Anesthesia and analgesia
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The esophageal-tracheal Combitube((R)) (ETC; Kendall-Sheridan Catheter Corp., Argyle, NY) is a new device designed for difficult airways and emergency intubation. The manufacturer recommends that the ETC model 37F SA be used in patients with a height of between 122 and 152 cm. The aim of this study was to evaluate whether ventilation is effective and reliable in patients taller than 152 cm by using the ETC 37F SA in the esophageal position. Also, we evaluated whether the airway protection is adequate and whether direct intubation of the trachea with the ETC inserted in the esophagus is possible. We studied 25 anesthetized, paralyzed adult patients, 150 to 180 cm in height. Methylene blue was given orally to all patients before anesthesia induction. Under direct vision, a ETC 37F SA was inserted in the esophagus of all patients. The pharyngeal balloon inflation volume was titrated to air leak and cuff pressures were measured. During surgery, a laryngoscope was inserted into the pharynx with the pharyngeal balloon deflated and the laryngoscopic view was evaluated by using the Cormack-Lehane scale. The presence of methylene blue in the hypopharynx was investigated by direct laryngoscopic vision. Ventilation was effective and reliable in all 25 patients who were 150 to 180 cm in height (average 169 +/- 7 cm). In addition, a direct relationship between the pharyngeal balloon volume and patient height was established (P < 0.05), by using linear regression models. The laryngoscopic view of the glottis was adequate to allow direct tracheal intubation. No trace of methylene blue was detected in the hypopharynx. The ETC Model 37F SA may be used in patients from 122 to 185 cm in height. The trachea could be directly intubated with the ETC in the esophageal position in patients with normal airways. The airway protection appears to be adequate. ⋯ The esophageal-tracheal Combitube((R)) Model 37F SA (Kendall-Sheridan Catheter Corp., Argyle, NY) may be used in patients from 122 to 185 cm in height. The trachea could be directly intubated with the Combitube((R)) in esophageal position in patients with normal airways. The airway protection appears to be adequate.
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Anesthesia and analgesia · Apr 2000
Randomized Controlled Trial Clinical TrialThe use of a ketamine-propofol combination during monitored anesthesia care.
Supplemental analgesics are commonly used to enhance analgesia and improve patient comfort during procedures performed under local anesthesia and sedation. Because the use of ketamine as an analgesic adjunct to propofol sedation has not been well established, we evaluated its impact on analgesia, sedation, and recovery after ambulatory surgery. One hundred female outpatients undergoing breast biopsy procedures under local anesthesia participated in this randomized, double-blinded, placebo-controlled study. After premedication with midazolam, 2 mg IV, patients received an infusion of a solution containing propofol (9.4 mg/mL) in combination with either placebo (saline) (Group 1) or ketamine, 0.94 mg/mL (Group 2), 1.88 mg/mL (Group 3), or 2.83 mg/mL (Group 4). The sedative infusion rate was varied to maintain a deep level of sedation (Observer Assessment of Alertness/Sedation score 4) and normal respiratory and hemodynamic functions. Sufentanil, 2.5 microg IV, "rescue" boluses were used as needed to treat patients' responses (if any) to local anesthetic infiltration or surgical stimulation. Ketamine produced a dose-dependent reduction in the "rescue" opioid requirements. However, there was an increase in postoperative nausea and vomiting, psychomimetic side effects, and delay in discharge times with the largest ketamine dosage (Group 4). The adjunctive use of ketamine during propofol sedation provides significant analgesia and minimizes the need for supplemental opioids. The combination of propofol (9.4 mg/mL)/ketamine (0.94-1.88 mg/mL) provides effective sedation/analgesia during monitored anesthesia care. ⋯ Ketamine, when used in subhypnotic dosages, may be an useful adjuvant to propofol sedation.
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Anesthesia and analgesia · Apr 2000
Sequencing cases in the operating room: predicting whether one surgical case will last longer than another.
A microscope will be used for the first case of the day in operating room (OR) 1 and then may be used in the second case of the day by a different surgeon in a different OR, OR 2. Provided that the probability is reasonably high that the first case of the day in OR 2 will last longer than the first case in OR 1, the OR manager can be confident in scheduling the microscope to be used by both surgeons on the same day. The OR manager can use statistical decision theory to sequence cases to decrease the impact of limitations in equipment or personnel on case scheduling. This increases utilization of both the capital equipment and OR time. In this study, we derived equations that can be programmed into a surgical services information system to reliably estimate the probability that one case will have a longer duration than another. We confirmed the accuracy of our method by using actual case duration data. ⋯ Our statistical method uses historical case duration data from an operating room information system to estimate the actual probability to within 1.5% that the second case of a pair will last longer than the first case of a pair.
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Anesthesia and analgesia · Apr 2000
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of intrathecal analgesia with fentanyl or sufentanil after total hip replacement.
We designed this study to compare the postoperative analgesic effects of intrathecal fentanyl and sufentanil, the end points being onset, quality, and duration of action. A total of 42 geriatric patients, scheduled for elective total hip replacement under continuous spinal anesthesia, were randomized in two double-blinded groups as soon as they experienced a pain score higher than 3 of 10 on the visual analog scale in the recovery room. Either 7.5 microg sufentanil or 40 microg fentanyl in 2 mL normal saline were intrathecally administered. Pain scores, rescue analgesia (ketorolac and morphine), and adverse effects (respiratory depression, postoperative nausea and vomiting, and itching) were recorded for 24 h after surgery. In both groups, comparing sufentanil to fentanyl, the time to a pain score <3 (9 +/- 9 vs 11 +/- 8 min), the time to the lowest pain score (18 +/- 6 vs 20 +/- 15 min), and the time to the first systemic analgesic intervention for a pain score >3 (241 +/- 102 vs 214 +/- 120 min) were comparable as were the analgesic requirements during the first 24 h. We conclude that, after total hip replacement, both lipid soluble opioids produce excellent analgesia with comparable onset, duration of action, and low incidence of minor adverse effects. ⋯ We compared the postoperative analgesic properties of 40 microg intrathecal fentanyl and 7.5 microg sufentanil after total hip replacement. Both opioids provided satisfactory analgesia, with comparable onset (11 +/- 8 vs 9 +/- 9 min) and duration of action (214 +/- 120 vs 241 +/- 102 min), as well as low incidence of minor side effects.