Caudal epidural blocks for elderly patients with lumbar canal stenosis.

Objective: To determine the efficacy of caudal epidural blocks (CEB) in relieving pain and the duration of pain relief with CEB in elderly patients suffering from degenerative lumbar canal stenosis (LCS).

Design: This study was a descriptive, prospective study with a 10-month follow-up.

Participants And Setting: Thirty patients, 76 +/- 6.

Autologous blood transfusion and intraoperative cell salvage in a patient with homozygous sickle cell disease.

Background: Autologous transfusion can eliminate the need for homologous transfusions. In addition, hypotensive anesthesia and devices that salvage red blood cells for return to the patient can reduce operative blood loss. However, blood from patients with sickle cell disease is difficult to store.

Vancomycin does not enhance hypotension under anesthesia.

The rapid administration of vancomycin is associated with flushing and hypotension, a consequence of histamine release. The manufacturer discourages administering vancomycin to anesthetized patients, stating that vancomycin aggravates the hypotensive effects of anesthetics. To test this, we randomly assigned 36 adults (ASA classes I through III) to one of two groups: preinduction (Preind, n = 19) and postinduction (Postind, n = 17).

Evaluation and treatment of chronic intractable rectal pain--a frustrating endeavor.

A study was undertaken to assess the evaluation and treatment of chronic intractable rectal pain. Sixty consecutive patients, 23 males and 37 females with a mean age of 69 (range, 29-87) years and a mean length of symptoms of 4.5 years, were evaluated by questionnaire, office examination, anal manometry, electromyography, cinedefecography, and pudendal nerve study.

Efficacy of intermittent epidural morphine following posterior spinal fusion in children and adolescents.

Postoperative pain is a distressing and disabling feature of scoliosis surgery. Epidural morphine has recently been advocated to reduce the frequency and severity of postoperative pain in adults. A retrospective study of 35 patients was conducted to determine whether epidural administration of morphine is useful in the management of postoperative pain in children and adolescents following posterior spinal fusion.

Epidural analgesia for total hip replacement in a patient with dilated cardiomyopathy.

A 69-year-old patient with severe impairment of left ventricular function secondary to dilated cardiomyopathy underwent a successful total hip replacement under epidural analgesia. Perioperative heart rate and mean arterial pressure were stable at an analgesic level up to the seventh thoracic dermatome, achieved with mepivacaine two per cent with epinephrine. Asymptomatic pulmonary hypertension, occurring during the insertion of the femoral prosthesis, subsided spontaneously over the next twelve hours.

Evaluation of creatinine phosphokinase screening as a predictor of malignant hyperthermia. A prospective study.

The efficiency, sensitivity and specificity of measurements of serum creatinine phosphokinase in the screening of malignant hyperthermia-susceptible patients in routine clinical practice has been examined. Although the overall efficiency of this screening method was high, the predictive value of a positive test in the ambulatory surgical population was poor.

Trimethaphan camsylate (Arfonad) and human plasma cholinesterase.

These results for the first time document that the brief duration of action of the ganglionic blocker, Arfonad (trimethaphan camsylate), is not due to inactivation by plasma cholinesterase. Inhibition of the enzyme in vitro by Arfonad was not altered by prior incubation of the drug in plasma at 37 degrees C for up to 16 hours nor by treatment with NaOH at 100 degrees C for 10 minutes. Both procedures inactivated succinylcholine.

Ethanol effects on active and passive Na+ flux in toad bladder.

Ethanol, like other anesthetics, has been reported to interfere with active Na+ transport in living membranes. In an attempt to elucidate the mechanism by which ethanol exerts this action, we tested in the toad bladder membrane: 1) the effect of ethanol on active Na+ transport, 2) the interaction of ethanol with vasopressin on Na+ transport, and 3) the effect of ethanol on passive Na+ flux. We found that, a) 1-500 microgram/ml of ethanol stimulated, and 10,000 microgram/ml depressed active Na+ transport; b) the combined effect of stimulating concentrations of ethanol and vasopressin, although suggestive of a positive interaction, might have arisen by chance (p = 0.

The effect of general anesthetic agents, ouabain, and aldosterone on striated muscle contraction in toad.

Na+ and K+ transport, resting potentials, action potentials, and muscle contraction are interrelated in the excitation-contraction coupling process. Since anesthetics affect the electrogenic Na+ transport mechanism in the toad bladder model and the coupled Na+, K+ transport in muscle, the authors tested the hypothesis that the effects of inhalation anesthetics on ion transport and muscle contraction are parallel. In this study, the effects were assessed of 4 inhalation anesthetics and, for comparison, the effects of ouabain and aldosterone, on contractions of toad sartorius muscle.

Relation of anesthesia to total hip replacement and control of operative blood loss.

Blood loss during total hip replacement has been reported as ranging from 500 to more than 4000 ml. To find reasons for this large variation, 167 case reports were studied. Blood loss was higher with nitrous oxide-oxygen-curare-morphine aneasthesia than with halothane-nitrous oxide-oxygen.