ABSTRACT
This study investigated a means of controlling the altered physiologic effects that occur when tourniquet inflation time is > or = 50 min during orthopaedic surgery in children. Forty patients were assigned randomly, 20 in each group. Both groups received inhalational anesthesia for induction. The control group had nitrous/narcotic with inhalation anesthesia for maintenance. The other group received a sympathetic blockade with 0.5% epidural bupivacaine, which was confirmed with the use of thermography technique and supplemented with 0.5-1% isoflurane. Duration of surgery and length of tourniquet inflation time were equal in the two groups. There was a significant difference in physiologic changes related to the tourniquet inflation time. The group with sympathetic blockade had only minor changes in blood pressure, pulse rate, and temperature compared with the control group.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, Inhalation , Anesthetics, Local/therapeutic use , Autonomic Nerve Block/methods , Bupivacaine/therapeutic use , Tourniquets/adverse effects , Body Temperature , Child , Child, Preschool , Hemodynamics , Humans , Infant , Thermography , Time FactorsABSTRACT
STUDY DESIGN: Intraoperative recording of somatosensory-evoked potentials is useful for monitoring spinal cord tolerance during spinal fusion with instrumentation. Volatile anesthetic agents are known to have prominent suppressive effects on somatosensory-evoked potentials. This study evaluates the effect of intrathecal administration of opioid, consisting of morphine sulfate and sufentanil, on somatosensory-evoked potential monitoring. OBJECTIVES: To study the effect of different anesthesia techniques on somatosensory-evoked potentials during spinal fusion. SUMMARY OF BACKGROUND DATA: The effect of intravenous narcotic administration on somatosensory-evoked potentials has been well studied and reported. This study shows the effect of intrathecal opioids on somatosensory-evoked potentials. METHODS: Ten patients scheduled for spinal fusion with Cotrel-Dubousset instrumentation were induced with thiopental and maintained with intrathecal morphine sulfate (20 micrograms/kg) and sufentanil 50 micrograms, supplemented with isoflurane 0.5% air and oxygen. Routine monitoring was done, including arterial line and continuous somatosensory-evoked potentials. Anesthesia was maintained constant, with a mean blood pressure of 55 mm Hg. Normocarbia and normothermia were maintained. Baseline somatosensory-evoked potentials were recorded using bilateral posterior tibial nerve stimulation, with constant somatosensory-evoked potential monitoring after the induction of anesthesia. RESULTS: There were no significant changes in either latencies or amplitudes in cortical somatosensory-evoked potentials after opioid injection at any time during the surgical procedures. CONCLUSIONS: Somatosensory-evoked potential monitoring was possible in all patients undergoing extensive spinal surgery. Intrathecal opioid anesthesia with low concentrations of isoflurane in air and oxygen seems to have no effects on somatosensory-evoked potentials.
Subject(s)
Analgesics, Opioid/pharmacology , Evoked Potentials, Somatosensory/drug effects , Morphine/pharmacology , Scoliosis/surgery , Spinal Fusion , Sufentanil/pharmacology , Adolescent , Female , Humans , Injections, Spinal , Male , Monitoring, Intraoperative , Scoliosis/etiology , Scoliosis/physiopathologyABSTRACT
We compared epidural and patient-controlled analgesia using morphine for pain relief during the first 30 h after orthopaedic surgery to examine whether intermittent epidural morphine (EM) offered a clinical advantage over patient-controlled analgesia in children. Forty patients were assigned randomly to receive either EM or morphine by the patient-controlled analgesia technique. In the special care unit, trained observers evaluated the patient's level of postoperative pain with a standardized objective pain scale. The differences in pain scores among the groups were compared. The two groups were not significantly different in age, weight, duration of operation, or anesthesia. There was no significant difference in quality of pain relief except for the amount of medicine required to control postoperative pain and the incidence of side effects between the two groups.
Subject(s)
Analgesia, Epidural , Analgesia, Patient-Controlled , Bone Diseases/surgery , Pain, Postoperative/drug therapy , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Pain MeasurementABSTRACT
The hemodynamic and metabolic effects of unilateral tourniquet use were assessed in 30 children. Intraoperative hyperthermia, tachycardia, endtidal CO2, and lactic acid concentration were measured before and after tourniquet inflation. Maximum changes in temperature and pulse rate occurred in patients who had tourniquet application time lasting greater than 75 min. Lactate and endtidal CO2 levels were also significantly increased in the same group of patients.
