Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialProphylactic antiemetics for laparoscopic cholecystectomy: ondansetron versus droperidol plus metoclopramide.
Two hundred adults undergoing laparoscopic cholecystectomy were enrolled in a prospectively randomized, double-blind investigation comparing ondansetron, 4 mg (Group O) with the combination of droperidol, 0.625 mg, and metoclopramide, 10 mg (Group DM). Antiemetic drugs were administered intravenously (IV) after induction of general anesthesia (propofol, desflurane). Moderate or severe nausea in the postanesthesia care unit was treated with the cross-over drug, i.e., ondansetron for patients in Group DM or droperidol plus metoclopramide for patients in Group O. ⋯ Of 102 patients in Group O, 44 required antiemetics in the postanesthesia care unit, compared with 24 of 98 patients in Group DM (P < 0.01). One patient (in Group DM) was admitted for persistent nausea. In conclusion, droperidol 0.625 mg IV in combination with metoclopramide 10 mg IV was more effective in preventing postoperative nausea than was ondansetron 4 mg IV in patients undergoing laparoscopic cholecystectomy, with no difference in the time to discharge.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Clinical TrialThe effect of epidural fentanyl on the minimum local analgesic concentration of epidural chloroprocaine in labor.
The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-mL volume in the first stage of labor. The aim of this study was to determine the local anesthetic sparing efficacy of epidural fentanyl by its effect on the MLAC of chloroprocaine. Fifty-six parturients, not exceeding 7 cm cervical dilation, who requested epidural analgesia were allocated to one of two groups in this double-blind, randomized, prospective study. ⋯ Analgesic efficacy was assessed using 100-mm visual analog pain scores with 10 mm or less within 30 min defined as effective. The MLAC of chloroprocaine was reduced from 0.43% wt/vol to 0.26% wt/vol by fentanyl (P = 0.023). Thus, the addition of epidural fentanyl 3 micrograms/mL (60 micrograms resulted in a significant 40% reduction in the MLAC of chloroprocaine in the first stage of labor.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block.
This study assessed the minimum dose of clonidine required to prolong the duration of both anesthesia and analgesia after axillary brachial plexus blockade. Eighty patients scheduled for elective hand surgery were divided into eight groups in a randomized, double-blind fashion. An axillary brachial plexus block was performed with 40 mL 1% mepivacaine plus 1:200,000 epinephrine. ⋯ The minimum dose of clonidine required to significantly prolong the duration of analgesia and anesthesia was, respectively, 0.1 and 0.5 microgram/kg. No side effects (sedation, drowsiness, bradycardia, arterial hypotension) were reported. We conclude that the dose of clonidine required to prolong significantly the duration of both anesthesia and analgesia after axillary brachial plexus blockade is 0.5 microgram/kg and that, at this dose, clonidine may be used without important reported side effects even in outpatients.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of variable-dose patient-controlled analgesia with fixed-dose patient-controlled analgesia.
We examined the effect on the quality of analgesia and side effects of increasing the patient control component of morphine patient-controlled analgesia (PCA) by offering the patient a choice of bolus dose sizes. Using a three-button hand piece, patients could choose between 0.5-, 1.0-, and 1.5-mg boluses of morphine (variable-dose PCA, VDPCA). Successful demands were delivered by a modified Graseby 3400 Anaesthesia Pump controlled by a Toshiba T1900 computer. ⋯ Treatment groups did not differ in their duration of PCA therapy, total morphine consumption, or time spent with mild or severe oxyhemoglobin desaturation. There were no differences in their ease of controlling pain, satisfaction with pain control, experience of pain on movement, quality of sleep, severity of nausea, or incidence of vomiting. Although the more complex VDPCA technique provides adequate postoperative analgesia, it does not offer any advantage over conventional FDPCA.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of isoflurane versus fentanyl as primary anesthetics for mitral valve surgery.
We conducted a randomize study of fentanyl compared to isoflurane anesthesia in patients with pulmonary hypertension undergoing mitral valve surgery. Patients were premedicated and randomly assigned to one of two groups: 21 patients had anesthesia induced with thiopental and maintained with isoflurane; 23 patients had anesthesia induced with a fentanyl bolus and maintained with a fentanyl infusion. Adjustments of fentanyl infusion and isoflurane concentration, as well as fentanyl boluses and vasoactive/positive inotropic medication, were administered to maintain preoperative arterial blood pressure. ⋯ Adequate hemodynamic profiles were achieved in both groups with comparable use of inotropic and vasoactive medication, with the exception of norepinephrine that was administered intraoperatively to significantly (P < 0.05) more patients in the isoflurane-based anesthesia group. Neither technique was associated with acute improvement of right heart performance or pulmonary hypertension, in large part because of morphologic changes of the pulmonary arterial bed, occurring with long-standing mitral valve disease. We conclude that isoflurane-based anesthesia is adequate for this type of surgery, although there is a higher anesthetic algorithm failure rate than with fentanyl-based anesthetic technique.