Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1994
Comparative StudyComparison of propofol and thiopental for rapid anesthesia induction in infants.
We compared the hemodynamic response to laryngoscopy and intubation, as well as emergence and recovery times, when propofol or thiopental were used for rapid intravenous induction of anesthesia in 59 infants undergoing repair of inguinal hernia. An intravenous catheter was inserted under N2O analgesia and atropine 0.01 mg/kg was administered to all patients. Subsequent induction with propofol (3 mg/kg), thiopental (5 mg/kg), or halothane (2%) was followed with succinylcholine (2 mg/kg) and tracheal intubation. ⋯ Infants who received thiopental induction had a higher incidence of perioperative airway complications than all others. There was no significant difference in the recovery and discharge times among the three groups. We conclude that when rapid intravenous induction is required for infants, propofol is more effective than thiopental in obtunding the hypertensive response to intubation, and in young infants (1-6 mo) it results in more prompt emergence after short surgical procedures.
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Comparative Study Clinical TrialUse of mivacurium during laparoscopic surgery: effect of reversal drugs on postoperative recovery.
We studied the influence of mivacurium on the recovery profile following outpatient laparoscopic tubal ligation in 60 healthy, nonpregnant women. After administration of midazolam 2 mg intravenously (IV), anesthesia was induced with fentanyl, 2 micrograms/kg, and thiopental, 4 mg/kg, IV. When the patient became unresponsive (loss of eyelid reflex), either succinylcholine 1 mg/kg, IV (Group I), or mivacurium 0.2 mg/kg, IV (Groups II and III), was administered to facilitate tracheal intubation. ⋯ In addition, a comparable number of patients in each treatment group required analgesic medication for postoperative pain. Although patients who received succinylcholine complained of significantly more neck pain during the 24-h period after discharge, nausea, vomiting, and shoulder pain were similar in all three groups during this period. We conclude that neostigmine and glycopyrrolate may contribute to the development of postoperative emesis when used for reversal of residual neuromuscular block.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Clinical TrialThe effects of perioperative ketorolac infusion on postoperative pain and endocrine-metabolic response.
We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2 mg/h). The control group (n = 47) received an IM bolus of NaCl 0.9% (1 mL) followed by continuous saline infusion (2 mL/h) for 24 h. ⋯ The ketorolac group required less morphine (not significant [NS]) than the control group and had less adverse effects (P = 0.002). Thus, perioperative ketorolac infusion improved the quality of postoperative pain relief, and had no major influence on endocrine-metabolic response and no negative influences on hemostatic and renal functions. This study suggests that preventive ketorolac administration, followed by a continuous infusion, is an easy, useful, and safe method for pain control after abdominal surgery.
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Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Multicenter Study Clinical TrialAn initial multicenter, randomized controlled trial on the safety and efficacy of acadesine in patients undergoing coronary artery bypass graft surgery. SPI Research Group.
Acadesine (5-amino-4-imidazole carboxamide riboside) is a purine nucleoside analog that has been shown in animals to reduce myocardial ischemic injury by selectively increasing the availability of adenosine in ischemic tissues. Because patients undergoing coronary artery bypass graft (CABG) surgery are especially vulnerable to developing myocardial ischemia, we investigated whether perioperative use of this adenosine-regulating drug with potential anti-ischemic properties could modify the incidence and severity of perioperative myocardial ischemia. The goals of this study were to evaluate safety and the effects of acadesine on myocardial ischemia, left ventricular function, and, secondarily, on adverse clinical outcomes (myocardial infarction, heart failure, life-threatening dysrhythmias, and death) in patients undergoing CABG surgery. ⋯ During prebypass, the incidence of ECG ischemia was similar in all three groups (0%, 3%, 3%, respectively). The incidence of TEE ischemia was numerically lower in the two acadesine groups (high-dose = 6%, low-dose = 15%) than in the control group (19%), but this was not statistically significant (P = 0.22). During postbypass, the incidence of ECG ischemia was 11% in the high-dose group, 22% in the low-dose group, and 18% in the control group (P = 0.42), and TEE ischemia was similar in incidence in all groups (placebo = 29%; low dose = 27%; high-dose = 24%) (P = 0.86).(ABSTRACT TRUNCATED AT 400 WORDS)