Neonatal acid-base status following general anesthesia for emergency abdominal delivery with halothane or isoflurane.

STUDY OBJECTIVE: To determine whether halothane or isoflurane as anesthesia for emergency abdominal delivery is associated with better fetal acid-base parameters. DESIGN: Randomized study. SETTING: Inpatient Level III perinatal referral center in a university hospital. PATIENTS: Sixty-six gravidas undergoing emergency abdominal delivery under general anesthesia for fetal distress. INTERVENTIONS: Randomization to receive halothane or isoflurane at 0.7 minimum alveolar concentration as part of a standard anesthetic technique. MEASUREMENTS AND MAIN RESULTS: Umbilical artery and vein blood gases were obtained and compared for hydrogen ion concentration, partial pressure of carbon dioxide, partial pressure of oxygen, and base deficit. There were no significant differences between the isoflurane and halothane groups. CONCLUSIONS: There is no difference in the frequency or severity of acidosis associated with isoflurane or halothane when used for general anesthesia for emergency abdominal delivery of a distressed fetus.

Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium.

STUDY OBJECTIVE: To determine the frequency of electroconvulsive therapy (ECT)-induced arrhythmias under methohexital, thiamylal, or thiopental sodium anesthesia with and without atropine premedication. DESIGN: A randomized, double-blind study, placebo-controlled for atropine. SETTING: The inpatient psychiatric unit at a university medical center. PATIENTS: Forty-nine patients scheduled for ECT. INTERVENTIONS: Atropine 0.6 mg intravenously (IV) or an equal volume of normal saline IV was given before IV induction of anesthesia with methohexital 0.5 to 1.0 mg/kg, thiamylal 1.5 to 2.5 mg/kg, or thiopental sodium 1.5 to 2.5 mg/kg. MEASUREMENTS AND MAIN RESULTS: Single-lead electrocardiogram (ECG) recordings were made for 1 minute before induction, during induction of anesthesia, and for 5 minutes after the ECT stimulus. Each ECG was evaluated for arrhythmias and evidence of ischemia in a blinded fashion. Blood pressure and ECG evidence of ischemia did not differ among the groups. Seizure duration was significantly (p less than 0.05) prolonged by a mean of 5 seconds during methohexital anesthesia compared with thiopental sodium and thiamylal (47.6 +/- 18.6 seconds, 42.7 +/- 13.2 seconds, and 42.7 +/- 15.2 seconds, respectively). The frequency of sinus bradycardia was decreased (p less than 0.05) with methohexital (8%) compared with thiopental sodium (20%) and thiamylal (20%). The frequency of premature atrial contractions was decreased (p less than 0.05) with methohexital (43%) compared with thiamylal (61%) but not with thiopental sodium (57%). The frequency of premature ventricular contractions was decreased (p less than 0.05) with methohexital (27%) compared with thiopental sodium (44%) but not with thiamylal (40%). Atropine decreased the frequency of bradycardia (9% vs. 24%) and premature atrial contractions (47% vs. 61%) and increased the frequency of sinus tachycardia (88% vs. 75%). CONCLUSIONS: These data suggest that anesthesia for ECT therapy should be induced with methohexital to minimize the possibility of potentially life-threatening cardiac arrhythmias. Atropine premedication may further decrease the frequency of premature atrial contractions and bradycardia, while increasing the frequency of tachycardia.

Intradermal anesthesia and comparison of intravenous catheter gauge.

A double-blinded randomized prospective study was performed to determine whether alkalinization of lidocaine decreases the pain of intradermal injection and if a larger intravenous catheter (16 gauge) causes more discomfort on insertion than a smaller (20 gauge) catheter when intradermal anesthesia has been used. In a random manner, 100 patients received skin wheals with commercially prepared lidocaine or lidocaine with the addition of sodium bicarbonate before the insertion of a 16- or 20-gauge intravenous catheter. Visual analogue pain scores were obtained after the skin wheal was placed and after the intravenous catheter was inserted. There was no statistically significant difference in pain scores between the two local anesthetic solutions. However, the catheter insertions pain scores were slightly, but statistically significantly larger in the 16-gauge group regardless of local anesthetic solution used. The addition of sodium bicarbonate to commercially prepared lidocaine does not decrease the pain associated with an intradermal skin wheal. There is a slight increase in patient discomfort upon insertion of a large-bore intravenous catheter, even with the prior use of local anesthetic.

Topical nasopharyngeal anaesthesia with vasoconstriction in preeclampsia-eclampsia.

We report the case of a 38-year-old eclamptic patient undergoing emergency Caesarean section who required awake nasotracheal intubation because of her massively swollen and lacerated tongue. Vasoconstriction, in addition to topical anaesthesia, was required due to thrombocytopaenia. The use of three per cent lidocaine with 0.125 per cent phenylephrine for anaesthesia and vasoconstriction is described with successful maternal and neonatal outcome.

Metastatic pain in the parturient: treatment with patient-controlled epidural sufentanil.

A 30-year-old primigravid woman presented at 28 weeks gestation with severe pain related to metastatic gastric carcinoma. Pain control was achieved with epidural sufentanil, administered via a patient-controlled analgesia pump, for 5 days, prior to caesarean delivery. Considerations in deciding the optimal therapeutic regime are discussed.

Spinal cord compression following labor and delivery with epidural analgesia.

Transient back pain is not uncommon during pregnancy and the postpartum period. Following an epidural anesthetic, back pain persisted in a postpartum patient beyond the expected period of soreness. Further diagnostic evaluation led to diagnosis and surgical decompression of a herniated thoracic disc.