Anesthesia and analgesia
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Anesthesia and analgesia · May 1995
Comparative Study Clinical Trial Controlled Clinical TrialAnalgesic and hemodynamic effects of epidural clonidine, clonidine/morphine, and morphine after pancreatic surgery--a double-blind study.
This study characterizes analgesia an hemodynamics after epidural clonidine 8 micrograms/kg (Group C) or clonidine 4 micrograms/kg+morphine 2 mg (Group CM) in comparison to epidural morphine 50 micrograms/kg (Group M). Forty-five patients scheduled for pancreatectomy in combined general/epidural anesthesia were studied. The study drugs were administered 75 min postoperatively and for 10 h pain intensity (visual analog scale [VAS]), heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO) were measured; filling pressures were kept > 5 mm Hg. ⋯ In Groups C and CM, HR, CO, and MAP were reduced significantly compared to baseline within the first 15-90 min, while stroke volume and systemic vascular resistance remained stable. We conclude, that hemodynamic alteration after epidural clonidine under conditions of stable filling pressures is caused mainly by a decrease in HR. It is not an effect of analgesia but of the intrinsic antihypertensive action of clonidine.
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Anesthesia and analgesia · May 1995
Randomized Controlled Trial Clinical TrialArterial and jugular venous bulb blood propofol concentrations during induction of anesthesia.
The aim of this study was to show that blood propofol concentrations at loss of consciousness vary with the rate of administration. Eighteen patients were allocated to receive a propofol infusion at 6 or 12 mg.kg-1.h-1 (approximately 8 and 15 mg/min) for induction of anesthesia. Propofol concentrations were analyzed from simultaneous arterial and jugular bulb venous blood samples. ⋯ There were no significant differences between the groups in the area between the arterial and venous time concentration curves from start of infusion to loss of consciousness (3.14 and 3.05 micrograms.mL-1.min-1). This study confirms that a target blood concentration of propofol cannot be identified with loss of consciousness under nonsteady state conditions. Both arterial and venous blood propofol concentrations at loss of consciousness depend on the rate of administration.
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Anesthesia and analgesia · May 1995
Randomized Controlled Trial Clinical TrialThe effects of chewing gum on gastric content prior to induction of general anesthesia.
To study the effects on gastric content and subjective well being of chewing gum in the immediate preoperative period, 60 female nonsmokers were randomized to use regular, sugar-free chewing gum preoperatively or to continue the overnight fast. In a similar fashion 44 habitual smokers were randomized to use nicotine gum 2 mg or not. Nonsmokers using chewing gum had significantly larger gastric fluid volumes than controls (mean 30 +/- 19 mL vs 20 +/- 15 mL; 95% confidence interval (CI) for difference 1-19 mL; P = 0.03), with no difference in gastric fluid acidity. ⋯ Although the use of nicotine gum in smokers was associated with a reduction in dryness of the mouth, thirst, and irritability, nonsmokers chewing regular gum did not report significant improvements in patient well being. In habitual smokers unable to abstain from nicotine, the use of nicotine gum on the morning of surgery may be beneficial. Although it is difficult to prove a direct influence on the incidence of pulmonary aspiration of increased gastric contents, the fact that regular, sugar-free chewing gum increased gastric fluid volumes probably means that it should not be used on the morning of surgery.
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Anesthesia and analgesia · May 1995
Postoperative nausea and vomiting after discharge from outpatient surgery centers.
We examined patients' experiences with nausea and vomiting after they were discharged from outpatient surgical centers. Data were collected on 211 surgical outpatients at 24-48 h after discharge via a telephone interview conducted by outpatient surgery nurses, and at 5 days after discharge via a patient-completed questionnaire. Telephone interviews were conducted with 193 patients. ⋯ Patients who experienced postdischarge nausea and vomiting were not able to resume their normal daily activities as quickly as those who did not. Patients managed postdischarge nausea and vomiting with little contact or intervention from health professionals and with minimal product purchases. The results indicate that postdischarge nausea and vomiting is common after outpatient surgery, and that it results in substantial distress and impairment for patients who experience it.