Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Clinical TrialSingle-dose ondansetron prevents postoperative vomiting in pediatric outpatients.
This randomized, double-blind, parallel-group, multicenter study evaluated the safety and efficacy of ondansetron (0.1 mg/kg to 4 mg intravenously) compared with placebo in the prevention of postoperative vomiting in 429 ASA status I-III children 1-12 yr old undergoing outpatient surgery under nitrous oxide- and halothane-based general anesthesia. The results show that during both the 2-h and the 24-h evaluation periods after discontinuation of nitrous oxide, a significantly greater percentage of ondansetron-treated patients (2 h 89%, 24 h 68%) compared with placebo-treated patients (2 h 71%, 24 h 40%) experienced complete response (i.e., no emetic episodes, not rescued, and not withdrawn; P < 0.001 at both time points). Ondansetron-treated patients reached criteria for home readiness one-half hour sooner than placebo-treated patients (P < 0.05). The age of the child, use of intraoperative opioids, type of surgery, and requirement to tolerate fluids before discharge may also have affected the incidence of postoperative emesis during the 0- to 24-h observation period. Use of postoperative opioids did not have any effect on complete response rates in this patient population. We conclude that the prophylactic use of ondansetron reduces postoperative emesis in pediatric patients, regardless of the operant influential factors. ⋯ Postoperative nausea and vomiting often occur after surgery and general anesthesia in children and are the major reason for unexpected hospital admission after ambulatory surgery. Our study demonstrates that the prophylactic use of a small dose of ondansetron reduces postoperative vomiting in pediatric patients.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialPretreatment with topical 60% lidocaine tape reduces pain on injection of propofol.
We determined whether pretreatment with topical 60% lidocaine tape reduced the incidence of pain on injection of propofol compared with mixing intravenous lidocaine with propofol. In a randomized, double-blind trial, 90 patients were allocated to one of three groups: pretreatment with a bioocclusive dressing and administration of a premixed solution of propofol 180 mg and 2 mL of normal saline (Group A); pretreatment with 60% lidocaine tape and a premixed solution of propofol and normal saline (Group B); or pretreatment with a bioocclusive dressing and a premixed solution of propofol 180 mg and lidocaine 40 mg (Group C). The incidences of pain in Groups A, B, and C were 86.7%, 33.4%, and 20%, respectively. Group B and Group C had a significantly lower incidence of pain than Group A. There was no significant difference in the incidence of pain between Group B and Group C. There was no significant difference in the distribution of site of pain on injection of propofol among the three groups. Pretreatment with topical 60% lidocaine tape reduced the incidence of pain on injection of propofol similar to that of intravenous lidocaine mixed with propofol. ⋯ Pretreatment with topical 60% lidocaine tape reduces the pain associated with injection of propofol, a frequently used intravenous anesthetic. This approach should increase patient comfort during induction of anesthesia.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialProphylaxis for vomiting by children after tonsillectomy: dexamethasone versus perphenazine.
The effects of dexamethasone and perphenazine on vomiting after tonsillectomy in children were compared in 226 healthy children aged 2-12 yr. The study was randomized, stratified, blocked, and double-blind. Anesthesia was induced intravenously (I.V.) with propofol or by inhalation with halothane and N2O. Dexamethasone 150 microg/kg or perphenazine 70 microg/kg was administered I.V. after the induction of anesthesia in a double-blind fashion. Perioperative management of emesis, pain, fluids, and patient discharge was all standardized. The groups had similar demographic characteristics. Perphenazine significantly reduced the incidence of in-hospital vomiting compared with dexamethasone (13% vs 36%, P < 0.001). The incidence of out-of-hospital vomiting was almost identical. Overall, the incidence was significantly different for perphenazine vs dexamethasone (33% vs 46%, P = 0.04) using logistic regression analysis. Of note, sex and induction technique were significant predictors of postoperative vomiting (P < 0.05) using logistic regression analysis, with male patients and those patients undergoing I.V. induction vomiting less. In conclusion, perphenazine more effectively decreases vomiting by children after tonsillectomy in an ambulatory hospital setting compared with dexamethasone. ⋯ Postoperative vomiting can have many debilitating effects, and children undergoing tonsillectomy are at particular risk. We compared the effects of dexamethasone and perphenazine on vomiting after tonsillectomy in 266 children. We found perphenazine more effective than dexamethasone before discharge from hospital but that the two drugs have similar effects after discharge.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of light wand and suspension laryngoscopic intubation techniques in outpatients.
Endotracheal intubation can produce postoperative sore throat and hoarseness, as well as changes in cardiovascular variables. A major goal of ambulatory surgery is the prompt return of patients to their daily activities. Postoperative sore throat may impede this and may decrease patient satisfaction with their anesthetic and surgical experience. We conducted a prospective, randomized study in 40 outpatients having lower extremity arthroscopies to compare the effects of direct laryngoscopy and light wand intubation on cardiovascular changes, sore throat, hoarseness, and dysphagia. Subjects were randomly assigned to either Group A (endotracheal intubation by rigid laryngoscopy) or Group B (endotracheal intubation with a light wand). A standardized anesthetic technique was used. Heart rate and blood pressure were recorded before induction, after induction but before endotracheal intubation, and at 1-min intervals for the first 5 min after intubation. Sixteen to twenty-four hours postoperatively, the incidence and severity of sore throat, hoarseness, and dysphagia was assessed by a follow-up phone call. This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence and severity of sore throat, hoarseness, and dysphagia when a light wand was used for intubation. In conclusion, this study suggests that light wand intubation may decrease the incidence and severity of postoperative sore throat, hoarseness, and dysphagia, thereby potentially increasing satisfaction in ambulatory surgical patients. ⋯ This prospective, randomized study found that the incidence and severity of postoperative sore throat, hoarseness, and difficulty in swallowing among ambulatory surgical patients is more frequent when they are endotracheally intubated with a rigid laryngoscope than with a light wand. The authors, therefore, recommend more frequent use of the light wand for endotracheal intubation.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Clinical TrialEmergence of elderly patients from prolonged desflurane, isoflurane, or propofol anesthesia.
Recovery from prolonged anesthesia might be compromised in elderly patients. Desflurane (DES) may be particularly well suited to achieve a rapid postoperative recovery because of its low lipid solubility. Postoperative recovery was compared in 45 elderly patients randomized to receive either DES, isoflurane (ISO), or propofol (PRO) to maintain anesthesia. Anesthesia was induced with PRO, vecuronium, and fentanyl and maintained with N2O, fentanyl, and the study drug. Times from end of anesthesia to tracheal extubation, eye opening and hand squeezing on command, and ability to state name and date of birth were recorded. Sedation and psychometric evaluation were tested 0.5, 1, 1.5, 2, and 24 h postoperatively. Results are given as means +/- SD. Differences among were analyzed by chi2 or analysis of variance. P < 0.05 compared with DES was considered significant. After a prolonged anesthesia (199 +/- 57 min with DES), immediate recovery times were significantly shorter with DES than with ISO or PRO (times to eye opening: 5.6 +/- 3.4 min, 11.5 +/- 8.4 min, and 11.9 +/- 7.6 min; times to extubation: 6.9 +/- 3 min, 13.1 +/- 8.9 min, 9.9 +/- 6.5 min for DES, ISO, and PRO, respectively). Intermediate recovery, as measured by psychometric testing, sedation levels, and time to discharge from the postanesthesia care unit, was similar in the three groups. In this study, DES provided a transient advantage compared with ISO or PRO with respect to early recovery after prolonged general anesthesia in elderly patients. ⋯ Recovery from prolonged anesthesia can sometimes be problematic in elderly patients. We evaluated 45 elderly patients who received either desflurane, isoflurane, or propofol for anesthesia. We found that desflurane provided a transient advantage in terms of postoperative recovery, but whether this difference is clinically important remains to be demonstrated.