Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2000
Randomized Controlled Trial Clinical TrialInterpleural analgesia does not influence postthoracotomy pain.
The management of postthoracotomy pain is a problem and may contribute to atelectasis, leading to hypoxemia, pulmonary infection, and permanent alveolar damage. We sought to determine the efficacy of interpleural analgesia for pain control and to evaluate independent predictors for postoperative pain intensity. Eighty-three patients undergoing elective anterolateral (n = 37) and posterolateral (n = 46) thoracotomy were included in a prospective, randomized, double-blinded trial. Patients were assigned to receive either 0.5% bupivacaine or saline solution interpleurally every 4 h for 10 doses postoperatively. All patients also received patient-controlled analgesics (PCA) with piritramide as the opioid for additional pain control. Pain was assessed on the basis of PCA requirements and by using a visual analog scale. Visual analog scale scores and PCA requirements were not different between groups. Both interpleural bupivacaine and saline significantly reduced pain scores 30 min after the administration. We concluded that pain reduction by interpleural instillation of bupivacaine reflects a placebo-like effect; however, interpleural analgesia is not effective in patients undergoing lateral thoracotomy. Sex and surgical approach were shown to influence postoperative pain intensity at rest, but not during coughing. The female patients, and those undergoing posterolateral thoracotomy, exhibited higher pain scores. This observation appears to be of only marginal clinical significance. The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study we demonstrated a lack of efficacy of interpleural analgesia. ⋯ The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study, we demonstrated a lack of efficacy of interpleural analgesia.
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Anesthesia and analgesia · Jul 2000
Randomized Controlled Trial Clinical TrialKetorolac suppresses postoperative bladder spasms after pediatric ureteral reimplantation.
We evaluated the efficacy of ketorolac in suppressing postoperative bladder spasms after ureteroneocystostomy (ureteral reimplantation). Twenty-four pediatric patients undergoing intravesical ureteroneocystostomy were enrolled prospectively to receive either ketorolac or placebo via double-blinded randomization. Twelve patients in each group shared similar preoperative characteristics. All were maintained on an epidural infusion of bupivacaine (0.1%) with fentanyl (2 microg/mL) throughout the study. Patients were given either ketorolac (0.5 mg. kg(-1). dose(-1)) or placebo (equivalent volume saline) IV after surgery and every 6 h thereafter for 48 h. Parents were instructed to record bladder spasm episodes prospectively by using a standardized time-flow diary. Three patients (25%) in the ketorolac group experienced bladder spasms, compared with 10 patients (83%) in the placebo group (two-sided P < 0.05). The median severity score for the ketorolac group was 1.2 (mild = 1.0, severe = 3.0), compared with 2.6 for the placebo group (P = 0.003). We conclude that IV ketorolac reduces the frequency and severity of postoperative bladder spasms after intravesical ureteroneocystostomy. ⋯ We studied the efficacy of ketorolac, a prostaglandin synthesis inhibitor, in the treatment of bladder spasm after ureteroneocystostomy (antireflux operation). Patients were randomized in a double-blinded manner to receive either ketorolac or placebo after the surgery. We demonstrate that ketorolac reduces the frequency and severity of postoperative bladder spasm.
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Anesthesia and analgesia · Jul 2000
Randomized Controlled Trial Clinical TrialNitrous oxide prevents movement during orotracheal intubation without affecting BIS value.
We sought to determine whether the addition of nitrous oxide (N(2)O) to an anesthetic with propofol and remifentanil modifies the bispectral index (BIS) during the induction of anesthesia and orotracheal intubation. Thirty ASA physical status I or II patients were randomly allocated to receive either 50% air in oxygen (control group) or 60%-70% N(2)O in oxygen (N(2)O group) that was commenced via a mask simultaneously with the induction of anesthesia. Anesthesia was performed in all the patients with IV propofol at the target effect compartment site concentration of 4 microg/mL throughout the study. A target-controlled infusion (TCI) of remifentanil was initiated 3 min after the TCI of propofol and maintained at the effect-site concentration of 4 ng/mL until the end of the study. After loss of consciousness, and before the administration of vecuronium 0.1 mg/kg, a tourniquet was applied to one arm and inflated to a value more than the systolic blood pressure. An examiner, blinded to the presence of N(2)O, sought to detect any gross movement within the first minute after tracheal intubation, which was performed 10 min after remifentanil TCI began. Inspired and expired oxygen, N(2)O, and carbon dioxide were continuously monitored. A BIS value was generated every 10 s. Arterial blood pressure and heart rate (HR) were measured noninvasively every minute. Measures of mean arterial pressure (MAP), HR, and BIS were obtained before the induction, before the start of the remifentanil TCI, before laryngoscopy, and 5 min after intubation. No significant intergroup differences were seen in BIS, HR, and MAP throughout the study. Maximum changes in BIS, HR, and MAP with intubation were significant (P < 0.01) for both groups but comparable. Six patients in the control group and none in the N(2)O group moved after intubation (P < 0.05). ⋯ We demonstrated that 0.6 minimal alveolar concentration of nitrous oxide combined with a potent anesthetic and an opioid prevents movement after orotracheal intubation without affecting the bispectral index. This demonstrates that the bispectral index is not a useful neurophysiologic variable to monitor the level of anesthesia when nitrous oxide is added to a general anesthetic regimen using propofol and remifentanil.
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Anesthesia and analgesia · Jul 2000
Randomized Controlled Trial Comparative Study Clinical TrialCerebral hemodynamic response to the introduction of desflurane: A comparison with sevoflurane.
Rapid increases in the inspired concentration of desflurane cause transient increases in heart rate and blood pressure. Desflurane also impairs cerebral autoregulation at clinical concentrations. Sevoflurane does not share these hemodynamic side effects. We compared the cerebral and systemic hemodynamic responses to the introduction of desflurane or sevoflurane after the induction of anesthesia with propofol. Twenty healthy adult patients scheduled for nonneurological surgery were recruited. After the induction of anesthesia with propofol, either desflurane or sevoflurane (n = 10 per group) was introduced at 7.2% or 2.2%, respectively, and increased to 10.8% or 3.3%, respectively, 2 min later. Middle cerebral artery blood flow velocity was measured continuously by using a 2-MHz transcranial Doppler ultrasound probe. Heart rate and blood pressure were recorded at 1-min intervals during the 12-min study period. Those patients receiving desflurane had significantly greater middle cerebral artery blood flow velocities, heart rates, and blood pressures than those receiving sevoflurane (P < 0.01). ⋯ The introduction of desflurane after the induction of anesthesia leads to significant disturbances in cerebral and systemic hemodynamics suggesting loss of cerebral autoregulation and cerebral hyperemia. This may have implications for patients undergoing anesthesia for intracranial surgery.
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Anesthesia and analgesia · Jul 2000
Case ReportsRapacuronium administration to two children with Duchenne's muscular dystrophy.
Children with Duchenne's muscular dystrophy should not be exposed to succinylcholine because of the risk of hyperkalemic cardiac arrest and rhabdomyolysis. This report describes the response to rapacuronium bromide in two patients with Duchenne's muscular dystrophy. Both patients had a recovery index 2 times longer than that reported in children with normal neuromuscular function.