Lung isolation during thoracic aneurysmectomy.
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Aortic Aneurysm↗
Biomedical subjects
N H Badner
Publications and source records attributed to N H Badner.
Low-dose bupivacaine does not improve postoperative epidural fentanyl analgesia in orthopedic patients.
Epidural infusions of 10 micrograms/mL fentanyl combined with low-dose bupivacaine (0.1%) were compared with epidural infusions of fentanyl alone for postoperative analgesia after total knee joint replacement. There were no detectable differences between the two groups in analgesia (visual analogue scale ranging between 15 and 40 mm), infusion rates (which averaged 7-9 mL/h), or serum fentanyl levels (which reached 1-2 ng/mL). The incidence of side effects, including nausea, vomiting, and pruritus, was also similar. Of the patients receiving fentanyl and low-dose bupivacaine, one developed a transient unilateral motor and sensory loss, and one developed significant hypotension and respiratory depression. The addition of low-dose bupivacaine does not improve epidural fentanyl infusion analgesia after knee surgery and may increase morbidity.
Aged↗
Preoperative anxiety: detection and contributing factors.
The purpose of this study was to determine whether there is a correlation between anxiety the night before surgery and that existing immediately preoperatively, whether anaesthetists can detect preoperative anxiety and to establish the presence of any factors that might assist in the determination of preoperative anxiety. Anxiety was measured objectively using the Spielberger State-Trait Anxiety Inventory (STAI), and the Multiple Affect Adjective Check List (MAACL). Anxiety was found to be higher in females and those not having had a previous anaesthetic, and to remain constant from the afternoon before surgery to the immediate preoperative period. Anaesthetists were found to be poor assessors of anxiety unless they specifically questioned their patients about this.
Adolescent↗
The prophylactic use of octreotide in a patient with ovarian carcinoid and valvular heart disease.
This case report describes the use of octreotide, a long-acting somatostatin analogue, in the management of a patient with an ovarian carcinoid tumour and severe cardiac valvular disease. This patient underwent laparotomy and tumour resection without complication. Anaesthesia was induced with midazolam, fentanyl, and vecuronium, and maintained with isoflurane as well as additional fentanyl and vecuronium. However, we feel that it was the use of octreotide that prevented a life-threatening crisis intraoperatively, and recommend its use in patients with carcinoid syndrome undergoing anaesthesia and surgery.
Anesthesia, Inhalation↗
Lumbar epidural fentanyl infusions for post-thoracotomy patients: analgesic, respiratory, and pharmacokinetic effects.
Ten patients undergoing a thoracotomy were studied for 24 hours postoperatively to determine the effects of a continuous lumbar epidural fentanyl infusion on postoperative pain, arterial blood gases (ABG), respiratory pattern (respiratory inductive plethysmography, RIP), and fentanyl plasma concentration (CONC). Patients served as their own controls because RIP and ABG data were obtained the night prior to surgery during sleep. Epidural fentanyl was administered as a bolus of 1.5 micrograms/kg followed by an infusion of 1.0 micrograms/kg/h started 1 hour after induction. Insufficient analgesia was treated with a bolus of 0.5 micrograms/kg and an infusion increase of 0.25 micrograms/kg/h. Postoperative assessment included RIP, ABG, CONC, and visual analog pain score (PS). The average infusion rate postoperatively was 1.47 +/- 0.08 micrograms/kg/h (114.3 +/- 8.3 micrograms/h). A mean PS of 2.1 +/- 0.3 was achieved; however, there was a delay in attaining this. There was no significant incidence postoperatively of apnea or slow respiratory rate. A significant but clinically insubstantial increase in PaCO2 and decrease in pH occurred. A steady state CONC of approximately 2.0 ng/mL was reached after 9 hours. The PS correlated with CONC in half the patients (0.60 less than r less than 0.86), indicating a systemic component may have contributed to the analgesic effect.
Adult↗
Bupivacaine added to epidural fentanyl does not improve postoperative analgesia.
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Aged↗
Addition of morphine to intra-articular bupivacaine does not improve analgesia following knee joint replacement.
BACKGROUND AND OBJECTIVES: In an effort to further decrease postoperative opioid requirements and improve analgesia in patients undergoing elective knee joint replacement, a study was made of the effectiveness of adding morphine to an intra-articular bupivacaine injection given immediately following surgery. METHODS: In random, double-blind fashion, 75 patients received a 31-mL intra-articular injection consisting of either 30 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1 mL normal saline (group BUP), 30 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1 mg (1 mL) preservative-free morphine (group BUP-MORPH), or 30 mL normal saline with 1:200,000 epinephrine and 1 mg preservative-free morphine (group MORPH). Postoperative analgesia was supplied by patient controlled analgesia (PCA) with morphine. Patients were assessed at 1, 2, 4, and 24 hours for pain (visual analog and verbal rating scales), morphine utilization, and side effects. Knee range of motion was measured before operation and at hospital discharge. RESULTS: There was no difference among the three groups in PCA morphine requirements, pain scores by either scale, range of motion, or incidence of side effects, including somnolence, urinary retention, nausea and vomiting, and pruritus. CONCLUSION: The addition of 1 mg morphine to an intra-articular injection of 30 mL 0.5% bupivacaine with 1:200,000 epinephrine given at wound closure does not improve analgesia in patients undergoing elective knee joint replacement.
Adult↗