Subject(s)
Subcutaneous Emphysema/surgery , Accidental Falls , Airway Obstruction/surgery , Emergencies , Female , Humans , Middle AgedABSTRACT
Respiratory effects, nausea, somnolence, and pruritus were compared during a 48-hr period of continuous epidural morphine (n = 34) and fentanyl (n = 32) infusion in 66 patients following elective total replacement of the hip or knee joint. Respiratory effects were assessed by PaCO2. Side effects were assessed by visual analogue scale and considered to be present when the score was above 30. Assessment was made at preoperative visits then 3, 6, 12, 24, 36, and 48 hr after the epidural injection. The bolus dose and subsequent infusion rate were 3,900 +/- 1,300 micrograms and 427 +/- 213 micrograms.hr-1 for morphine, and 85 +/- 46 micrograms and 56 +/- 27 micrograms.hr-1 for fentanyl. Pain relief was similar in both groups. In the morphine group, PaCO2 elevation and nausea occurred over a period of more than 12 hr (P less than 0.05). In the fentanyl group, there was no PaCO2 change, and nausea was confined to the first few hours. Nausea was more severe (P less than 0.01 at six hours and more frequent (24 hr cumulative incidence, 53 vs 28%, P less than 0.05) in the morphine group. Somnolence was prominent within several hours in two-thirds of patients in both groups. Somnolence continued to decline thereafter in the morphine group, but it was demonstrable in approximately half of the patients throughout the second day in the fentanyl group. The incidence was higher in the fentanyl group at the 48th hr (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Analgesia, Epidural/adverse effects , Fentanyl/adverse effects , Morphine/adverse effects , Pain, Postoperative/prevention & control , Adult , Aged , Aged, 80 and over , Carbon Dioxide/metabolism , Female , Fentanyl/administration & dosage , Hip Prosthesis , Humans , Hypercapnia/chemically induced , Knee Prosthesis , Male , Middle Aged , Morphine/administration & dosage , Nausea/chemically induced , Pruritus/chemically induced , Respiration/drug effects , Respiratory Insufficiency/chemically induced , Sleep Stages/drug effects , Time FactorsABSTRACT
To assess cardiac sympathetic nervous function in diabetics, the heart rates attained following a pharmacological dose of intravenous atropine, 23 micrograms.kg-1, were studied under N2O, isoflurane anaesthesia in diabetics (n = 21) and nondiabetics (n = 30). Atropine-induced heart rate in diabetics was significantly lower than that in nondiabetics (95 +/- 14 (SD) bpm vs 109 +/- 12 bpm, P less than 0.001) and were closely related to preoperative orthostatic diastolic blood pressure change (r = 0.60, P less than 0.01). There was some correlation between the atropine-induced heart rate and preoperative RR-variation in diabetics (r = 0.50, P less than 0.05). The findings suggest that cardiac sympathetic function may also be impaired in diabetics with orthostatic hypotension.
