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  • 1990-1994  (4)
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  • 1
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The efficacy of thoracic epidural sufentanil 50 μg was compared with lumbar epidural sufentanil 50 μg in 30 patients (n = 15 in each group) undergoing lateral thoracotomy. Sufentanil was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg-1 and thiopentone 2–5 mg.kg-1 intravenously. Anaesthesia, nitrous oxide 66%, halothane 0.3% and sufentanil 25 μg intravenously were given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre-operative value and heart rate exceeded 90 beat.min-1 in the absence of hypovolaemia, or when other autonomic or somatic signs were seen. Four patients in the thoracic epidural group and five in the lumbar epidural group needed supplementary sufentanil. Six patients in the thoracic epidural group and three in the lumbar epidural group each had a single hypotensive episode. Lumbar and thoracic epidural sufentanil are equally effective in contributing to intra-operative analgesia for lateral thoracotomy.
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  • 2
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The effects of epidural administration of alfentanil on the intravenous alfentanil dose requirements and the plasma concentrations required to suppress responses to surgical stimulation during nitrous oxide-oxygen-alfentanil anaesthesia in 20 patients undergoing lower abdominal surgery were studied. Before induction of anaesthesia, patients in one group (E) received an epidural injection of 1mg alfentanil, followed by an epidural infusion of alfentanil 0.2mg.h-1 until skin closure, whilst patients in the other group (C, control) received a continuous infusion of sodium chloride via a sham catheter in order to blind the main investigator to the treatment. Anaesthesia was induced and maintained with nitrous oxide (66%) in oxygen and a‘target’-controlled intravenous infusion of alfentanil. During surgery, the‘target’alfentanil concentration was increased or decreased according to patients’responses. The number of responses to surgical stimulation was smaller in patients from group E (median 1, range 0-3) than in patients from group C (median 4, range 1–15; p 〈 0.005), even though the alfentanil intravenous infusion rates were smaller in group E [mean (SD): 1.6(0.5)μg.kg-1min-1] than in group C [2.9(1.2)μg.kg-1min-1, p 〈 0.02]. Both the lowest concentrations associated with no response [133(40)ng.ml-1]and the highest concentrations associated with a response [155(65)ng.ml-1] in group E were lower than those in group C [238(100) ng.ml-1, p 〈 0.01 and 334(163) ng.ml-1, p 〈 0.05, respectively]. We concluded that epidural administration of alfentanil reduces intravenous alfentanil requirements during nitrous oxide-oxygen-alfentanil anaesthesia for lower abdominal surgery. The results indicate a spinal mechanism of action of epidural alfentanil.
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  • 3
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The plasma concentration-time profile of alfentanil following epidural administration was determined in eight patients undergoing lower abdominal surgery under nitrous oxide (66%)-oxygen (33%)-halothane (0.3%) anaesthesia, supplemented with intravenous sufentanil. Alfentanil (1 mg) was administered epidurally before induction of general anaesthesia. Blood samples for the determination of plasma alfentanil concentrations by capillary gas chromatography were collected at intervals until 12h after the epidural injection. Peak plasma concentrations [mean (SD)] were 9.7 (2.3)ng.ml-1, and were attained in a median (range) time of 90 (30-120) min. The results suggest that alfentanil is slowly absorbed from the epidural space into the general circulation.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The efficacy of thoracic epidural sufentanil 50 μg was compared with bupivacaine 0.5% with adrenaline 5 μg.ml-1 (dose 40 mg) or saline, in 30 patients (n = 10 in each group) undergoing lateral thoracotomy. Sufentanil, bupivacaine or saline was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg-1 and thiopentone 2–5 mg.kg-1. Anaesthesia was maintained with nitrous oxide 66% and halothane 0.3%. Supplementary sufentanil 25 μg was given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre-operative value, whenever heart rate exceeded 90 beat. Min-1 in the absence of hypovolaemia, or when other autonomic or somatic signs occurred. Fewer patients in the epidural sufentanil (n = 4, p 〈 0.005) and bupivacaine (n = 1, p 〈 0.001) groups required supplementary sufentanil compared to the placebo group, in which all patients needed supplementary sufentanil, but there was no statistical difference between the sufentanil and bupivacaine groups. One or more hypotensive episodes occurred in five patients in the sufentanil group, in all patients in the bupivacaine group and in no patient in the placebo group, and the differences were significant (p 〈 0.02).
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