Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialEffects of ketorolac versus bupivacaine coadministration during patient-controlled hydromorphone epidural analgesia after thoracotomy procedures.
We studied the comparative effects of ketorolac versus bupivacaine supplementation of hydromorphone (HM) patient-controlled epidural analgesia (PCEA) on the HM requirement, postoperative pain, and pulmonary function in 62 consenting patients after thoracotomy procedures. Patients were randomly assigned to receive one of three different combinations of analgesic medications after the operation according to a double-blind, placebo-controlled study. The treatment groups consisted of: Group 1 (n = 23): PCEA HM 3-mL (0.15 mg) bolus doses + saline 1 mL intravenously (IV) q6h, Group 2 (n = 20): PCEA HM (0.15 mg) in 0.125% bupivacaine 3-mL bolus doses + saline 1 mL IV q6h, and Group 3 (n = 19): PCEA HM 3-mL (0.15 mg) bolus doses + ketorolac 1 mL (30 mg) IV q6h. ⋯ Significant reductions in forced vital capacity, forced expiratory volume in 1 s, forced expiratory flow 25%-75% of the vital capacity, and peak expiratory flow rate (PEFR) were noted on PODs 1 and 2 in all three treatment groups. The decrease in PEFR on PODs 1 and 2 was significantly less with ketorolac compared with bupivacaine supplementation. We conclude that ketorolac supplementation of HM PCEA reduces the incidence of nonincisional pain and HM requirement compared with HM PCEA alone and may have a beneficial effect on pulmonary function compared with bupivacaine supplementation of HM PCEA in postthoracotomy patients.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialEpidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration.
Increased postoperative pain may be caused by central nervous system plasticity, which may be related to actions of N-methyl-D-aspartic acid (NMDA) receptors on neurons in the dorsal horn of the spinal cord. Opioids act mainly on presynaptic receptors and reduce neurotransmitter release, while ketamine antagonizes NMDA receptors and prevents wind-up and long-term potentiation. Thus, we postulated that central nervous system sensitization would be prevented more effectively by the preoperative use of these two drugs simultaneously, and the effect of preemptive analgesia would be demonstrated. ⋯ The duration of analgesia was longer (P < 0.01) in Group 1 (31.1 +/- 16.0 h) than in Group 2 (21.1 +/- 12.0 h), and the proportion of patients who needed supplemental injections was decreased (P < 0.05) in Group 1 (56.7%) compared with Group 2 (90.0%). The incidence of adverse effects was not different between the two groups. In conclusion, preoperative administration of morphine and ketamine is more effective in reducing postoperative pain than it is when given during the operation.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialDecreased mivacurium constant infusion requirements with defasciculating doses of pancuronium.
This study was designed to verify a technique in which the pharmacologic profile of mivacurium infusions could be altered by small doses of pancuronium to reduce the infusion requirement without altering the subsequent recovery kinetics. Thirty ASA physical status I or II patients were randomized into two groups in a blinded fashion. One group was administered pancuronium 10 micrograms/kg followed by pancuronium 2.5 micrograms.kg-1.h-1 thereafter. ⋯ The mivacurium infusion requirement for the group receiving the pancuronium supplementation was 2.77 +/- 1.38 micrograms.kg-1.min-1 (mean +/- SD), which represented a 49% decrease compared with the group that used mivacurium alone which required an infusion rate of 5.43 +/- 1.85 micrograms.kg-1.min-1. No statistically significant difference was found in the recovery profiles of the two groups when the infusion was terminated. We conclude that the addition of a small amount of pancuronium decreased the required mivacurium infusion rate by nearly 50% without affecting the spontaneous recovery when terminating the infusion.
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Anesthesia and analgesia · Mar 1997
Clinical TrialEfficacy of the self-inflating bulb in differentiating esophageal from tracheal intubation in the parturient undergoing cesarean section.
We studied the efficacy of the self-inflating bulb (SIB) in differentiating tracheal from esophageal intubation in 40 parturients undergoing elective cesarean section under general anesthesia. After induction and muscle relaxation, the trachea was intubated under direct vision with cuffed tube. In 20 parturients, the esophagus was also intubated with an identical tube. ⋯ The incidence of false positive results immediately after induction was 30% with T1 and 35% with T2. The mechanism of false negative responses may be attributed to decreased functional residual capacity leading to reduced caliber of intrathoracic airways and terminal airway closure; whereas false positive responses may be related to an incompetent gastroesophageal junction. We conclude that the SIB is unreliable for differentiating tracheal from esophageal intubation in the parturient undergoing cesarean section.
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Anesthesia and analgesia · Mar 1997
The association between Doppler transmitral flow variables measured by transesophageal echocardiography and pulmonary capillary wedge pressure.
The association between Doppler transmitral flow variables, measured by transesophageal echocardiography (TEE), and pulmonary capillary wedge pressure (PCWP) was studied in 88 patients undergoing coronary artery surgery. The Doppler flow variables and PCWP were measured after sternotomy by blinded investigators. In the first part of the study, patients were divided into two groups according to left ventricular (LV) ejection fraction (EF): Group A, EF > 35% (n = 38) and Group B, EF < or = 35% (n = 34). ⋯ When the relationship between DCT-E and PCWP was tested prospectively in a third group of patients [Group C; EF < or = 35% (n = 16)], a close agreement between the calculated and measured PCWP (bias = -0.55 +/- 3.87 mm Hg) was noted. The sensitivity, specificity, and positive predictive value of DCT-E > or = 150 ms for PCWP < 10 mm Hg were 93.3%, 100%, and 100%, respectively. In summary, patients with decreased left ventricular systolic function undergoing coronary artery surgery demonstrated high, statistically significant, correlations between PCWP and the deceleration time or deceleration slope of early diastolic filling as measured by transesophageal Doppler echocardiography.