Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2001
Randomized Controlled Trial Clinical TrialThe effect of dexamethasone on postoperative pain and emesis after intrathecal neostigmine.
We evaluated the effect of a single dose of dexamethasone on the incidence and severity of postoperative nausea and vomiting (PONV) after intrathecal injection of tetracaine plus neostigmine. Sixty ASA physical status I patients scheduled for inguinal herniorrhaphy were studied with a randomized, double-blinded, placebo-controlled protocol. The dexamethasone group (Group D) received 10 mg of dexamethasone IV before performance of spinal anesthesia, whereas the placebo group (Group P) received saline. Spinal anesthesia was performed with intrathecal injection of 15 mg tetracaine plus neostigmine 100 microg in both groups. Pain, PONV, and other side effects were evaluated 24 h after surgery. The duration and severity of analgesia and the incidence of PONV were not significantly different between the two groups. Our results demonstrate that a single dose of dexamethasone (10 mg) did not potentiate the analgesic effect or reduce the incidence of PONV after intrathecal injection of tetracaine and neostigmine. ⋯ The results of our evaluation of the effect of IV dexamethasone versus saline control on analgesia and nausea and vomiting after intrathecal neostigmine and tetracaine suggest that IV dexamethasone did not enhance the analgesic effect of neostigmine or reduce the incidence of emesis after intrathecal administration.
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Anesthesia and analgesia · Jan 2001
Randomized Controlled Trial Clinical TrialThe dose-range effects of sufentanil added to 0.125% bupivacaine on the quality of patient-controlled epidural analgesia during labor.
To determine the minimal sufentanil concentration required to improve the quality of patient-controlled epidural analgesia during labor, we compared the efficacy of a combination of 0.125% bupivacaine with 1:800,000 epinephrine and different concentrations of sufentanil in a double-blinded randomized study. Concentrations were no sufentanil (n = 66), 0.078 microg/mL sufentanil (n = 65), 0.156 microg/mL sufentanil (n = 65), 0.312 microg/mL sufentanil (n = 65), and 0.468 microg/mL sufentanil (n = 67). The patient-controlled epidural analgesia setting was a 12-mL bolus dose and a 25-min lockout interval. Pain was scored at 5-6 cm, 7-8 cm, and full cervical dilation by using a 10-cm visual analog scale. At full cervical dilation, the pain scores were lower in the groups receiving a solution of at least 0.156 microg/mL sufentanil. Few differences were observed when using the larger concentrations, except for increased pruritus intensity. The duration of labor and the mode of delivery were similar in each group. Rescue analgesia, which consisted of 6 mL of 0.25% bupivacaine, was infrequent and comparable between groups. The use of the pump did not differ between groups. Adding a small concentration of sufentanil to 0.125% bupivacaine for patient-controlled epidural analgesia during labor improved the quality of analgesia but did not modify the bupivacaine requirement. Reducing the sufentanil concentrations to 0.156 microg/mL decreased the pruritus intensity without reducing analgesia. ⋯ Adding a small concentration of sufentanil to 0.125% bupivacaine for patient-controlled epidural analgesia during labor improved the quality of analgesia but did not modify the bupivacaine requirement. Reducing the sufentanil concentrations to 0.156 microg/mL decreased the pruritus intensity without reducing analgesia.
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Anesthesia and analgesia · Jan 2001
Randomized Controlled Trial Clinical TrialThe clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty: a randomized clinical trial.
The first aim of this prospective clinical study was to characterize the relationship between embolic events observed during cemented total hip arthroplasty using transesophageal echocardiography (TEE), and changes in cardiopulmonary function. The second aim was to assess the efficiency of a modified cementing technique that was developed to reduce the risk of embolism. The modification consists in a vacuum drainage placed in the proximal femur to reduce the increase of intramedullary pressure during insertion of the prosthesis. One hundred twenty patients were randomized into two groups. Group 1 received a total hip arthroplasty cemented conventionally, whereas Group 2 was cemented with the modified technique. Continuous TEE, hemodynamic monitoring, and blood gas analysis were done during the perioperative period. Severe embolic events were imaged during the insertion of the femoral component and the reduction of the hip joint. Embolism occurred in 93.3% of patients operated on with the conventional cementing technique, compared with 13.3% of patients operated on with the modified technique (P < 0.05). Intraoperative shunt values during insertion of the femoral component increased from 8.2% to 10.3% (P < 0.05) in Group 1 patients, whereas there was no significant change in Group 2 patients. We observed no clinical signs of fat embolism syndrome in any study patient. The results of the study indicate that embolic events observed using TEE can cause increased pulmonary shunt values during hip arthroplasty, especially in patients with systemic disease (ASA physical status III). The modified surgical technique effectively reduced the incidence of embolization during cemented hip arthroplasty. ⋯ Use of conventional cementing techniques is associated with echocardiographic evidence of embolism in 93% of patients and with a significant increase in pulmonary shunting. The incidence of embolism and change in shunting are reduced with a modified cementing technique that limits increases in intramedullary pressure.
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Anesthesia and analgesia · Jan 2001
Randomized Controlled Trial Clinical TrialProfile soft-seal cuff, a new endotracheal tube, effectively inhibits an increase in the cuff pressure through high compliance rather than low diffusion of nitrous oxide.
We assessed the nitrous oxide (N(2)O) gas-barrier properties of a new endotracheal tube cuff, the Profile Soft-Seal Cuff (PSSC) (Sims Portex, Kent, UK). The tracheas of randomly selected patients were intubated with the Trachelon (Terumo, Tokyo, Japan), Profile Cuff (PC) (Sims Portex), or PSSC (n = 15 for each) endotracheal tube. Cuffs were inflated with air, and intracuff pressure was measured during anesthesia with 67% N(2)O. ⋯ The incidence of postoperative sore throat in the Trachelon group was significantly higher than in the other two groups. In summary, the PSSC effectively inhibits an increase in cuff pressure during anesthesia with N(2)O. The underlying mechanism is probably the higher compliance of the thinner cuff, rather than a reduction in N(2)O diffusion into the cuff.
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Anesthesia and analgesia · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialDeflationary phenomenon of the nitrous oxide-filled endotracheal tube cuff after cessation of nitrous oxide administration.
After cessation of nitrous oxide (N(2)O) administration, intracuff pressure of the endotracheal tube may decrease through rediffusion of N(2)O. There may then be an increased risk for air leaks, aspiration of gastric contents, or both. In this study, the time required for intracuff pressure to decrease by 50% (T(1/2)) after substituting oxygen for N(2)O inspired was estimated with the least-squares method. Fifty patients were randomly assigned to five groups, and their tracheas were intubated with the Hi-Contour, Sheridan, Rush, Reinforce, or Profile Soft-Seal Cuff endotracheal tubes. Cuffs were inflated with 40% N(2)O, and cuff pressure was measured during anesthesia with 67% N(2)O. After 120 min, N(2)O inspired was replaced with 100% oxygen, and cuff pressure was measured until the cuff pressure decreased by about 30%. In the five groups, stable cuff pressures were achieved during 120 min of anesthesia with N(2)O. The cuff pressures at 120 min were not different among groups (P = 0.098). After cessation of N(2)O administration, the intracuff pressure decreased exponentially. T(1/2) in the Hi-Contour group was 27.8 +/- 8.5 min, which was significantly shorter than in the Profile Soft-Seal Cuff group (49.7 +/- 18.5 min; P < 0.01). Therefore, our results demonstrate that pressure of the N(2)O-filled cuff decreases quickly when N(2)O-inspired concentrations are reduced, and we suggest that intracuff pressure should be checked frequently to avoid air leaks or aspiration of gastric contents during delayed extubation or transportation of patients with tracheal intubations. ⋯ A recently developed method for maintaining stable cuff pressure (N(2)O-filled cuffs) enables us to assess the decrease in cuff pressure after cessation of N(2)O administration. Our results confirm the limitations of N(2)O-filled cuffs when N(2)O-inspired concentrations are reduced.