M. Emanuelli

TL;DR: The slow induction time with midazolam may put the mother at risk for pulmonary inhalation and a plane of anesthesia that may risk awareness and potential neonatal depression is the main drawback of the two newer induction drugs.

Abstract: Twenty‐eight elderly patients scheduled for urological surgery were randomly assigned to receive, in a double‐blind study, subarachnoidhyperbaric bupivacaine 15 mg with 50 μg (group A, n = 7), 25 μg (group B, n = 7), or 12.5 μg (group C, n = 7) of fentanyl or 1 ml of saline (group D, n = 7) in a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before and 90, 150 and 480 min after the subarachnoid injection. In group A, mild pruritus and sedation occurred in five patients, while nausea, vomiting and periodic breathing occurred in two. In group B, mild pruritus and sedation were observed in four patients, while nausea and vomiting occurred in two. No significant differences in minute ventilation, respiratory drive and respiratory timing were observed between the groups. Patients receiving fentanyl 50 ug showed a percentual change from baseline values as function of time (slope V̇E/PE'co2 significantly below baseline at 90 and 150 min (p < 0.05). However, the baseline values in this group reverted after 480 min. No side effects were observed in groups C or D. It is concluded that subarachnoid fentanyl 50 μg can cause an early respiratory depression and its use as a postoperative analgesic should be avoided in the elderly.

TL;DR: The predelivery administration of morphine, fentanyl and sufentanil significantly improved the intraoperative analgesia and the number of patients having pruritus and vomiting was significantly higher in the morphine and buprenorphine groups, respectively.

TL;DR: The alkalinization allowed the surgery to proceed more rapidly, significantly decreasing the time interval between epidural block and delivery of the infant.