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Biomedical subjects

G Capogna

Publications and source records attributed to G Capogna.

At least 37 records · Page 2Linked to original sources
PubMed1993

Alkalinization improves the quality of lidocaine-fentanyl epidural anaesthesia for caesarean section.

This double-blind randomized study of 116 healthy women was undertaken to evaluate whether alkalinization potentiated the analgesic effects of epidural fentanyl-lidocaine for elective Caesarean section. After a test-dose of 3 ml, lidocaine 2% with adrenaline 1:200,000, all patients received 100 micrograms, fentanyl in 5 ml saline and they were then divided into two groups, to receive incremental doses of 5 ml lidocaine 2% with adrenaline 1:200,000 with or without 0.1 mEq.ml-1 sodium bicarbonate, to obtain anaesthesia to T4. The addition of bicarbonate to lidocaine resulted in a mean (SD) pH increase from 6.58 (0.01) to 7.14 (0.02) and in a mean PCO2 increase from 3.8 (0.8) to 345.1 (5.9) mmHg. Onset of sensory analgesia to the S1 segment as well as the interval between the block and the delivery of the baby were shorter in the bicarbonate group (respectively 15.4 (6.9) vs 18.9 (4.8) min and 28.9 (9.5) versus 33.9 (11.8) min; P < 0.01 and 0.05). No differences were noted in the onset to T4 or in the degree of motor block. The percentage of patients experiencing pain during surgery and requiring intravenous analgesics was higher in the group which did not receive bicarbonate (3% vs 16%; P < 0.05). There were no differences in intraoperative maternal side-effects, neonatal outcome or in maternal venous and umbilical venous and arterial lidocaine concentrations between the groups. The concentrations of fentanyl in maternal plasma, umbilical artery, and the umbilical artery to maternal vein ratio were greater in the alkalinized group (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

IV clonidine for post-extradural shivering in parturients: a preliminary study.

We have studied the efficacy of i.v. clonidine to suppress post-extradural shivering in parturients. Forty healthy parturients who received extradural block for labour (n = 20) or for Caesarean section (n = 20) and who required treatment for shivering after delivery were allocated randomly to two groups. Group I received i.v. clonidine 30 micrograms diluted in saline to a total volume of 5 ml (therapeutic solution). This bolus was repeated every 5 min if the initial therapy produced no improvement, up to a maximum dose of 90 micrograms. Group II received saline 5 ml (placebo solution), repeated every 5 min if the initial bolus produced no improvement, up to a maximum of three boluses. After 15 min of observation, patients in group I received the placebo solution and those in group II received the study solution. All patients who received clonidine improved, and 75% ceased to shiver within 5 min after only one dose of clonidine 30 micrograms. In contrast, none of the patients treated with saline improved. When patients in the placebo group received clonidine, improvement occurred. Arterial pressure, heart rate, core and peripheral temperature and oxygen saturation did not differ significantly between and within the groups before and after administration of clonidine. We conclude that a small dose of i.v. clonidine may be useful to suppress post-extradural shivering in parturients.

Anesthesia Recovery Period↗
PubMed1992

Ventilatory effects of subarachnoid fentanyl in the elderly.

Twenty-eight elderly patients scheduled for urological surgery were randomly assigned to receive, in a double-blind study, subarachnoid hyperbaric bupivacaine 15 mg with 50 micrograms (group A, n = 7), 25 micrograms (group B, n = 7), or 12.5 micrograms (group C, n = 7) of fentanyl or 1 ml of saline (group D, n = 7) in a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before and 90, 150 and 480 min after the subarachnoid injection. In group A, mild pruritus and sedation occurred in five patients, while nausea, vomiting and periodic breathing occurred in two. In group B, mild pruritus and sedation were observed in four patients, while nausea and vomiting occurred in two. No significant differences in minute ventilation, respiratory drive and respiratory timing were observed between the groups. Patients receiving fentanyl 50 micrograms showed a percentual change from baseline values as function of time (slope VE/PE'CO2) significantly below baseline at 90 and 150 min (p less than 0.05). However, the baseline values in this group reverted after 480 min. No side effects were observed in groups C or D. It is concluded that subarachnoid fentanyl 50 micrograms can cause an early respiratory depression and its use as a postoperative analgesic should be avoided in the elderly.

Aged↗
PubMed1991

Propofol and thiopentone for caesarean section revisited: maternal effects and neonatal outcome.

In 56 women undergoing elective caesarean section, general anaesthesia was induced with either propofol 1% or thiopentone 2.5% followed by 50% nitrous oxide in oxygen and isoflurane 0.75% until delivery. In the thiopentone group the arterial pressure rose following tracheal intubation and skin incision, while in the propofol group there was a significant tendency to hypotension immediately following induction of anaesthesia. There were differences in electroencephalogram (EEG) between the groups, while laryngoscopy, intubation and surgical stimulation had no effect on EEG pattern. Recovery after anaesthesia did not differ between groups. None of the patients had recall of the intraoperative period, but 53% of patients induced with propofol showed signs of light anaesthesia between induction and delivery. Neonates in the propofol group had lower Apgar scores 1 min after birth than those in the thiopentone group, but these differences were no longer significant at 5 min. No differences were noted in neurobehavioural status at 1, 4 and 24 h.

Journal Article↗
PubMed1991

[Post-operative analgesia with sub-arachnoid fentanyl: ventilatory effects in elderly patients].

Twenty eight elderly patients scheduled for urologic surgery were randomly assigned to receive in a double blind fashion subarachnoid hyperbaric bupivacaine 15 mg with the addition of 50 micrograms (group A, n = 7), 25 micrograms (group B, n = 7), 12.5 micrograms (group C, n = 7), of fentanyl or 1 ml of saline (group D, n = 7) for a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before 90, 150, 480 minutes after the subarachnoid injection. In group A mild pruritus and sedation occurred in 5 patients, nausea, vomiting and periodic breathing occurred in 2 patients. In group B mild pruritus and sedation were observed in 4 patients, nausea, vomiting in 2 patients. No significant changes in VE, Vt/Ti and Ti/Ttot were observed between the groups. Patients receiving 50 micrograms of fentanyl showed a slope VE/PET CO2 significantly below baseline values at 90 and 150 minutes (p less than 0.05). In this group the baseline values were restored after 480 minutes. No side effects were observed in group C and D. 25 micrograms fo fentanyl is the only dose with a significant analgesic effect without any respiratory depression.

Aged↗
PubMed1989

Neurobehavioural effects of propofol on the neonate following elective caesarean section.

Forty mothers undergoing elective Caesarean section under general anaesthesia were allocated randomly to receive either propofol 2.8 mg kg-1 (n = 20) or thiopentone 5 mg kg-1 (n = 20) for induction of anaesthesia. Twenty neonates delivered by uncomplicated vaginal delivery were evaluated also as unmedicated controls. Neurobehavioural examinations were carried out at 1, 4 and 24 h after delivery. Infants in the propofol group had lower Apgar scores at 1 and 5 min; 25% of them had muscular hypotonus at 5 min. This hypotonus was not noted during the Early Neonatal Neurobehavioural Scale (ENNS) examination. Newborn children examined 1 h after birth, after maternal anaesthesia with propofol, showed a depression in alert state, pinprick and placing reflexes, and mean decremental count in Moro and light. There was a generalized irritability in 25% of them. This depression was not observed at 4 h.

Anesthesia, General↗
PubMed1989

Spinal buprenorphine for postoperative analgesia after caesarean section.

Two doses of intrathecal buprenorphine for postoperative analgesia have been compared. Forty-five women undergoing elective caesarean section under spinal anaesthesia were randomly divided into three groups. Group A (controls, n = 15) received hyperbaric bupivacaine; Groups B and C received the same but with the addition of 0.03 mg or 0.045 mg buprenorphine, respectively. Patients receiving buprenorphine had a longer pain-free interval than the controls (P less than 0.01). Within the buprenorphine groups, patients receiving the higher dose had a longer effect (420 min s.d. 24) than those receiving the lower dose (173 min s.d. 31) (P less than 0.01) without any increase in side-effects.

Adult↗
PubMed1988

Epidural fentanyl plus bupivacaine 0.125 per cent for labour: analgesic effects.

Ninety-five healthy nulliparous women, ASA physical status I-II with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural analgesia. Patients in Group A (n = 35) received bupivacaine 0.125 per cent with epinephrine 1:800.000; Groups B (n = 30) and C (n = 30) received the same agents as Group A but with the addition to the initial dose of 50 or 100 micrograms of fentanyl respectively. All patients were evaluated for duration and quality of analgesia, duration of labour, method of delivery and total dose of bupivacaine used. The addition of either 50 or 100 micrograms of fentanyl resulted in longer duration of analgesia (93 +/- 9 min and 106 +/- 8 min respectively vs 55 +/- 7) and reduced bupivacaine total doses (64 +/- 0.03 and 55 +/- 1.5 respectively vs 109.5 +/- 1.3). Only the addition of 100 micrograms of fentanyl improved significantly the quality of analgesia (43.3 per cent of excellent scores vs 6.6 per cent in Group B and 5.7 per cent in Group A). Addition of fentanyl did not affect the duration of labour, the method of delivery and the neonatal neurobehaviour scores.

Adult↗
PubMed1988

Intrathecal buprenorphine for postoperative analgesia in the elderly patient.

Ninety patients aged 56-85 years scheduled for suprapubic prostatectomy, randomly received intrathecally either bupivacaine 30 mg (group A, n = 30), bupivacaine 30 mg plus buprenorphine 0.03 mg (group B, n = 30) or bupivacaine 30 mg plus buprenorphine 0.045 mg (group C, n = 30). Prolonged postoperative analgesia, minimal disturbance of consciousness and comfortable breathing were common to the groups that received buprenorphine. The higher concentration of buprenorphine improved the quality and duration of analgesia. The only side effects found in the buprenorphine groups were nausea and vomiting in 11 and 14 patients, respectively, in groups B and C. Our study shows that buprenorphine is an effective analgesic, suitable for the management of postoperative pain in elderly patients.

Aged↗
PubMedDate not supplied

Epidural mepivacaine for cesarean section: effects of a pH-adjusted solution.

STUDY OBJECTIVE: To determine the clinical effects of the alkalinization of 2% mepivacaine with epinephrine used for epidural block during cesarean section. DESIGN: Randomized, double-blind, placebo-controlled (standard commercial preparation of 2% mepivacaine with epinephrine) study. SETTING: Inpatient obstetric department at a general hospital. PATIENTS: Seventy patients scheduled for elective cesarean section under epidural anesthesia. INTERVENTIONS: Two groups of 35 patients each receiving either the standard commercial preparation of mepivacaine or the pH-adjusted solution (prepared with the addition of 0.1 meq/ml of sodium bicarbonate to the standard commercial solution). MEASUREMENTS AND MAIN RESULTS: Measurements of sensory (pinprick) and motor (Bromage's criteria) block were taken at 1- to 2-minute intervals beginning after the completion of the epidural injection. Increasing the pH of the mepivacaine resulted in a significant shortening of the time of analgesia onset (9.3 minutes compared with 16.01 minutes, p less than 0.01) and of peak effect (11.1 minutes compared with 21.2 minutes, p less than 0.01). The alkalinization did not affect duration of the block, intensity of motor block, or mean dose of local anesthetic used. CONCLUSION: The alkalinization allowed the surgery to proceed more rapidly, significantly decreasing the time interval between epidural block and delivery of the infant.

Adult↗
PubMedDate not supplied

Which induction drug for cesarean section? A comparison of thiopental sodium, propofol, and midazolam.

STUDY OBJECTIVE: To determine maternal and neonatal effects of three different induction drugs (thiopental sodium, propofol, and midazolam) for cesarean section. DESIGN: Randomized, double-blind study. SETTING: Inpatient obstetric department at a general hospital. PATIENTS: 90 healthy patients undergoing elective cesarean section with general anesthesia. INTERVENTIONS: 3 groups of 30 patients each receiving thiopental 5 mg/kg, propofol 2.4 mg/kg, or midazolam 0.3 mg/kg for induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Time to induce anesthesia, hemodynamic changes, depth of anesthesia, recovery after anesthesia, placental transfer, and neonatal outcome (Apgar and neurobehavioral examinations) were studied. In the thiopental and midazolam groups, systolic blood pressure and heart rate rose following endotracheal intubation and skin incision (p < 0.001 and p < 0.0025, respectively), while in the propofol group, there was significant hypotension after induction (p < 0.005). Electroencephalographic patterns showed a light depth of anesthesia with propofol and midazolam between anesthesia induction and delivery, confirmed by the presence of clinical signs of light anesthesia in 50% of propofol patients and 43% of midazolam patients. Time to induce anesthesia was longer with midazolam (p < 0.0001). Neonates in the midazolam and propofol groups had lower Apgar and neurobehavioral scores than those in the thiopental group. Umbilical artery to umbilical vein ratios were above 1 in the propofol and midazolam groups. CONCLUSION: Thiopental still remains the first-choice induction drug for cesarean section. The slow induction time with midazolam may put the mother at risk for pulmonary inhalation. A plane of anesthesia that may risk awareness and potential neonatal depression is the main drawback of the two newer induction drugs.

Adult↗
PubMedDate not supplied

Epidural analgesia during and after cesarean delivery. Comparison of five opioids.

A randomized, double-blind study was designed to determine the effects on maternal intraoperative analgesia of adding one of the following opioids to the local anesthetic at the onset of epidural block, before surgery and neonatal delivery: morphine (3 mg), fentanyl (75 micrograms), sufentanil (50 micrograms), buprenorphine (0.3 mg) and oxymorphone (1 mg). The duration of postoperative analgesia, the presence of side effects and the neonatal outcome were also studied. Ninety healthy multiparas, at term, undergoing elective cesarean delivery using lumbar epidural anesthesia with 2% lidocaine were randomized in six equal groups to receive one of the opioids or saline. The predelivery administration of morphine, fentanyl and sufentanil significantly improved the intraoperative analgesia. Patients who received fentanyl, sufentanil, buprenorphine or oxymorphone had more somnolence than the others (p less than 0.01), but this did not interfere with the first mother-infant relationship during surgery. Patients in the buprenorphine group had more vomiting during surgery when compared with the others (p less than 0.01). Morphine provided the longest pain-free interval, followed by oxymorphone, buprenorphine, sufentanil and fentanyl. Postoperatively, the number of patients having pruritus and vomiting was significantly higher in the morphine and buprenorphine groups, respectively (p less than 0.01 versus others). No adverse neonatal effects were noted in any group.

Adult↗