Anesthesia and analgesia
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane versus isoflurane for maintenance of anesthesia: are serum inorganic fluoride ion concentrations of concern?
Sevoflurane administration can result in increased serum inorganic fluoride ion concentrations, which have been associated with inhibition of renal concentrating ability. We measured serum fluoride levels, renal function, and recovery variables as a function of time in ASA grade I-III patients administered general anesthesia with isoflurane or sevoflurane for at least 1 h. Fifty patients were exposed to sevoflurane (< or = 2.4% inspired concentration) or isoflurane (< or = 1.9% inspired concentration) for maintenance of anesthesia as part of a multicenter trial. ⋯ Those two patients also demonstrated an increase in serum blood urea nitrogen and creatinine at 24 h after sevoflurane administration compared with baseline. The elimination half-life of serum fluoride ion was 21.6 h. The results of this study suggest the possibility of sevoflurane induced nephrotoxicity.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia.
Ketorolac prolongs bleeding time and inhibits platelet aggregation and platelet thromboxane production in healthy, awake volunteers. However, platelet function was recently shown not to worsen after ketorolac was given during general anesthesia. The purpose of this study was to investigate platelet function changes during a standardized spinal anesthetic and surgery, as well as after a single intraoperative dose of intravenous (IV) ketorolac. ⋯ Platelet TxB2 production decreased dramatically in the ketorolac group from preoperative to poststudy drug data points (157.2 +/- 129.4 to 0.3 +/- 0.3 ng/mL; P < 0.01). Platelet function does not appear to be accentuated during spinal anesthesia as it is during general anesthesia. Unlike during general anesthesia, platelet function during spinal anesthesia is impaired, with respect to bleeding time and platelet aggregometry to collagen, by a single intraoperative dose of IV ketorolac.
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Anesthesia and analgesia · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialDose-response study of intrathecal morphine versus intrathecal neostigmine, their combination, or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty.
This study was designed to examine postoperative analgesia with intrathecal neostigmine in a randomized, blinded trial with morphine as the active control in patients undergoing anterior and posterior vaginoplasty. A secondary aim was to provide preliminary data on the interaction between these two drugs. The incidence of adverse effects was also assessed. ⋯ Increasing doses of intrathecal morphine (50 micrograms, 100 micrograms, and 200 micrograms) and intrathecal neostigmine (50 micrograms, 100 micrograms, and 200 micrograms) showed a dose-dependent pattern of analgesia (P < 0.001). The M50 + N50 combination resulted in a better analgesic effect with fewer side effects than M50, N50, and control groups. These preliminary data suggest that spinal neostigmine produces analgesia for vaginoplasty surgery similar in duration to spinal morphine and that the combination of morphine and neostigmine may allow a reduction in the dose of each component for postoperative analgesia.
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Anesthesia and analgesia · Jun 1996
Comparative Study Clinical Trial Controlled Clinical TrialThe effect of stabilization on the onset of neuromuscular block when assessed using accelerometry.
Accelerometry is increasingly being used for neuromuscular monitoring. We sought to determine whether this system is sensitive to the period of stabilization of muscle twitch prior to the administration of neuromuscular relaxant. We recruited 20 patients. ⋯ The data collected was subjected to a paired t-test with P < 0.05 taken as significant. The mean onset times for patients who received vecuronium was 148.5s for the arms stabilized for 3 min and 151.5s for the arms stabilized for 20 min, and in those who received atracurium it was 138.0s and 130.5s, respectively. We conclude that there is no significant difference in the onset of neuromuscular block with either vecuronium or atracurium after stabilization periods of 3 or 20 min when assessed by accelerometry.