摘要:

Sixty healthy patients scheduled for elective cesarean delivery under epidural anesthesia were randomized to receive either lidocaine or 2-chloroprocaine as the primary local anesthetic agent. When patients first complained of postoperative pain in the recovery room, they were given either fentanyl 50 μg or butorphanol 2 mg, epidurally, in a randomized, blinded fashion. Postoperative analgesia, quantitated on a visual analogue scale, as well as time elapsed until first request for supplemental opioid, did not differ for patients receiving butorphanol after either 2-chloroprocaine or lidocaine anesthesia. In contrast, epidural fentanyl produced a shorter and lesser degree of sensory analgesia after 2-chloroprocaine use, whereas epidural fentanyl after lidocaine anesthesia provided pain relief similar to that seen in the butorphanol groups. Side effects were limited to somnolence with butorphanol and pruritus with fentanyl. No evidence of respiratory depression was seen in any patient. We conclude that 2 mg of butorphanol epidurally provides approximately 2 to 3 h of effective analgesia after cesarean delivery with either lidocaine or 2-chloroprocaine anesthesia. Epidural fentanyl seems to be antagonized when 2-chloroprocaine, but not lidocaine, is used as the primary local anesthetic agent. We suggest a possible mu-receptor-specific etiology for this effect.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Opioid analgesia requirements, distribution into breast milk, and influence on neonatal neurobehavior were evaluated in ten parturient-neonate pairs nursing after elective cesarean section during epidural anesthesia. Five patients received first a loading dose of intravenous meperidine after umbilical cord clamping, then patient-controlled analgesia (PCA) with intravenous meperidine, and finally meperidine tablets as needed. Five patients received morphine in the same manner. Treatment groups showed no differences with respect to neonatal Apgar scores or visual analog scale (VAS) pain or satisfaction scores at 24 and 48 h postpartum. Breast milk specimens, obtained at 12, 24, 36, 48, 72, and 96 h postpartum and analyzed for opioids and metabolites, showed persistently elevated normeperidine concentrations in the meperidine group. A blinded psychologist evaluated each infant once on the 3rd day of life with the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Apriori, the “alertness” and three “human orientation” outcomes of the NBAS were chosen for analysis as best measures of opioid-induced effects. On all four outcomes, neonates in the morphine group scored significantly higher (P< 0.05) than neonates in the meperidine group. We conclude that post-cesarean delivery PCA with morphine provides equivalent maternal analgesia and overall satisfaction as that provided by PCA with meperidine, but with significantly less neurobehavioral depression among breast-fed neonates on the 3rd day of life.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To determine the relationship among diaphragm, orbicularis oculi, and adductor pollicis blockade, train-of-four stimulation was applied to the phrenic, facial, and ulnar nerves in 16 adult patients anesthetized with alfentanil-propofol-oxygen. Vecuronium 0.04 or 0.07 mg/kg was given. The response of the adductor pollicis was measured with a force transducer, and that of the other muscles by electromyography (EMG). No statistically significant differences were detected with either dose in the intensity of maximum blockade measured at the three muscles. With 0.04 mg/kg, the first response (Tl) in the train-of-four was decreased (mean ± SEM) 78 ± 8, 62 ±11, and 84 ± 3% for the diaphragm, orbicularis oculi, and adductor pollicis, respectively. Corresponding values after 0.07 mg/kg were 95 ± 3, 82 ± 11, and 95 ± 2%, respectively. However, onset time was longer at the adductor pollicis than at the diaphragm, and the orbicularis oculi onset time approached that of the diaphragm. With 0.04 mg/kg, time to maximum diaphragmatic blockade was 2.9 ± 0.3 min, compared with 3.7 ± 0.6 min at the orbicularis oculi (no significant difference [NS]) and 6.6 ± 0.4 min at the adductor pollicis (P< 0.001). With vecuronium 0.07 mg/kg the values were 2.2 ± 0.3, 3.4 ± 0.5 (P= 0.024), and 6.3 ± 0.6 (P< 0.001), respectively. Time to 75% Tl recovery was similar at the diaphragm and the orbicularis oculi, but significantly longer at the adductor pollicis. The values were 14.6 ± 2.4, 17.8 ± 5.2 (NS), and 24.0 ± 2.8 min (P= 0.01), respectively, after 0.04 mg/kg, and were 26.0 ± 4.0, 28.7 ± 4.1 (NS), and 35.2 ± 4.0 min (P= 0.005), respectively, after 0.07 mg/kg. It is concluded that the orbicularis oculi response to facial stimulation reflects the extent of neuromuscular blockade of the diaphragm better than does the response of the adductor pollicis to ulnar nerve stimulation.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To assess the increase in functional residual capacity (FRC) with growth, FRC was measured after induction of anesthesia in two groups of children. One group consisted of 74 children, 0.1–11.2 yr of age, without signs of cardiorespiratory disease (referred to here as “normal” children), and the other of 21 children, 0.2–6.9 yr of age, with cardiac malformations. Anesthesia was maintained with halothane in the normal children and with fentanyl, droperidol, and nitrous oxide in the children with cardiac anomalies. All patients were paralyzed, their tracheas intubated, and their lungs mechanically ventilated. FRC was measured with an automated tracer gas washout technique. In 70 patients the measurements were performed in duplicate with a mean coefficient of variation of 2.0%. FRC correlated significantly with height, weight, and age in both groups. Multiple regression analysis for both groups considered together indicated no significant improvement when factors for the sex of the child or for the presence of cardiac anomalies were incorporated into the model. In normal children the simple linear and nonlinear regression equations for FRC (in milliliters)versusheight (in centimeters) were: FRC = −529 + 9.48 × height, r = 0.96; and FRC = 0.00175 × height2.66, r = 0.97, respectively. The corresponding equations for FRC (in milliliters)versusweight (in kilograms) were: FRC = −92 + 29.9 × weight, r = 0.93; and FRC = 9.51 × weight1.31, r = 0.95. The ratio of FRC to body weight was lower in normal infants (n = 21) than in normal children above 1 yr of age (n = 53): the values (mean ± SD) were 17 ± 4 and 24 ± 6 ml/kg, respectively (P< 0.001). It is concluded that FRC in anesthetized children whose tracheas are intubated can be predicted from height, weight, or age; that the ratio of FRC to body weight was lower in infants than in older children; and that FRC was not affected by the presence of cardiac anomalies.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To evaluate whether, after high thoracic segmental epidural anesthesia, sympathetic blockade spreads caudally beyond sensory blockade, we assessed regional skin temperatures by infrared tele-thermometry in 53 nonpremedicated patients at constant ambient temperature. Either bupivacaine (4.2 ml, 0.75%, n = 10) or an equal volume of saline (placebo, n = 10) was injected at the C7-T2 epidural space in a randomized double-blinded fashion. Results were contrasted to those observed after midthoracic (T6-T9, n = 13) and lumbar (L2-T12, n = 10) epidural injection of an identical dose of bupivacaine or saline (n = 10). Despite restriction of sensory block to the upper thorax with high thoracic epidural anesthesia, skin temperatures increased significantly (P< 0.05vs. saline) on the foot (great toe: +1.2° C ± 2.9 SD; little toe: +0.9° C ± 2.6) and hand (thumb: +2.0° C ± 4.0, digit 5: +2.9° C ± 4.2) but decreased after saline. Midthoracic injection also increased significantly skin temperature on the foot (great toe: +4.0° C ± 4.9; little toe: +3.6° C ± 4.8) but not on the hand. In contrast, with lumbar epidural anesthesia, skin temperature increased significantly on the foot (great toe: +8.5° C ± 2.5; little toe: +8.6° C ± 2.8) but decreased significantly on the hand (thumb: −3.1° C ± 2.1; digit 5: −2.8° C ± 2.5). Whereas the increase in foot skin temperature was greater after lumbar than after high (P< 0.003) or midthoracic (P< 0.03) segmental epidural anesthesia, there was no difference (P= 0.6) in foot skin temperature change between high and midthoracic injection. On the trunk, skin temperatures either did not change or decreased significantly even within analgesic dermatomes. Thus, a substantial, albeit submaximal, increase in foot skin temperature was observed with thoracic epidural anesthesia. Assuming that increased foot skin temperatures reflect diminished sympathetic outflow, we conclude that mid- and even high thoracic segmental epidural anesthesia involving only a few dermatomes can result in a widespread sympathetic block that includes the most caudal parts of the sympathetic nervous system.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To determine the incidence and duration of hypoxemia in the postanesthesia care unit (PACU), 200 patients were investigated in a single-blind observer study. The number of unrecognized hypoxemic episodes, as well as risk factors and possible association between hypoxemia and postoperative morbidity, were studied. Oxygenation was monitored continuously with a pulse oximeter. One or more hypoxemic episodes (Spo2≤ 90%) were noted in 55% of the patients. Spo2values ≤ 80% were noted in 13% of the patients. Supplementary oxygen was given during 55% of the 447 hypoxemic episodes registered. The hypoxemic episodes were unrecognized by the staff in 95% of the cases. With stepwise multiple logistic regression analyses, risk factors associated with a higher incidence of hypoxemia were: duration of anesthesia (P< 0.0001), age (P< 0.002) and a history of smoking (P< 0.01). Patients who had undergone regional anesthesia had a lower risk of hypoxemia (P< 0.0002). The occurrence of hypoxemia in the PACU could not be correlated to postoperative morbidity. We conclude that hypoxemic episodes in our PACU are common and that the routine use of supplemental oxygen combined with normal clinical surveillance did not prevent hypoxemic episodes.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Using a prospective, randomized, and double-blind study design, alfentanil (n = 15), fentanyl (n = 14), or sufentanil (n = 16), in combination with N2O, were administered to patients undergoing craniotomy for supratentorial tumor resection. Physicians were given two syringes, one of which was labeled as “load” for the initial loading dose and the other as “maintenance” for continuous infusion. The concentration of drug in each syringe was adjusted to permit administration on a milliliter per kilogram basis. The target loading doses for alfentanil, fentanyl, and sufentanil were 75, 10, and 1 μg/kg, respectively, and initial infusion rates were 33.5, 2.0, and 0.3 μg·kg−1·h−1, respectively. Additional supplementary boluses and changes in maintenance infusion rate were made according to predetermined guidelines. Isoflurane, in increasing 0.2% inspired increments, was used only when the maximum allowed opioid dose had been given (i.e., supplementary bolus doses equal to 75% of the calculated loading dose or supplementary bolus doses equal to 50% of the calculated loading dose combined with a 50% increase in the maintenance infusion rate). Opioid infusions were stopped at the time of bone flap replacement. Antihypertensive medications and naloxone were subsequently given at the discretion of the anesthesiologist. Group demographics were not different. Total volumes of drug were similar among groups indicating equipotent preparations. Administration of isoflurane, antihypertensive medications, and naloxone were not different among groups. Although decreases in blood pressure seen with induction were similar among groups, alfentanil-treated patients received ephedrine more frequently before intubation. Thirty minutes after entry into the postanesthesia recovery area, respiratory rate andpH were lowest in sufentanil-treated patients. Level of consciousness among groups in the postanesthesia recovery area was not significantly different, although there appeared to be a tendency for alfentanil-treated patients to be more alert. No other variables, including brain condition upon dural opening, durations of intubation following either discontinuance of the maintenance infusion or completion of the head dressings, duration of intensive monitoring following surgery, or final discharge neurologic status were found to distinguish one opioid as superior to the others. Pharmacy opioid acquisition cost per procedure was greatest for the alfentanil-treated group.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A potentially serious complication of long-term epidural catheterization in cancer patients is infection. The early signs of infection were studied in 350 patients in whom long-term epidural catheters were inserted. Three areas of the catheter track were found to be involved; exit site and superficial catheter track infection, and epidural space infection. The authors identified the early signs of infection in each area and the progress of the infection from the deep track to include the epidural space in four of these patients. All 19 patients who developed deep track or epidural infections were successfully treated with antibiotics and catheter removal. None of the patients required surgery for spinal cord decompression. Catheters were replaced in 15 of the 19 treated patients who requested them after treatment with no recurrent infections. It was concluded that use of long-term epidural catheterization is associated with a definable epidural infection rate. The use of epidural opioid analgesia is an effective and safe means of obtaining pain relief for terminally ill patients when patients are monitored for possible infection and receive prompt treatment when the diagnosis is established.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The effect of ketamine (105and 104M) on the intrinsic contractility of left ventricular papillary muscle from normal hamsters and those with cardiomyopathy (BIO 82.62, 6-month old) was investigated. At these concentrations, ketamine induced a positive inotropic effect on normal papillary muscle, as shown by an increase in maximum unloaded shortening velocity (+19 ± 4 and +34 ± 5%,P< 0.05), active isometric force (+32 ± 8 and +57 ± 11%,P< 0.05), and peak power output (+40 ± 8 and +80 + 16%,P< 0.05), and induced a slight decrease in sarcoplasmic reticulum function. Ketamine had no effect on the curvature of the total force-velocity curve, suggesting that it does not modify myothermal economy. Contractility of papillary muscle from hamsters with cardiomyopathy was less than that of controls, as shown by the decrease in isometric active force (-41%,P< 0.02), peak power output (-33%,P< 0.05), and sarcoplasmic reticulum function. The positive inotropic effect of ketamine on papillary muscle from hamsters with cardiomyopathy was less marked than in controls and almost suppressed in some cases: only the maximum unloaded shortening velocity was significantly increased with 10−5M ketamine (+7 ± 6%,P< 0.05), whereas no significant changes were observed in active isometric force (+14 ± 8 and +13 ± 11%; nonsignificant [NS]) and peak power output (+9 ± 5 and +13 ± 8%; NS) with ketamine (10−5and 10−4M, respectively). The effects of ketamine on contraction-relaxation coupling under low and heavy loads were similar to those observed with normal muscle. The direct mechanical effects of ketamine on cardiac muscle therefore depend on the pathophysiologic state; ketamine did not induce a significant inotropic effect on cardiomyopathy muscles.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The effects of the highly selective alpha2-adrenoceptor agonist dexmedetomidine on contractility, relaxation, and the intracellular Ca2+transients of isolated ventricular myocardium were studied in isolated right ventricular papillary muscles obtained from reserpinized ferrets. Dexmedetomidine (10−10-10−5M) did not alter amplitude and time variables of isometric, isotonic and zero-load-clamped twitches, except for a slight increase in maximal isotonic relaxation rate at 10−5M. Dexmedetomidine (10−8-10−5M) caused no changes in the intracellular Ca2+transient detected with aequorin. These results suggest that dexmedetomidine has no intrinsic myocardial contractile effects.

ISSN:0003-3022    

出版商:OVID    

年代:1990

数据来源: OVID