Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialEvaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures.
Adequate postoperative analgesia without side effects is necessary to facilitate same-day discharge of ambulatory patients after ambulatory surgery. This study compared the use of intravenous morphine and fentanyl after painful ambulatory procedures with respect to analgesic efficacy, the incidence of side effects, and impact on the patient's readiness for discharge. Fifty-eight patients undergoing ambulatory surgery were prospectively randomized to receive morphine or fentanyl for postoperative analgesia and studied in double-blind fashion. ⋯ There was no significant difference in the duration of stay in the PACU (morphine vs fentanyl, 69 +/- 15 min vs 71 +/- 20 min), the times to achieve recovery milestones, and fitness for discharge (morphine vs fentanyl, 136 +/- 41 min vs 132 +/- 40 min). The short duration of fentanyl was not associated with faster discharge times; most patients required additional analgesia to control pain. Morphine produced a better quality of analgesia but was associated with an increased incidence of nausea and vomiting, the majority of which occurred after discharge.
-
Anesthesia and analgesia · Mar 1997
Clinical TrialPlasma concentrations of bupivacaine in neonates after continuous epidural infusion.
This study reports plasma bupivacaine concentrations in 13 neonates who received lumbar epidural anesthesia during major abdominal surgery. A bolus of 1.8 mg/kg of bupivacaine (2.5 mg/mL) was administered after induction of anesthesia, followed by a continuous infusion of 0.2 mg.kg-1.h-1 (1.25 mg/mL). Plasma concentrations of total and free bupivacaine and alpha 1-acid-glycoprotein (AAG) were determined. ⋯ However, a substantial number of patients still had increasing concentrations of total plasma bupivacaine at 48 h. Furthermore, the interindividual variation was considerable. These observations cause concern about the safety of epidural infusions longer than 48 h in the age group studied.
-
Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting after gynecologic surgery.
This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women undergoing gynecologic incontinence surgery with standardized general anesthesia. At the end of surgery, the patients received either tropisetron 5 mg, droperidol 1.25 mg, or 0.9% saline intravenously (i.v.). ⋯ The number of emetic episodes (retching and/or vomiting) per patient within 48 h was significantly decreased under tropisetron when compared with placebo (tropisetron 2.5 +/- 3.4, droperidol 4.2 +/- 6.1, placebo 5.9 +/- 7.1). With regard to adverse events, the patients in the droperidol group had significantly more anxiety than the placebo group (2-6 h postoperatively), more drowsiness than the tropisetron and placebo groups (0-2 h postoperatively), and more dissatisfaction than the tropisetron (0-6 h postoperatively) and placebo groups (2-6 h postoperatively). We conclude that tropisetron given 5 mg i.v. during anesthesia in gynecologic incontinence surgery effectively prevents vomiting but not nausea and retching, while 1.25 mg i.v. droperidol fails to prevent any of these emetic symptoms and results in adverse events.
-
Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialLate intraoperative clonidine administration prevents postanesthetic shivering after total intravenous or volatile anesthesia.
Postoperative administration of clonidine is an effective treatment for shivering. However, the ability of this drug to stop postanesthetic shivering when administered intraoperatively remains controversial. Furthermore, the relative efficacy of clonidine during isoflurane and propofol anesthesia remains unknown. ⋯ Clonidine administration significantly reduced postoperative pain. The incidence of postanesthetic shivering was significantly less after propofol anesthesia than after isoflurane/nitrous oxide anesthesia. However, a late intraoperative bolus administration of 3 micrograms/kg clonidine prevents postoperative shivering in patients given either type of anesthesia.
-
Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of lidocaine and saline for epidural top-up during combined spinal-epidural anesthesia in volunteers.
This study was designed to determine the efficacy of saline as an epidural top-up to prolong spinal anesthesia during combined spinal-epidural anesthesia (CSEA). Eight volunteers received three separate CSEAs with intrathecal lidocaine (50 mg). After two-segment regression, each subject received either a saline (10 mL), lidocaine 1.5% (10 mL), or control sham (0.5 mL saline) epidural injection in a randomized, double-blind, triple cross-over fashion. ⋯ Instead, saline decreased the duration of tolerance to TES by 20 and 24 min at the knee and ankle (P < 0.05). Recovery from motor block at the quadriceps was prolonged by an epidural injection of lidocaine (P < 0.05). We conclude that when 10 mL of epidural saline is administered after two-segment regression, it is an ineffective top-up and may decrease the duration of spinal anesthesia during CSEA.