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Acta Anaesthesiol Scand 2001 Jul;45(6):786-9
Department of Anesthesiology and Reanimation, Karadeniz Technical University, Medical Faculty, Trabzon, Turkey. acsenel@ktu.edu.tr
BACKGROUND: Administration of bupivacaine caudally has been used for postoperative analgesia after urogenital, rectal and lower abdominal surgery in children. Caudal opioids may offer analgesic advantages over bupivacaine alone but have been associated with side effects such as respiratory depression. Tramadol is an analgesic assumed to lack a respiratory depressant effect and has been shown to provide effective, long-lasting analgesia after epidural administration in adults and children. The aim of this study was to determine whether the addition of tramadol to bupivacaine caudally prolongs the duration of analgesia compared with bupivacaine alone, with respect to side effects, and whether caudal tramadol alone provides satisfactory analgesia. METHODS: Sixty boys, aged 12-84 months, undergoing unilateral herniorrhaphy, were allocated randomly to three groups. Children in group B received 0.25% plain bupivacaine 1 ml kg(-1), group BT received an identical local anesthetic dose mixed with tramadol 1.5 mg kg(-1) and group T received caudal tramadol 1.5 mg kg(-1) in 0.9% sodium chloride in the same total volume (1 ml kg(-1)). Pain and demeanour assessments were made 1, 2, 3, 4, 6, 12 and 24 h after recovery from anesthesia with reference to a three-point scale. RESULTS: Analgesia time (time between caudal injection and first administration of analgesic) in group BT (13.5+/-2.2 h) was significantly longer than in the other two groups (P<0.05). In group T, more patients required additional analgesia after surgery than in the other two groups (P<0.05). Pain scores in the three groups were similar up to 4 h after operation but the mean score in group T was higher than groups B and BT 4 and 6 h after operation (P<0.05). Significantly more patients who had received caudal bupivacaine alone or with tramadol had lower pain and demeanour scores during the first 24 h after operation compared with those in the tramadol group. CONCLUSION: Caudal administration of bupivacaine with the addition of tramadol resulted in superior analgesia with a longer period without demand for additional analgesics compared with caudal bupivacaine and tramadol alone without an increase of side effects.
Publication Types:
PMID: 11421842, UI: 21314821
Acta Anaesthesiol Scand 2001 Jul;45(6):772-5
Department of Anaesthesiology, Polyclinique de Savoie, Annemasse, France. chahe@yahoo.com
BACKGROUND: No studies have evaluated the relationship between duration of time sitting and spinal needle type on the maximal spread of local anaesthetics. The few trials available have studied the influence of time spent sitting on the spread of anaesthesia without standardising spinal needle types, and have not found any effect. METHODS: In this randomised, blinded study, 60 patients scheduled for elective orthopaedic surgery of the lower limbs were divided into 4 groups. With the patient sitting erect, 15 mg hyperbaric bupivacaine were injected in a standard manner through a 24G Sprotte or a 27G Whitacre needle and patients were placed supine after 1 min (24G/1 group and 27G/1 group) or 4 min (24G/4 group and 27G/4 group). RESULTS: Time to achieve maximum block height after injection was similar in all groups. Block height levels were significantly lower at all time points for the 24G/4 group. Maximum block heights were Th4 in the 24G/1, 27G/1 and 27G/4 groups, and Th6 in the 24G/4 group (P<0.0001). CONCLUSION: In a standard spinal anaesthesia procedure, when different lengths of time spent sitting are compared, spinal needle characteristics influence the maximum spread of hyperbaric bupivacaine. However, within the limits of our study, a two-segment difference in block height is too small to consider using spinal needles as valuable tools to control block height during spinal anaesthesia in our daily practice.
PMID: 11421839, UI: 21314818
Acta Anaesthesiol Scand 2001 Jul;45(6):766-71
Department of Anaesthesiology, University of Heidelberg, Germany. thomas.grau@med.uni-heidelberg.de
BACKGROUND: The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to investigate whether pre-puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia. METHODS: We used digital ultrasound equipment with a 5-MHz transducer to assess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were scheduled for epidural anaesthesia. The women were randomised into two equal groups. In all patients, the standard loss of resistance technique was used. In the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultrasound images was compared to the ES depth measured by the needle. We compared the number of puncture attempts with the standard method (control group) to the number of attempts under ultrasound guidance. RESULTS: Ultrasonography significantly improved operating conditions for epidural anaesthesia. The maximum VAS scores and patient acceptance were significantly better. CONCLUSIONS: With ultrasound measurement of the ES depth, the quality of epidural anaesthesia was enhanced.
PMID: 11421838, UI: 21314817
Acta Anaesthesiol Scand 2001 Jul;45(6):756-60
Department of Anaesthesia, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi, India.
BACKGROUND: Pediatric strabismus surgery is associated with a very high incidence of postoperative nausea and vomiting [(PONV) 44-88%]. Droperidol (10-75 microg kg(-1)) and ondansetron (50-150 microg kg(-1)) have shown variable success in reducing the incidence and severity of PONV. Combination of these two drugs has shown promising results. This randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy and safety of the combination of these two drugs in reducing the incidence and severity of PONV in pediatric strabismus surgery. METHODS: After institutional approval and parental informed consent, 240 children of ASA physical status I and II of either sex, aged 1-15 years were included in this study. None of the children received any premedication and a standardized anesthesia technique was used for all the children. They were prospectively randomized to one of the four treatment groups. Group PP received normal saline placebo intravenously after induction and at the end of the procedure. Group DP received droperidol 25 microg kg(-1) after induction and normal saline at the end. Group OP received ondansetron 150 microg kg(-1) after induction and saline at the end. Group DO received droperidol 15 microg kg(-1) after induction and ondansetron 100 microg kg(-1) at the end. RESULTS: Combination prophylaxis resulted in a lower incidence of PONV (13%) as compared to placebo (62.5%, P<0.001), ondansetron (37%, P<0.001), or droperidol (32%, P<0.01). CONCLUSION: Droperidol 15 microg kg(-1) in combination with ondansetron 100 microg kg(-1), administered at the induction and end of the operative procedure respectively, is more effective than either drug given individually in reducing the incidence of PONV after strabismus surgery.
PMID: 11421836, UI: 21314815
Acta Anaesthesiol Scand 2001 Jul;45(6):690-5
Department of Anesthesiology, University Hospital MAS, Malmo, Sweden.
BACKGROUND: The lower inflexion point (LIP) on the inspiratory part of the pressure-volume (PV) loop has been suggested to be related to the pressure at which air spaces collapse. Our hypothesis is that airway collapse might instead be assessed from the upper inflexion point on the expiratory part of the PV-loop (UIPexp), where lung volume starts to decrease significantly. We therefore examined whether there was a relation between LIP and UIPexp in premature surfactant-treated lambs. METHODS: Ten lambs, at 119-141 days of gestational age, were delivered by cesarean section and given 200 mg/kg modified natural porcine surfactant before the first breath. The lambs were then connected to a ventilator and PV-loops using airway pressures of 0-35-0 (ZEEP-loop) and 5-35-5 cmH2O (PEEP-loop) were obtained after lung recruitment at 15, 60 and 120 min after birth. From the loops, LIP, UIPexp, upper inflexion point of the inspiratory part of the loop (UIP insp), inspiratory capacity (IC) as well as inspiratory and expiratory maximal compliance of the respiratory system (Crs(insp) and Crs(exp)) were calculated. RESULTS: The ZEEP-loop showed a substantial hysteresis with a distinct LIP at 19+/-2 cmH2O (mean+/-SD), which was different (P<0.001) from UIPexp (9+/-2 cmH2O). The pressures at LIP and UIPexp were unrelated (r2=0.06). UIPinsp was located at 28+/-2 cmH2O. Crs(insp) was 2.1+/-0.6 ml x cmH2O(-1) x kg(-1), which was lower (P<0.001) than Crs(exp) (2.8+/-0.6 ml x cmH2O(-1) x kg(-1)). IC was 26+/-6 ml/kg. The PEEP-loop had a minimal hysteresis with an expiratory part coinciding with that of the ZEEP-loop. CONCLUSION: In surfactant-treated premature lambs the pressures at LIP and UIPexp are not related, showing that LIP does not indicate the pressure at which airways collapse.
PMID: 11421826, UI: 21314805
Anaesthesia 2001 Sep;56(9):855-8
Magill Department of Anaesthesia, Intensive Care & Pain Management, London SW10 9NH, UK.
Unfractionated heparin is widely used for prophylaxis against venous thromboembolism after Caesarean section. We performed a survey of thromboprophylactic methods after elective Caesarean section in 50 maternity units in the United Kingdom. We found that a variety of regimens were used. Thirteen (26%) used subcutaneous unfractionated heparin at standard (non-pregnant) doses. We then studied anti-Xa activity in women following elective Caesarean section under regional anaesthesia. Initially, eight women were given 5000 U unfractionated heparin subcutaneously after surgery and anti-Xa activity was measured 1, 2, 3, 4, 5, 6, 8 and 10 h after administration. There was no detectable anti-Xa activity in any of the samples so the dose was increased to 7500 U in a further five women and a single anti-Xa assay performed at 3 h when peak activity should occur. Again, no activity was detected so the dose was increased to 10 000 U heparin in a final group of 10 women and anti-Xa activity measured at 0.5, 1, 1.5, 2, 3, 4, 5 and 6 h. Although there was some activity after 10 000 U heparin, the level was below that accepted for prophylaxis. If anti-Xa activity is an appropriate monitor of prophylactic unfractionated heparin, doses up to 10 000 U are inadequate. Since there is evidence that enoxaparin is effective at producing adequate prophylactic anti-Xa activity following Caesarean section, we suggest abandoning the use of unfractionated heparin in favour of enoxaparin for this purpose.
PMID: 11531671, UI: 21422869
Anaesthesia 2001 Sep;56(9):829-35
Cardiac Centre, Morriston Hospital, Swansea SA6 6NL, UK. john.dingley@morrnhst-tr.wales.nhs.uk
Xenon anaesthesia is thought to have minimal haemodynamic side-effects. It is, however, expensive and requires special delivery systems for economic use. In this randomised cross-over study, we: (i) investigated the haemodynamic profile and recovery characteristics of xenon compared with propofol sedation in postoperative cardiac surgery patients, and (ii) evaluated a fully closed breathing system to minimise xenon consumption. We demonstrated a significantly faster recovery from xenon (3 min 11 s) than propofol sedation (25 min 23 s). Relative to propofol, xenon sedation produced no change in heart rate or mean arterial pressure and there were significantly higher mean values for central venous pressure (10.6 vs. 8.9 mmHg), pulmonary artery occlusion pressure (11.2 vs. 9.5 mmHg), mean pulmonary artery pressure (20.1 vs. 18.3 mmHg) and systemic vascular resistance index (2170 vs. 1896 dyn.s.cm-5.m-2). The haemodynamic profile seen with propofol reflected its known vasodilator effects. This was supported by the almost identical left ventricular stroke work indexes seen with both methods of sedation.
PMID: 11531666, UI: 21422864
Anaesthesia 2001 Sep;56(9):825-8
Department of Anaesthesia, Royal Devon & Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK.
We studied the effect of cricoid pressure and lateral tilt on airway patency during ventilation by facemask in a simulated obstetric setting. The lungs of 50 patients were ventilated by facemask and Guedel airway using a Nuffield Penlon 200 ventilator and Bain system with standard settings. Expired tidal volumes and peak inspiratory pressures were recorded for 10 breaths in each of four combinations: supine with no cricoid pressure, supine with cricoid pressure, 15 degrees lateral tilt with no cricoid pressure and 15 degrees lateral tilt with cricoid pressure. The timing of cricoid pressure was randomised and blinded to all observers. In both supine and tilted positions, cricoid pressure produced a reduction in tidal volume (p < 0.001) and an increase in peak inspiratory pressure (p < 0.001). Cricoid pressure with lateral tilt did not produce any additional airway obstruction to that in the supine position. Complete airway obstruction (tidal volume < 200 ml) resulted on three occasions, all with cricoid pressure applied.
PMID: 11531665, UI: 21422863
Anesth Analg 2001 Sep;93(3):804
PMID: 11524367, UI: 21415347
PMID: 11524366, UI: 21415346
Anesth Analg 2001 Sep;93(3):802-3
PMID: 11524363, UI: 21415343
Anesth Analg 2001 Sep;93(3):798-9
PMID: 11524360, UI: 21415340
Anesth Analg 2001 Sep;93(3):776-80
Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan.
Near-fatal pulmonary embolism can occur immediately after tourniquet release after orthopedic surgeries. In this study, we determined the relationship between tourniquet time and the occurrence of pulmonary emboli in 30 patients undergoing arthroscopic knee surgeries, by using transesophageal echocardiography. The right atrium (RA) was continuously monitored by transesophageal echocardiography, and the number of emboli present was assessed with the following formula: Amount of emboli = 100 x [(total embolic area in the RA after tourniquet release) - (total area of emboli or artifact in the RA before tourniquet release)]/(RA area). The area was assessed 0-300 s after tourniquet release by using image-analysis software. The peak amount of emboli appeared approximately 50 s after tourniquet release. In addition, there was a significant correlation between amount of emboli (Ae [%]) and tourniquet time (Ttq [min]): (Ae = 0.1 x Ttq - 1.0, r = 0.795, P < 0.01). This study suggests that acute pulmonary embolism may occur within 1 min of tourniquet release and that the number of emboli is dependent on Ttq.
PMID: 11524355, UI: 21415335
Anesth Analg 2001 Sep;93(3):771-5
Clinique Chirurgicale Bordeaux-Merignac, Merignac, France. henri.iskandar@wanadoo.fr
Clonidine added to local anesthetics results in an increased duration of anesthesia or analgesia after brachial plexus block. We investigated the effect of selective application of clonidine to the median and musculocutaneous nerves during midhumeral block, a technique allowing selective nerve blocks with the use of different local anesthetics. Initially, 58 patients scheduled for hand surgery were prospectively enrolled to receive a midhumeral block. These patients were randomly allocated into two groups. The Control group (n = 28) received 10 mL of plain mepivacaine 1.5% for each nerve (median, musculocutaneous, ulnar, and radial). The Clonidine group (n = 30) received 10 mL of plain mepivacaine 1.5% for each nerve, but the median and musculocutaneous nerves also received a dose of 50 microg clonidine. One patient in the Control group and two patients in the Clonidine group with a failed block were therefore excluded from the analysis. The onset time of surgical anesthesia was recorded. The durations of sensory and motor blocks were checked every 15 min. The plasma mepivacaine concentration was analyzed from 10 patients in each group. Onset times for complete sensory block were similar between the two groups. Adding 50 microg clonidine to the median and musculocutaneous nerves resulted in a significant increase in the duration of sensory block in these nerves (P < 0.0001). Recovery of motor block was not different between the two groups. No significant difference was found between the two groups in the mean plasma mepivacaine concentration.
PMID: 11524354, UI: 21415334
Anesth Analg 2001 Sep;93(3):755-60
Departments of Anesthesiology and Neurosurgery, Virginia Mason Medical Center, Seattle, Washington 98111, USA. anedjk@vmmc.org
Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, we compared the onset, extent, and duration of sensory and motor blockade produced by plain 0.5% levobupivacaine (15 mL, 75 mg) with that of 0.5% levobupivacaine with the addition of 1:400,000 or 1:200,000 epinephrine in 117 patients undergoing elective spine surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in all groups (12.4 +/- 6.6 min for plain levobupivacaine, 13.9 +/- 7.9 min for levobupivacaine with 1:400,000 epinephrine, and 12.7 +/- 4.9 min for levobupivacaine with 1:200,000 epinephrine), with an average peak block height of T5. Time to complete regression of sensory blockade was also similar between groups (357 +/- 119 min for plain levobupivacaine, 378 +/- 98 min for levobupivacaine with 1:400,000 epinephrine, and 348 +/- 80 min for levobupivacaine with 1:200,000 epinephrine). Peak serum levobupivacaine levels were reduced in each of the epinephrine-containing groups. We conclude that 0.5% levobupivacaine with or without 1:200,000 or 1:400,000 epinephrine produced effective epidural anesthesia in patients having lumbar spine surgery. Epinephrine 1:400,000 is as effective as 1:200,000 in reducing the resultant serum levobupivacaine levels after epidural anesthesia.
PMID: 11524352, UI: 21415332
Anesth Analg 2001 Sep;93(3):749-54
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA. sholman@usuhs.mil
To investigate the effects of age and dose on the spread of thoracic epidural anesthesia, we placed thoracic epidural catheters in 50 surgical patients divided into groups by age (Group I [young], 18-51 yr; Group II [old], 56-80 yr) and randomly assigned patients to receive either 5 mL (A) or 9 mL (B) of 2% lidocaine (plain) injected via the epidural catheter. Hemodynamic variables were measured (heart rate, mean arterial blood pressure, noninvasive impedance cardiac index) at baseline and every 5 min for 30 min. Detectable blockade occurred within 8 min after injection of 3 + 2 mL or 3 + 6 mL in 48 of 50 patients. Maximum spread of analgesia to pinprick occurred 15-23 min after completion of local anesthetic injection and was significantly different between age and volume groups by two-way analysis of variance (Group IA [young 5], 10.9 +/- 4.0 dermatomes; Group IIB [young 9], 13.9 +/- 4.5 dermatomes; Group IIA [old 5], 14.1 +/- 5.6 dermatomes; and Group IIB [old 9], 17.4 +/- 5.1 dermatomes). Minor decreases in mean arterial blood pressure (8%-17%) and heart rate (4%-11%) were noted. Two patients in the Old 9 group required IV ephedrine or ephedrine/atropine to treat hypotension and bradycardia. We conclude that given the rapid onset (3-8 min), extensive spread (11-14 dermatomal segments), and consistent hemodynamic stability, thoracic epidural anesthesia should be initiated with lidocaine 100 mg (5 mL 2% lidocaine) to establish proper location of the catheter in the epidural space in both younger and older patients.
PMID: 11524351, UI: 21415331
Anesth Analg 2001 Sep;93(3):743-8
Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Kanazawa University, Kanazawa, Japan. ohmura@med.kanazawa-u.ac.jp
We compared the systemic toxicity of bupivacaine, levobupivacaine, and ropivacaine in anesthetized rats. We also compared the ability to resuscitate rats after lethal doses of these local anesthetics. Bupivacaine, levobupivacaine, or ropivacaine was infused at a rate of 2 mg. kg(-1). min(-1) while electrocardiogram, electroencephalogram, and arterial pressure were continuously monitored. When asystole was recorded, drug infusion was stopped and a resuscitation sequence was begun. Epinephrine 0.01 mg/kg was administered at 1-min intervals while external cardiac compressions were applied. Resuscitation was considered successful when a systolic arterial pressure > or =100 mm Hg was achieved within 5 min. The cumulative doses of levobupivacaine and ropivacaine that produced seizures were similar and were larger than those of bupivacaine. The cumulative doses of levobupivacaine that produced dysrhythmias and asystole were smaller than the corresponding doses of ropivacaine, but they were larger than those of bupivacaine. The number of successful resuscitations did not differ among groups. However, a smaller dose of epinephrine was required in the Ropivacaine group than in the other groups. We conclude that the systemic toxicity of levobupivacaine is intermediate between that of ropivacaine and bupivacaine when administered at the same rate and that ropivacaine-induced cardiac arrest appears to be more susceptible to treatment than that induced by bupivacaine or levobupivacaine.
PMID: 11524350, UI: 21415330
Anesth Analg 2001 Sep;93(3):667-8
Department of Anesthesiology & Reanimation, Adnan Menderes University, Faculty of Medicine, Aydin, Turkey. ibrahimkurt_2000@yahoo.com
IMPLICATIONS: A new nasal cannula that provides oxygenation and suctioning simultaneously prevents rebreathing during surgery in spontaneously breathing patients under surgical drapes. When air is not suctioned, inspired CO(2) levels increase significantly, whereas suctioning prevents this increase. Expiratory CO(2), respiratory rate, heart rate, and arterial blood pressure remain stable regardless of suctioning.
PMID: 11524338, UI: 21415318
Anesth Analg 2001 Sep;93(3):645-6
Surgical Center, The Institute of Medical Science, and Department of AnesthesiologyThe University of Tokyo, Tokyo, Japan. nishiyam@ims.u-tokyo.ac.jp
IMPLICATIONS: Bronchoconstriction was induced by anesthetic induction with propofol in two patients with allergic diseases. One had severe bronchospasm improved by epinephrine. Propofol should be used with caution in patients with allergic disease.
PMID: 11524333, UI: 21415313
Anesth Analg 2001 Sep;93(3):606-12
Department of Anesthesiology, Hopital Ambroise Pare, Boulogne-Billancourt, France.
Ketamine may prevent postoperative hyperalgesia. In patients undergoing arthroscopic meniscectomy using general anesthesia, we tested whether a single intraoperative dose of ketamine enhanced postoperative analgesia and improved functional outcome compared with a typical multimodal analgesic regimen. After the induction of anesthesia, 50 patients were randomly assigned to ketamine (0.15 mg/kg IV just after the induction of anesthesia) or a vehicle placebo. Standardized general anesthesia included propofol, alfentanil, and nitrous oxide. Bupivacaine (0.5%) and morphine (5 mg) were given intraarticularly at the end of surgery. Postoperative analgesia was initially provided with morphine and subsequently with naproxen sodium (550 mg orally twice daily) and Di-Antalvic (400 mg acetaminophen and 30 mg dextropropoxyphene) as needed. Pain scores, analgesic requirements, side effects, and ability to walk were assessed in the ambulatory unit and at home for three postoperative days. Times to awakening and to discharge were similar in the two groups. However, the Ketamine group had significantly less postoperative pain at rest and during mobilization on Days 0, 1, and 2. Furthermore, they consumed significantly fewer Di-Antalvic tablets than the control group (13 [7-17] vs 27 [16-32], median [25%-75% interquartile range]). Patients given ketamine were also able to walk for longer periods of time on the first postoperative day. In conclusion, adding small-dose ketamine to a multimodal analgesic regimen improved postoperative analgesia and functional outcome after outpatient knee arthroscopy.
PMID: 11524327, UI: 21415307
Anesth Analg 2001 Sep;93(3):601-5
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. klein006@mc.duke.edu
Providing intraarticular analgesia with a continuous infusion of local anesthetic via a disposable infusion pump has gained popularity. Despite the prevalence of this technique, data comparing this method of analgesia to conventional regional anesthesia are not available. We present a prospective study that compared a single-dose interscalene block with a single-dose interscalene block plus continuous intraarticular infusion of local anesthetic. Forty patients scheduled for shoulder arthroscopy were entered in this prospective, double-blinded study. All patients received an interscalene brachial plexus block as their primary anesthetic. Patients were randomly assigned to 1 of 2 groups: 1. interscalene block with 1.5% mepivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.5% ropivacaine at 2 mL/h, or 2. interscalene block with 0.5% ropivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.9% saline (placebo) at 2 mL/h. Postoperative infusions were maintained for 48 h. Visual analog scale pain scores and postoperative oxycodone consumption were measured for 48 h. Visual analog scale scores at rest and with ambulation in the Mepivacaine/Intraarticular Ropivacaine group were reduced when compared with the Ropivacaine/Saline group (rest: P = 0.003, ambulation: P = 0.006). Oxycodone consumption was also decreased (28 +/- 21 mg vs 44 +/- 28 mg, P = 0.046), respectively. We conclude that a brachial plexus block with 1.5% mepivacaine and a continuous intraarticular infusion of 0.5% ropivacaine at 2 mL/h provides improved analgesia for minor surgery at 24 and 48 h versus a single-injection interscalene block with 0.5% ropivacaine.
PMID: 11524326, UI: 21415306
Anesth Analg 2001 Sep;93(3):590-3
Department of Pediatric Anesthesia and Intensive Care, La Timone University Hospital, Marseilles, France. opaut@ap-hm.fr
We compared EMLA cream with nitrous oxide (N(2)O) for providing pain relief during venous cannulation in children. In a prospective, double-blinded, randomized study, 40 children, 6-11 yr, ASA status I or II, undergoing scheduled surgery received either EMLA cream and inhaled air and oxygen (Group EMLA) or a placebo cream and inhaled 70% N(2)O in oxygen (Group N(2)O) before venous cannulation. Pain was evaluated with a visual analog scale and the Objective Pain Scale. The ease of venous cannulation and the observer's assessment of its efficacy for preventing pain were assessed. Heart rate, blood pressure, respiratory rate, and oxygen saturation were compared before and after venous cannulation. Visual analog scale scores (4.4 +/- 7.5 vs 3.9 +/- 9.3 mm, P = 0.85), Objective Pain Scale scores (median 0 [0-6] vs 0 [0-1], P = 0.61), efficacy (median 0 [0-1] vs 0 [0-1], P = 0.59), and ease of venous cannulation (0 [0-2] vs 0 [0-1], P = 0.84) were not different between EMLA and N(2)O groups, respectively. There was no statistical difference between the groups for the physiologic variables. Minor side effects were significantly more common in the N(2)O group (11 of 20) than in the EMLA group (7 of 20) (P = 0.0248). We conclude that both techniques provided adequate pain relief during venous cannulation, as demonstrated by the low pain scores.
PMID: 11524323, UI: 21415303
Br J Pharmacol 2001 Sep;134(2):418-24
Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, SUNY, Buffalo, New York, NY 14260-1200, U.S.A.
[Medline record in process]
Recent studies indicate that nitroglycerin (NTG) can produce beneficial clinical effects in healing anal fissures through the relaxation of the internal anal sphincter. The in vivo relaxation effects of NTG on the anorectal smooth muscle have not been studied and it is not known whether this tissue may also exhibit pharmacological tolerance toward NTG. We have developed an in vivo procedure in the anaesthetized rat that permits continual monitoring of anorectal pressure after intravenous (i.v.) and intra-rectal application of NTG. The relaxant effects of NTG were quantified via the area-under-the-contraction-waveforms vs time curve (AUEC). AUEC decreased significantly after intra-rectal bolus doses of NTG (5 - 25 &mgr;g), in a dose- and time-dependent manner. Sustained relaxation effects on anorectal pressure were also observed after continuous intra-rectal infusions of NTG. Two-hours of i.v. NTG infusion led to a significant reduction in the mean arterial blood pressure (MAP) response toward a i.v. NTG (30 &mgr;g) bolus challenge. In contrast, relaxation of the anorectal pressure toward the challenge dose was not altered after NTG infusion. In isolated tissues, cyclic GMP accumulation was significantly decreased after NTG pre-incubation in the rat aorta but not in the rat anorectal smooth muscle and anal sphincter. These results indicate that the relaxation response toward NTG was not diminished in the anorectum under conditions that produced vascular tolerance. Thus, NTG causes significant and sustained in vivo relaxation of anorectal smooth muscle in the anaesthetized rat without evidence of tolerance development.
PMID: 11564661, UI: 21448242
Br J Pharmacol 2001 Sep;134(2):333-42
Johannes-Muller-Institute of Physiology (Charite), Humboldt University Berlin, Germany. Institute of Molecular Pharmacology, Berlin, Germany. Department of Experimental and Clinical Medicine, Section of Pharmacology, University of Ferrara, Ferrara, Italy.
In this study we administered nociceptin/orphanin FQ (NC) ionotophoretically onto neurons located in functionally distinct thalamic structures of urethane-anesthetized rats. Extracellular single unit recordings were made in the medial and lateral ventroposterior nucleus, posterior thalamic nucleus, zona incerta, lateral posterior nucleus, laterodorsal nucleus, ventrolateral nucleus and reticular nucleus. NC decreased the firing rate in 60% of thalamic neurons. This decrease in firing rate was accompanied by a significant reduction in the number of high threshold bursts. In about 20% of the neurons NC increased the firing rate. In most cells NC-induced increases in discharge rate could be blocked by the GABA(A) receptor antagonists bicuculline and SR 95531. The NC receptor ligands [Phe(1)Psi(CH(2)-NH)Gly(2)] nociceptin(1-13)NH(2), Ac-RYYRIK-NH(2) and [Nphe(1)]NC(1-13)NH(2) were also evaluated. All these peptides inhibited NC-induced changes in firing rate. In addition, in some neurons where NC inhibited firing, [Nphe(1)]NC(1-13)NH(2) and Ac-RYYRIK-NH(2) elicited per se an increase in firing rate, suggesting the existence of tonic innervation of thalamic neurons by NC-containing fibres. In NC-inhibited neurons nocistatin induced a significant increase in firing rate. The present study demonstrated that NC regulates various thalamic nuclei related not only to somatosensory, but also to the visual and motor functions.
PMID: 11564651, UI: 21448232
Eur J Anaesthesiol 2001 Sep;18(9):605-14
Department of Anaesthesia, Derriford Hospital, Plymouth, PL6 8DH, Devon, UK. rsneyd@pms.ac.uk
BACKGROUND: and objective This open, multicentre study compared the efficacy and safety of remifentanil with fentanyl during balanced anaesthesia with 0.8% isoflurane (end-tidal concentration) for major abdominal and gynaecological surgery, and the efficacy and safety of remifentanil for pain management in the immediate postoperative period. METHODS: Two-hundred and eighty-six patients were randomized to receive remifentanil 1 microg kg(-1) followed by 0.2 microg kg(-1) min-1 (n=98), remifentanil 2 microg kg(-1) followed by 0.4 microg kg(-1) min(-1) (n=91) or fentanyl 3 microg kg(-1) (n=97) at induction. Thereafter, the study opioids and isoflurane were titrated to effect during the operation. RESULTS: Compared with fentanyl, remifentanil 2 microg kg(-1) followed by 0.4 microg kg(-1) min(-1) reduced the incidence of response to tracheal intubation (30% vs. 13%, P < 0.01), skin incision (33% vs. 4%, P < 0.001) and skin closure (11% vs. 3%, P < 0.05), respectively. Patients receiving remifentanil 1 microg kg(-1) followed by 0.2 microg kg(-1) min(-1) had fewer responses to skin incision than the fentanyl group (12% vs. 33%, P < 0.001), but the incidences of response to tracheal intubation and skin closure were similar. Significantly fewer patients in both remifentanil groups had > or = 1 responses to surgical stress intraoperatively compared with fentanyl (68% and 48% vs. 87%, P < 0.003). The mean isoflurane concentrations required were less in both remifentanil groups compared with the fentanyl group (0.1%, P=0.05). In remifentanil-treated patients, continuation of the infusion at 0.1 microg kg(-1) min(-1) with titration increments of +/- 0.025 microg kg(-1) min(-1) was effective for the management of immediate postoperative pain prior to transfer to morphine analgesia. However, a high proportion of patients experienced at least moderate pain whilst the titration took place. CONCLUSIONS: Anaesthesia combining isoflurane with a continuous infusion of remifentanil was significantly more effective than fentanyl at blunting responses to surgical stimuli. Significantly fewer patients responded to tracheal intubation with remifentanil at 0.4 microg kg(-1) min(-1), supporting the use of a higher initial infusion rate before intubation. Both remifentanil and fentanyl were well-tolerated, with reported adverse events typical of mu-opioid agonists.
PMID: 11553256, UI: 21437525
Eur J Anaesthesiol 2001 Jul;18(7):486
PMID: 11437880, UI: 21331527
Eur J Anaesthesiol 2001 Jul;18(7):423-39
Department of Anaesthesiology, Hospital Clinico, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
The aim of specific monitoring in neuroanaesthesia is to detect, as quickly as possible, intraoperative ischaemic insults so that the brain and the spinal cord may be protected from harmful and frequently inevitable events due to the type of surgery, patient positioning, haemodynamic changes or any intercurrent event. New monitors are being introduced into the operating theatre, but only a few are considered to be an absolute standard of care in neurosurgery, e.g. facial nerve monitoring for surgery of acoustic neuromas and recording of evoked potentials during repair of scoliosis. In the past decade, new monitoring devices have moved from the experimental stage to the operating theatre and although most are still in a phase of technological development and/or definition of their field of applicability they are being used as guides for clinical practice in those instances where cerebral well-being might be impaired. The metabolic consequences of hyperventilation, pharmacological electroencephalogram burst suppression, hypothermia, etc. can now be assessed in the operating theatre. Non-invasive monitoring is being rapidly integrated into our daily work because of its lack of secondary effects. Nevertheless, each new development is regarded as an addition rather than as a substitute for existing equipment. The perfect combination of monitors to provide essential information during an individual surgical procedure to influence a better patient outcome, is still uncertain and needs extensive clinical research.
PMID: 11437871, UI: 21331518
Eur J Anaesthesiol 2001 Jul;18(7):419-22
PMID: 11437870, UI: 21331517
Lancet 2001 Aug 18;358(9281):590
PMID: 11536460, UI: 21417933
Pediatr Dent 2001 May-Jun;23(3):238-40
rnouri@intergate.bc.ca
This case report describes management of a 3-year-old child with early childhood caries and anterior crossbite. Restorative care was postponed until after crossbite correction to eliminate occlusal interferences associated with premature contact and a functional shift of the mandible. Crossbite correction was performed with a fixed anterior bite plane appliance, and comprehensive restorative care was performed under general anesthesia.
PMID: 11447954, UI: 21341304
Pediatr Dent 2001 May-Jun;23(3):223-31
Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas, Texas, USA.
PURPOSE: This study compared 2 oral ketamine-diazepam regimens (8 mg/kg and 10 mg/kg of ketamine in combination with 0.1 mg/kg diazepam) in preschool age children with respect to physiological, behavioral and amnestic parameters. METHODS: Twenty-five children completed the double-blind, crossover design. Physiologic, behavioral and amnestic effects were evaluated. RESULTS: ANOVA demonstrated significant changes in systolic blood pressures and heart rates in both the 8 mg/kg group and 10 mg/kg group (P < 0.05), as well as significant changes in diastolic blood pressures in the 10 mg/kg group (P < 0.05). However, these changes were not clinically significant. Success rates were 28% for the 8 mg/kg dosage and 44% for the 10 mg/kg dosage. There was a cumulative vomiting rate of 50% and a psychic phenomena rate of 10%. There were no statistically significant differences between the two dosages with regard to success rates, postoperative vomiting, or psychic phenomena using McNemar's test. CONCLUSIONS: There is no advantage of 10 mg/kg dose of ketamine over the 8 mg/kg dose. Ketamine did not demonstrate amnestic effects in this study. There were statistically but no clinically significant changes in physiological parameters in either group. This study does not support the use of either 8 mg/kg or 10 mg/kg oral ketamine for the sedation of uncooperative children.
PMID: 11447952, UI: 21341302
Reg Anesth Pain Med 2001 Sep-Oct;26(5):491
Departement d'Anesthesie Reanimation, Centre Hospitalier Universitaire de Rouen, Rouen, France.
PMID: 11561274, UI: 21445372
Reg Anesth Pain Med 2001 Sep-Oct;26(5):478-83
Department of Anesthesia, Valencia University Medical School, Valencia, Spain.
PMID: 11561271, UI: 21445369
Reg Anesth Pain Med 2001 Sep-Oct;26(5):456-60
Department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Japan.
Background and Objectives: Postoperative paralytic ileus is frequently encountered in chronic schizophrenic patients who undergo abdominal surgery. We investigated whether epidural analgesia with local anesthetics minimizes postoperative ileus in schizophrenic patients who are treated long term with antipsychotic drugs. METHODS: We measured the VAS pain after surgery and the time that elapsed before the first passage of flatus and/or feces after the end of surgery in schizophrenic patients provided analgesia with systemic buprenorphine (group A) and schizophrenic patients receiving epidural analgesia with local anesthetics (group B). RESULTS: The frequency of patients who did not pass flatus and/or feces for more than 120 hours postoperatively was significantly higher in group A. Postoperative pain scores of group A at 8 and 24 hours after the end of anesthesia were 36.0 +/- 12.8 and 31.7 +/- 10.7 (0 to 100 mm scale), which were significantly higher than 25.4 +/- 13.2 and 20.5 +/- 9.4 scores in group B. CONCLUSIONS: Epidural analgesia with local anesthetics in chronic schizophrenic patients undergoing abdominal surgery minimizes postoperative ileus compared to patients receiving systemic buprenorphine. Reg Anesth Pain Med 2001;26:456-460.
PMID: 11561267, UI: 21445365
Reg Anesth Pain Med 2001 Sep-Oct;26(5):444-9
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Background and Objectives: Epidural analgesia has been shown to provide superior pain control compared with intravenous (IV) opioids after major surgical procedures. In this study, we compared the effect of epidural analgesia and IV morphine patient-controlled analgesia (PCA) on pain relief, duration of hospitalization, oral nutrition, ambulation, and side effects in patients undergoing a major surgical procedure (i.e., unilateral mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction). METHODS: Eighteen patients were prospectively randomized to receive either epidural analgesia or PCA during the postoperative period. The intensity of pain was assessed daily by a 100-mm visual analog scale. The total length of hospital stay, time to ambulation, and time to oral nutrition were recorded. RESULTS: The epidural group had significantly lower pain scores at 3 evaluation times through postoperative day number 4 (P <.05). The total length of hospitalization for the epidural group (median, 101 hours) was significantly less than the PCA group (median, 126 hours; P =.0498). The time to first ambulation, time to first bowel sounds, time to tolerating oral nutrition, incidence of nausea/vomiting or pruritus, and time to first flatus were not statistically different between the groups. CONCLUSIONS: These results show that epidural analgesia compared with PCA offered improved pain control after breast reconstruction with immediate transverse rectus abdominis musculocutaneous flap reconstruction. It also resulted in a 25-hour reduction in time of hospitalization. Reg Anesth Pain Med 2001;26:444-449.
PMID: 11561265, UI: 21445363
Reg Anesth Pain Med 2001 Sep-Oct;26(5):434-438
Department of Anesthesiology, Faculty of Medicine, Ondokuz Mayiotas University, Samsun, Turkey.
[Record supplied by publisher]
Background and Objectives: To evaluate the analgesic and anesthetic effects of 40 mL bupivacaine 0.25%, 40 mL bupivacaine 0.25% plus fentanyl 2.5 &mgr;g/mL, and 40 mL bupivacaine 0.125% plus fentanyl 2.5 &mgr;g/mL for axillary brachial plexus block. METHODS: Sixty patients were randomly allocated to 3 groups and received axillary brachial plexus block with 40 mL bupivacaine 0.25% (group B), 40 mL bupivacaine 0.25% with fentanyl 2.5 &mgr;g/mL (group BF), or 40 mL bupivacaine 0.125% with fentanyl 2.5 &mgr;g/mL (group DBF). The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events were noted. RESULTS: The mean duration of sensory block and analgesia were longer in group BF (10.1 hours and 20.9 hours) than group B (6.9 hours and 11.6 hours) and DBF (5.9 hours and 12.0 hours) (P <.01, P <.001, respectively). The mean duration of motor block was also longer in group BF (10.7 hours) than group B (4.9 hours) (P <.01). Only 2 patients experienced motor block in group DBF. The frequency of successful block was 35% in group DBF (P <.01). Hemodynamic parameters were similar in all groups. In group B, only 1 patient experienced dizziness. Nausea was observed in 1 patient in each fentanyl group. CONCLUSION: The addition of 100 &mgr;g/mL fentanyl to 0.25% bupivacaine almost doubles the duration of analgesia following axillary brachial plexus block when compared with 0.25% bupivacaine alone. Reg Anesth Pain Med 2001;26:434-438.
PMID: 11561263
Reg Anesth Pain Med 2001 Sep-Oct;26(5):420-7
Klinik und Poliklinik fur Anasthesiologie und operative Intensivmedizin, Universitatsklinikum Munster, Munster, Germany.
Background and Objectives: The dependence of unilateral spinal anesthesia on injection flow is controversial. We hypothesized that it is possible to achieve strictly unilateral sympathetic block (as assessed by temperature measurements of the limbs) and unilateral sensory and motor block, respectively, during spinal anesthesia by a slow and steady injection of a hyperbaric local anesthetic solution. METHODS: Forty-four patients (American Society of Anesthesiologists [ASA] physical status I-III) undergoing surgery of one lower extremity were randomly assigned to one of two groups. Dependent on the patients' height, 1.4 to 1.7 mL hyperbaric bupivacaine 0.5% was injected manually with the patient in the lateral decubitus position, which was maintained for 30 minutes after injection. Injection flow was approximately 0.5 mL/min in group I ("air-buffered" injections performed by 4 mL air between the local anesthetic and the syringe's plunger, n = 25) and approximately 7.5 mL/min in group II ("conventional" injections, n = 19). Sympathetic block was defined as a temperature increase of more than 0.5 degrees C at the foot. Any reduction in the ability to move the hip, knee, or ankle as well as loss of temperature discrimination and/or pinprick even in one dermatome on the nondependent side was considered as a bilateral block. RESULTS: Before surgery, significant differences (P <.05) were observed for unilateral motor paralysis (92% in group I v 68.4% in group II), unilateral sensory block (48.0% v 10.5%), and unilateral sympathetic block (72% v 42.1%). Strictly unilateral spinal anesthesia was found to be significantly more frequent in group I (40% v 5.3%). Significant hemodynamic differences between the groups were not detected. CONCLUSIONS: For hyperbaric spinal anesthesia, the injection flow is an important factor in achieving unilateral sympathetic block. A slow injection proves useful to restrict spinal anesthesia to the side of surgery. Reg Anesth Pain Med 2001;26:420-427.
PMID: 11561261, UI: 21445359
Reg Anesth Pain Med 2001 Jul-Aug;26(4):384-5
PMID: 11464366, UI: 21357135
Reg Anesth Pain Med 2001 Jul-Aug;26(4):382
PMID: 11464362, UI: 21357131
Reg Anesth Pain Med 2001 Jul-Aug;26(4):376-8
Pain Management Centre, Guy's & St Thomas' Hospital Trust, London, United Kingdom.
BACKGROUND AND OBJECTIVES: The psoas compartment block is used to produce analgesia of the lumbar plexus mainly for hip and knee surgery. It has also been used for the management of a long-standing pain due to hip joint degeneration. CASE REPORT: A 55-year-old woman with severe left hip pain received repetitive psoas compartment blocks over 18 months. The blocks provided her with effective pain control. The quality and duration of the block was improved by the addition of opioid to the local anesthetic. CONCLUSION: We successfully performed repeated psoas compartment blocks with a local anesthetic and subsequently with added opioids, which produced substantial pain relief, especially after the addition of opioids.
PMID: 11464361, UI: 21357130
Reg Anesth Pain Med 2001 Jul-Aug;26(4):357-62
Center of Teaching and Training in Anesthesiology, Orthopedic Hospital of Goiania, Goiania, Brazil.
BACKGROUND AND OBJECTIVES: We did not find clinical studies of the alkalization of ropivacaine in the literature. The objectives of this study were: (1) to determine the quantity of sodium bicarbonate (NaHCO(3)), which alkalinizes 0.75% ropivacaine (with and without adrenaline); (2) to verify the physico-chemical alterations arising from this alkalization; and (3) to determine whether alkalinized ropivacaine produces a higher-quality epidural block measured via sensory-motor onset, block spread and anesthesia duration. METHODS: It was determined in the laboratory that 0.012 and 0.015 mEq of NaHCO(3), respectively, alkalinized 10 mL of the 0.75% ropivacaine solutions without and with adrenaline (1:200,000). In the second phase, the study was random and double-blind and involved 60 patients divided into 3 groups of 20 (G1, G2, and G3). Via epidural lumbar blocks, these groups received, respectively, 10 mL of 0.75% ropivacaine plus 0.5 mL of 0.9% NaCl (solution A), 10 mL of 0.75% ropivacaine plus 0.0012 mEq of NaHCO(3) (solution B), and 10 mL of 0.75% ropivacaine (with adrenaline) plus 0.015 mEq of NaHCO(3) (solution C). The pH, PCO(2) (partial CO(2) pressure), and the nonionized fractions of the 0.75% ropivacaine solutions were compared before and after the addition of 0.9% NaCl or NaHCO(3) or adrenaline plus NaHCO(3). The motor and sensory onsets, block spread, and the duration of the block were evaluated. RESULTS: The values of the pH, PCO(2), and nonionized fractions increased significantly in solutions B and C in relation to solution A. No differences among the groups were observed in relation to block spread and sensory-motor onset. The duration of the sensory blocks was significantly greater in the patients in groups G2 and G3. CONCLUSION: This study indicates that the quantity of NaHCO(3) needed to alkalize 10 mL of 0.75% ropivacaine at room temperature is 0.012 mEq. When the solution contains adrenaline 1:200,000 (mg.mL(-1)), up to 0.015 mEq of NaHCO(3) may be added. The alkalization of the 0.75% ropivacaine solution did not cause a reduction of sensory-motor onset, but did provide a significant increase in the duration of the epidural block with no significant differences between the solutions with and without adrenaline.
PMID: 11464357, UI: 21357126
Reg Anesth Pain Med 2001 Jul-Aug;26(4):337-41
Department of Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
OBJECTIVE: Epidural pressure has remained a relatively unused test of physiological monitoring for the past 3 decades. It is our hypothesis that epidural pressure waveforms (EPWFs) obtained by transducing an epidural catheter (EC) can be used as a surrogate for the accurate location of the EC. The goal of this study was to validate this new method by comparing it with a more objective radiographic technique such as computed tomography cathetergram (CTC). METHODS: The EPWF and CTC were studied in 13 patients receiving continuous epidural analgesia (12 patients who had postoperative pain and 1 patient who had chronic pain). Of these 13 patients, 8 patients had reported inadequate analgesia, and 5 had reported satisfactory analgesia. First, the end of the EC was connected to a disposable pressure transducer, this was followed by a 5-mL normal saline bolus injection to ensure the patency of the EC, and the EPWF was recorded. Next, the patient was taken to an imaging suite and, after injecting contrast through the EC, the course of the catheter was imaged with computed tomography (CT). The CT images were studied by the neuroradiologist and correlated with the EPWF. RESULTS: The EPWF of 5 patients with clinically adequate analgesia revealed a pulsatile waveform on transducing the EC and a crescentic spread of contrast in the epidural space on CTC. In 8 patients with inadequate epidural analgesia, the EPWF measurement failed to show oscillations, and contrast collections were observed in the paraspinous muscles. The results of EPWF and CTC were compared using Fisher's exact test. CONCLUSIONS: The strong relationship between EPWF and CTC suggests that EPWF can be used reliably to confirm the correct placement of the EC in a selected group of patients.
PMID: 11464353, UI: 21357122
Reg Anesth Pain Med 2001 Jul-Aug;26(4):329-32
First Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi, Japan. y-kimura@dokkyomed.ac.jp
BACKGROUND AND OBJECTIVES: The aim of this study is to examine the duration and magnitude of vasodilative effect induced by sympathetic block with the addition of clonidine to mepivacaine. METHODS: We measured mean arterial pressure (MAP), heart rate (HR), and right and left brachial artery blood flow (BABF) before and after stellate ganglion block (SGB) in dogs. The experimental protocol was designed as follows: (1) left SGB using 1.0 mL 0.5% mepivacaine (n = 6) and (2) left SGB using the addition of clonidine 0.5 microg to 1.0 mL 0.5% mepivacaine (n = 6). RESULTS: MAP and HR did not change significantly throughout the study in either group. Left SGB with mepivacaine increased left BABF significantly from 10 minutes through 50 minutes after SGB (baseline, 100%; peak at 10 minutes after SGB, 176% +/- 28%; P <.01). Left SGB with the addition of clonidine to mepivacaine induced a significant increase of left BABF from 10 minutes through 70 minutes after SGB (baseline, 100%; peak at 10 minutes after SGB, 223% +/- 42%; P <.01). The values of left BABF after SGB with the addition of clonidine to mepivacaine were significantly higher than those of SGB with mepivacaine alone from 10 minutes through 80 minutes after SGB (P <.05). Right BABF decreased significantly after SGB throughout the study in both groups. CONCLUSIONS: The addition of clonidine increases both duration and magnitude of the vasodilative effect induced by sympathetic block over that caused by mepivacaine alone.
PMID: 11464351, UI: 21357120
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