摘要:

It is universally recognized that an epidural catheter may be misplaced in the subarachnoid space or a vein, with aspiration and test dose administration designed to detect these situations. However, subarachnoid blockade may result even when these tests are correctly performed, implying that subdural catheter misplacement may occur. In addition, other epidural anomalies may also result from such subdural placement. The authors list and give clinical examples of situations in which they trace potential consequences of epidural catheter passage via a subdurally placed needle.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A healthy gravida presented for elective cesarean section. A 3-eye, closed-end catheter was inserted easily through a 17-gauge Tuohy needle 4 cm into the epidural space. A test dose of 3 ml of 1% lidocaine with epinephrine 1:200,000 was injected; aspiration before and after the injection was negative. Over the next 20 min, 17.5 ml of 2% lidocaine was added: after the final 2.4 ml, the woman experienced a brief period of drowsiness. Because of this event, 3% chloroprocaine was used and, after 6 ml, drowsiness and perioral numbness occurred. Aspiration continued to be negative despite opening of the catheter to air in a dependent position. Since intravenous placement of the catheter was certain and the patient refused reinsertion of the catheter, a general anesthetic was administered. Near the end of surgery, 3 ml of 1% lidocaine with epinephrine 1:200,000 were injected through the epidural catheter as a repeat test-dose: again there was no change in heart rate or blood pressure. Postoperatively, when the patient was moved onto the stretcher, frank blood could be aspirated from the catheter.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Epinephrine is commonly employed as a component of epidural solutions to uncover IV injection. Since epinephrine may only produce transient and evanescent effect, as well as be capable of altering utero-placental perfusion and fetal well-being, the authors tested the potential for replacing epinephrine with ephedrine in test doses.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Considerable controversy exists about the relative safety and effectiveness of single-holed versus multiholed epidural catheters in obstetric anesthesia. To assess the relative incidence of adverse effects with these catheters a series of parturients was randomly assigned to have epidural anesthesia administered via a single-holed or a multi-holed epidural catheter, all inserted via a 16-gauge Tuohy needle by means of a loss-of-resistance technique. All catheters were tested with 2% lidocaine and aspiration for blood and CSF performed. Each anesthetist then completed a standard questionnaire.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Injection of small amounts of fluid through the epidural needle before catheter insertion is thought to open up the epidural space, reduce time to analgesia onset, and rule out intrathecal or intravascular placement. The current study was designed to assess if such injection might reduce common complications of catheter insertion such as paresthesias and/or blood vessel trauma.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In order to assess factors which might clinically modify shivering associated with extradural anesthesia, 84 parturients were randomly divided into 4 groups. Group I received extradural block with 0.5% bupivacaine at room temperature. Group II received plain 0.5% bupivacaine warmed to 38.5–39°C. Group III received room temperature 0.5% bupivacaine with added 1:200,000 epinephrine. Group IV received room temperature 0.5% bupivacaine with 50 jug of fentanyl. The injectate volume was 10 ml in all patients. Data collected included demographics, cardiorespiratory parameters, pain and anxiety levels, labor ward ambient temperature, presence or absence of shivering before blockade, post block development of analgesia, presence of shivering, patient temperature and cardiovascular parameters.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The aim of the study was to compare the effect of epidural ropivacaine 0.5% on epidural blood flow with that of bupivacaine 0.5% in patients scheduled for elective abdominal surgery. Ten patients in each group received 20 ml of the anesthetic; they were matched for age (60 vs. 56 years), sex, height, and weight. The epidural catheter was inserted at L2–3 the day before surgery, and epidural blood flow was measured by epidural injection of133Xe diluted in isotonic saline. Immediately after injection isotonic saline was delivered by an infusion pump at a rate of 8 ml/h during the measurement. One hour before surgery, 20 ml of anesthetic was given, and epidural blood flow was reassessed 30 min after injection of the local agent during continuous infusion of 8 ml/h. Sensory level of analgesia to pinprick was determined 30 min after the initial dose of anesthetic.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Local anesthetic-induced neuroblockade can be reversed rapidly by washing isolated nerve preparations with crystalloid solutions. To assess if similar results were clinically feasible, the authors studied 26 women undergoing elective non-laboring cesarean section under epidural anesthesia produced by 0.75% bupivacaine. A blinded investigator measured the level of sensory anesthesia and the degree of motor blockade using the Bromage scale. Levels were recorded before incision, at the end of surgery, and then every 15 minutes during recovery. Patients were randomly assigned to one of three groups, on the basis of receiving, over 30 minutes after the end of surgery via the epidural catheter, no injection, three 15-ml injections of Ringer's lactate or normal saline. 20 patients had plasma bupivacaine levels determined at the end of surgery and 45 minutes later.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In view of reports indicating that epidural opioids may improve the analgesic effects of local anesthetics employed for epidural anesthesia for cesarean section, the authors studied 30 healthy women scheduled for elective cesarean section at term. Following placement of a lumbar epidural catheter, all patients received a total dose of 10 ml of 0.5% bupivacaine with all commonly accepted precautions. The patients were then randomly assigned to receive, in a double-blind fashion, 8 ml of 0.5% bupivacaine with 100 μg of fentanyl (Group A) or with saline (Group B). Additional bupivacaine was then given until a T4 sensory level was attained. Note was made of total drug volume injected, time to attain T4block, the intensity of intraoperative pain from skin incision to peritoneal closure, the need for supplemental anesthetic agents, side effects such as nausea, pruritus or ventilatory depression, and neonatal outcome.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Following an open clinical trial indicating that supplementation of 0.5% bupivacaine with fentanyl epidurally produced better intraoperative analgesia than plain bupivacaine, the authors designed a randomized double-blind trial involving 60 women with a singleton gestation requiring elective cesarean section. Epidural anesthesia was produced with all routine precautions employing 20 ml of 0.5% bupivacaine to which had been added, from coded ampoules, 2 ml of a solution containing either saline or 100 μg of fentanyl. Note was made of onset and duration of sensory and motor blockade, intraoperative analgesia (failed to excellent), time of worst intraoperative pain, neonatal condition, and fentanyl levels in umbilical venous and arterial blood and maternal venous blood.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID