Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialRemifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. The Remifentanil/Alfentanil Outpatient TIVA Group.
The purpose of this study was to test the hypothesis that using a 1:4 ratio of remifentanil to alfentanil, a remifentanil infusion would provide better suppression of intraoperative responses and comparable recovery profiles after ambulatory laparoscopic surgery than an alfentanil infusion, as part of total intravenous anesthesia. Two hundred ASA physical status I, II, or III adult patients participated in this multicenter, double-blind, parallel group study. Patients were randomly assigned 2:1 to either the remifentanil-propofol or alfentanil-propofol regimens. ⋯ Actual discharge times from the ambulatory center were similar between groups (174 min for remifentanil versus 204 min for alfentanil) (P = 0.06). In conclusion, remifentanil can be used for maintenance of anesthesia in a 1:4 ratio compared with alfentanil, for total IV anesthesia in ambulatory surgery. This dose of remifentanil provides more effective suppression of intraoperative responses and does not result in prolonged awakening.
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Anesthesia and analgesia · Mar 1997
Randomized Controlled Trial Clinical TrialNitrous oxide does not increase vomiting after dental restorations in children.
The effect of nitrous oxide on postoperative vomiting was evaluated in 330 children who underwent outpatient dental restorations. There were two groups in this single-blind, randomized, controlled study. One group received nitrous oxide during their anesthetic, while the non-nitrous oxide group did not receive nitrous oxide at any time. ⋯ Overall, the incidence of vomiting was similar, with 30% of the control patients and 35% of the nitrous-treated patients vomiting after their anesthetic. However, in-hospital vomiting was less in the control group: 15% vs 24%, control versus nitrous oxide, P = 0.03. In conclusion, nitrous oxide does not alter postoperative vomiting after halothane anaesthesia for dental restorations in children.
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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
Clinical Trial Controlled Clinical TrialClinical trial of a new device for fiberoptic orotracheal intubation (Augustine Scope).
Blind oral intubation using the Augustine Guide is helpful for intubating the trachea of patients presenting with difficult airways. This device has been modified by adding a fiberoptic scope with a built-in battery-powered light. We studied this Augustine Scope in 104 patients (Group AS) and compared the results with 96 patients managed by direct laryngoscopy (Group DL). ⋯ The mean +/- SD time needed to perform intubation was 19 +/- 10 s in Group AS and 21 +/- 13 s in Group DL (P = not significant). No traumatizing effects were observed. We conclude that the Augustine Scope is an effective and safe device for orotracheal intubation in routine and difficult airways.
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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.