The low incidence of backache at 24 h and the absence of associated symptoms of neurogenic pain, sensory and motor disturbances, does not support the hypothesis that TRI is a neurotoxic reaction, subsequent to the use of hyperbaric lidocaine.
We studied the hemodynamic response to preoperative emptying of the stomach by means of a gastric tube in 20 non-fasting non-premedicated patients aged 39 (24-54) (median and quartiles) presenting for emergency surgery. Systolic and diastolic blood pressure and heart rate increased by 24.4% (P less than 0.01), 29.9% (P less than 0.01) and 36% (P less than 0.01), respectively. Arterial oxygen saturation decreased by 2.1% (P less than 0.01). The rate pressure product increased by 68% (P less than 0.01), exceeding 20,000 (mmHg.min-1) [2667 kPa.min-1] in nine patients. The cardiovascular response is of the same magnitude as reported after tracheal intubation without use of analgesics and is likely to cause cardiac ischemia and other adverse effects in patients suffering from coronary artery disease.
Forty-five men aged 50-80 yr undergoing urological surgery under spinal anaesthesia were allocated randomly to three groups. All patients received 0.5% plain bupivacaine 3 ml injected at the L2-3 interspace. The temperature of the solution in group 1 was 19 degrees C, in groups 2 and 3 37 degrees C. In groups 1 and 2 the injection was performed with the patient sitting; in group 3 the patient was in a lateral horizontal position. Spread of block, intensity of motor block and cardiovascular stability were measured. Warming the solution from 19 degrees C to 37 degrees C before spinal injection with the patient in the sitting position did not significantly affect these variables. However, the extent of analgesia was reduced significantly when the 37 degrees C solution was injected with the patient in the lateral horizontal compared with the sitting position.
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