Efficacy and side effect profile of varying doses of intrathecal fentanyl added to bupivacaine for labor analgesia.

The purpose of this randomized, double blinded and controlled study was to determine the optimal dose of intrathecal fentanyl when combined with bupivacaine 2.5 mg for initiation of labor analgesia. Parous parturients with cervical dilation between 3 and 5 cm were randomized to receive intrathecal fentanyl 0 (control), 5, 10, 15, 20 or 25 micrograms, combined with bupivacaine 2.5 mg, followed by a lidocaine/epinephrine epidural test dose. Visual analog pain scores (VAPS) and the presence of side effects were determined every 15 min until the parturient requested additional analgesia. Fetal heart rate (FHR) tracings were compared between groups. All parturients who received fentanyl >/= 15 micrograms had VAPS < 20 mm and duration of analgesia > 15 min, but this was not true for all parturients with fentanyl doses < 15 micrograms. Duration of analgesia was shorter for fentanyl groups 0, 5 and 10 micrograms, compared to groups 15, 20 and 25 micrograms, but there was no difference between the 15, 20 and 25 micrograms groups. There was no difference in the incidence of nausea and vomiting, or in FHR tracing changes. The incidence of pruritus was greater in all fentanyl groups compared to control. These data suggest that, when combined with intrathecal bupivacaine 2.5 mg, fentanyl 15 micrograms provides satisfactory analgesia to all parturients. Higher fentanyl doses produced no additional benefit in duration or quality of analgesia.

The effect of lidocaine on bacterial growth in propofol.

UNLABELLED: Extrinsically contaminated propofol has been associated with multiple infectious complications. Injection of propofol is associated with pain that is diminished by the addition of lidocaine. Lidocaine has antibacterial properties at high concentrations, but low concentrations of lidocaine (0.1%) have not been studied. We examined the growth rates of Staphylococcus aureus, Serratia marcescens, Pseudomonas aeruginosa, and Candida albicans in propofol containing disodium edeteate with and without added lidocaine 0.1% 2, 5, and 24 h after inoculation. There was no significant difference in the number of colony-forming units between propofol with and without added lidocaine at any time after inoculation. IMPLICATIONS: The addition of lidocaine to propofol in concentrations clinically effective in reducing pain on injection had no effect on microbial growth. Adherence to strict aseptic technique is further emphasized.

Geographic factors and plasma selenium in uremia and dialysis.

The importance of selenium (Se) as an essential trace element for man has been increasingly recognized. Blood Se levels in chronic uremic patients are frequently reported to be lower than in controls. Definitive determination of the Se status in uremic patients, however, is hampered by the wide range of blood Se content in humans from different parts of the world. The present study was designed to assess and compare the Se status in two European populations from Rostock (Germany) and Chieti (Italy). Plasma Se levels were evaluated in healthy controls, chronic renal failure nondialyzed patients (CRF) and hemodialysis patients (HD). All Se determinations were performed in a single laboratory. The Se concentration was significantly higher (p < 0.005) in Italian healthy controls than in German healthy controls. In contrast, Se levels were similar in both CRF and HD patients from both cities. In both countries, the Se concentration in CRF and HD patients was significantly lower (p < 0.001) than in their corresponding controls, but no difference between CRF and HD was found. CRF and HD patients from the two countries showed quite similar laboratory and anthropometric data. In CRF patients in Chieti, a significant (p < 0.05) negative correlation between plasma Se and serum creatinine was found. In both HD groups, the length of time on HD and type of membrane dialyzer used did not influence the Se status. A significant positive correlation (p < 0.01) between Se levels and the protein catabolic rate was found in both HD groups. Uremia seems to be a strong factor which overrules the difference in Se levels that is present in healthy adults from different European countries. Uremia in itself may influence and level the Se concentration in patients with geographic diversity.