Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialEpidural meperidine after cesarean section: the effect of diluent volume.
We investigated the effect of diluent volume on analgesia and systemic absorption from epidural meperidine after cesarean section in a randomized, double-blind study. At the first request for postoperative analgesia, 36 parturients were given epidural meperidine 25 mg diluted with saline to either 2 mL (12.5 mg/mL), 5 mL (5 mg/mL), or 10 mL (2.5 mg/mL). Visual analog pain scores measured in the first 30 min were greater in the 2-mL group compared with both the 5-mL group (P = 0.028) and the 10-mL group (P = 0.031). ⋯ No adverse side effects were recorded. Previous work has suggested that injection of epidural opioids in large volumes increases the potential risk of respiratory depression from cephalad spread of the drug. Therefore, we conclude that analgesia is optimum when epidural meperidine is administered diluted to 5 mL.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialOndansetron versus metoclopramide in the treatment of postoperative nausea and vomiting.
In this prospective, randomized, double-blind study, we compared the efficacy and safety of ondansetron and metoclopramide in the treatment of postoperative nausea and vomiting (PONV). One hundred seventy-five patients with PONV during recovery from anesthesia for gynecological laparoscopy were treated intravenously with either ondansetron 4 mg (58 patients), metoclopramide 10 mg (57 patients), or placebo (60 patients). Early antiemetic efficacy (abolition of vomiting within 10 min and of nausea within 30 min from the administration of the study drugs with no further vomiting or nausea episodes during the first hour) was obtained in 54 of 58 patients (93.1%) in the ondansetron group, in 38 of 57 patients (66.7%) in the metoclopramide group, and in 21 of 60 patients (35%) in the placebo group (P < 0.001). ⋯ Early antiemetic efficacy was inversely related to the amount of fentanyl administered during anesthesia, regardless of treatment. According to the Kaplan-Meier method, the probability of remaining PONV-free for 48 h after a successful treatment was 0.59 (95% confidence interval 0.45-0.71) in the ondansetron group, 0.45 (0.29-0.60) in the metoclopramide group, and 0.33 (0.15-0.53) in the placebo group (P = 0.003). In conclusion, ondansetron 4 mg is more effective than metoclopramide 10 mg and placebo in the treatment of established PONV.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialImmediate 8% sevoflurane induction in children: a comparison with incremental sevoflurane and incremental halothane.
We compared the efficacy and tolerance of pediatric inductions with immediate 8% sevoflurane in 70% nitrous oxide with either incremental sevoflurane or incremental halothane in 70% nitrous oxide. Forty-six unpremedicated children had anesthesia induced by immediate 8% sevoflurane (high sevoflurane [HS]; circuit primed with 70% N2O and 8% sevoflurane before application of the face mask), gradual sevoflurane (GS; primed with 70% N2O with increments of sevoflurane), and gradual halothane (HAL; 70% N2O with incremental halothane). Blind video recordings were made, and each child's distress was rated prior to mask application, during mask application, and every 10 s thereafter using a behavioral rating scale. ⋯ Times to eye closure were also significantly different (P < 0.001): HS 37 +/- 10 s (range 15-56); GS 70 +/- 18 s (range 35-114); HAL 81 +/- 34 s (range 55-140). Distress scale scores showed more rapid decrement with HS than with GS or HAL. We conclude that 1) immediate 8% sevoflurane/N2O results in a significantly faster induction than GS or HAL;2) in children, HS in N2O will not result in a single-breath induction under the conditions of this study; 3) in this small group, HS was extremely well tolerated in ASA class I and II patients.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Clinical TrialMidazolam premedication increases sedation but does not prolong discharge times after brief outpatient general anesthesia for laparoscopic tubal sterilization.
Preoperatively administered midazolam may contribute to postoperative sedation and delayed recovery from brief outpatient general anesthesia, particularly in patients who receive significant postoperative opioid analgesics. We evaluated the effects of midazolam premedication (0.04 mg/kg) on postoperative sedation and recovery times after laparoscopic tubal sterilization (Falope rings) in 30 healthy women in a randomized, double-blind, placebo-controlled study. Patients received midazolam or saline-placebo intravenously 10 min before anesthesia. ⋯ Midazolam was associated with impairment of performance on the TDT and DSST after premedication administration and 15 (TDT and DSST) and 30 (DSST) min after postanesthesia care unit (PACU) arrival. There were no differences in PACU time and time to discharge-readiness. In conclusion, midazolam premedication augments postoperative sedation in this population but does not prolong recovery times.
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Anesthesia and analgesia · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe arterial blood propofol concentration preventing movement in 50% of healthy women after skin incision.
To target appropriate drug concentrations and to facilitate comparisons between drugs, the potency of propofol must be firmly established. We therefore determined the arterial blood propofol concentration preventing movement in 50% of patients after skin incision and the ability of arterial blood pressure and heart rate to predict movement after incision. Fifteen healthy women scheduled for breast surgery were randomly assigned to computer-targeted propofol blood concentrations. ⋯ The MABP50 and MABP95 values were 63 +/- 4 mm Hg and 43 mm Hg, respectively. Heart rate did not differ significantly in patients who moved and who did not move. Propofol blood concentrations required to prevent movement in most patients resulted in significant arterial hypotension.