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Biomedical subjects

R A Victory

Publications and source records attributed to R A Victory.

9 recordsLinked to original sources
PubMed1995

Nebulized bupivacaine attenuates the heart rate response following tracheal intubation.

STUDY OBJECTIVE: To determine whether nebulized bupivacaine attenuates the acute hemodynamic response to laryngoscopy and intubation. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Operating room at a university medical center. PATIENTS: 40 health ASA physical status I and II patients scheduled for minor surgical procedures. INTERVENTIONS: Patients were randomized to receive 4 ml of a nebulized solution of either saline (n = 20) or 0.75% bupivacaine (n = 20) 15 minutes before induction of anesthesia. On completion of the aerosol treatment, fentanyl 1.5 micrograms/kg was given intravenously (i.v.), and 3 minutes later anesthesia was induced with thiopental sodium 5 mg/kg i.v. and succinylcholine 1.5 mg/kg i.v.. Laryngoscopy was begun 60 seconds after induction, and the trachea was intubated at 90 seconds. Anesthesia was maintained with 50% nitrous oxide in oxygen following intubation, and 1% isoflurane was administered at 180 seconds. MEASUREMENTS AND MAIN RESULTS: Heart rate (HR) and blood pressure were recorded automatically every 30 seconds for 5 minutes. Bupivacaine significantly attenuated HR (p < 0.05) but not the hypertensive response to laryngoscopy and intubation. CONCLUSION: Nebulized 0.75% bupivacaine was only partially effective in blunting the hemodynamic response to tracheal intubation.

Adult↗
PubMed1995

Effect of preincision versus postincision infiltration with bupivacaine on postoperative pain.

STUDY OBJECTIVE: To compare the efficacy of preincision wound infiltration with bupivacaine to wound infiltration at the end of the operation. DESIGN: A prospective, randomized, double-blind study. SETTING: University medical center. PATIENTS: 56 ASA status I and II women scheduled for abdominal hysterectomy were randomly assigned to one of three treatment groups. INTERVENTIONS: Group 1 (control) received no local anesthetic infiltration. Group 2 received subcutaneous infiltration with 40 ml of bupivacaine 0.5% (pH 6.9) 15 minutes prior to incision. Group 3 received wound infiltration with a similar solution at the end of surgery. Anesthesia was induced with thiopental 3.0 mg/kg i.v., droperidol 50 micrograms/kg i.v., and sufentanil 0.5 microgram/kg i.v. and maintained with nitrous oxide 67% in oxygen and sufentanil 0.1 microgram/kg IV boluses as required. Postoperative pain was treated with morphine via a patient-controlled analgesia delivery system for 24 hours, followed by oral hydrocodone for 3 days. MEASUREMENTS AND MAIN RESULTS: The opioid consumption was recorded for 4 days postoperatively. Pain scores were measured at 4 to 8-hour intervals using 100 mm visual analog scales. There was no difference in either the opioid analgesic requirements or the pain scores between the three study groups. CONCLUSIONS: Wound infiltration, either preincision or postincision, had no clinically significant effect on the pain scores or analgesic requirements following abdominal hysterectomy.

Adult↗
PubMed1994

Use of the laryngeal mask airway after oesophageal intubation.

We have compared insertion of a tracheal tube and laryngeal mask airway (LMA) both with and without the presence of a tube in the oesophagus in 20 ASA I and II patients undergoing elective laparoscopy. After induction of anaesthesia and neuromuscular block, we measured the times for an experienced anaesthetist to correctly position both an LMA and a tracheal tube with and without a tube in the oesophagus. The time to intubation was significantly less with the LMA than with the tracheal tube, both with and without an oesophageal tube in place (P < 0.05). We conclude that if a tracheal tube is placed unintentionally in the oesophagus, an LMA may be used subsequently to provide rapid and effective oxygenation of the patient.

Adolescent↗
PubMed1993

Tracheal tube cuff inflation as an aid to blind nasotracheal intubation.

We have assessed the efficacy of tracheal tube cuff inflation in the oropharynx as an aid to blind nasotracheal intubation in 20 ASA I and II patients undergoing elective oral surgery. The trachea was intubated once using the technique of tracheal tube cuff inflation in the oropharynx and once keeping the tracheal tube cuff deflated throughout the manoeuvre. With the cuff deflated, intubation was successful in nine of 20 (45%) patients; in eight of 20 (40%) it was successful on the first attempt. With the tracheal tube cuff inflated, intubation was successful in 19 of 20 patients (95%), 15 of 20 (75%) of these on the first attempt. The success rates were significantly different (P < 0.01). Times to intubate were not significantly different (P > 0.05). We conclude that, in normal patients, tracheal tube cuff inflation in the oropharynx increases the success rate of blind nasotracheal intubation.

Adolescent↗
PubMed1993

Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia.

This study was designed to compare the efficacy of an ephedrine infusion with crystalloid administration for reducing the incidence of hypotension during spinal anesthesia. Fifty-four ASA I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 15 mL/kg of crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 70-90 mg of hyperbaric 5% lidocaine. Patients in the infusion group immediately thereafter received an ephedrine infusion at a rate of 5 mg/min for the first 2 min and then 1 mg/min for the next 18 min. The incidence of hypotension was 15/27 (55%) in the crystalloid group and 6/27 (22%) in the infusion group (P < 0.05). There was no significant difference between the groups in relation to the level of anesthesia or maximal heart rate, and hypertension did not occur in either group. We conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia and compares favorably with crystalloid administration in this patient population in terms of efficacy and incidence of side effects.

Adult↗
PubMed1991

Transient blindness following epidural analgesia.

A 43-year-old woman was given an epidural injection of steroid mixed with local anaesthetic, under general anaesthesia, for treatment of low back pain. In the recovery room she complained of blindness in one eye. Fundoscopy revealed retinal and vitreous haemorrhages in both eyes. Retinal haemorrhages can be caused by an increase in intracranial pressure and are therefore a possible complication of epidural anaesthesia.

Adult↗