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Biomedical subjects

W E Ackerman

Publications and source records attributed to W E Ackerman.

At least 19 recordsLinked to original sources
PubMed1992

The air-liquid interface and the pH and PCO2 of alkalinized local anaesthetic solutions.

The alkalinization of certain local anaesthetics with sodium bicarbonate hastens the onset of epidural analgesia. Increases in both the pH and PCO2 of the local anaesthetic are necessary to hasten onset. However, carbon dioxide can diffuse from local anaesthetic solutions following alkalinization with sodium bicarbonate and change both the pH and PCO2 of the mixture. This study examined changes in pH and PCO2 of three local anaesthetics reported to have a faster onset of analgesia following mixture with sodium bicarbonate and examined the effects of time and the local anaesthetic container air/liquid interface on the pH and PCO2 of the buffered local anaesthetic solutions. Bupivacaine 0.5%, lidocaine 2%, and chloroprocaine 2% were each buffered with sodium bicarbonate. The pH and PCO2 of each solution were measured at time 0 and at 5, 10, 15, 20, 30, 40, 50 and 60 min intervals. The solutions were placed in containers as follows: 30 ml in 40 ml containers, 10 ml in 40 ml containers, 10 ml in 13 ml containers, and 10 ml in polypropylene syringes. The pH and PCO2 increased following alkalinization but gradually decreased in all containers except in polypropylene syringes.

Air↗
PubMed1992

Transient bradycardia associated with extradural blood patch after inadvertent dural puncture in parturients.

We have studied prospectively 10 ASA I or II postpartum patients after inadvertent dural puncture during labour. An extradural blood patch (autologous blood 15 ml) was performed within 18 h of delivery, with continuous EEG, upper facial EMG (Datex: Anesthesia and Brain Activity Monitor), pulse oximetry and heart rate measurement before, during and for 30 min after extradural injection. Non-invasive arterial pressure measurements (Dinamap) were recorded at 5-min intervals. After extradural blood patch, a statistically significant (Student's t test, P < 0.05) decrease in heart rate, from a mean baseline of 88.6 (SD 7.31) beat min-1 to 51.3 (7.6) beat min-1, occurred within 122.6 (16.9) s from the time of the EBP. Bradycardia was observed for a mean duration of 12.4 (1.1) s. Upper facial EMG, EEG, SpO2 and arterial pressure did not change.

Analgesia, Epidural↗
PubMed1991

The management of oral mexiletine and intravenous lidocaine to treat chronic painful symmetrical distal diabetic neuropathy.

Intravenous local anesthestics administered to patients with chronic pain have been shown to provide significant levels of systemic analgesia. Furthermore, oral mexiletine which is similar in structure has been demonstrated to be efficacious in the treatment of diabetic neuropathy. It is recommended that this combined form of treatment be considered with those patients whose diabetic neuropathy is resistant to more conventional forms of treatment.

Chronic Disease↗
PubMed1991

Prevention of accidental injection of drugs in epidural tubing.

Numerous drugs have been injected into the epidural space unintentionally and different methods of prevention have been reported. This article describes the use of a needle cap as an available cost-effective alternative to prevent this mishap.

Anesthesia, Epidural↗
PubMed1991

Epidural morphine pruritus reduction with hydroxyzine in parturients.

A majority of patients experience pruritus, nausea and/or emesis following epidural morphine administration post-cesarean section. Naloxone or diphenhydramine are commonly used to treat these side effects. Prevention or reduction in the incidence of side effects of epidural morphine is a clinical goal. The purpose of the study was to observe the efficacy of prophylactic administration of hydroxyzine on the incidence and severity of pruritus following the epidural administration of morphine in 40 patients who requested epidural morphine for postoperative pain relief. Group I (n = 20) received saline, while Group II (n = 20) received 50 mg of hydroxyzine ten minutes after the administration of 5 mg epidural morphine. Both solutions were administered by deep intramuscular injection in the thigh area. The results of this investigation demonstrated that hydroxyzine was efficacious in attenuating the incidence of severe pruritus.

Adult↗
PubMed1990

Effect of position on the spread of buffered 2% chloroprocaine administered epidurally for the second stage of labor.

Increasing the pH of epidurally administered local anesthetics hastens their onset of action and improves the quality of neural blockade. The effect of body position on the epidural spread of alkalinized 2% chloroprocaine HCl for the second stage of labor has not been reported. We studied the epidural cephalad and caudad spread of 2% chloroprocaine buffered with sodium bicarbonate administered epidurally at the beginning of the second stage of labor. We randomly assigned 30 patients to one of two groups, each consisting of 15 patients. Group 1 received an epidural redose in the upright position, and the patients in group 2 received a redose in the supine position. There were no differences with respect to the sacral or cephalad spread. From the results of this study, we conclude that patients may receive epidurally administered 2% chloroprocaine late during the first stage of labor while in a supine position.

Adult↗
PubMed1990

Maternal paraparesis after epidural anesthesia and cesarean section.

Continuous epidural infusion of local anesthetics containing epinephrine has become increasingly popular. This technique has been associated with few, if any, complications. We have presented a case of anterior spinal artery syndrome with paraparesis after continuous lumbar epidural infusion of an anesthetic during labor and subsequent emergency cesarean section.

Adult↗
PubMed1989

A comparison of the incidence of pruritus following epidural opioid administration in the parturient.

Epidural morphine is associated with a high incidence of pruritus when used for pain control in the post-Caesarean section population. The purpose of this study was to compare the incidence of pruritus associated with epidural morphine, fentanyl, buprenorphine and butorphanol. Sixty healthy Caesarean section patients were studied in a double-blind randomized fashion. Patients were questioned at 1, 3, 12 and 24 hours postpartum for the incidence of pruritus. This study demonstrated that the incidence of pruritus was significantly higher following the use of epidural morphine and fentanyl. Even though epidural butorphanol and buprenorphine exhibited a low incidence of pruritus, their duration of analgesia was not long enough to make either attractive for single-dose administration.

Adult↗
PubMed1989

The effect of pH-adjusted 2-chloroprocaine on the onset of epidural analgesia in pregnant patients in the lying and sitting position during the first stage of labor.

The purpose of this prospective, randomized, double-blind study was to compare the epidural onset time of 2% 2-chloroprocaine with pH-adjusted 2-chloroprocaine administered in either the sitting or supine position in pregnant patients during the first stage of labor. Patients in Groups I and III received the control solution in the sitting and supine position, respectively. Patients in Groups II and IV received the buffered solution in the sitting and supine position, respectively. The pH and pCO2 of the control and buffered solutions differed significantly. The pH and pCO2 of the control and buffered solutions were 4.38 +/- 0.01, 18.4 +/- 2.2 mm Hg and 7.70 +/- 0.04, 114.9 +/- 3.0 mmHg, respectively. A statistically significant reduction in the time of onset of analgesia in the pH-adjusted groups was noted. Groups I and II had onset times of 4 +/- 1.2 and 4.3 +/- 1.0, whereas Groups II and IV had onset times of 2.6 +/- 0.9 and 2.7 +/- 0.6 min., respectively. There were no intergroup differences in the cephalad spread of analgesia or duration of analgesia. Position had no effect on the onset of analgesia at the S2-3 dermatomes nor on the bilateral cephalad spread of the epidural study solutions. Our results indicate that a pregnant patient may be dosed in the lateral supine position without adversely affecting the caudad or cephalad spread of plain or pH-adjusted 2% 2-chloroprocaine, which is clinically important because the incidence of aortocaval compression is increased in the supine position when compared with the lateral supine position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The effect of pH and PCO2 on epidural analgesia with 2% 2-chloroprocaine.

Increasing the pH of local anesthetics with sodium bicarbonate has been reported to hasten their onset of action. The purpose of this study was to compare the onset and duration of epidural analgesia with the use of sodium bicarbonate and tromethamine to increase the pH of 2% chloroprocaine (2CP). Five groups of patients were studied: Group I received 2CP; Group II received 2CP buffered to a pH of 7.1 with tromethamine; Group III received 2CP buffered to a pH of 7.1 with sodium bicarbonate; Group IV received 2CP buffered to a pH of 7.7 with tromethamine; and Group V received 2CP buffered to a pH of 7.7 with sodium bicarbonate. The final pH and PCO2 of each solution were measured. Time to onset of analgesia was significantly delayed with either of the tromethamine buffered groups (II [5.6 +/- 1.0 minutes] and IV [5.4 +/- 0.4 minutes]) when compared with data from the unbuffered control (I [4.4 +/- 0.1 minutes]) and the sodium bicarbonate buffered (III [4.5 +/- 0.8 minutes] groups and Group V [2.7 +/- 0.9 minutes]). Only when sodium bicarbonate buffer adjusted to pH 7.7 (Group IV) was onset significantly more rapid than the unbuffered 2CP (I) and tromethamine buffered 2CP (II and IV). Multiple regression analysis revealed that onset times were significantly related to both pH and PCO2. The coefficient of determination for this model was 0.5156.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Butorphanol for the relief of shivering associated with extradural anesthesia in parturients.

STUDY OBJECTIVE: To assess the efficacy of butorphanol for the relief of shivering following the epidural administration of 2% lidocaine. DESIGN: Randomized, double-blind study. SETTING: Labor and delivery department of a university-affiliated hospital inpatient facility. PATIENTS: Sixty-one healthy labor patients. INTERVENTIONS: Patients who had sustained shivering associated with lidocaine epidural anesthesia were given normal saline or butorphanol 1 mg. Patients were observed for 20 minutes following the administration of a study solution. MEASUREMENTS AND MAIN RESULTS: Shivering ceased within a mean time of 12.9 +/- 3.8 minutes in approximately 81% of the patients who received epidural butorphanol (p < 0.01), while 3% of the patients in the placebo group had no shivering following the administration of epidural saline. No sedation or changes in fetal heart rate were associated with epidural butorphanol. CONCLUSIONS: Epidural butorphanol is effective in the treatment of postepidural shivering associated with epidural lidocaine. Epidural agonist opioids have been reported to be efficacious in the management of postepidural shivering. This study demonstrated that a partial agonist opioid also is effective in the treatment of postepidural shivering.

Adult↗
PubMedDate not supplied

Ineffective ventilation during conscious sedation due to chest wall rigidity after intravenous midazolam and fentanyl.

Chest wall rigidity has been reported after the administration of high-dose intravenous fentanyl. This case report supports the observation that low-dose intravenous fentanyl may also cause chest wall rigidity. The treatment of chest wall rigidity with naloxone or neuromuscular blocking agents is controversial. A discussion of the management of fentanyl-induced chest wall rigidity is presented.

Adult↗