reported in either group.
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Int Anesthesiol Clin · Jan 1990
ReviewContinuous infusions of local anesthetics and narcotics for epidural analgesia in the management of labor.
It appears that complete analgesia for labor using epidural and subarachnoid opiates alone, with a minimum of side effects, remains an unfulfilled goal. However, the combination of extremely small doses of local anesthetics and opiate drugs seems to provide excellent analgesia with a minimum of side effects. ⋯ These drugs include catecholamines, clonidine, GABA agonists, substance P antagonists, prostaglandin synthetase inhibitors, and many other drugs capable of altering neural transmission in such a way that analgesia results. Obviously, labor analgesia is one area in which these combinations will be explored extensively, and the next few years should be very exciting ones.