Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialVomiting after outpatient tonsillectomy and adenoidectomy in children: the role of nitrous oxide.
The role of nitrous oxide anesthesia in causing postoperative vomiting (POV) was studied in 60 children undergoing outpatient tonsillectomy and adenoidectomy. In this controlled, randomized, double-blind investigation, anesthesia was induced by inhalation of a volatile anesthetic in both groups. ⋯ Pharmacologic intervention was administered on the basis of evaluation by the nurses. Although a high incidence of POV was noted in both groups, there was no difference in either the incidence or the severity of POV between the group receiving nitrous oxide and the group receiving no nitrous oxide.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialA double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding.
The study was designed to compare intravenous ketorolac to rectal acetaminophen for analgesia and bleeding in pediatric patients undergoing tonsillectomy. We studied 50 patients, aged 2-15 yr undergoing tonsillectomy with or without adenoidectomy. In a randomized, prospective double-blind fashion, patients were assigned to receive either ketorolac (1 mg/kg) or rectal acetaminophen (35 mg/kg). ⋯ Significantly more measures to achieve hemostasis were required in the ketorolac group (P = 0.012). We conclude that ketorolac is no more effective than high-dose rectal acetaminophen for analgesia in the patient undergoing tonsillectomy. Hemostasis during tonsillectomy was significantly more difficult to achieve in patients receiving ketorolac.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialThe influence of the duration of control stimulation on the onset and recovery of neuromuscular block.
The onset of action of atracurium 450 micrograms/kg, mivacurium 160 micrograms/kg, and vecuronium 80 micrograms/kg was measured after train-of-four (TOF) stimulation had been applied for 1, 5, 10, 15, or 20 min in groups of 10 patients each during anesthesia with thiopental, nitrous oxide-oxygen, and fentanyl. TOF stimulation was applied to the ulnar nerve at 2 Hz every 12 s and the force of contraction of the adductor pollicis muscle recorded. There was a progressive and significant reduction in the time to onset of maximum block with increasing times of control stimulation with all three relaxants (P < 0.0001). ⋯ The time to recovery of T1 (first response in the TOF stimulation) to 25% of control (duration of clinical relaxation) increased from 33 +/- 5.7 to 52 +/- 13.4 min with atracurium, 25 +/- 7.6 to 38 +/- 9.4 min with vecuronium, and 13 +/- 2.5 to 18 +/- 3.5 min with mivacurium with the period of control stimulation increasing from 1 to 20 min. The differences were significant for atracurium and vecuronium (P < 0.05-0.0001). We conclude that increasing periods of control stimulation are associated with decreasing time to onset of neuromuscular block with atracurium, vecuronium, and mivacurium at the adductor pollicis muscle.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialHemodynamic and analgesic effects of clonidine added repetitively to continuous epidural and spinal blocks.
Clonidine in spinal and epidural blocks prolongs anesthesia, but can cause hypotension and bradycardia. The aim of our study was to compare hemodynamic and analgesic effects of spinal versus epidural clonidine alone and after repetitive dosing. In a prospective, randomized, double-blind study, we evaluated 40 patients scheduled for lower extremity orthopedic surgery under continuous spinal or epidural anesthesia with bupivacaine 0.5% (initial dose 5 mg and 50 mg, respectively). ⋯ Duration of spinal and epidural anesthesia was increased more than two fold by clonidine. In summary, the addition of clonidine prolongs analgesia by either route. These results may be explained by clonidine's sites of action in hemodynamic control and the density of bupivacaine-induced block.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialPharmacokinetics and pharmacodynamics of oxycodone when given intravenously and rectally to adult patients with cancer pain.
The single-dose pharmacokinetics and pharmacodynamics of oxycodone administered by the intravenous and rectal routes were determined in 12 adult cancer patients with moderate to severe cancer pain (visual analog scale [VAS] score, approximately 5). Oxycodone was administered by the intravenous and rectal routes with open drug administration and a cross-over design. After single-dose intravenous administration (7.9 +/- 1.5 mg, mean +/- SD), the mean (+/- SD) terminal half-life was 3.4 h (+/- 1.1), the mean (+/- SD) plasma clearance was 45.4 L/h (+/- 10.1), and the mean (+/- SD) volume of distribution in the terminal phase was 3.0 L/kg (+/- 1.1). ⋯ However, rectal oxycodone provided analgesia of much longer duration (approximately 8-12 h) than did intravenous oxycodone (approximately 4 h). There were no significant differences (P > 0.05) in the incidence and severity of side effects between intravenous and rectal oxycodone. The marked interindividual variation observed in the pharmacokinetics and pharmacodynamics of oxycodone in this study emphasizes the need for individualized dosing regimens.