The Experts below are selected from a list of 3561 Experts worldwide ranked by ideXlab platform
A. Hak - One of the best experts on this subject based on the ideXlab platform.
-
British Journal of Anaesthesia 1994; 73: 458-463 Effect of ventilation on first-pass pulmonary retention of alfentanil and Sufentanil in patients undergoing coronary artery surgery
2016Co-Authors: F. Boer, J. G. Bovill, A. G. L. Burm, A. HakAbstract:We have studied, in 14 patients undergoing elective aorto-coronary bypass surgery, the effect of the type of ventilation on pulmonary retention of alfentanil and Sufentanil using a double indicator technique. Patients were allocated to one of two groups to receive either bolus doses of Sufentanil 33.2 ug (n = 6) or alfentanil 654 ug (n = 8), mixed with indocyanine green. In each patient, pulmonary first-pass retention was studied during apnoea (during the 1-min study period), normoventilation and positive end-expiratory pressure (10 mm Hg) ventilation, the order of which was randomized. After Sufentanil, mean (95 % confidence interval) first-pass pulmonary retention was 50.9(41.7-60.1) % during apnoea, 50.8 (42.9-58.8) % during normoventilation and 54.4 (43.7-65.0) % during positive end-expiratory pressure ventilation. After alfentanil, first-pass pulmonary retention was 18.7(5.4-32.0) % during apnoea, 19.9(8.3-31.5) % during normoventilation and 16.6(5.6-27.6) % during positive end-expiratory pressure ventilation. First-pass pulmonary retention of alfen-tanil and Sufentanil was not significantly affected by the type of ventilation. (Br. J. Anaesth. 1994
-
effect of ventilation on first pass pulmonary retention of alfentanil and Sufentanil in patients undergoing coronary artery surgery
BJA: British Journal of Anaesthesia, 1994Co-Authors: F. Boer, J. G. Bovill, A. G. L. Burm, A. HakAbstract:We have studied, in 14 patients undergoing elective aorto—coronary bypass surgery, the effect of the type of ventilation on pulmonary retention of alfentanil and Sufentanil using a double indicator technique. Patients were allocated to one of two groups to receive either bolus doses of Sufentanil 33.2 μg (n=6) or alfentanil 654 μg (n=8), mixed with indocyanine green. In each patient, pulmonary first-pass retention was studied during apnoea (during the 1-min study period), normoventilation and positive end-expiratory pressure (10 mm Hg) ventilation, the order of which was randomized. After Sufentanil, mean (95% confidence interval) first-pass pulmonary retention was 50.9 (41.7−60.1)% during apnoea, 50.8 (42.9−58.8)% during normoventilation and 54.4 (43.7−65.0)% during positive end-expiratory pressure ventilation. After alfentanil, first-pass pulmonary retention was 18.7 (5.4−32.0)% during apnoea, 19.9 (8.3−31.5)% during normoventilation and 16.6 (5.6−27.6)% during positive end-expiratory pressure ventilation. First-pass pulmonary retention of alfentanil and Sufentanil was not significantly affected by the type of ventilation.
Eugene Vandermeersch - One of the best experts on this subject based on the ideXlab platform.
-
intrathecal Sufentanil and fetal heart rate abnormalities a double blind double placebo controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor
Anesthesia & Analgesia, 2004Co-Authors: M Van De Velde, A Teunkens, Myriam Hanssens, Eugene Vandermeersch, Johan VerhaegheAbstract:Combined spinal epidural analgesia (CSE) for labor pain relief has become increasingly popular. However, the effect of intrathecal Sufentanil on the incidence of uterine hyperactivity and fetal heart rate (FHR) abnormalities remains controversial. We hypothesized that the use of intrathecal Sufentanil in a dose of 7.5 μg is more likely to induce a nonreassuring FHR tracing than a small dose of spinal Sufentanil combined with bupivacaine or epidural analgesia. Three-hundred parturients were randomized into three groups. In the first group, epidural analgesia was initiated with 12.5 mg of bupivacaine, 12.5 μg of epinephrine, and 7.5 μg of Sufentanil in a volume of 10 mL (EPD group). In Group 2, initial intrathecal analgesia consisted of 2.5 mg of bupivacaine, 2.5 μg of epinephrine, and 1.5 μg of Sufentanil (BSE group); in Group 3, spinal analgesia consisted of 7.5 μg of Sufentanil (SUF group). Analgesia was maintained in all groups with patient-controlled epidural analgesia using bupivacaine 0.125%, 1.25 μg/mL of epinephrine, and 0.75 μg/mL of Sufentanil (bolus, 4 mL; lockout, 15 min). Cardiotocography was monitored continuously 15 min before analgesia and for 60 min after the start of analgesia. The quality of analgesia, labor, and neonatal outcome and side effects were recorded. Twenty-four percent of patients in the SUF group developed FHR abnormalities (bradycardia or late decelerations) during the first hour after initiation of analgesia compared with 12% in the BSE group and 11% in the EPD group. Uterine hyperactivity occurred in 12% of parturients in the SUF group but in only 2% in the other groups. Onset of analgesia was more rapid in both CSE groups as compared with the EPD group. However, 29% of patients in the BSE group developed severe hypotension, requiring IV ephedrine (29% in the BSE group versus 7% and 12% in the EPD and SUF groups, respectively). All these differences reached statistical significance. The present data corroborate previous recommendations of caution when performing CSE using a large dose (7.5 μg or more) of spinal Sufentanil because of the risk of uterine hyperactivity and FHR abnormalities.
-
fetal heart rate abnormalities after regional analgesia for labor pain the effect of intrathecal opioids
Regional Anesthesia and Pain Medicine, 2001Co-Authors: M Van De Velde, Marcel Vercauteren, Eugene VandermeerschAbstract:Abstract Background and Objectives: Intrathecal opioids used to relieve labor pain have been associated with uterine hyperactivity and nonreassuring fetal heart rate abnormalities. We retrospectively evaluated all charts of singleton, term, vertex-presenting parturients in active labor requesting neuraxial pain relief during a 1-year period for the occurrence of nonreassuring fetal heart rate tracings. Methods: Three different strategies to relieve labor pain were routinely used in our department: conventional epidural using 10 mL bupivacaine 0.125% and Sufentanil 0.75 μg/mL; combined spinal and epidural (CSE) using intrathecal Sufentanil (7.5 μg); and CSE using intrathecal bupivacaine (2.5 mg) and Sufentanil (1.5 μg). Charts (n = 1,293) were evaluated for nonreassuring fetal heart tracings and uterine hyperactivity as well as for neonatal and labor outcome. Results: Intrathecal Sufentanil (7.5 μg) produced significantly more nonreassuring tracings and uterine hyperactivity. However, this did not result in more cesarean deliveries or detrimental neonatal outcome. Conclusion: Based on this retrospective analysis, we conclude that intrathecal Sufentanil in a dose of 7.5 μg has the potential to result in more nonreassuring fetal heart rate tracings compared with both intrathecal analgesia using a bupivacaine (2.5 mg)/Sufentanil (1.5 μg) mixture and epidural analgesia using bupivacaine, Sufentanil, and epinephrine. Reg Anesth Pain Med 2001;26:257-262.
Sanjay Datta - One of the best experts on this subject based on the ideXlab platform.
-
intrathecal ropivacaine for labor analgesia a comparison with bupivacaine
Anesthesia & Analgesia, 1998Co-Authors: Aaron Levin, Sanjay Datta, William CamannAbstract:Ropivacaine has less potential for central nervous system and cardiovascular toxicity than bupivacaine; in pregnant patients and volunteers, it produces less motor block in equianalgesic doses than bupivacaine.We compared two doses of intrathecal ropivacaine combined with Sufentanil with a standard dose of intrathecal bupivacaine plus Sufentanil for labor analgesia using a combined spinal-epidural (CSE) technique. In a prospective, randomized, double-blind fashion, 48 patients requesting labor analgesia received either 2.5 mg of intrathecal bupivacaine plus Sufentanil 10 [micro sign]g (B), 2 mg of intrathecal ropivacaine plus Sufentanil 10 [micro sign]g (R2), or 4 mg of intrathecal ropivacaine plus Sufentanil 10 [micro sign]g (R4). Duration of analgesia and side effects, such as motor block, pruritus, hypotension, ephedrine requirements and fetal bradycardia, were recorded. Duration of analgesia (mean +/- SD) was 79 +/- 30 min for R2, 98 +/- 19 min for R4, and 92 +/- 38 min for B (P = not significant). No differences in motor block or side effects were detected among the groups. We conclude that ropivacaine, when combined with Sufentanil, is effective for providing CSE labor analgesia and offers no advantage over bupivacaine in the studied doses. Implications: In this study, we compared a standard dose of intrathecal bupivacaine with Sufentanil for combined spinal epidural analgesia with two doses of the new local anesthetic ropivacaine. Both local anesthetics provided similar labor analgesia duration with equivalent side effect profiles in the doses studied. (Anesth Analg 1998;87:624-7)
-
the addition of bupivacaine to intrathecal Sufentanil for labor analgesia
Anesthesia & Analgesia, 1995Co-Authors: David Campbell, William Camann, Sanjay DattaAbstract:We designed a prospective, randomized, double-blind study to evaluate the efficacy of the combination of intrathecal Sufentanil with a low dose of local anesthetic in an attempt to prolong analgesia in labor. Fifty-two patients received one of the following intrathecal study solutions: 2.5 mg of bupivacaine; 10 micrograms of Sufentanil; or 2.5 mg of bupivacaine plus 10 micrograms of Sufentanil. The mean duration of analgesia (min +/- SD) was significantly different among all three groups: 70 +/- 34 min for bupivacaine, 114 +/- 26 min for Sufentanil, and 148 +/- 27 min for bupivacaine-Sufentanil (P < 0.001). Visual analog scale (VAS) scores for pain were significantly higher in the bupivacaine group compared to both the Sufentanil group and the bupivacaine-Sufentanil group (P < 0.02), and were significantly higher in the Sufentanil group compared to bupivacaine-Sufentanil at 75 min postinjection and beyond (P < 0.02). Hypotension was not observed in the Sufentanil group but occurred transiently in the other two groups (P = 0.09). There was no evidence of motor blockade, excessive somnolence, fetal heart rate (FHR) abnormalities, or postdural puncture headache (PDPH) in any of the patients. The addition of 2.5 mg of bupivacaine to 10 micrograms of intrathecal Sufentanil significantly prolonged labor analgesia without adverse maternal or fetal effects.
-
intrathecal Sufentanil for labor analgesia effects of added epinephrine
Anesthesiology, 1993Co-Authors: William Camann, Beth H Minzter, Roger A Denney, Sanjay DattaAbstract:Background Intrathecal Sufentanil has been found to provide profound analgesia during labor. Epinephrine, when added to various local anesthetic agents or opioids, may modify the analgesic profile and incidence of side effects. The authors sought to determine the effect of adding 0.2 mg epinephrine to 10 micrograms Sufentanil when administered for analgesia during labor. Methods Forty women during active labor received 10 micrograms intrathecal Sufentanil either with (n = 20) or without (n = 20) 0.2 mg epinephrine in a randomized, blinded fashion. A combined spinal-epidural technique was used in which a 25-G Whitacre spinal needle was passed through a standard 17-G epidural needle. After injection of the study drug, an epidural catheter was passed, but no local anesthetics were given. Analgesia was quantitated using visual analog scores, as well as time elapsed until first request for additional analgesia via the epidural catheter (0.25% bupivacaine). The incidence and severity of pruritus, nausea, and somnolence were assessed. Results The duration (median, range) of analgesia was 90 (40-310) min in the plain Sufentanil group (SUF) and 90 (45-230) min in the Sufentanil-epinephrine (SUF-EPI) group (P = NS). The onset of analgesia was rapid (within 5 min) in both groups and visual analog scores did not differ at any observation point between groups. The incidence of pruritus was 80% (16/20) in the SUF group, and 45% (9/20) in the SUF-EPI group (P = 0.05). Four patients in the SUF group rated the pruritus as severe versus none in the SUF-EPI groups (P = 0.05). Seven patients (35%) in the SUF-EPI group experienced nausea, versus none in the SUF group (P = 0.004). No patient developed hypotension, motor blockade, fetal heart rate abnormalities, excessive sedation, or postdural puncture headache. Conclusions Intrathecal Sufentanil 10 micrograms, both with and without epinephrine, provided rapid-onset, albeit short-duration, analgesia during labor. Epinephrine did not prolong the duration of intrathecal Sufentanil analgesia. The addition of epinephrine increased the incidence of nausea and decreased the incidence and severity of pruritus.
M Van De Velde - One of the best experts on this subject based on the ideXlab platform.
-
intrathecal Sufentanil and fetal heart rate abnormalities a double blind double placebo controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor
Anesthesia & Analgesia, 2004Co-Authors: M Van De Velde, A Teunkens, Myriam Hanssens, Eugene Vandermeersch, Johan VerhaegheAbstract:Combined spinal epidural analgesia (CSE) for labor pain relief has become increasingly popular. However, the effect of intrathecal Sufentanil on the incidence of uterine hyperactivity and fetal heart rate (FHR) abnormalities remains controversial. We hypothesized that the use of intrathecal Sufentanil in a dose of 7.5 μg is more likely to induce a nonreassuring FHR tracing than a small dose of spinal Sufentanil combined with bupivacaine or epidural analgesia. Three-hundred parturients were randomized into three groups. In the first group, epidural analgesia was initiated with 12.5 mg of bupivacaine, 12.5 μg of epinephrine, and 7.5 μg of Sufentanil in a volume of 10 mL (EPD group). In Group 2, initial intrathecal analgesia consisted of 2.5 mg of bupivacaine, 2.5 μg of epinephrine, and 1.5 μg of Sufentanil (BSE group); in Group 3, spinal analgesia consisted of 7.5 μg of Sufentanil (SUF group). Analgesia was maintained in all groups with patient-controlled epidural analgesia using bupivacaine 0.125%, 1.25 μg/mL of epinephrine, and 0.75 μg/mL of Sufentanil (bolus, 4 mL; lockout, 15 min). Cardiotocography was monitored continuously 15 min before analgesia and for 60 min after the start of analgesia. The quality of analgesia, labor, and neonatal outcome and side effects were recorded. Twenty-four percent of patients in the SUF group developed FHR abnormalities (bradycardia or late decelerations) during the first hour after initiation of analgesia compared with 12% in the BSE group and 11% in the EPD group. Uterine hyperactivity occurred in 12% of parturients in the SUF group but in only 2% in the other groups. Onset of analgesia was more rapid in both CSE groups as compared with the EPD group. However, 29% of patients in the BSE group developed severe hypotension, requiring IV ephedrine (29% in the BSE group versus 7% and 12% in the EPD and SUF groups, respectively). All these differences reached statistical significance. The present data corroborate previous recommendations of caution when performing CSE using a large dose (7.5 μg or more) of spinal Sufentanil because of the risk of uterine hyperactivity and FHR abnormalities.
-
fetal heart rate abnormalities after regional analgesia for labor pain the effect of intrathecal opioids
Regional Anesthesia and Pain Medicine, 2001Co-Authors: M Van De Velde, Marcel Vercauteren, Eugene VandermeerschAbstract:Abstract Background and Objectives: Intrathecal opioids used to relieve labor pain have been associated with uterine hyperactivity and nonreassuring fetal heart rate abnormalities. We retrospectively evaluated all charts of singleton, term, vertex-presenting parturients in active labor requesting neuraxial pain relief during a 1-year period for the occurrence of nonreassuring fetal heart rate tracings. Methods: Three different strategies to relieve labor pain were routinely used in our department: conventional epidural using 10 mL bupivacaine 0.125% and Sufentanil 0.75 μg/mL; combined spinal and epidural (CSE) using intrathecal Sufentanil (7.5 μg); and CSE using intrathecal bupivacaine (2.5 mg) and Sufentanil (1.5 μg). Charts (n = 1,293) were evaluated for nonreassuring fetal heart tracings and uterine hyperactivity as well as for neonatal and labor outcome. Results: Intrathecal Sufentanil (7.5 μg) produced significantly more nonreassuring tracings and uterine hyperactivity. However, this did not result in more cesarean deliveries or detrimental neonatal outcome. Conclusion: Based on this retrospective analysis, we conclude that intrathecal Sufentanil in a dose of 7.5 μg has the potential to result in more nonreassuring fetal heart rate tracings compared with both intrathecal analgesia using a bupivacaine (2.5 mg)/Sufentanil (1.5 μg) mixture and epidural analgesia using bupivacaine, Sufentanil, and epinephrine. Reg Anesth Pain Med 2001;26:257-262.
William Camann - One of the best experts on this subject based on the ideXlab platform.
-
intrathecal ropivacaine for labor analgesia a comparison with bupivacaine
Anesthesia & Analgesia, 1998Co-Authors: Aaron Levin, Sanjay Datta, William CamannAbstract:Ropivacaine has less potential for central nervous system and cardiovascular toxicity than bupivacaine; in pregnant patients and volunteers, it produces less motor block in equianalgesic doses than bupivacaine.We compared two doses of intrathecal ropivacaine combined with Sufentanil with a standard dose of intrathecal bupivacaine plus Sufentanil for labor analgesia using a combined spinal-epidural (CSE) technique. In a prospective, randomized, double-blind fashion, 48 patients requesting labor analgesia received either 2.5 mg of intrathecal bupivacaine plus Sufentanil 10 [micro sign]g (B), 2 mg of intrathecal ropivacaine plus Sufentanil 10 [micro sign]g (R2), or 4 mg of intrathecal ropivacaine plus Sufentanil 10 [micro sign]g (R4). Duration of analgesia and side effects, such as motor block, pruritus, hypotension, ephedrine requirements and fetal bradycardia, were recorded. Duration of analgesia (mean +/- SD) was 79 +/- 30 min for R2, 98 +/- 19 min for R4, and 92 +/- 38 min for B (P = not significant). No differences in motor block or side effects were detected among the groups. We conclude that ropivacaine, when combined with Sufentanil, is effective for providing CSE labor analgesia and offers no advantage over bupivacaine in the studied doses. Implications: In this study, we compared a standard dose of intrathecal bupivacaine with Sufentanil for combined spinal epidural analgesia with two doses of the new local anesthetic ropivacaine. Both local anesthetics provided similar labor analgesia duration with equivalent side effect profiles in the doses studied. (Anesth Analg 1998;87:624-7)
-
the addition of bupivacaine to intrathecal Sufentanil for labor analgesia
Anesthesia & Analgesia, 1995Co-Authors: David Campbell, William Camann, Sanjay DattaAbstract:We designed a prospective, randomized, double-blind study to evaluate the efficacy of the combination of intrathecal Sufentanil with a low dose of local anesthetic in an attempt to prolong analgesia in labor. Fifty-two patients received one of the following intrathecal study solutions: 2.5 mg of bupivacaine; 10 micrograms of Sufentanil; or 2.5 mg of bupivacaine plus 10 micrograms of Sufentanil. The mean duration of analgesia (min +/- SD) was significantly different among all three groups: 70 +/- 34 min for bupivacaine, 114 +/- 26 min for Sufentanil, and 148 +/- 27 min for bupivacaine-Sufentanil (P < 0.001). Visual analog scale (VAS) scores for pain were significantly higher in the bupivacaine group compared to both the Sufentanil group and the bupivacaine-Sufentanil group (P < 0.02), and were significantly higher in the Sufentanil group compared to bupivacaine-Sufentanil at 75 min postinjection and beyond (P < 0.02). Hypotension was not observed in the Sufentanil group but occurred transiently in the other two groups (P = 0.09). There was no evidence of motor blockade, excessive somnolence, fetal heart rate (FHR) abnormalities, or postdural puncture headache (PDPH) in any of the patients. The addition of 2.5 mg of bupivacaine to 10 micrograms of intrathecal Sufentanil significantly prolonged labor analgesia without adverse maternal or fetal effects.
-
intrathecal Sufentanil for labor analgesia effects of added epinephrine
Anesthesiology, 1993Co-Authors: William Camann, Beth H Minzter, Roger A Denney, Sanjay DattaAbstract:Background Intrathecal Sufentanil has been found to provide profound analgesia during labor. Epinephrine, when added to various local anesthetic agents or opioids, may modify the analgesic profile and incidence of side effects. The authors sought to determine the effect of adding 0.2 mg epinephrine to 10 micrograms Sufentanil when administered for analgesia during labor. Methods Forty women during active labor received 10 micrograms intrathecal Sufentanil either with (n = 20) or without (n = 20) 0.2 mg epinephrine in a randomized, blinded fashion. A combined spinal-epidural technique was used in which a 25-G Whitacre spinal needle was passed through a standard 17-G epidural needle. After injection of the study drug, an epidural catheter was passed, but no local anesthetics were given. Analgesia was quantitated using visual analog scores, as well as time elapsed until first request for additional analgesia via the epidural catheter (0.25% bupivacaine). The incidence and severity of pruritus, nausea, and somnolence were assessed. Results The duration (median, range) of analgesia was 90 (40-310) min in the plain Sufentanil group (SUF) and 90 (45-230) min in the Sufentanil-epinephrine (SUF-EPI) group (P = NS). The onset of analgesia was rapid (within 5 min) in both groups and visual analog scores did not differ at any observation point between groups. The incidence of pruritus was 80% (16/20) in the SUF group, and 45% (9/20) in the SUF-EPI group (P = 0.05). Four patients in the SUF group rated the pruritus as severe versus none in the SUF-EPI groups (P = 0.05). Seven patients (35%) in the SUF-EPI group experienced nausea, versus none in the SUF group (P = 0.004). No patient developed hypotension, motor blockade, fetal heart rate abnormalities, excessive sedation, or postdural puncture headache. Conclusions Intrathecal Sufentanil 10 micrograms, both with and without epinephrine, provided rapid-onset, albeit short-duration, analgesia during labor. Epinephrine did not prolong the duration of intrathecal Sufentanil analgesia. The addition of epinephrine increased the incidence of nausea and decreased the incidence and severity of pruritus.
