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International journal of obstetric anesthesia 02/2012; 21(2):195-6. · 1.85 Impact Factor
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ABSTRACT: Previous estimates for the end-tidal concentration of desflurane that allows removal of the laryngeal mask airway in 50% of anaesthetised adults (ED50) have ranged from 2.1% to 5.3%. To assess which value is correct, we studied 32 female patients (aged 30-50 years) undergoing intracavity caesium implants for cervical carcinoma under general anaesthesia. Anaesthesia was induced with propofol 2-3 mg.kg(-1) and maintained with desflurane in a 50% nitrous oxide-oxygen mixture. At the end of surgery, a predetermined target end-tidal desflurane concentration (starting at 4%) was maintained for 10 min using Dixon's up-down method and the laryngeal mask airway was removed. The target end-tidal concentration in the next patient was increased or decreased by 0.5% depending upon the response of the previous patient. Removal of the laryngeal mask airway without coughing, clenching, biting, movement or any adverse airway event during or within 1 min after removal was considered to be successful. We found that the laryngeal mask airway can be successfully removed in 50% (ED50) and 95% (ED95) of the anaesthetised adults at end-tidal desflurane concentrations of 2.4% (95% CI 1.3-2.9) and 3.8% (3.1-9.6), respectively.
Anaesthesia 09/2011; 66(9):808-11. · 2.96 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate haemodynamic stability, perioperative analgesia and neonatal outcome following intrathecal 0.5% bupivacaine 7.5 mg with varying doses of fentanyl, in parturients with pregnancy-induced hypertension. Forty-five parturients with pregnancy-induced hypertension scheduled for caesarean section were randomly allocated to receive 7.5 mg bupivacaine with saline 1 mL (group B), fentanyl 10 μg (group Bf10) or fentanyl 20 μg (group Bf20) intrathecally. Heart rate, blood pressure, and sensory block were recorded at regular intervals. Pain, nausea, vomiting, pruritus or any other side effects were sought. Neonatal outcome was assessed using Apgar score and umbilical artery blood gas analysis. Adequate surgical anaesthesia was established in all three groups. There was a statistically significant fall in mean arterial pressure in all three groups within 4-6 min of subarachnoid block (P < 0.05), but the decrease in MAP was <20% of baseline in all three groups. Pain and discomfort during surgery were experienced more frequently in group B than in groups Bf10 and Bf20 (P < 0.05). Duration of postoperative analgesia was significantly longer in group Bf20 (5.55 ± 1.18 h) than in group Bf10 (3.97 ± 2.12 h) and group B (3.27 ± 1.8 h) (P < 0.05). Neonatal outcome was similar in the three groups. Intrathecal fentanyl with low dose bupivacaine provides good surgical anaesthesia and prolongs the duration of analgesia without haemodynamic or neonatal compromise in patients with pregnancy-induced hypertension undergoing caesarean delivery.
International Journal of Obstetric Anesthesia.
