Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy.
We compared ondansetron with droperidol, given prophylactically, in a randomized, prospective, double-blind study of women undergoing outpatient gynecologic laparoscopy. One-hundred fifty-eight women received either ondansetron (4 mg) or droperidol (20 micrograms/kg) intravenously during induction of anesthesia. Nausea was measured at three intervals: at admission to the postanesthesia care unit (PACU), 1 h after admission to the PACU, and on Postoperative Day 1. The incidence of vomiting was tabulated in the PACU and on Postoperative Day 1. Sedation was assessed 1 h after admission to the PACU. No differences in nausea, sedation, or number of patients vomiting in the PACU were found. More patients in the ondansetron group reported vomiting on Postoperative Day 1 than subjects in the droperidol group (25 vs 11). No difference in opiate use was found among patients who vomited. We conclude that droperidol is equivalent to ondansetron for the prophylactic treatment of nausea and vomiting in patients undergoing gynecologic laparoscopy, and that significant cost savings can be appreciated if droperidol is used. ⋯ Either ondansetron or droperidol, frequently used antiemetics, was given to women before they underwent gynecologic laparoscopy. No difference in the number of women experiencing postoperative nausea and vomiting or their level of sedation was found. Equivalent effectiveness and significant cost-savings may be obtained by using droperidol prophylactically for laparoscopic surgery.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialThe effects of dexamethasone on antiemetics in female patients undergoing gynecologic surgery.
This randomized, double-blind study compared the effects of dexamethasone plus either droperidol, metoclopramide, or granisetron with each antiemetic alone for preventing postoperative nausea and vomiting (PONV) in 270 female patients undergoing general anesthesia for major gynecological surgery. Patients were randomly assigned to receive either droperidol 1.25 mg (Group D1, n = 45), droperidol 1.25 mg plus dexamethasone 8 mg (Group D2, n = 45), metoclopramide 10 mg (Group M1, n = 45), metoclopramide 10 mg plus dexamethasone 8 mg (Group M2, n = 45), granisetron 40 micrograms/kg (Group G1, n = 45), or granisetron 40 micrograms/kg plus dexamethasone 8 mg (Group G2, n = 45) immediately before the induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used throughout the study. Complete response, defined as no PONV and no administration of rescue antiemetic medication during the first 24 h after anesthesia, was 49% in Group D1, 60% in Group D2 (P = 0.199 versus Group D1), 51% in Group M1, 62% in Group M2 (P = 0.198 versus Group M1), 80% in Group G1, and 96% in Group G2 (P = 0.025 versus Group G1). Our results suggest that dexamethasone enhances the antiemetic efficacy of granisetron but does not potentiate the other antiemetics-droperidol and metoclopramide-in female patients undergoing major gynecological surgery. ⋯ We compared the efficacy of dexamethasone plus three different antiemetics-droperidol, metoclopramide, and granisetron-for the prevention of nausea and vomiting after gynecologic surgery. The granisetron-dexamethasone combination was the most effective for preventing post-operative emetic symptoms.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialDoes dextrose affect analgesia or the side effects of intrathecal sufentanil?
Intrathecal (i.t.) sufentanil provides rapid effective pain relief for early labor, but it also produces undesirable side effects, which may be primarily related to cephalad spread. Although the combination of dextrose and positioning the patient head-up limits the spread of other spinally administered drugs, these factors have not been examined in laboring women receiving i.t. sufentanil. We hypothesized that the addition of dextrose to i.t. sufentanil injected with women in the sitting position would limit cephalad spread and side effects. Sixty-six healthy nulliparous parturients in early labor were randomized to receive 2-mL i.t. injections of sufentanil 10 micrograms plus saline with patients in either the lateral decubitus or sitting position, sufentanil 10 micrograms plus dextrose 7.5% with patients in either the lateral decubitus or sitting positions, or plain dextrose 7.5%. Pain scores using a 10-cm visual analog pain scale, sensory block height, and side effects were recorded. Dextrose 7.5% did not affect cephalad spread, as measured by block height to pin testing, but it did significantly reduce the duration of analgesia and the incidence of pruritus from i.t. sufentanil administered to patients in the sitting position compared with patients in the lateral position. In contrast, patient position had no effect on analgesia or side effects in patients receiving i.t. sufentanil in saline. I.t. dextrose alone had no effect. ⋯ The authors conclude that the addition of dextrose to intrathecal sufentanil injected into patients in the sitting position reduces the duration of analgesia without significantly reducing side effects with the exception of pruritus, and therefore does not improve the clinical utility of intrathecal sufentanil.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialSplanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method.
Carbon dioxide (CO2) pneumoperitoneum together with an increased intraabdominal pressure (IAP) induces a hemodynamic stress response, diminishes urine output, and may compromise splanchnic perfusion. A new retractor method may be less traumatic. Accordingly, 30 ASA physical status I or II patients undergoing laparoscopic cholecystectomy were randomly allocated to a CO2 pneumoperitoneum (IAP 12-13 mm Hg) (control) or to a gasless abdominal wall lift method (retractor) group. Anesthesia and intravascular fluids were standardized. Direct mean arterial pressure (MAP), urine output, urine-N-acetyl-beta-D-glucosaminidase (U-NAG), arterial blood gases, gastric mucosal PCO2, and intramucosal pH (pHi) were measured. Normoventilation was instituted in all patients. MAP increased (P < 0.001) only with CO2 pneumoperitoneum. Minute volume of ventilation had to be increased by 35% with CO2 insufflation. PaCO2 was significantly higher (P < 0.05) for 3 h postoperatively in the control group. Diuresis was less (P < 0.01) and U-NAG levels (P < 0.01) higher in the control group. The pHi decreased after induction of pneumoperitoneum up to three hours postoperatively and remained intact in the retractor group. We conclude that the retractor method for laparoscopic cholecystectomy ensures stable hemodynamics, prevents respiratory acidosis, and provides protection against biochemical effects, which reveal the renal and splanchic ischemia caused by CO2 insufflation. ⋯ A mechanical retractor method (gasless) was compared with conventional CO2 pneumoperitoneum for laparoscopic cholestectomy. The gasless method ensured stable hemodynamics, prevented respiratory acidosis, and provided protection against the renal and splanchnic ischemia seen with CO2 pneumoperitoneum.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialThe relationship between cytochrome P4502E1 activity and plasma fluoride levels after sevoflurane anesthesia in humans.
We determined whether the perianesthetic plasma fluoride levels after sevoflurane anesthesia in humans were correlated with the metabolic ratio (MR) of 6-hydroxychlorzoxazone to chlorzoxazone, an in vivo probe for cytochrome P4502E1 (CYP2E1) activity. Thirty ASA physical status I or II patients scheduled for extraabdominal surgery were randomized to a chlorzoxazone (n = 20) or a control group (n = 10). Patients in the chlorzoxazone group received 500 mg chlorzoxazone orally on the morning of the day of surgery. Chlorzoxazone and its 6-hydroxymetabolite concentrations were measured in plasma 2 h after drug administration. Anesthesia was induced with propofol, fentanyl, and atracurium intravenously and maintained with sevoflurane (inspired concentration 1-3 vol%). Plasma fluoride concentrations were determined before the induction of anesthesia, at the cessation of sevoflurane, and 2, 4, 6, 10, and 24 h thereafter. The area under the plasma fluoride concentration-time curve (AUC) was calculated up to 24 h after sevoflurane cessation. MR correlated significantly with the plasma fluoride AUC (r2 = 0.28, P < 0.025), the elimination constant calculated for the postanesthetic 10- to 24-h period (r2 = 0.30, P < 0.025), and the plasma fluoride levels 24 h after the cessation of sevoflurane (r2 = 0.48, P < 0.05). A comparison between groups indicated that the administration of chlorzoxazone itself did not alter the postanesthetic fluoride kinetics. Thus, the interindividual variability in perianesthetic plasma fluoride levels after sevoflurane anesthesia is reflected by differences in the MR of chlorzoxazone and hence is related to the interindividual variability in CYP2E1 activity. We conclude that although the predictive value is limited, this study provides a reasonable basis for examining renal function after sevoflurane anesthesia in a subgroup of patients with a high preoperative metabolic ratio of chlorzoxazone. ⋯ CYP2E1 metabolizes sevoflurane as measured by the metabolic ratio of chlorzoxazone. Patients with a high ratio may be used to justify examining renal function in patients receiving sevoflurane.