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48 primiparae received epidural analgesia in labor with 10 ml of 0.125% bupivacaine with epinephrine 1:800 000, and then were divided in 4 equal groups (n = 12) to receive one of the following: 5 ml saline (B); 100 mug of fentanyl (BF); 150 microg of clonidine (BC); 75 microg of clonidine and 50 microg of fentanyl (BCF). All the patients had satisfactory analgesia. Onset was similar in the 4 groups but the duration of analgesia was significantly prolonged by the addition of either 100 microg of fentanyl or 150 microg of clonidine (respectively 89.8 min and 92.5 min vs 62.5 min) (P < 0.0001). The addition of both clonidine (75 microg) and fentanyl (50 microg) produced a considerably prolonged analgesia (177.5 min) (P < 0.0001). No episodes of bradycardia were observed. Hypotension, reversed by i.v. ephedrine, occurred in 2 patients of BCF group and in 1 patient of BF and BC groups. Only patients receiving fentanyl had pruritus. Both fentanyl and clonidine produced sedation, but both incidence and severity were greater with the mixture. No differences in neonatal outcome assessed by Apgar scores and NACS, were observed.

BACKGROUND AND OBJECTIVES: The randomized, double-blind, dose-response study was designed to evaluate the effects of the addition of clonidine to epidural morphine on postoperative analgesia and side effects in patients undergoing cesarean delivery.METHODS: Sixty patients, undergoing cesarean delivery under epidural anesthesia, were randomly divided in three equal groups to receive, at the end of surgery, an epidural analgesic mixture consisting of 10 mL solution containing 2 mg of morphine diluted with 0.125% bupivacaine plus 1:800,000 epinephrine and 0, 75, or 150 micrograms of clonidine. Duration of analgesia was assessed as the pain-free interval between the end of surgery and patient's first analgesic request. The analgesic mixture was repeated, on patient's request, to 36 hours after the operation. Arterial blood pressure, heart rate, respiratory rate, and side effects were noted. The total amount of morphine and clonidine delivered was also noted.RESULTS: The addition of clonidine (0, 75, or 150 micrograms) to morphine significantly increased the duration of postoperative analgesia (P < .0001) (6.27 versus 13.25 and versus 21.55 hours) and reduced the mean total dose of morphine (9.40 mg versus 5.0 mg versus 3.60 mg) (P < .0001). No significant differences in side effects were noted.CONCLUSIONS: A low dose of clonidine such as 75 micrograms doubled the duration of analgesia produced by 2 mg of morphine and a dose of 150 micrograms further increased the duration of postoperative complete analgesia without increasing the incidence of side effects. The morphine requirements during the postoperative period (36 hours) was greatly reduced by the addition of clonidine to the analgesic epidural mixture.

We organized a training program for oral fiber optic intubation (FOI) under conscious sedation. The efficacy of the program was evaluated by comparing the performances of experts and novices.The training procedure was divided into two sessions: a theoretical session on difficult airways, the fiber optic bronchoscope (FOB), remifentanil, topical anesthesia and patient interactions; and a session involving simulations of the FOI technique on dummies. For in vivo FOI, we enrolled patients requiring orotracheal intubation for elective surgery. Electrocardiograms, mean arterial pressure was railroaded over the fiberscope, and tracheal intubati6 and 7) FOIs, respectively, joined the study. To reach ±23 bpm, P=0.02), and RR was decreased (from 16±3 to 12±4 bpm, P0.05). No differences were recorded between the experts and less-experienced anesthesiologists. The average duration of FOI was 3.3±2.0 min for experts and 4.2±2.4 min for novices (P=0.03). Procedures were successful in both groups, with patients in each group being equally satisfied with the procedures.This study highlights the importance of a structured FOI training program, demonstrating that it is possible to learn to perform FOI proficiently by practicing on dummies.