Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1997
Recovery from doxacurium infusion administered to produce immobility for more than four days in pediatric patients in the intensive care unit.
Doxacurium was administered by titrated infusion to 14 pediatric patients for 4.7-12.3 days after laryngotracheal reconstruction to produce minimum spontaneous movement and less than five posttetanic movements of the first toe after stimulation of the posterior tibial nerve. Recovery was documented by stimulation of the ulnar nerve with 2 Hz for 2 s (train-of-four [TOF]) at intervals of 1 min and measurement of the ratio of the fourth to the first response (TOF ratio) at the adductor pollicis. ⋯ In six of the patients, weakness and decreased coordination were noted for a few days to weeks postoperatively. There were no complications related to impairment of upper airway function or ventilation in those patients who had recovery of neuromuscular transmission to the extent of TOF ratio equal to 1 prior to extubation or in those patients in whom weakness or lack of coordination was noted after tracheal extubation.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialIntrathecal morphine for coronary artery bypass grafting and early extubation.
Aggressive control of pain during the immediate postoperative period after cardiac surgery with early tracheal extubation may decrease morbidity and mortality. This prospective, randomized, double-blinded, placebo-controlled clinical study examined the use of intrathecal morphine in patients undergoing cardiac surgery and its influence on early tracheal extubation and postoperative analgesic requirements. Patients were randomized to receive either 10 micrograms/kg of intrathecal morphine (n = 19) or intrathecal placebo (n = 21). ⋯ Although mean postoperative IV morphine use for 48 h was less in patients who received intrathecal morphine (42.8 mg) when compared to patients who received intrathecal placebo (55.0 mg), the difference between groups was not statistically significant. In conclusion, intrathecal morphine offers promise as a useful adjunct in controlling postoperative pain in patients after cardiac surgery. However, the optimal dose of intrathecal morphine in this setting, along with the optimal intraoperative baseline anesthetic that will provide significant analgesia, yet not delay extubation in the immediate postoperative period, remains to be elucidated.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Clinical TrialThe effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery.
A randomized, double-blind, placebo-controlled study was designed to compare the relative efficacy of prophylactic ondansetron, 4 mg intravenously (IV), when administered before induction of anesthesia or at the end of surgery to an outpatient population at high risk of developing postoperative nausea and vomiting (PONV). Patients undergoing otolaryngologic surgery were randomly assigned to one of three different treatment groups: Group 1 (placebo) received saline 5 mL prior to induction of anesthesia and again at the end of surgery; Group II received ondansetron 4 mg in 5 mL prior to induction of anesthesia and saline 5 mL at the end of surgery; and Group III received saline 5 mL prior to induction of anesthesia and ondansetron 4 mg at the end of surgery. All patients received the same general anesthetic technique. ⋯ After discharge from the ambulatory surgery unit, the incidence of nausea, vomiting, and the need for rescue antiemetic drugs were similar in all three treatment groups. In conclusion, ondansetron (4 mg IV) was more effective in reducing the need for rescue antiemetics in the recovery room when administered at the end versus prior to the start of otolaryngologic surgery. Therefore, when ondansetron is used for antiemetic prophylaxis in outpatients undergoing otolaryngologic procedures, it should be administered at the end of the operation rather than prior to induction of anesthesia.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialHands-up positioning during asymmetric sternal retraction for internal mammary artery harvest: a possible method to reduce brachial plexus injury.
This study compares the hands-up (HU) with the arms at side (AAS) position to determine whether one is beneficial in reducing brachial plexus stress during asymmetric sternal retraction. Eighty patients undergoing cardiac surgery were assigned to either Group 1 (AAS) or Group 2 (HU). Perioperative neurologic evaluations of the brachial plexus were performed and somatosensory evoked potentials (SSEPs) were collected during internal mammary artery harvest using asymmetric sternal retraction. ⋯ During asymmetric sternal retraction, HU positioning offered minimal benefit in reducing brachial plexus stress as measured by SSEP. Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury. However, none of the four patients with plexus symptoms in the HU group had ulnar nerve problems, suggesting that the higher incidence of postoperative symptoms observed with AAS positioning may occur from ulnar nerve compression.