B. L.K. Mokriski

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.

Effect of Epinephrine on Intrathecal Fentanyl Analgesia in Patients Undergoing Postpartum Tubal Ligation

Eighty women receiving spinal anesthesia for postpartum tubal ligation were entered into a double-blind, randomized protocol studying the effects of epinephrine on intrathecal fentanyl-induced postoperative analgesia. All patients received 70 mg hyperbaric lidocaine with either 0.2 mg epinephrine (LE), 10 micrograms fentanyl (LF), epinephrine and fentanyl (LFE), or 0.4 ml saline (L). Onset and regression of anesthesia, degree of intraoperative comfort, incidence of pruritus, and extent of postoperative analgesia were evaluated. The simultaneous administration of epinephrine and fentanyl prolonged the duration of complete analgesia (137 +/- 47 min (LFE); 76 +/- 32 min (LE); 85 +/- 44 min (LF); 65 +/- 36 min (L)) and the duration of effective analgesia (562 +/- 504 min (LFE); 227 +/- 201 min (LE); 203 +/- 178 min (LF); 198 +/- 342 min (L)). Administration of epinephrine decreased the incidence of pruritus associated with intrathecal fentanyl (1/18 (LFE); 1/21 (LE); 8/19 (LF); 2/19 (L)).

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.

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. Theuseof three per cent lidocaine with 0.125 per cent phenylephrine for anaesthesia and vasoconstriction is described with successful maternal and neonatal outcome.RésuméOn rapporte le cas ďune patiente àgée de 38 ans atteinte ďéclampsie devant subir une césarienne ďurgence et requérant une intubation nasotrachéale éveillée à cause ďune lacération et ďun oedème massif de sa langue. Une vasoconstriction était requise à cause ďune thrombocytopénic. Ľutilisation ďune solution de lidocaïne à trois pour cent avec 0.125 pour cent de phényléphrine pour ľanésthésie et la vasoconstriction est décrite amenant une issue favorable tant maternelle que néonatale.

Choice of Local Anesthetic Affects Post-Cesarean Epidural Fentanyl Analgesia

&NA; This prospective, randomized study compared the analgesia obtained after the epidural injection of fentanyl (50 μg) after 0.5% bupivacaine, 2% lidocaine with epinephrine 1:200,000, or 3% 2‐chloroprocaine anesthesia for cesarean section. Satisfactory analgesia was obtained for up to 45 minutes mean duration after the loss of sensory anesthesia after bupivacaine and lidocaine. Analgesia following 2‐chloroprocaine anesthesia did not extend beyond the regression of sensory anesthesia to pinprick. Alkalinization of the 2‐chloroprocaine to a pH of 7.09 did not lengthen the duration of analgesia.

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.

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.