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Biomedical subjects

N H Badner

Publications and source records attributed to N H Badner.

At least 19 recordsLinked to original sources
PubMed2001

Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis.

UNLABELLED: Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. Postoperative epidural analgesia is considered to have beneficial effects on cardiac outcomes. The use in high-risk cardiac patients remains controversial. No study has shown that postoperative epidural analgesia decreases postoperative myocardial infarction (PMI) or death. All studies are underpowered to show such a result, and the cost of conducting a large trial is prohibitive. We performed a metaanalysis to determine whether postoperative epidural analgesia continued for more than 24 h after surgery reduces PMI or in-hospital death. The available databases were searched for randomized controlled trials of epidural analgesia that was extended at least 24 h into the postoperative period. The search yielded 17 studies, of which 11 were randomized controlled trials comprising 1173 patients. Metaanalysis was conducted by using the fixed-effects model, calculating both an odds ratio and a rate difference. Postoperative epidural analgesia resulted in better analgesia for the first 24 h after surgery. The rate of PMI was 6.3%, with lower rates in the Epidural group (rate difference, -3.8%; 95% confidence interval [CI] -7.4%, -0.2%; P = 0.049). The frequency of in-hospital death was 3.3%, with no significant difference between Epidural and Nonepidural groups (rate difference, -1.3%; 95% CI, -3.8%, 1.2%, P = 0.091). Subgroup analysis of postoperative thoracic epidural analgesia showed a significant reduction in PMI in the Epidural group (rate difference, -5.3%; 95% CI, -9.9%, -0.7%; P = 0.04). IMPLICATIONS: Postoperative epidural analgesia, especially thoracic epidural analgesia, continued for more than 24 h reduces postoperative myocardial infarctions.

Analgesia, Epidural↗
PubMed2001

Preoperative oral B vitamins prevent nitrous oxide-induced postoperative plasma homocysteine increases.

UNLABELLED: Nitrous oxide increases total homocysteine (tHcy) plasma levels, which are associated with an increase in perioperative myocardial ischemia. We designed this study to determine whether oral B vitamins, which are cofactors in homocysteine metabolism, can prevent nitrous oxide anesthesia-induced tHcy increases in patients undergoing elective surgery scheduled to last longer than 3 h. Fifty-three patients presenting for elective revision knee or hip arthroplasty received in random, double-blinded fashion oral vitamin B complex (folate 2.5 mg, B(6) 25 mg, and B(12) 500 microg) or placebo daily for 1 wk before surgery. Anesthesia was induced with propofol and maintained with an opioid, isoflurane, and nitrous oxide/oxygen (inspired nitrous oxide >50%). Blood samples for measurement of tHcy concentration were obtained at study enrollment, before induction, on arrival in the postanesthesia care unit, and on Day 5. Fourteen patients had their surgery rescheduled after taking their vitamins and were removed from the study. The Placebo group had a mean increase in tHcy concentration from baseline of 15% +/- 31% compared with the Vitamin group, which had an initial decrease of 9.1% +/- 11% (P = 0.035). This was maintained throughout the 5-day study period. The use of an oral B vitamin complex prevented the increase in postoperative tHcy by nitrous oxide. IMPLICATIONS: The use of nitrous oxide anesthesia increases postoperative homocysteine concentrations and associated myocardial ischemia. This study indicates that a 1-wk course of oral B vitamins can prevent the increase in homocysteine from nitrous oxide, and, by implication, myocardial ischemia as well.

Administration, Oral↗
PubMed2000

Nitrous oxide-induced increased homocysteine concentrations are associated with increased postoperative myocardial ischemia in patients undergoing carotid endarterectomy.

UNLABELLED: Nitrous oxide anesthesia causes increased postoperative plasma homocysteine levels. Acute increases in plasma homocysteine are associated with impaired endothelial function and procoagulant effects. This nitrous oxide-induced plasma homocysteine increase may therefore affect the risk of perioperative cardiovascular events. This prospective, randomized study was therefore designed to evaluate the effect of nitrous oxide anesthesia and postoperative plasma homocysteine levels on myocardial ischemia in patients undergoing carotid endarterectomy. After institutional review board approval and written informed consent, 90 ASA Class I-III patients presenting for elective carotid endarterectomy were randomized to receive general anesthesia with or without nitrous oxide. Prior to induction, on arrival in the postanesthesia care unit, and after 48 h, blood samples were obtained for homocysteine analysis. Three hours prior to induction and for 48 h postoperatively patients were monitored by a three-channel, seven-lead Holter monitor. Postoperatively in the postanesthesia care unit and at 48 h the nitrous oxide group had increased mean plasma homocysteine concentrations of 15.5 +/- 5.9 and 18.8 +/- 14.7 when compared with the nonnitrous group of 11.4 +/- 5.2 and 11.3 +/- 4.0 micromol/L, P: < 0.001. The nitrous oxide group had an increased incidence of ischemia (46% vs. 25%, P: < 0.05), significantly more ischemia (63 +/- 71 vs. 40 +/- 68 min, P: < 0.05), had more ischemic events (82 vs. 53, P: < 0.02), and had more ischemic events lasting 30 min (23 vs. 14, P: < 0.05) than the nonnitrous group. This study reconfirmed that intraoperative nitrous oxide is associated with postoperative increases in plasma homocysteine concentration. This was associated with an increase in postoperative myocardial ischemia. IMPLICATIONS: Use of nitrous oxide during carotid artery surgery induces increases in postoperative plasma homocysteine concentration and is associated with increases in postoperative myocardial ischemia.

Aged↗
PubMed1998

Anaesthesia preadmission assessment: a new approach through use of a screening questionnaire.

PURPOSE: The preadmission assessment of patients one to two weeks preoperatively has become the standard across North America. We have devised a new approach that utilises a preoperative screening questionnaire, and this study attempted to determine the effectiveness of this technique. METHODS: Over six weeks, the attending anaesthetist for each patient undergoing non-cardiac surgery processed through the preadmission clinic (PAC) completed a study survey. This survey questioned if the assessment was appropriate with reasons, the consequences of no assessment, and if time was saved/lost on the day of surgery. RESULTS: Three hundred and seventy patients were processed (243 same-day (SD), 111 outpatient (O/P), and 16 inpatients (I/P)). Of these, 224 were assessed in the PAC (101 by medicine, 84 by anaesthesia and 39 by both): 42% (94) based on the questionnaire, 12% (26) due to consultation, and 46% (104) due to positive questionnaires and consultation. The physician assessments were appropriate 184/219 (84%) times, inappropriate in 35 (16%), while there was no answer for five. Assessments were inappropriate because 25/35 (71%) were unnecessary, while in nine (26%) the patient was not optimised. Of the patients not assessed in the PAC only 9/145 (6%) should have been assessed. CONCLUSION: The use of our screening tool in combination with direct referrals appropriately determines assessment needs of patients and allows for more efficient use of medical personnel in the PAC.

Ambulatory Surgical Procedures↗
PubMed1998

The use of intraoperative nitrous oxide leads to postoperative increases in plasma homocysteine.

UNLABELLED: Hyperhomocysteinemia is an independent risk factor for coronary artery and cerebrovascular disease, but its significance in the perioperative period is unknown. Nitrous oxide inhibits methionine synthase, which aids in the conversion of homocysteine to methionine. In this prospective, controlled, randomized study, we determined the effect of intraoperative nitrous oxide exposure on postoperative plasma homocysteine concentrations. Twenty ASA physical status I-III patients, aged >18 yr, presenting for elective craniotomy, were randomized to receive general anesthesia with or without nitrous oxide (inspired nitrous oxide >50%). Plasma was sampled before the induction of anesthesia, on arrival in the postanesthesia care unit (PACU) after discontinuation of nitrous oxide, and 24 h after induction. There was a significant increase (22.6+/-11.4 vs 13.0+/-4.7 micromol/L; P = 0.0038 for postoperative versus preinduction values) in plasma homocysteine concentrations in the nitrous oxide group on arrival in the PACU and for 24 h. In the nonnitrous oxide group, mean plasma homocysteine concentrations did not change (9.5+/-1.9 vs 9.8+/-1.6 micromol/L; P = 0.86 for postoperative versus preinduction values). The change in plasma homocysteine concentrations in the nitrous oxide group was significantly different from that in the nonnitrous group (P = 0.0031). We conclude that the use of intraoperative nitrous oxide leads to significant increases in perioperative plasma homocysteine concentrations. IMPLICATIONS: Short-term exposure to nitrous oxide led to significant increases in plasma homocysteine. Further investigations are required to determine the clinical significance of this change.

Adult↗
PubMed1998

Myocardial infarction after noncardiac surgery.

BACKGROUND: In this study, the authors intensively monitored isoenzyme and electric activity of the heart for the first 7 days after noncardiac surgery in a large group of patients at risk for postoperative myocardial infarction (PMI). METHODS: After institutional review board approval and written informed consent were received, 323 patients, aged 50 yr or older, who had ischemic heart disease and presented for noncardiac surgery, were enrolled in this prospective, blinded study. After operation, patients had daily clinical assessments, electrocardiograms, and measurements of creatine kinase (CK), CK-2 (mass and activity), and Troponin-T on the operative night, twice daily on postoperative days 1-4, and then daily on days 5-7. A diagnosis of PMI was made if the total CK was > 174 U/l and in the presence of two of the following: (1) CK-2/CK (mass or activity) > 5%, (2) new Q waves lasting > or = 0.04 s and 1 mm deep in at least two contiguous leads, (3) Troponin-T was > 0.2 microg/l, or (4) a positive result of pyrophosphate scan. RESULTS: Eighteen of the 323 patients (5.6%) had a PMI, of which 3 (17%) were fatal. Only 3 of 18 patients had chest pain, whereas 10 of 18 patients (56%) had other clinical findings. The electrocardiographic classification of the PMI was Q wave in 6, non-Q wave in 10, and indeterminate in 2. The PMIs occurred on the day of operation in 8, on day one in 6, on day two in 3, and on day four in 1 patient. CONCLUSIONS: This study determined that PMI was an early event, only occasionally associated with chest pain, and usually non-Q wave in nature.

Aged↗
PubMed1997

Patient attitudes regarding pca and associated costs.

PURPOSE: To determine patients' knowledge and attitudes towards patient-controlled analgesia (PCA) costs through the use of our acute pain service quality assurance (QA) programme. METHODS: Quality Assurance questionnaires were distributed to all patients receiving PCA opioids for > 12 hr. Patients were asked to note the presence of side effects (nausea/vomiting, pruritus, urinary retention), to indicate their satisfaction with regard to their pain relief, follow-up assessments, treatment of side effects, and to recall the previous method of pain relief and their satisfaction with it. Patients were also asked to estimate the total cost of PCA (0-$50, $50-100, $100-200, > $200), and what amount if any they would be willing to pay (0-$50, $50-100, $100-200, > $200). Results obtained over a recent four month period were reviewed. RESULTS: One hundred and thirty-three questionnaires were distributed and 103 (77%) were returned. The percentage of patients rating their satisfaction as very good or excellent was 86% for pain relief, 96% for follow-up, 71% for side effect treatment, but only 43% for their previous surgical pain relief (P < 0.001). The distribution of cost estimates was 10% $50-100, 37% $100-200 and 53% > $200 with 60% willing to pay a portion of this cost. Those willing to pay were more likely to have had very good or excellent pain relief (94% vs 71%, P < 0.05) and treatment of side effects (71% vs 48%, P < 0.05) than those not willing to pay. CONCLUSIONS: Patients continue to be highly satisfied with PCA therapy and are aware of the costs involved. A majority of patients were willing to pay to obtain this service if necessary. Patients who had poorer pain relief and less efficacious treatment of their side effects were less willing to pay.

Analgesia, Patient-Controlled↗
PubMed1997

Comparison of pulsatile versus nonpulsatile perfusion on the postcardiopulmonary bypass aortic-radial artery pressure gradient.

OBJECTIVE: To investigate whether the type of perfusion, pulsatile (PP) or nonpulsatile (NP), has any effect on the pressure gradient that exists between the aortic root and the radial artery after cardiopulmonary bypass (CPB). DESIGN: Prospective, randomized study. SETTING: Tertiary care, university hospital. PARTICIPANTS: Eighty patients undergoing elective, hypothermic coronary artery bypass graft (CABG) surgery. INTERVENTIONS: Pulsatile perfusion with a pulse pressure of 10 to 20 mmHg and a frequency of 60 to 80 beats/min was created during the hypothermic phase of CPB. Both the radial artery and aorta were cannulated and attached to separate transducers but displayed and analyzed on the same monitor. MEASUREMENTS AND MAIN RESULTS: Simultaneous recordings of radial artery and aortic root blood pressure were made prebypass, during CPB, and after discontinuation of CPB at 2, 5, and 10 minutes. During CPB, the PP group had a significantly higher mean pulse pressure measured at the aortic root than the NP group (15.5 +/- 8.1 v 1.7 +/- 2.7, p < 0.0001). The aortic-to-radial-artery gradient within both groups was significantly different after CPB for systolic (SBP), diastolic (DBP), and mean pressure (MAP) (p < 0.0001). There were, however, no statistically significant differences between the PP and NP groups in the aortic-to-radial-artery gradient after CPB for either SBP, DBP, or MAP. CONCLUSIONS: Pulsatile perfusion had no effect on the aortic root radial artery blood pressure gradient after CPB in elective CABG surgery patients.

Aorta↗
PubMed1997

The addition of continuous intravenous infusion of ketorolac to a patient-controlled analgetic morphine regime reduced postoperative myocardial ischemia in patients undergoing elective total hip or knee arthroplasty.

This double-blind randomized trial assessed the effect of adding an intravenous continuous infusion of ketorolac to a patient-controlled analgesia (PCA) morphine regimen on analgesia, heart rate, arterial blood pressure, and postoperative myocardial ischemia. Patients having elective total hip or knee replacement were randomized to receive ketorolac 30 mg bolus, followed by an infusion of 5 mg/h for 24 h or placebo. All patients had access to PCA morphine (20 microg/kg bolus, with a lockout of 6 min). Patients were monitored for pain visual analog scale, blood pressure, heart rate, and ST segment depression via a continuous Holter monitor. ST depression of 1 mm 60 ms after the J point was considered significant if it lasted more than 1 min. There was no difference in demographics, risk factors, or cardiac medications between the groups. Ketorolac-treated patients had significantly better pain control at 2, 6, and 24 h. There was significant morphine sparing at all times after 3 h. There was no difference in the number of ischemic events between the groups. The ischemic episodes of the patients who received ketorolac occurred at slower heart rates (97 +/- 15 vs 114 +/- 16 bpm, P = 0.001) than those of patients in the placebo group. The duration of ST depression was shorter in ketorolac-treated patients (24 +/- 35 vs 76 +/- 95 min, P < 0.05). All ST depressions were clinically silent. Logistic regression of factors predicting ischemia included the use of calcium channel blockers and low pain score. These results suggest that analgesia with ketorolac reduces the duration of ischemic episodes in the first 24 h postoperatively.

Aged↗
PubMed1996

Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery: a dose-finding study.

PURPOSE: A dose-finding study to investigate the use of epidural infusions of ropivacaine for postoperative analgesia following orthopaedic surgery. METHODS: This was a randomized, double-blind study. Surgery was performed using a combination of a lumbar epidural block utilizing ropivacaine 0.5% and a standardized general anaesthetic. Postoperatively, an epidural infusion of the study solution (saline, ropivacaine 0.1%, 0.2% or 0.3%) was started at the rate of 10 ml.hr-1 and continued for 21 hr after arrival in the PACU. Analgesia was supplemented with PCA morphine (dose = 1.0 mg, lock-out = 5 min). RESULTS: Forty-four patients completed the study. The ropivacaine 0.1%, 0.2%, 0.3% groups required less morphine over the 21 hr than the saline group (P < 0.01). The VAS pain scores were also lower in the three ropivacaine groups (P < 0.001). The ropivacaine groups maintained sensory anaesthesia to pinprick when compared with saline (P < 0.05). The motor block in the 0.3% group was significantly higher than the saline group at all times (P < 0.05), and higher than the 0.1% group at eight hours (P < 0.01), while the 0.2% group had higher Bromage scores than saline at 4 and 21 hr (P < 0.05). CONCLUSIONS: The use of continuous epidural infusions of ropivacaine 0.1%, 0.2% and 0.3% at 10 ml.hr-1 improved postoperative pain relief and decreased PCA morphine requirements in patients undergoing major orthopaedic surgery. The 0.1% and 0.2% concentrations produced similar sensory anaesthesia with less motor blockade than the 0.3% concentration.

Adult↗
PubMed1996

Effect of varying intravenous patient-controlled analgesia dose and lockout interval while maintaining a constant hourly maximum dose.

STUDY OBJECTIVE: To investigate the effect on the use of intravenous patient-controlled analgesia (PCA) of varying the dose (D) and lockout interval (LI) while keeping the hourly maximum dose constant. DESIGN: Randomized, prospective study. SETTING: Teaching hospital. PATIENTS: 75 patients scheduled to receive PCA morphine following abdominal surgery. INTERVENTIONS: Postoperatively, patients were randomly assigned to receive PCA morphine with the following parameters: D = 1 mg, LI = 6 min (Group 1-6), D = 1.5 mg, LI = 9 min (Group 1.5-9), or D = 2 mg, LI = 12 min (Group 2-12), so that each group could receive a maximum hourly dose or 10 mg. Inadequate analgesia was managed by increasing the dose and lockout interval, while excessive sedation or respiratory rate less than 10 breaths/min resulted in decreasing the dose and lockout interval. MEASUREMENTS AND MAIN RESULTS: Patients were assessed for pain [visual analog scale (VAS), verbal rating scale (VRS)] and side effects at 1, 2, 4, and 24 hours. The number of doses administered, missed attempts, and morphine used for the first 24 hours was recorded by automatic printout from the PCA machine. There was no difference in the total 24-hour morphine consumption, analgesia, or incidence of side effects among the three groups at any of the measurement times. Two patients, one each in the 1.5-9 and 2-12 groups, required naloxone for respiratory depression. The number of PCA injections, attempts, missed attempts, and the incidence of dosage adjustment were all significantly higher for the 1-6 group (p < 0.05). CONCLUSION: The use of 1.0 mg with a 6-minute lockout may represent appropriate dose titration because this group obtained equivalent analgesia, morphine use, and side effects as the two larger dose and lockout groups. However, the increased number of PCA attempts and missed attempts may reflect lower satisfaction with PCA therapy.

Abdomen↗
PubMed1996

Intra-articular injection of bupivacaine in knee-replacement operations. Results of use for analgesia and for preemptive blockade.

The effectiveness of an intra-articular injection of bupivacaine, administered before the incision or after closure of the wound, was studied in an effort to decrease the need for postoperative narcotics and to improve analgesia for patients who have elective knee replacement. Eighty-two patients received two intra-articular injections in a random, double blind fashion. Twenty-eight of them received thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution before the incision and an injection of thirty milliliters of plain saline solution after closure of the wound (Group 1). Twenty-seven patients received an injection of thirty milliliters of plain saline solution before the incision and thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution after closure of the wound (Group 2). Twenty-seven patients were given thirty milliliters of plain saline solution (a placebo) for both injections (Group 3). The patients who had received bupivacaine after closure of the wound (Group 2) used less morphine from the patient-controlled analgesia pumps than the patients who had received bupivacaine before the incision (Group 1) and the patients who had received the placebo (Group 3). In the first twenty-four hours after the operation, the administration of morphine (mean and standard deviation) was 59 +/- 27 milligrams for Group 2 compared with 68 +/- 30 milligrams for Group 1 (p = 0.26) and 81 +/- 30 milligrams for Group 3 (p = 0.006). At the time of discharge from the hospital, the patients in Group 2 also had a significantly greater mean range of motion (85.2 +/- 8.0 degrees) compared with that of the patients in Groups 1 (80.6 +/- 6.8 degrees, p = 0.02) and 3 (80.1 +/- 6.2 degrees, p = 0.009). However, there was no difference among the groups with respect to the effectiveness of the analgesia, as measured with use of either the visual-analog or the verbal pain-rating scale, or in the prevalence of side effects, including somnolence, urinary retention, nausea and vomiting, or pruritus. Serum concentrations of bupivacaine were well below toxic levels. It was our conclusion that that and intra-articular injection of thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution after closure of the wound decreases the need for narcotics and increases the range of motion after an elective knee replacement. The clinical importance of the amount of increased motion is questionable and needs long-term monitoring.

Analgesics↗
PubMed1994

Bupivacaine 0.125% improves continuous postoperative epidural fentanyl analgesia after abdominal or thoracic surgery.

The addition of 0.125% and 0.25% bupivacaine to continuous postoperative epidural infusions of fentanyl, in a 10 micrograms.ml-1 concentration, were studied in 39 patients following abdominal or thoracic surgery in prospective, random, double-blind fashion. Patients received an initial bolus of 0.1 ml.kg-1 of the the study solution and an infusion of 6 ml.hr-1 which was titrated to maintain analgesia (VAS < 40). Assessments of pain (VAS), pulmonary function (pH, PaCO2), and bowel function (time to flatus or po fluids) were made until the second post-operative morning. There was a difference among the three groups in analgesia (means VAS scores) over time (P < 0.01), with the fentanyl-alone group producing less analgesia than the 0.125% bupivacaine group (P < 0.01). There was no difference in the average infusion rates, postoperative pulmonary function, or bowel function. The incidence of side effects including somnolence, nausea and vomiting, and pruritus was also similar. Fewer patients in the 0.125% bupivacaine group than in the 0.25% group developed a transient sensory loss to pinprick and ice (3 vs 10, P < 0.001). Four patients in both bupivacaine groups had leg weakness, those in the 0.125% were all a Bromage 1 score, while in the 0.25% group one had a Bromage 1, one a Bromage 2, and two Bromage 3 scores. The addition of 0.125% bupivacaine improves the analgesia of epidural infusions of fentanyl (10 microgms.ml(-1)) when used following abdominal or thoracic surgery and results in minimal sensorimotor disturbance.

Abdomen↗
PubMed1994

An amrinone bolus prior to weaning from cardiopulmonary bypass improves cardiac function in mitral valve surgery patients.

This double-blind, randomized study was performed to assess the effectiveness of a single bolus dose of 2 mg/kg of amrinone given during cardiopulmonary bypass (CPB) to patients undergoing mitral valve surgery. Outcome variables were hemodynamic function and the number and amount of vasopressors or inotropes required to wean from CPB. In amrinone-treated patients, cardiac index (CI) increased significantly by 48 +/- 14% following CPB (T3) versus 10 +/- 10% for placebo-treated patients (P = 0.029). Similarly, on arrival in the intensive care unit (T4), CI was increased by 52 +/- 20% in amrinone patients versus 8 +/- 8% for placebo patients (P = 0.04). There was a corresponding decrease in systemic vascular resistance index of 47 +/- 6% at T3 in the amrinone patients versus 10 +/- 14% in placebo patients (P = 0.001), and a decrease of 30 +/- 7% at T4 versus an increase of 10 +/- 22% for the placebo patients (P = 0.036). There was no difference in other measured hemodynamic variables. While on CPB, mean arterial pressure at 5 minutes following administration of the study drug was decreased in amrinone patients by 20 +/- 4% versus 4 +/- 3% in placebo patients (P = 0.005), but was no different at 10 and 15 minutes. There were no statistically significant differences in the number of patients who required supplemental inotropes or vasopressors either during CPB, following separation from CPB, or upon arrival in the ICU. Thus, amrinone improved CI without changing pulmonary vascular resistance or the requirement for supplemental inotropes or vasopressors in patients undergoing elective mitral valve surgery.

Aged↗
PubMed1992

Bupivacaine 0.1% does not improve post-operative epidural fentanyl analgesia after abdominal or thoracic surgery.

Epidural infusions of fentanyl, in a 10 micrograms.ml-1 concentration, combined with bupivacaine 0.1% were compared with epidural infusions of fentanyl alone for postoperative analgesia following abdominal or thoracic surgery. There were no detectable differences between the two groups in analgesia (mean visual analogue scale pain scores ranging between 15-35 mm), average infusion rates of 7-9 ml.hr-1, and serum fentanyl concentrations which reached 1-2 ng.ml-1. There was no difference in postoperative pulmonary function (pH, PaCO2, SaO2), or bowel function (time to flatus or po fluids). The incidence of side-effects including somnolence, nausea and vomiting, pruritus and postural hypotension was also similar. Of the patients receiving fentanyl and bupivacaine 0.1%, three developed a transient unilateral sensory loss to pinprick and ice, and two of these patients had unilateral leg weakness equal to a Bromage 1 score. The addition of bupivacaine 0.1% does not improve epidural infusions of fentanyl using a 10 micrograms.ml-1 concentration following abdominal or thoracic surgery.

Abdomen↗
PubMed1992

Differences in pH management and pulsatile/nonpulsatile perfusion during cardiopulmonary bypass do not influence renal function.

The renal effects of pulsatile (pulse pressure 18.0 +/- 1.5 mm Hg [mean +/- SEM]) or nonpulsatile perfusion (mean pulse pressure 1.9 +/- 0.4 mm Hg) during either alpha-stat (mean PaCO2 41.2 +/- 0.9 mm Hg measured at 37 degrees C) or pH-stat (mean PaCO2 60.6 +/- 1.7 mm Hg measured at 37 degrees C) pH management of hypothermic cardiopulmonary bypass (CPB) were studied in 100 patients undergoing elective coronary artery bypass surgery. Mean urine output, fractional excretion of sodium and potassium, and renal failure index all increased during the study period; however, there was no difference among the four different CPB management groups. Mean postoperative creatinine and blood urea nitrogen values decreased compared with preoperative values, again without differences among treatment groups. Three patients developed acute renal insufficiency; of these, two had received nonpulsatile perfusion and pH-stat management, and the other had been managed with pulsatile perfusion and pH-stat management. These three patients all had undergone prolonged CPB and required at least two vasoactive drugs and the use of an intraaortic balloon pump to be weaned from CPB. In patients with normal preoperative renal function undergoing hypothermic CPB, neither the mode of perfusion, pulsatile or nonpulsatile, nor the method of pH management, pH-stat or alpha-stat, influences perioperative renal function.

Cardiopulmonary Bypass↗