ABSTRACT
BACKGROUND: Few studies have been published concerning the excretion of bupivacaine and lidocaine into the breast milk and none concerning ropivacaine. AIM: The aim of this study was to determine the levels of ropivacaine in plasma and breast milk after combined spinal-epidural anesthesia for cesarean delivery and postoperative patient-controlled epidural analgesia (PCEA), as well as possible adverse effects from these levels on the neonate. METHODS: Twenty-five parturients admitted for cesarean delivery under combined spinal-epidural anesthesia participated in the study. The PCEA regimen was prepared as 0.15% ropivacaine and fentanyl 2 microg/mL (basal rate, 6 mL/h; demand dose, 4 mL/20 min). Blood samples were collected before anesthesia and from the umbilical cord immediately after birth, followed by blood and breast milk samples 18 and 24 hrs after initiation of PCEA. The newborns were clinically appraised with the Apgar score at delivery and Neurological and Adaptive Capacity Score 24 hrs later. Local anesthetic side effects were recorded. Ropivacaine levels were determined by high-performance liquid chromatography with a UV detector. RESULTS: Ropivacaine excretion into the breast milk produced concentrations that significantly correlated with those in the plasma 18 and 24 hrs after administration, achieving milk-plasma ratios (mean +/- SD) of 0.25 +/- 0.08 and 0.23 +/- 0.07, respectively. Most newborns had maximal Apgar and Neurological and Adaptive Capacity Scores. No adverse effects from ropivacaine were noted in mothers or neonates. CONCLUSIONS: The milk-plasma concentration ratio of ropivacaine was found to be lower than that reported for other local anesthetics It seems that PCEA with ropivacaine/fentanyl after cesarean delivery is not associated with excessive milk-plasma concentrations of ropivacaine.
Subject(s)
Amides/pharmacokinetics , Analgesia, Patient-Controlled/methods , Anesthetics, Local/pharmacokinetics , Milk, Human/metabolism , Adult , Amides/administration & dosage , Amides/blood , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Anesthetics, Local/administration & dosage , Apgar Score , Cesarean Section , Female , Fentanyl/administration & dosage , Humans , Infant, Newborn , Middle Aged , Pregnancy , Ropivacaine , Young AdultABSTRACT
STUDY OBJECTIVE: To examine the efficacy of mannitol in the prevention of lipid peroxidation during major liver resections performed during hepatic inflow occlusion. DESIGN: Prospective, randomized, open-label study. SETTING: Aretaieion Hospital, a university-affiliated hospital. PATIENTS: 30 ASA physical status II and III patients, less than 75 years of age, scheduled for elective liver resection. INTERVENTIONS: All patients received combined general and epidural anesthesia. Laparotomy was performed through a bilateral subcostal incision, and hepatectomy was performed by inflow vascular exclusion (Pringle's maneuver). Before this maneuver, and if the patients were hemodynamically stable, they were randomized to receive either mannitol 20% 1.5 mL kg(-1) (group M) or normal saline 1.5 mL kg(-1) (group S) intravenously for 30 minutes. MEASUREMENTS: Venous blood malondialdehyde (MDA) concentration, as an index of lipid peroxidation, was measured spectrophotometrically at selected time points. MAIN RESULTS: Patients in both groups presented with raised MDA values (P < 0.05) for the period starting before the release of vascular occlusion until 6 days postoperatively. In patients receiving mannitol, lower MDA values were observed (P < 0.05) compared with group S at the end of operation. CONCLUSION: Mannitol has an antioxidant activity, but we were unable to confirm a positive impact on the postoperative clinical course.
Subject(s)
Diuretics, Osmotic/pharmacology , Hemostasis, Surgical/methods , Hepatectomy/methods , Lipid Peroxidation/drug effects , Mannitol/pharmacology , Adolescent , Adult , Aged , Analysis of Variance , Anesthesia, Epidural/methods , Anesthesia, General/methods , Aspartate Aminotransferases/blood , Bilirubin/blood , Female , Humans , Liver Circulation/drug effects , Male , Malondialdehyde/blood , Middle Aged , Prospective Studies , Prothrombin Time/methods , Sodium Chloride/administration & dosage , Time Factors , Treatment OutcomeABSTRACT
We studied the effects of sevoflurane, remifentanil hydrochloride, and alfentanil anesthesia in terms of the hemodynamic responses and emergence characteristics of patients scheduled for elective microlaryngeal surgery. Sixty patients (ASA I to III) were randomly allocated into 2 groups: group S-R (sevoflurane-remifentanil) and group S-A (sevoflurane-alfentanil; 1:20 and 1:4 ratios of remifentanil to alfentanil for induction and maintenance of anesthesia, respectively; doses not strictly equipotent). The mean arterial pressure and heart rate were measured before and after induction of anesthesia, 1 and 3 minutes after endotracheal intubation, at the insertion of the operating laryngoscope, and every 3 minutes during surgery. The emergence times and side effects during the first 30 minutes after surgery were also recorded. The mean arterial pressure values at the insertion of the operating laryngoscope and throughout the procedure were significantly greater (p < .05) in group S-A than in group S-R. The emergence times and postoperative side effects did not differ, except for the greater pain score (p < .05) in group S-R. In conclusion, sevoflurane with remifentanil seems to maintain cardiovascular stability during microlaryngeal surgery more effectively than sevoflurane with alfentanil. Both anesthetic regimens seem to provide rapid and uneventful emergence.
