Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparative analgesic efficacy of patient-controlled analgesia with ketorolac versus morphine after elective intraabdominal operations.
We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (by visual analog scale [VAS]), patients were randomly assigned to one of two groups. ⋯ Mean pain scores were less in Group 1 than in Group 2 at each time, but only significantly so at 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) after starting PCA. Time to acceptance of oral liquids was equivalent in Groups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, although well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.
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Anesthesia and analgesia · Jun 1995
Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium.
The purpose of this study was to measure the degree of residual neuromuscular block at different times after a single dose of vecuronium, and to evaluate the effectiveness of two different doses of neostigmine in antagonizing this residual block. Train-of-four (TOF) ratios were examined for up to 4 h after a single dose of vecuronium, 0.1 mg/kg, in 60 patients during nitrous oxide/isoflurane/fentanyl anesthesia. The effect of neostigmine, 40 micrograms/kg, was studied at 1,2,3, or 4 h. ⋯ One patient, at 1 h, had a TOF ratio of 0.00 and this did not reach 0.75 until 57 min after neostigmine, 40 micrograms/kg. There was a high incidence (50%) of adverse cardiovascular effects after both doses of neostigmine. In making the decision as to whether neostigmine should be administered, the risk to the patient of residual neuromuscular block must be balanced against the adverse cardiovascular effects of the neostigmine.
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for outpatient arthroscopic knee sugery with intraarticular bupivacaine and ketorolac.
Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Systemic ketorolac is also useful in the management of these patients. Ketorolac, a nonsteroidal antiinflammatory drug (NSAID), alters the sensitivity of peripheral nociceptors by reducing the local concentration of allogenic chemicals which are activated by peripheral tissue injury. ⋯ The results of this study revealed a significant difference in analgesia from the IA administration of ketorolac. The group who received a combination of IA bupivacaine and IA ketorolac had decreased postoperative pain, a decreased need for postoperative analgesics, and an increased analgesic duration. We conclude that the use of IA ketorolac improved comfort in patients undergoing knee arthroscopy.
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Clinical TrialPeroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics.
The aims of this study were to investigate the influence of adenosine infusion, firstly, on postoperative analgesic requirements, and secondly, on peroperative isoflurane requirements. Seventy-five women, aged 18-70 yrs, ASA grades I and II, scheduled for breast surgery, were randomly assigned to peroperatively receive a double-blind intravenous infusion of either adenosine, 80 micrograms.kg-1.min-1, or placebo, during surgery under isoflurane/N2O/O2 anesthesia. ⋯ Further, the postoperative 24-h opioid requirements were reduced by 27% in the adenosine group (P < 0.03). In conclusion, we found that a peroperative infusion of a small dose of adenosine during breast surgery, reduces the peroperative anesthetic requirements, and the demand for post-operative analgesics.
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Clinical TrialAttenuation of cardiovascular responses to tracheal extubation with diltiazem.
We conducted a randomized, double-blind study to examine the effects of intravenous (i.v.) diltiazem (0.1 or 0.2 mg/kg) on hemodynamic changes during tracheal extubation and emergence from anesthesia in 80 ASA physical status I patients undergoing elective gynecologic surgery. The effect of diltiazem was compared with that of lidocaine or saline. Anesthesia was maintained with 0.5%-1.5% isoflurane and 60% nitrous oxide (N2O) in oxygen. ⋯ The inhibitory effect on these cardiovascular responses was greatest with diltiazem 0.2 mg/kg, while the extent of attenuation by diltiazem 0.1 mg/kg was similar to that by lidocaine. We concluded that a bolus dose of i.v. diltiazem 0.1 or 0.2 mg/kg given 2 min before extubation was of value in attenuating the cardiovascular changes occurring in association with tracheal extubation and emergence from anesthesia. This alleviative effect of diltiazem was equal or superior to that of i.v. lidocaine 1 mg/kg.