Dose-response relationship of intrathecal morphine for postcesarean analgesia.

Abstract:

BACKGROUND:This series investigated the quality of analgesia and the incidence and severity of side effects of intrathecal morphine for post-cesarean analgesia administered over a dose range of 0.0-0.5 mg. METHODS:ONE hundred eight term parturients undergoing cesarean delivery at term and given spinal anesthesia were randomized to receive a single dose of intrathecal morphine (0.0, 0.025, 0.05, 0.075, 0.1, 0.2, 0.3, 0.4, or 0.5 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. PCA morphine use, incidence and severity of side effects, and need for treatment interventions were recorded for 24 h. Data were analyzed with analysis of variance and linear regression analysis for trends among groups. RESULTS:Patient-controlled analgesia use differed significantly between groups; PCA use was higher in the control group than in groups receiving 0.075, 0.1, 0.3, 0.4, or 0.5 mg. Twenty-four-hour PCA morphine use was 45.7 mg lower (95% CI, 4.8-86.6 mg lower) in the 0.075-mg group than the control group. There was no difference in PCA morphine use between the 0.075- and 0.5-mg groups (95% CI, 36.8 mg lower to 45.0 mg higher); despite a fivefold increase in intrathecal morphine dose, PCA morphine use remained constant. There was no difference between control and treatment groups or among treatment groups with respect to nausea and vomiting. Pruritus and the need for treatment interventions increased in direct proportion to the dose of intrathecal morphine (linear regression, P = 0.001 and P = 0.0002, respectively). CONCLUSIONS:These data indicate there is little justification for use of more than 0.1 mg for post-cesarean analgesia. For optimal analgesia, augmentation [corrected] of intrathecal morphine with systemic opioids may be necessary.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Palmer CM,Emerson S,Volgoropolous D,Alves D

doi

10.1097/00000542-199902000-00018

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

437-44

issue

2

eissn

0003-3022

issn

1528-1175

journal_volume

90

pub_type

临床试验,杂志文章,随机对照试验
  • Pulmonary blood flow redistribution with low levels of positive end-expiratory pressure.

    abstract:BACKGROUND:Recent studies have questioned the importance of the gravitational model of pulmonary perfusion. Because low levels of positive end-expiratory pressure (PEEP) are commonly used during anesthesia, the authors studied the distribution of pulmonary blood flow with low levels of PEEP using a high spatial resolut...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199805000-00021

    authors: Kallas HJ,Domino KB,Glenny RW,Anderson EA,Hlastala MP

    更新日期:1998-05-01 00:00:00

  • Administration of nitrous oxide to pediatric patients provides analgesia for venous cannulation.

    abstract::To determine whether administration of nitrous oxide, 50% and 70%, could provide analgesia and anxiolysis during venous cannulation in pediatric patients, 165 ASA Physical Status 1 patients scheduled for elective surgery were studied. Children, 3 weeks to 18 yr of age, were randomly assigned either to receive nitrous ...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199002000-00010

    authors: Henderson JM,Spence DG,Komocar LM,Bonn GE,Stenstrom RJ

    更新日期:1990-02-01 00:00:00

  • Helium induces preconditioning in human endothelium in vivo.

    abstract:AIMS:Helium protects myocardium by inducing preconditioning in animals. We investigated whether human endothelium is preconditioned by helium inhalation in vivo. METHODS AND RESULTS:Forearm ischemia-reperfusion (I/R) in healthy volunteers (each group n = 10) was performed by inflating a blood pressure cuff for 20 min....

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3182751300

    authors: Smit KF,Oei GT,Brevoord D,Stroes ES,Nieuwland R,Schlack WS,Hollmann MW,Weber NC,Preckel B

    更新日期:2013-01-01 00:00:00

  • Continuous cardiac output in septic shock by simulating a model of the aortic input impedance: a comparison with bolus injection thermodilution.

    abstract:BACKGROUND:To compare continuous cardiac output obtained by simulation of an aortic input impedance model to bolus injection thermodilution (TDCO) in critically ill patients with septic shock. METHODS:In an open study, mechanically ventilated patients with septic shock were monitored for 1 (32 patients), 2 (15 patient...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199905000-00016

    authors: Jellema WT,Wesseling KH,Groeneveld AB,Stoutenbeek CP,Thijs LG,van Lieshout JJ

    更新日期:1999-05-01 00:00:00

  • Thermoregulatory thresholds for vasoconstriction in patients anesthetized with various 1-minimum alveolar concentration combinations of xenon, nitrous oxide, and isoflurane.

    abstract:BACKGROUND:Nitrous oxide limits intraoperative hypothermia because the vasoconstriction threshold with nitrous oxide is higher than with equi-minimum alveolar concentrations of sevoflurane or isoflurane, presumably because of its stimulating actions on the sympathetic nervous system. Xenon, in contrast, does not cause ...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199909000-00011

    authors: Goto T,Matsukawa T,Sessler DI,Uezono S,Ishiguro Y,Ozaki M,Morita S

    更新日期:1999-09-01 00:00:00

  • The corrugator supercilii, not the orbicularis oculi, reflects rocuronium neuromuscular blockade at the laryngeal adductor muscles.

    abstract:BACKGROUND:Some studies suggest that the orbicularis oculi is resistant to neuromuscular blocking drugs and behaves like laryngeal muscles. Others report little or no difference between the orbicularis oculi and the adductor pollicis. These discrepancies could be related to the exact site of recording. The purpose of t...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000542-200107000-00019

    authors: Plaud B,Debaene B,Donati F

    更新日期:2001-07-01 00:00:00

  • Propofol suppresses macrophage functions and modulates mitochondrial membrane potential and cellular adenosine triphosphate synthesis.

    abstract:BACKGROUND:Propofol is an intravenous anesthetic agent that may impair host defense system. The aim of this study was to evaluate the effects of propofol on macrophage functions and its possible mechanism. METHODS:Mouse macrophage-like Raw 264.7 cells were exposed to propofol, at 3, 30 (a clinically relevant concentra...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200305000-00021

    authors: Chen RM,Wu CH,Chang HC,Wu GJ,Lin YL,Sheu JR,Chen TL

    更新日期:2003-05-01 00:00:00

  • Barbiturate anesthetics inhibit thromboxane-, potassium-, but not angiotensin-induced pulmonary vasoconstriction.

    abstract::Administration of the oxidant lipid peroxide tertiary butyl hydroperoxide (t-bu-OOH) in the isolated rabbit lung leads to acute pulmonary vasoconstriction, which is caused by the synthesis of thromboxane. The inhalational anesthetics, halothane, nitrous oxide, and cyclopropane, markedly enhance t-bu-OOH-induced pulmon...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198905000-00012

    authors: McShane AJ,Crowley K,Shayevitz JR,Michael JR,Adkinson NF Jr,Traystman RJ,Gurtner GH

    更新日期:1989-05-01 00:00:00

  • Involvement of cerulospinal glutamatergic neurotransmission in fentanyl-induced muscular rigidity in the rat.

    abstract:BACKGROUND:Investigators in the authors' laboratory previously established the critical participation of the cerulospinal noradrenergic pathway in muscular rigidity elicited by fentanyl. The identification of colocalization of glutamate with tyrosine hydroxylase in most locus ceruleus neurons suggests a role for cerulo...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199712000-00024

    authors: Fu MJ,Tsen LY,Lee TY,Lui PW,Chan SH

    更新日期:1997-12-01 00:00:00

  • The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients.

    abstract:BACKGROUND:Thermoregulatory vasoconstriction minimizes further core hypothermia during anesthesia. Elderly patients become more hypothermic during surgery than do younger patients, and take longer to rewarm postoperatively. These data indicate that perianesthetic thermoregulatory responses may be especially impaired in...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199309000-00008

    authors: Kurz A,Plattner O,Sessler DI,Huemer G,Redl G,Lackner F

    更新日期:1993-09-01 00:00:00

  • Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function.

    abstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyograph...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000002400

    authors: Murphy GS,Szokol JW,Avram MJ,Greenberg SB,Shear TD,Deshur M,Benson J,Newmark RL,Maher CE

    更新日期:2018-11-01 00:00:00

  • High thoracic epidural anesthesia does not inhibit sympathetic nerve activity in the lower extremities.

    abstract:BACKGROUND:Sympathetic nerve activity was recorded in the leg during high thoracic epidural anesthesia with a segmental sensory blockade of the upper thoracic dermatomes to test the hypothesis that the sympathetic blockade accompanying thoracic epidural anesthesia includes caudal parts of the sympathetic nervous system...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000542-199911000-00021

    authors: Magnúsdóttir H,Kirnö K,Ricksten SE,Elam M

    更新日期:1999-11-01 00:00:00

  • α2δ-1-Bound N-Methyl-D-aspartate Receptors Mediate Morphine-induced Hyperalgesia and Analgesic Tolerance by Potentiating Glutamatergic Input in Rodents.

    abstract:BACKGROUND:Chronic use of μ-opioid receptor agonists paradoxically causes both hyperalgesia and the loss of analgesic efficacy. Opioid treatment increases presynaptic N-methyl-D-aspartate receptor activity to potentiate nociceptive input to spinal dorsal horn neurons. However, the mechanism responsible for this opioid-...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000002648

    authors: Deng M,Chen SR,Chen H,Pan HL

    更新日期:2019-05-01 00:00:00

  • Glutamate release from the ovine fetal brain during maternal hemorrhage. A study using chronic in utero cerebral microdialysis.

    abstract:BACKGROUND:Glutamate has been implicated in the pathophysiology of neuronal injury associated with cerebral hypoxia-ischemia. A model using chronic in utero microdialysis was developed to sample the extracellular space of the fetal brain. Using this model, we tested the hypothesis that glutamate efflux from the parasag...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199502000-00022

    authors: Penning DH,Chestnut DH,Dexter F,Hrdy J,Poduska D,Atkins B

    更新日期:1995-02-01 00:00:00

  • Analgesic effects of intravenous lidocaine and morphine on postamputation pain: a randomized double-blind, active placebo-controlled, crossover trial.

    abstract:BACKGROUND:Phantom and stump pains, common sequelae of limb amputations, are significant impediments to rehabilitation of amputees. The pathophysiology and optimal treatment of postamputation pain states are unclear. While stump pain may result from neuromas in the stump, phantom pain is thought to be related to cortic...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200204000-00010

    authors: Wu CL,Tella P,Staats PS,Vaslav R,Kazim DA,Wesselmann U,Raja SN

    更新日期:2002-04-01 00:00:00

  • Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials.

    abstract:OBJECTIVE:The authors reviewed efficacy and safety data for ondansetron for preventing postoperative nausea and vomiting (PONV). METHODS:Systematically searched, randomized, controlled trials (obtained through MEDLINE, EMBASE, Biological Abstracts, manufacturer's database, manual searching of journals, and article ref...

    journal_title:Anesthesiology

    pub_type: 杂志文章,meta分析

    doi:10.1097/00000542-199712000-00004

    authors: Tramèr MR,Reynolds DJ,Moore RA,McQuay HJ

    更新日期:1997-12-01 00:00:00

  • Astrocytes Protect against Isoflurane Neurotoxicity by Buffering pro-brain-derived Neurotrophic Factor.

    abstract:BACKGROUND:Isoflurane induces cell death in neurons undergoing synaptogenesis via increased production of pro-brain-derived neurotrophic factor (proBDNF) and activation of postsynaptic p75 neurotrophin receptor (p75). Astrocytes express p75, but their role in neuronal p75-mediated cell death remains unclear. The author...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000000824

    authors: Stary CM,Sun X,Giffard RG

    更新日期:2015-10-01 00:00:00

  • Intravenous lidocaine and bupivacaine dose-dependently attenuate bronchial hyperreactivity in awake volunteers.

    abstract:BACKGROUND:In standard textbooks, intravenous lidocaine is recommended for intubation of patients with bronchial hyperreactivity. However, whether and to what extent intravenous local anesthetics attenuate bronchial hyperreactivity in humans is unknown. Accordingly, nine awake volunteers with known bronchial hyperreact...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199603000-00007

    authors: Groeben H,Schwalen A,Irsfeld S,Stieglitz S,Lipfert P,Hopf HB

    更新日期:1996-03-01 00:00:00

  • Intravenous lidocaine inhibits visceral nociceptive reflexes and spinal neurons in the rat.

    abstract:BACKGROUND:Systemically administered local anesthetics and other sodium channel blockers produce analgesia in patients with hypersensitivity disorders. To assess whether these agents have a role in the treatment of visceral pain, the present study examined the effects of intravenous lidocaine on neuronal and reflex res...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200006000-00028

    authors: Ness TJ

    更新日期:2000-06-01 00:00:00

  • Transcutaneous cardiac pacing during thoracic surgery. Feasibility and hemodynamic evaluation by transesophageal echocardiography.

    abstract:BACKGROUND:Occasionally, emergency perioperative pacing is necessary. Transcutaneous cardiac pacing is noninvasive, safe, and readily available. Its feasibility and hemodynamic effects during thoracic surgery and one-lung ventilation have not been established. METHODS:Twenty anesthetized patients (aged 25-70 yr) witho...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000542-199310000-00013

    authors: Amar D,Gross JN,Burt M,Schwinger ME,Rusch VW,Reinsel RA

    更新日期:1993-10-01 00:00:00

  • Major histocompatibility complex haplotype is associated with postherpetic pain in mice.

    abstract:BACKGROUND:Postherpetic neuralgia is one of the major complications of herpes zoster caused by the reactivation of varicella-zoster virus and is characterized by severe pain. The authors previously showed the association of a human major histocompatibility complex (MHC) haplotype with postherpetic neuralgia. This study...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200605000-00024

    authors: Sato-Takeda M,Takasaki I,Takeda K,Sasaki A,Andoh T,Nojima H,Shiraki K,Kuraishi Y,Hanaoka K,Tokunaga K,Yabe T

    更新日期:2006-05-01 00:00:00

  • The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss.

    abstract:BACKGROUND:Postoperative visual loss after prone spine surgery is increasingly reported in association with ischemic optic neuropathy, but its etiology is unknown. METHODS:To describe the clinical characteristics of these patients, the authors analyzed a retrospectively collected series of 93 spine surgery cases volun...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200610000-00007

    authors: Lee LA,Roth S,Posner KL,Cheney FW,Caplan RA,Newman NJ,Domino KB

    更新日期:2006-10-01 00:00:00

  • Opposing actions of etomidate on cortical theta oscillations are mediated by different gamma-aminobutyric acid type A receptor subtypes.

    abstract:BACKGROUND:Cortical networks generate diverse patterns of rhythmic activity. Theta oscillations (4-12 Hz) are commonly observed during spatial learning and working memory tasks. The authors ask how etomidate, acting predominantly via gamma-aminobutyric acid type A (GABAA) receptors containing beta2 or beta3 subunits, a...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200502000-00017

    authors: Drexler B,Roether CL,Jurd R,Rudolph U,Antkowiak B

    更新日期:2005-02-01 00:00:00

  • Brain stem opioidergic and GABAergic neurons mediate the antinociceptive effect of nitrous oxide in Fischer rats.

    abstract:BACKGROUND:Recent studies have revealed that N2O exerts its antinociceptive effect by inducing opioid peptide release in the brain stem, thereby activating the descending noradrenergic inhibitory neurons, which modulate pain processing in the spinal cord. However, the precise neuronal pathways that mediate these events...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200310000-00030

    authors: Ohashi Y,Guo T,Orii R,Maze M,Fujinaga M

    更新日期:2003-10-01 00:00:00

  • Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months: A Prospective Randomized Controlled Study.

    abstract:BACKGROUND:High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months ...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000002045

    authors: Lilot M,Evain JN,Bauer C,Cejka JC,Faure A,Balança B,Vassal O,Payet C,Bui Xuan B,Duclos A,Lehot JJ,Rimmelé T

    更新日期:2018-03-01 00:00:00

  • Cardiac Slo2.1 Is Required for Volatile Anesthetic Stimulation of K+ Transport and Anesthetic Preconditioning.

    abstract:BACKGROUND:Anesthetic preconditioning (APC) is a clinically important phenomenon in which volatile anesthetics (VAs) protect tissues such as heart against ischemic injury. The mechanism of APC is thought to involve K channels encoded by the Slo gene family, and the authors showed previously that slo-2 is required for A...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000001046

    authors: Wojtovich AP,Smith CO,Urciuoli WR,Wang YT,Xia XM,Brookes PS,Nehrke K

    更新日期:2016-05-01 00:00:00

  • Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations.

    abstract:BACKGROUND:Ketamine has been associated with a unique spectrum of subjective "psychedelic" effects in patients emerging from anesthesia. This study quantified these effects of ketamine and related them to steady-state plasma concentrations. METHODS:Ketamine or saline was administered in a single-blinded crossover prot...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199801000-00015

    authors: Bowdle TA,Radant AD,Cowley DS,Kharasch ED,Strassman RJ,Roy-Byrne PP

    更新日期:1998-01-01 00:00:00

  • Acute lung injury after instillation of human breast milk or infant formula into rabbits' lungs.

    abstract:BACKGROUND:Recent interest in shortening the fasting interval after ingestion of milk products demonstrated large volumes of breast milk in the stomach 2 h after breastfeeding. Although aspiration is a rare event, if it were to occur with human breast milk, it is important to understand the extent of the lung injury th...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199606000-00015

    authors: O'Hare B,Lerman J,Endo J,Cutz E

    更新日期:1996-06-01 00:00:00

  • Propofol: relation between brain concentrations, electroencephalogram, middle cerebral artery blood flow velocity, and cerebral oxygen extraction during induction of anesthesia.

    abstract:BACKGROUND:The potential benefit of propofol dose regimens that use physiologic pharmacokinetic modeling to target the brain has been demonstrated in animals, but no data are available on the rate of propofol distribution to the brain in humans. This study measured the brain uptake of propofol in humans and the simulta...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000542-200212000-00006

    authors: Ludbrook GL,Visco E,Lam AM

    更新日期:2002-12-01 00:00:00

  • Anesthesia for creation of a forearm fistula in patients with endstage renal failure.

    abstract::The effects of local infiltration anesthesia, brachial plexus blockade, isoflurane, or halothane anesthesia on blood flow through the brachial artery and through a newly created forearm arteriovenous fistula (AVF) were compared in 36 patients with endstage renal failure. Brachial artery blood flow was measured at two ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198906000-00005

    authors: Mouquet C,Bitker MO,Bailliart O,Rottembourg J,Clergue F,Montejo LS,Martineaud JP,Viars P

    更新日期:1989-06-01 00:00:00