Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Comparative StudyManagement of patient-controlled analgesia: a comparison of primary surgeons and a dedicated pain service.
Although Patient-Controlled Analgesia (PCA) is routinely available in most hospitals in the United States, there appears to be little standardization regarding who provides this valuable service to postoperative patients. This study evaluates the differences in PCA management practices and patient outcomes between primary service (PS) physicians and acute pain service (APS) physicians. Over a 3-mo period, 40 patients prescribed PCA by PS physicians were prospectively studied without the knowledge of the physicians or nurses involved in PCA management. ⋯ Although pain scores were not different between groups, APS patients had fewer side effects, were more likely to receive a loading dose, had their PCA settings adjusted more often (P < 0.05), and used more opioid. PS patients were more likely to receive intramuscular medications after PCA discontinuation (P < 0.05). This study demonstrates potentially important PCA management differences between APS and PS physicians.
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Anesthesia and analgesia · Jul 1997
Classification of malignant hyperthermia-equivocal patients by 4-chloro-M-cresol.
To clarify the contracture response to 4-chloro-m-cresol (4-CmC) in malignant hyperthermia (MH) equivocal (MHE) muscle, we studied the effect of cumulative concentrations of 4-CmC. In vitro contracture test (IVCT) was performed in 35 probands according to the European MH test protocol. Surplus muscle bundles were exposed to 4-CmC (25-200 micromol/L), maintaining each concentration for 4 and 8 min. ⋯ Therefore, 4-CmC might reduce the frequency of MHEh diagnosis based on standard halothane-caffeine IVCT. However, since MHE individuals may also represent an aberrant genetic status, with MH causing defects linked to unknown mutations, it is premature to consider 4-CmC as a solution to the diagnostic uncertainty of the true status of MHE probands. Presently, 4-CmC may provide supplementary information for a more precise phenotypic categorization of MHE individuals.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA comparison of oral ketorolac and hydrocodone-acetaminophen for analgesia after ambulatory surgery: arthroscopy versus laparoscopic tubal ligation.
This multicenter study compared the analgesic efficacy and side effects of ketorolac and hydrocodone-acetaminophen when administered orally after ambulatory arthroscopic or laparoscopic tubal ligation procedures. After awakening from general anesthesia, 252 patients experiencing moderate or severe postoperative pain were randomly assigned to receive one of three analgesic treatments according to a placebo-controlled, double-blind protocol. Group 1 (n = 83) received oral ketorolac 10 mg every 6 h for up to 3 days, Group 2 (n = 82) received hydrocodone 7.5 mg plus acetaminophen 750 mg every 6 h for up to 3 days, and Group 3 (n = 87) received placebo capsules followed by ketorolac 10 mg every 6 h for up to 3 days. ⋯ However, the ketorolac group scored higher in terms of overall tolerability than the hydrocodone-acetaminophen group. In conclusion, there was no difference in the efficacy between oral ketorolac and hydrocodone-acetaminophen combination in controlling pain after outpatient arthroscopic surgery procedures. Neither oral analgesic proved to be very effective after laparoscopic tubal ligation.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Comparative Study Clinical TrialUric acid excretion increases during propofol anesthesia.
We compared the effect of propofol with that of sevoflurane anesthesia on uric acid (UA) excretion in ASA physical status I and II patients with normal renal function. A propofol group (n = 11) received propofol-nitrous oxide-fentanyl after induction of anesthesia by propofol, while a sevoflurane group (n = 12) received sevoflurane-nitrous oxide-fentanyl after induction of anesthesia by thiamylal. UA, creatinine (Cr), and urea nitrogen concentrations in serum and urine were measured before induction of anesthesia, 1, 2, and 3 h after induction, and on Postoperative Day 1. ⋯ The CUA of the propofol group was significantly higher than that of the sevoflurane group (22.9 +/- 10.6 vs 5.9 +/- 3.4 mL/min, mean +/- SD, P < 0.05). There were no significant differences in other renal variables between the two groups. The present study demonstrated that the UA excretion increased during propofol anesthesia, while it remained stable during sevoflurane anesthesia.
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Anesthesia and analgesia · Jul 1997
Randomized Controlled Trial Clinical TrialThe effects of adding sufentanil to bupivacaine for postoperative patient-controlled epidural analgesia.
We tested the hypothesis that postoperative patient-controlled epidural analgesia was more effective with the combination of sufentanil and bupivacaine (Group 2) than with bupivacaine alone (Group 1). One hundred patients undergoing thoracic, upper abdominal, and aortic surgery were provided with an epidural catheter and randomly allocated to one of the two groups. Postoperatively, patients were monitored in a postanesthetic care unit for at least 1 day before they were transferred to a ward. ⋯ Motor block was only seen in patients with lumbar epidural catheters. There was no difference between groups, and all patients with thoracic catheters could be mobilized beginning on the first postoperative day. We conclude that 1) the addition of sufentanil to a small-dose bupivacaine augments epidural analgesia and 2) thoracic epidural catheters should be used for postoperative analgesia after abdominal or thoracic surgery.