Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1996
Randomized Controlled Trial Clinical TrialPatient-controlled intranasal analgesia: a method for noninvasive postoperative pain management.
Recently, a new device for patient-controlled intranasal analgesia (PCINA) was described, and a pilot study demonstrated promising results with respect to efficacy and patient satisfaction. The present study compares PCINA with intravenous (IV) patient-controlled analgesia (PCA). Fifty orthopedic patients were prospectively studied over an 8-h period on the first day after surgery. ⋯ There was no significant intergroup difference in pain intensity. No patient had problems using the PCINA device. The present study demonstrates, that PCINA provides relief of postoperative pain as effectively as IV PCA.
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Anesthesia and analgesia · Sep 1996
Clinical Trial Controlled Clinical TrialThe effects of the menstrual cycle on the incidence of emesis and efficacy of ondansetron.
Postoperative nausea and vomiting after general anesthesia remains a complex and perturbing phenomenon associated with several factors. In women, the phase of the menstrual cycle as a factor in postoperative nausea and emesis is controversial. This retrospective study was performed to assess the effects of the menstrual cycle and efficacy of the antiemetic ondansetron on postoperative emesis. ⋯ There was no relationship (P = 0.100) between the incidence of emesis and the phase of the menstrual cycle in the group receiving the placebo. There was, however, a significant reduction (P < 0.001) in emesis for the ondansetron-treated patients regardless of the phase of the menstrual cycle. In addition, ondansetron had a similar dose-response curve in both menstruating and nonmenstruating women.
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Anesthesia and analgesia · Sep 1996
The dermatomal spread of epidural bupivacaine with and without prior intrathecal sufentanil.
Clinicians often use a technique combining intrathecal sufentanil and epidural bupivacaine to provide labor analgesia. This study determines the effect of 27- or 24-gauge dural puncture and intrathecal sufentanil 10 micrograms on the dermatomal spread of epidural bupivacaine. Healthy laboring women received no dural puncture (n = 77) (no puncture group [NPG]) or dural puncture with a 27-gauge Whitacre needle (n = 33) or a 24-gauge Sprotte needle (n = 37) and intrathecal sufentanil 10 micrograms (dural puncture group [DPG]) before epidural injection of 13 mL bupivacaine 0.25%. ⋯ More patients in the DPG had sensory blockade T-4 or higher (17 of 70 DPG patients vs 8 of 77 NPG patients; P < 0.05). No patient in either group showed clinical evidence of respiratory compromise. In conclusion, epidural bupivacaine anesthetized more dermatomes when administered 104 +/- 42 min after dural puncture and intrathecal sufentanil 10 micrograms than when given without prior dural puncture and intrathecal injection.
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Because of remifentanil's unique pharmacokinetics, its systemic administration may be suitable for clinical settings where a potent, fast-acting, systemic mu-opioid with a rapid recovery is required, e.g., short painful intervention in the emergency room or the intensive care unit, or procedures in the day surgery or endoscopy suite. Total intravenous anesthesia for longer lasting procedures may become more promising because of the predictability of the offset of remifentanil even after long infusions. ⋯ Remifentanil might be the first potent mu-opioid that does not accumulate in this fashion, and therefore it opens promising new clinical perspectives (52). However, as mentioned above, the relative short-lasting analgesic effect after cessation of the remifentanil infusion might require new, sophisticated techniques from the anesthetist to prevent immediate onset of postoperative pain.
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Anesthesia and analgesia · Sep 1996
Prone positioning improves pulmonary function in obese patients during general anesthesia.
We investigated the effects of prone position on functional residual capacity (FRC), the mechanical properties (compliance and resistance) of the total respiratory system, lung and chest wall, and the gas exchange in 10 anesthetized and paralyzed obese (body mass index more than 30 kg/m2) patients, undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique. ⋯ Resistance of the total respiratory system, lung, and chest wall were not modified on turning the patients prone. The increase in FRC and lung compliance was paralleled by a significant (P < 0.01) improvement of PaO2 from supine to prone position (130 +/- 31 vs 181 +/- 28 mm Hg, P < 0.01), while PaCO2 was unchanged. We conclude that, in anesthetized and paralyzed obese subjects, the prone position improves pulmonary function, increasing FRC, lung compliance, and oxygenation.