Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialRecovery from outpatient laparoscopic tubal ligation is not improved by preoperative administration of ketorolac or ibuprofen.
The analgesic efficacy of a single dose of ketorolac or ibuprofen given preoperatively was assessed in healthy outpatients undergoing general anesthesia for laparoscopic tubal ligation. Fifty patients were randomized to receive either ketorolac 60 mg intravenously (i.v.), ibuprofen 800 mg orally, or placebo in a double-blind manner. Anesthesia was induced with fentanyl 2 micrograms/kg, thiopental 5 mg/kg, and either vecuronium 0.1 mg/kg or succinylcholine 1.5 mg/kg i.v. and was maintained with nitrous oxide 67% in oxygen and isoflurane. ⋯ The dose of parenteral morphine required in the PACU was not different between the control (7 +/- 1.2 mg), ibuprofen (5.7 +/- 1.4 mg), and ketorolac (6.1 +/- 1.4 mg) groups. There was no difference between groups in terms of pain visual analog scale (VAS) scores, fatigue VAS scores, recovery times, or the incidence of postoperative nausea and vomiting. The preoperative administration of either parenteral ketorolac or oral ibuprofen did not decrease postoperative pain or side effects when compared to placebo in this outpatient population.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialInterpleural infusion of 2% lidocaine with 1:200,000 epinephrine for postthoracotomy analgesia.
The value of intrapleural analgesia after thoracotomy is still controversial. We investigated the pharmacokinetics of interpleural analgesia in 14 patients with and without thoracic drainage (Groups TD+ and TD-, respectively) to determine the safety of the technique. The infusion led to a high steady-state concentration (Css) of 5.91 +/- 2.46 mg/mL in Group TD-. ⋯ The VAS score was slightly reduced after the bolus (6.6 +/- 1.0 vs 8.7 +/- 0.3; P < 0.05 vs the placebo group) but the cumulative doses of morphine were similar in both groups. There was a slight, but not sustained, improvement in pulmonary function test. In conclusion, interpleural analgesia by continuous infusion of lidocaine is poor after thoracotomy and may lead to blood levels in the toxic range.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialEffectiveness of low levels of nonventilated lung continuous positive airway pressure in improving arterial oxygenation during one-lung ventilation.
Continuous positive airway pressure (CPAP) of 5 and 10 cm H2O applied to the nonventilated lung is effective in improving arterial oxygenation during one-lung ventilation (1-LV). The effectiveness of lower levels of CPAP on improving oxygenation, however, has not been reported, possibly because of limitations of previous methods of CPAP delivery. Recently, a disposable, self-assembled CPAP system capable of delivering CPAP over a wide range of pressures has been introduced (Mallinckrodt Medical, Inc., St. ⋯ Application of CPAP followed 20 min of stable 1-LV in the lateral decubitus position. Compared with two-lung ventilation, PaO2 (mean +/- SD) was significantly less with 1-LV (Group I, 126 +/- 75 mm Hg, and Group II, 173 +/- 79 mm Hg). Application of the assigned CPAP resulted in an increase in PaO2 compared to 1-LV (Group I, 270 +/- 112 mm Hg, and Group II, 386 +/- 66 mm Hg; P < or = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Aug 1994
Midazolam pharmacokinetics in patients undergoing abdominal aortic surgery.
Fentanyl and its analogs are eliminated slowly by patients having abdominal aortic surgery. This is principally due to larger volumes of distribution, compared to the pharmacokinetics determined in other surgical patients. Midazolam, like these opioids, is a lipophilic organic base, suggesting that it may also have a larger volume of distribution in patients undergoing abdominal aortic reconstruction. ⋯ The volume of the central compartment (Vc) and the volume of distribution at steady state (Vdss) were 5.8 +/- 5.3 L and 118.2 +/- 70.4 L, respectively. The elimination half-life was 6.3 +/- 3.6 h, 1.5- to 3-fold longer than has been previously reported in patients undergoing surgery. Compared to previously published studies of other groups of patients, metabolic clearance of midazolam was slower in patients undergoing abdominal aortic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Aug 1994
Determination of end-tidal sevoflurane concentration for tracheal intubation and minimum alveolar anesthetic concentration in adults.
The purpose of this study was to determine both the concentration of sevoflurane required for tracheal intubation (MACEI) and its minimum alveolar anesthetic concentration (MAC) in adults. The study group consisted of 86 elective surgical patients, ASA physical status I or II, aged 16-59 yr. There was no premedication administered. ⋯ The MAC of sevoflurane was 1.58% (95% confidence limits, 1.14%-1.98%), and the AD95 (anesthetic ED95) was 2.96%. The MACEI/MAC ratio was 2.86 (95% confidence limits, 2.63-3.43). Anesthesia induction followed by tracheal intubation can be accomplished in adults when sevoflurane is administered as a sole anesthetic, but in excess of 8% end-tidal concentration.