The efficacy and safety of postoperative analgesia with continuous epidural infusion of either morphine or fentanyl in combination with bupivacaine were evaluated in 85 patients, ASA physical status I or II, undergoing thoracic and/or upper abdominal surgery. Patients were treated with one of the combinations for 48 h after surgery. The morphine/bupivacaine group (MB; n = 45) received morphine at the rate of 0.2 mg.h-1, and bupivacaine at the rate of 10 mg.h-1 for the first 24 h or 5 mg.h-1 for the second 24 h; the fentanyl/bupivacaine group (FB; n = 40) received fentanyl at the rate of 20 micrograms.h-1, and bupivacaine at the rate of 10 mg.h-1 for the first 24 h or 5 mg.h-1 for the second 24 h. The degree of pain relief assessed by the visual pain scale and the modified Prince Henry pain scale was satisfactory in most patients in both groups. In group MB 74% and in group FB 76% of patients did not need any supplementary analgesics. No significant differences were observed between the groups in assessment of pain. The incidence of hypotension (P < 0.05) and pruritus (P < 0.05) was higher in group MB than in group FB. None of the patients developed respiratory depression in either group.
To maintain BIS of 40-50 during combined epidural/general anaesthesia for lower abdominal surgery, sevoflurane concentrations were lower and less variable with lidocaine 2% than with 1%. In addition, the larger concentration of lidocaine suppressed the stress hormone responses better.
SummaryWe compared haemodynamic changes following induction of anaesthesia with propofol during tracheal intubation with and without epidural anaesthesia. Nineteen patients were divided into two groups to receive epidurally administered saline (Group C) or lidocaine 1.5% (Group E). The propofol infusion was started to produce blood concentrations of 3 lg.ml )1 , and following fentanyl and vecuronium administration, tracheal intubation was performed. Mean arterial blood pressure (MBP), heart rate (HR), Bispectral index and effect-site propofol concentration were recorded. Time to loss of consciousness was significantly shorter in Group E than in Group C. The effect-site propofol concentration at loss of consciousness was significantly lower in Group E than in Group C. MBP and HR were significantly lower following propofol induction in both groups, and were significantly increased following intubation in Group C but not in Group E. In conclusion, epidural anaesthesia did not produce profound hypotension following induction of anaesthesia and produced a reduction in the haemodynamic response to tracheal intubation during a target controlled infusion of propofol.
Breath-holding spells (BHS) are commonly seen in childhood. However, there are no case reports of BHS occurring in adolescents or young adults. We report two young adult cases and discuss the pathogensis, both physically and psychologically. BHS occurred for 1-2 minutes after hyperventilation accompanied by cyanosis in both cases. Oxygen saturation was markedly decreased. Each patient had shown distress and a regressed state psychologically. These cyanotic BHS occurred after hyperventilation, and we considered that a complex interplay of hyperventilation followed by expiratory apnea increased intrathoracic pressure and respiratory spasm. Breath-holding spells can occur beyond childhood.
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