Showing papers in "Anesthesiology in 1999"
TL;DR: In this article, the authors investigated whether risk scores are valid across centers and whether risk score based on logistic regression coefficients can be simplified without the use of logistic regressions.
Abstract: BackgroundRecently, two centers have independently developed a risk score for predicting postoperative nausea and vomiting (PONV). This study investigated (1) whether risk scores are valid across centers and (2) whether risk scores based on logistic regression coefficients can be simplified without
1,649 citations
TL;DR: In this article, the authors tested the hypothesis that postoperative analgesic techniques influence surgical outcome and the duration of convalescence after major knee surgery, and found that continuous passive motion after knee surgery optimizes the functional prognosis but causes severe pain.
Abstract: BackgroundContinuous passive motion after major knee surgery optimizes the functional prognosis but causes severe pain The authors tested the hypothesis that postoperative analgesic techniques influence surgical outcome and the duration of convalescenceMethodsBefore standardized general anesthesia
1,020 citations
TL;DR: Semilinear canonical correlation defined a new measure of prop ofol effect on the EEG, the canonical univariate parameter for propofol, which is faster than previously reported and indicates Elderly patients are more sensitive to the hypnotic and EEG effects of propofl than are younger persons.
Abstract: BackgroundThe authors studied the influence of age on the pharmacodynamics of propofol, including characterization of the relation between plasma concentration and the time course of drug effect.MethodsThe authors evaluated healthy volunteers aged 25-81 yr. A bolus dose (2 mg/kg or 1 mg/kg in person
995 citations
TL;DR: Infusion of 0.9% saline, but not lactated Ringer's solution, caused a metabolic acidosis with hyperchloremia and a concomitant decrease in the strong ion difference and the amount of weak plasma acid.
Abstract: Background Changes in acid-base balance caused by infusion of a 0.9% saline solution during anesthesia and surgery are poorly characterized. Therefore, the authors evaluated these phenomena in a dose-response study. Methods Two groups of 12 patients each who were undergoing major intraabdominal gynecologic surgery were assigned randomly to receive 0.9% saline or lactated Ringer's solution in a dosage of 30 ml x kg(-1) x h(-1). The pH, arterial carbon dioxide tension, and serum concentrations of sodium, potassium, chloride, lactate, and total protein were measured in 30-min intervals. The serum bicarbonate concentration was calculated using the Henderson-Hasselbalch equation and also using the Stewart approach from the strong ion difference and the amount of weak plasma acid. The strong ion difference was calculated as serum sodium + serum potassium - serum chloride - serum lactate. The amount of weak plasma acid was calculated as the serum total protein concentration in g/dl x 2.43. Results Infusion of 0.9% saline, but not lactated Ringer's solution, caused a metabolic acidosis with hyperchloremia and a concomitant decrease in the strong ion difference. Calculating the serum bicarbonate concentration using the Henderson-Hasselbalch equation or the Stewart approach produced equivalent results. Conclusions Infusion of approximately 30 ml x kg(-1) x h(-1) saline during anesthesia and surgery inevitably leads to metabolic acidosis, which is not observed after administration of lactated Ringer's solution. The acidosis is associated with hyperchloremia.
699 citations
TL;DR: The authors prospectively studied 17,638 consecutive outpatients who had surgery to identify predictors of postoperative nausea and vomiting (PONV).
Abstract: BackgroundRetrospective [1] studies fail to identify predictors of postoperative nausea and vomiting (PONV). The authors prospectively studied 17,638 consecutive outpatients who had surgery to identify these predictors.MethodsData on medical conditions, anesthesia, surgery, and PONV were collected i
528 citations
Journal Article•
467 citations
TL;DR: In the past few years, changes have been made in the diagnosis, preoperative preparation, surgical and anesthetic management and perioperative care of patients with liver disease, and the aim of this review is to examine whether these changes have resulted in improvedPerioperative outcomes.
Abstract: Background: Patients with cirrhosis have a reduced life expectancy. Anesthesia and surgery have been associated with clinical decompensation in patients with cirrhosis. Metbods: The authors retrospectively reviewed the records of all patients with the diagnosis of cirrhosis who underwent any surgical procedure under anesthesia at their institution between January 1980 and January 1991 (n = 733). Univariate and multivariate analyses were used to identify the variables associated with perioperative complications and short- and long-term survival. Results: The perioperative mortality rate (within 30 days of surgery) was 11.6%. The perioperative complication rate was 30.1%. Postoperative pneumonia was the most frequent complication. Multivariate factors that were associated with perioperative complications and mortality included male gender, a high Child-Pugh score, the presence of ascites, a diagnosis of cirrhosis other than primary biliary cirrhosis (especially cryptogenic cirrhosis), an elevated creatinine concentration, the diagnosis of chronic obstructive pulmonary disease, preoperative infection, preoperative upper gastrointestinal bleeding, a high American Society of Anesthesiologists physical status rating, a high surgical severity score, surgery on the respiratory system, and the presence of intraoperative hypotension. Conclusion: Risk factors have been identified for patients with cirrhosis who undergo anesthesia and surgery.
362 citations
TL;DR: Increasing PEEP to 10 cm H2O significantly reduced elastances of the respiratory system, lung, and chest wall in obese patients but not in normal subjects, and improves respiratory function during anesthesia and paralysis.
Abstract: BACKGROUND Morbidly obese patients, during anesthesia and paralysis, experience more severe impairment of respiratory mechanics and gas exchange than normal subjects. The authors hypothesized that positive end-expiratory pressure (PEEP) induces different responses in normal subjects (n = 9; body mass index 40 kg/m2). METHODS The authors measured lung volumes (helium technique), the elastances of the respiratory system, lung, and chest wall, the pressure-volume curves (occlusion technique and esophageal balloon), and the intraabdominal pressure (intrabladder catheter) at PEEP 0 and 10 cm H2O in paralyzed, anesthetized postoperative patients in the intensive care unit or operating room after abdominal surgery. RESULTS At PEEP 0 cm H2O, obese patients had lower lung volume (0.59 +/- 0.17 vs. 2.15 +/- 0.58 l [mean +/- SD], P < 0.01); higher elastances of the respiratory system (26.8 +/- 4.2 vs. 16.4 +/- 3.6 cm H2O/l, P < 0.01), lung (17.4 +/- 4.5 vs. 10.3 +/- 3.2 cm H2O/l, P < 0.01), and chest wall (9.4 +/- 3.0 vs. 6.1 +/- 1.4 cm H2O/l, P < 0.01); and higher intraabdominal pressure (18.8 +/-7.8 vs. 9.0 +/- 2.4 cm H2O, P < 0.01) than normal subjects. The arterial oxygen tension was significantly lower (110 +/- 30 vs. 218 +/- 47 mmHg, P < 0.01; inspired oxygen fraction = 50%), and the arterial carbon dioxide tension significantly higher (37.8 +/- 6.8 vs. 28.4 +/- 3.1, P < 0.01) in obese patients compared with normal subjects. Increasing PEEP to 10 cm H2O significantly reduced elastances of the respiratory system, lung, and chest wall in obese patients but not in normal subjects. The pressure-volume curves were shifted upward and to the left in obese patients but were unchanged in normal subjects. The oxygenation increased with PEEP in obese patients (from 110 +/-30 to 130 +/- 28 mmHg, P < 0.01) but was unchanged in normal subjects. The oxygenation changes were significantly correlated with alveolar recruitment (r = 0.81, P < 0.01). CONCLUSIONS During anesthesia and paralysis, PEEP improves respiratory function in morbidly obese patients but not in normal subjects.
356 citations
TL;DR: An in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia found deficiencies in labeling and vigilance were common causes for awake paralysis.
Abstract: BackgroundAwareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the c
352 citations
349 citations
TL;DR: Patients in whom tracheal intubation has been difficult should be observed for and told to watch for the development of symptoms and signs of retropharyngeal abscess, mediastinitis, or both.
Abstract: BackgroundAirway injury during general anesthesia is a significant source of morbidity for patients and a source of liability for anesthesiologists. To identify recurrent patterns of injury, the authors analyzed claims for airway injury in the American Society of Anesthesiologists (ASA) Closed Claim
TL;DR: Ropvacaine was significantly less potent than bupivacaine for epidural analgesia in the first stage of labor and no difference in motor effects was observed.
Abstract: Background The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to assess the relative analgesic potencies of epidural bupivacaine and ropivacaine by determining their respective minimum local analgesic concentrations. Methods Seventy-three parturients at Results The minimum local analgesic concentration of ropivacaine was 0.111% wt/vol (95% confidence interval, 0.100-0.122), and the minimum local analgesic concentration of bupivacaine was 0.067% wt/vol (95% confidence interval, 0.052-0.082). Ropivacaine was significantly less potent than bupivacaine, with a potency ratio of 0.6 (95% confidence interval, 0.49-0.74). No difference in motor effects was observed. Conclusion Ropivacaine was significantly less potent than bupivacaine for epidural analgesia in the first stage of labor.
TL;DR: The purpose of this systematic review was to investigate the effect of intrathecal opioids added to spinal anesthesia on intraoperative and postoperative pain and to evaluate adverse effects in patients scheduled for cesarean section, using evidence from all relevant randomized controlled and blinded trials.
Abstract: SPINAL anesthesia is commonly used for cesarean section, and it has become a popular practice to add opioids to spinal solutions to enhance and prolong intraoperative and postoperative analgesia. Morphine and fentanyl are the opioids most often used for this purpose, but there is not a general consensus about the benefits of the various regimens, and the incidence of side effects with different opioids and doses is controversial. Recently, a number of systematic reviews have been published in the field of pain and perioperative medicine. The aim of a systematic review is to summarize available information from controlled clinical trials to produce evidence-based estimates of the true clinical effect of an intervention. The purpose of this systematic review was to investigate the effect of intrathecal opioids added to spinal anesthesia on intraoperative and postoperative pain and to evaluate adverse effects in patients scheduled for cesarean section, using evidence from all relevant randomized controlled and blinded trials.
TL;DR: The first documented occurrence of aseptic meningitis in an infant after spinal anesthesia is reported, which may avoid the prolonged and indiscriminate use of antibiotics if the fever is attributed to other sources.
Abstract: and anesthesia in a neonate, especially those aged less than 2 months, may indicate an infectious problem either related or unrelated to the operative and anesthetic techniques. We report the first documented occurrence of aseptic meningitis in an infant after spinal anesthesia. Because of the infant’s underlying status and recent life-threatening illness, it was not possible to definitely prove a causal relationship between the aseptic meningitis and the spinal anesthetic. Although no definitive treatment is necessary, the recognition of aseptic meningitis may avoid the prolonged and indiscriminate use of antibiotics if the fever is attributed to other sources.
TL;DR: In common with other volatile anesthetic agents, sevoflurane has an intrinsic dose-dependent cerebral vasodilatory effect, however, this effect is less than that of isofl Lurane.
Abstract: The effect of volatile anesthetics on cerebral blood flow depends on the balance between the indirect vasoconstrictive action secondary to flow–metabolism coupling and the agent's intrinsic vasodilatory action. This study compared the direct cerebral vasodilatory actions of 0.5 and 1.5 minimum alveolar concentration (MAC) sevoflurane and isoflurane during an propofol-induced isoelectric electroencephalogram.
Twenty patients aged 20–62 yr with American Society of Anesthesiologists physical status I or II requiring general anesthesia for routine spinal surgery were recruited. In addition to routine monitoring, a transcranial Doppler ultrasound was used to measure blood flow velocity in the middle cerebral artery, and an electroencephalograph to measure brain electrical activity. Anesthesia was induced with propofol 2.5 mg/kg, fentanyl 2 μg/kg, and atracurium 0.5 mg/kg, and a propofol infusion was used to achieve electroencephalographic isoelectricity. End-tidal carbon dioxide, blood pressure, and temperature were maintained constant throughout the study period. Cerebral blood flow velocity, mean blood pressure, and heart rate were recorded after 20 min of isoelectric encephalogram. Patients were then assigned to receive either age-adjusted 0.5 MAC (0.8–1%) or 1.5 MAC (2.4–3%) end-tidal sevoflurane; or age-adjusted 0.5 MAC (0.5–0.7%) or 1.5 MAC (1.5–2%) end-tidal isoflurane. After 15 min of unchanged end-tidal concentration, the variables were measured again. The concentration of the inhalational agent was increased or decreased as appropriate, and all measurements were repeated again. All measurements were performed before the start of surgery. An infusion of 0.01% phenylephrine was used as necessary to maintain mean arterial pressure at baseline levels.
Although both agents increased blood flow velocity in the middle cerebral artery at 0.5 and 1.5 MAC, this increase was significantly less during sevoflurane anesthesia (4 ± 3 and 17 ± 3% at 0.5 and 1.5 MAC sevoflurane; 19 ± 3 and 72 ± 9% at 0.5 and 1.5 MAC isoflurane [mean ± SD];P< 0.05). All patients required phenylephrine (100–300 μg) to maintain mean arterial pressure within 20% of baseline during 1.5 MAC anesthesia.
In common with other volatile anesthetic agents, sevoflurane has an intrinsic dose-dependent cerebral vasodilatory effect. However, this effect is less than that of isoflurane.
TL;DR: The present survey shows that the number of anesthetic procedures has increased by 120% since 1980, and the rate of anesthesia procedures increased from 6.6 to 13.5 per 100 population, the major changes being observed in patients aged > or = 75 yr and in those with an American Society of Anesthesiologists physical status of 3.
Abstract: BackgroundTo identify the growth in the number of anesthetic procedures since 1980 and the changes in the practice of anesthesia, the present survey was designed to collect and analyze the anesthetic activity performed in France in 1996, from a representative sample collected in all French hospitals
TL;DR: Ulasonographic localization of the internal jugular vein was superior to the landmarks technique in terms of overall success, speed, and decreased incidence of carotid artery puncture.
Abstract: BackgroundPercutaneous cannulation of the internal jugular vein in infants is technically more difficult and carries a higher risk of carotid artery puncture than in older children and adults. In this prospective study, the authors tested their hypothesis that using an ultrasound scanner would incre
TL;DR: In this paper, the authors tested the hypothesis that supplemental perioperative oxygen administration reduces the incidence of postoperative nausea or vomiting, and found that supplemental oxygen administration reduced the incidence by 20% and 70%.
Abstract: BackgroundDespite new anesthetic drugs and antiemetics, particularly 5-hydroxytryptamines, the incidence of postoperative nausea or vomiting remains between 20% and 70%. The authors tested the hypothesis that supplemental perioperative oxygen administration reduces the incidence of postoperative nau
TL;DR: The incidence of spinal epidural abscess after epidural analgesia in Denmark during a 1-yr period is estimated and the overall use of epidural opioid analgesia during the same period is evaluated to evaluate the treatment and outcome in patients with spinal epidurals abscess.
Abstract: EPIDURAL analgesia is most often used for postoperative pain relief, whereas it is no longer so commonly used for long-term treatment of pain from malignant diseases. For perioperative use, the epidural catheter is most frequently inserted before induction of anesthesia while the patient is awake, although there has recently been some debate as to whether regional techniques should or should not be performed during general anesthesia. Side effects of epidural analgesia are common, but the majority are innocuous and well known to anesthesiologists. However, two serious complications of epidural analgesia may result in severe morbidity: the spinal epidural hematoma and the spinal epidural abscess. In a recent editorial, the incidence of spinal epidural hematoma after epidural analgesia in association with the use of low-molecular-weight heparin was estimated to vary from 1:1,000 to 1:10,000 epidural procedures, which is much higher than previously thought. The incidence of spinal epidural abscess after epidural analgesia remains unknown but has been reported to vary widely. No cases of epidural abscess were found in a large Swedish study of 9,232 epidural procedures, whereas there were two cases of abscess formation among 13,000 epidural procedures in a German report, and 3% of the patients in a smaller North American study developed epidural abscess after long-term epidural treatment of chronic pain. The incidence has also been reported to vary from 0.6 to 0.77 per 1,000 catheter days. The present study was undertaken to estimate the incidence of epidural abscess after epidural analgesia in Denmark during a 1-yr period and to evaluate the overall use of epidural analgesia during the same period. We further wished to analyze the treatment and outcome in patients with spinal epidural abscess.
TL;DR: The literature does not consistently support the importance of anticoagulation monitoring techniques during CPB, and a small number of well-controlled studies suggest that bleeding and transfusion outcomes can be improved by refining heparin monitoring techniques.
Abstract: The literature does not consistently support the importance of anticoagulation monitoring techniques during CPB. This is best reflected by studies that have evaluated the impact of the ACT method on blood loss and transfusion outcomes. Inconsistent findings from studies that evaluated the impact of ACT monitoring may be related to either suboptimal study design (i.e., retrospective, unblinded, nonrandomized) or possibly the diagnostic inprecision of the ACT method used in these studies. There are a small number of well-controlled studies, some of which suggest that bleeding and transfusion outcomes can be improved by refining heparin monitoring techniques, either by sustaining better anticoagulation during CPB or by optimizing protamine doses (i.e., when empiric protocols result in excessive protamine doses). More well-controlled studies are needed to better define the importance of anticoagulation management during CPB.
TL;DR: There is little justification for use of more than 0.1 mg for post-cesarean analgesia and for optimal analgesia, augmentation [corrected] of intrathecal morphine with systemic opioids may be necessary.
Abstract: BackgroundThis 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.MethodsOne hundred eight term parturients undergoing cesarean delivery at term and given spinal
TL;DR: The result indicates that the augmentation of blood volume with preloading, regardless of the fluid used, must be large enough to result in a significant increase in cardiac output for effective prevention of hypotension.
Abstract: BackgroundThe role of crystalloid preloading to prevent hypotension associated with spinal anesthesia in parturients during cesarean section has been challenged. Direct measurement of blood volume should provide insight regarding the volume-expanding effects. The aim of the current study was to clar
TL;DR: In this study population, the frequency of perioperative pulmonary aspiration in children was quite low, serious respiratory morbidity was rare, and there were no associated deaths.
Abstract: BackgroundPulmonary aspiration of gastric contents during the perioperative period in infants and children may be associated with postoperative mortality or pulmonary morbidity. There has not been a recent determination of the frequency of this event and its outcomes in infants and children.MethodsT
TL;DR: The authors defined two new terms, underutilization and overutilization, and illustrated how these measures might be used to evaluate the use of surgical subspecialty ORs, and described capacity planning using a minimal cost analysis (MCA) model.
Abstract: Background Operational inefficiencies in the use of operating rooms (ORs) are hidden by traditional measures of OR utilization. To better detect these inefficiencies, the authors defined two new terms, underutilization and overutilization, and illustrated how these measures might be used to evaluate the use of surgical subspecialty ORs. The authors also described capacity planning (optimizing surgical subspecialty block time allotments) using a minimal cost analysis (MCA) model. Methods The authors evaluated post hoc all surgeries performed over 6 yr at a large teaching hospital. To prepare utilization estimates, surgical records were categorized relative to budgeted OR block time for each subspecialty. Surgical cases beginning and ending during budgeted OR block time were categorized as budgeted utilization, budgeted time not used for surgery was underutilization, and cases beginning before/after budgeted block time were classified as overutilization. Cases that overlapped budgeted and nonbudgeted OR block time were parsed and the portions were assigned appropriately. Probability distributions were fitted to the historical patterns of surgical demand, and MCA block time budgets were estimated that minimized the costs of underutilization and overutilization for each subspecialty. To illustrate the potential savings if these MCA budgets were implemented, the authors compared actual operational costs to the estimated MCA budget costs and expressed the savings as a percentage of actual costs. Results The authors analyzed data from 58,251 surgical cases and 10 surgical subspecialty blocks. Classic utilization for each block-day by surgical subspecialty ranged from 44-113%. Average daily block-specific underutilization ranged from 16 to 60%, whereas overutilization ranged from 4 to 49%. Conclusions Underutilization and overutilization are important measures because they may be used to evaluate the quality of OR schedules and the efficiency of OR utilization. Overutilization and underutilization also allow capacity planning using an MCA model This study indicated that the potential savings, if the MCA budgets were to be implemented, would be significant.
TL;DR: A single calibration of the model appears sufficient to monitor continuous cardiac output over a 2-day period with a bias of -0.1 +/- 0.34, and changes in bolus TDCO are reflected by calibrated MCO over a range of cardiac output values.
Abstract: BackgroundTo 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.MethodsIn an open study, mechanically ventilated patients with septic shock were monitored for 1 (32 patients
TL;DR: Halothane caused a global whole-brain metabolic reduction with significant shifts in regional metabolism and statistical parametric mapping analysis revealed significantly less relative metabolism in the basal forebrain, thalamus, limbic system, cerebellum, and occiput during halothane anesthesia.
Abstract: BACKGROUND Propofol and isoflurane anesthesia were studied previously with functional brain imaging in humans to begin identifying key brain areas involved with mediating anesthetic-induced unconsciousness. The authors describe an additional positron emission tomography study of halothane's in vivo cerebral metabolic effects. METHODS Five male volunteers each underwent two positron emission tomography scans. One scan assessed awake-baseline metabolism, and the other scan assessed metabolism during halothane anesthesia titrated to the point of unresponsiveness (mean +/- SD, expired = 0.7+/-0.2%). Scans were obtained using a GE2048 scanner and the F-18 fluorodeoxyglucose technique. Regions of interest were analyzed for changes in both absolute and relative glucose metabolism. In addition, relative changes in metabolism were evaluated using statistical parametric mapping. RESULTS Awake whole-brain metabolism averaged 6.3+/-1.2 mg x 100 g(-1) x min(-1) (mean +/- SD). Halothane reduced metabolism 40+/-9% to 3.7+/-0.6 mg x 100 g(-1) x min(-1) (P< or =0.005). Regional metabolism did not increase in any brain areas for any volunteer. The statistical parametric mapping analysis revealed significantly less relative metabolism in the basal forebrain, thalamus, limbic system, cerebellum, and occiput during halothane anesthesia. CONCLUSIONS Halothane caused a global whole-brain metabolic reduction with significant shifts in regional metabolism. Comparisons with previous studies reveal similar absolute and relative metabolic effects for halothane and isoflurane. Propofol, however, was associated with larger absolute metabolic reductions, suppression of relative cortical metabolism more than either inhalational agent, and significantly less suppression of relative basal ganglia and midbrain metabolism.
TL;DR: A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children if administered at the induction of anesthesia, and children with adequate analgesia with acetamine have less postoperative nausea and vomiting.
Abstract: BackgroundPostoperative pain is a major problem in day-case surgery in children. Nonsteroidal antiinflammatory drugs have gained popularity in management of pediatric surgical patients to reduce the need for opioids. The aim of this study was to evaluate the efficacy of different doses of rectal ace
TL;DR: A possible mechanism for the reduced risk of perioperative myocardial infarction is the attenuation of the excitotoxic effects of catecholamine surges by β-blockade.
Abstract: BackgroundPerioperative β-blockade has been shown to improve long-term cardiac outcome in noncardiac surgical patients. A possible mechanism for the reduced risk of perioperative myocardial infarction is the attenuation of the excitotoxic effects of catecholamine surges by β-blockade. It was hypothe
TL;DR: This study demonstrated that levobupivacaine and ropivacane are of similar potency for epidural analgesia in the first stage of labor.
Abstract: Background: The minimum local analgesic concentration has been defined as the median effective local analgesic concentration (EC50) in a 20-ml volume for epidural analgesia in the first stage of labor The aim of this study was to assess the relative analgesic potencies of epidural levobupivacaine and ropivacaine by determination of their respective minimum local analgesic concentrations Methods: Parturients at 7 cm of cervical dilation or less who requested epidural analgesia were allocated to one of two groups in this double-blind, randomized, prospective study After lumbar epidural catheter placement, 20 ml of the test solution was given: levobupivacaine (n 35) or ropivacaine (n 35) The concentration of local anesthetic was determined by the response of the previous patient in that group to a higher or lower concentration using up‐ down sequential allocation Analgesic efficacy was assessed using 100-mm visual analog pain scale scores, with 10 mm or less within 30 min defined as effective An effective result directed a 001% wt/vol decrement for the next patient An ineffective result directed a 001% wt/ vol increment Results: Of 105 women enrolled, 35 were excluded, leaving 70 for analysis The minimum local analgesic concentration of levobupivacaine was 0087% wt/vol (95% CI, 0081‐ 0094%), and the minimum local analgesic concentration of ropivacaine was 0089% wt/vol (95% CI, 0075‐ 0103%) Levobupivacaine and ropivacaine were of similar potency with a ropivacaine: levobupivacaine potency ratio of 098 (95% CI, 080 ‐120) No difference in motor effects was observed Conclusions: This study demonstrated that levobupivacaine and ropivacaine are of similar potency for epidural analgesia in the first stage of labor