Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2000
Comparative Study Clinical Trial Controlled Clinical TrialRespiratory efficacy of subglottic low-frequency, subglottic combined-frequency, and supraglottic combined-frequency jet ventilation during microlaryngeal surgery.
We tested the respiratory efficacy of different jet ventilation techniques (subglottic low-frequency versus subglottic combined-frequency and subglottic combined-frequency versus supraglottic combined frequency) in patients undergoing microlaryngeal surgery. The PaCO(2) and the quotient of arterial oxygen tension (PaO(2)) over FIO(2) were measured. After anesthetic induction (propofol, remifentanil, vecuronium), an endotracheal Mon-Jet catheter (Xomed, Jacksonville, FL) for subglottic jet ventilation and a laryngoscope for supraglottic jet ventilation (Carl Reiner G.m.b.H., Vienna, Austria) were inserted. In Group 1 (n = 18), subglottic low-frequency (15 breaths/min), combined-frequency (600 and 15 breaths/min), and low-frequency jet ventilation was subsequently performed (15 min each). In Group 2 (n = 19), the sequence was supraglottic, subglottic, and supraglottic combined-frequency jet ventilation. The driving pressures were initially adjusted to achieve normocapnia and were not changed during the entire study period. The FIO(2) was measured endotracheally. The Wilcoxon's signed rank test was applied. In Group 1, PaCO(2) and PaO(2)/FIO(2) improved significantly after switching from subglottic low-frequency to subglottic combined-frequency jet ventilation (PaCO(2), from 46.6 +/-8.3 to 42.1+/-8.1 mm Hg; PaO(2)/FIO(2), from 311+/-144 to 361+/-141 mm Hg; P<0.05). In Group 2, PaCO(2) increased and PaO(2)/FIO(2) decreased significantly after switching from supraglottic to subglottic combined-frequency jet ventilation (PaCO(2), from 39.4+/-7.1 to 45.9+/-7.5 mm Hg; PaO(2)/FIO(2), from 415+/-114 to 351+/-129 mm Hg; P<0.05). We conclude that subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency ventilation, but more effective than subglottic low-frequency jet ventilation. ⋯ The combination of high and low respiratory frequencies (600 and 15 breaths/min) improves pulmonary gas exchange during subglottic jet ventilation via an endotracheal catheter. However, subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency jet ventilation via a jet ventilation laryngoscope.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Clinical TrialMultimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy.
Because no completely effective antiemetic exists for the prevention of postoperative nausea and vomiting (PONV), we hypothesize that a multimodal approach to management of PONV may reduce both vomiting and the need for rescue antiemetics in high-risk patients. After IRB approval, women undergoing outpatient laparoscopy were randomized to one of three groups. Group I (n = 60) was managed by using a predefined multimodal clinical care algorithm. ⋯ Return to normal daily activity and overall satisfaction were not different among groups. Multimodal management resulted in a 98% complete response rate and a 0% incidence of vomiting before discharge; however, this improvement did not result in an increased level of patient satisfaction when compared with routine monotherapy prophylaxis. We conclude that both multimodal management and routine monotherapy antiemetic prophylaxis resulted in an increased level of patient satisfaction than symptomatic treatment in this high-risk population.
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Anesthesia and analgesia · Dec 2000
Clinical TrialThe effects of the reverse trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery.
Anesthesia adversely affects respiratory function, particularly in morbidly obese patients. Although many studies have been performed to determine the optimal ventilatory settings in these patients, this question has not been answered. The aim of this study was to evaluate the effect of reverse Trendelenburg position (RTP) on gas exchange and respiratory mechanics in 15 obese patients undergoing biliopancreatic diversion. ⋯ When the patients were placed in RTP, P(A-a)O(2) showed a significant improvement and a return toward baseline values. As for mechanics, total respiratory system compliance was significantly higher in RTP than in the other phases. In conclusion, our data suggest that RTP is an appropriate intraoperative posture for obese subjects because it causes minimal arterial blood pressure changes and improves oxygenation.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Clinical TrialTransdermal ketamine as an adjuvant for postoperative analgesia after abdominal gynecological surgery using lidocaine epidural blockade.
We examined the postoperative analgesia of a controlled delivery ketamine transdermal patch after minor abdominal gynecological surgery using lidocaine epidural blockade. Fifty-two patients were randomized to one of two groups. Epidural anesthesia was performed with 25 mL 2% plain lidocaine. At the end of the surgical procedure, a controlled delivery transdermal patch containing either ketamine (25 mg/24 h) (Ketamine group) or placebo (Placebo group) was applied. Pain and adverse effects were assessed hourly postoperatively for 24 h. IM dipyrone was available at patient request. The two groups were demographically similar. The time to first rescue analgesic was longer in the Ketamine group (230+/-112 min) compared with the Placebo group (94+/-54 min); (P<0.00001). There were more dipyrone dose injections in 24 h in the Placebo group compared with the Ketamine group (P<0.0001). The incidence of adverse effects was similar between groups. We conclude that the transdermal-controlled delivery of ketamine prolonged the duration of analgesia after minor gynecological procedures. ⋯ Transdermal delivery of ketamine was an useful adjuvant to postoperative analgesia after epidural lidocaine blockade in the population studied.
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Anesthesia and analgesia · Dec 2000
Comparative Study Clinical TrialWork of breathing during spontaneous ventilation in anesthetized children: a comparative study among the face mask, laryngeal mask airway and endotracheal tube.
Work of breathing (WOB) increases during general anesthesia in adults, but such information has been limited in pediatric patients. We studied WOB in 24 healthy children (mean age 2+/-1.9 yrs), during elective urogenital surgery under 1 minimum alveolar anesthetic concentration halothane-nitrous oxide anesthesia with a caudal block while breathing spontaneously. WOB was measured with an esophageal balloon, miniature flowmeter, and a computerized (Bicore) system. ⋯ Tidal volume (both ZEEP and CPAP) and end-tidal PCO(2) (with CPAP only) were significantly (P<0.05) decreased only in the ETT group, whereas no significant difference was found in respiratory rate or minute volume among the four airway apparatus groups, either with or without CPAP. The reduction in WOB, when breathing through ETT was primarily attributable to decreases in tidal volume and volume work. The finding that WOB decreases with CPAP in all groups except for the ETT group suggests that the decrease is a result of improved patency of the upper airway rather than of increases in functional residual capacity and lung compliance.