Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2002
Randomized Controlled Trial Clinical TrialSmall-dose ketamine improves the postoperative state of depressed patients.
We investigated whether ketamine is suitable for depressed patients who had undergone orthopedic surgery. We studied 70 patients with major depression and 25 patients as the control (Group C). The depressed patients were divided randomly into two groups; patients in Group A (n = 35) were induced with propofol, fentanyl, and ketamine and patients in Group B (n = 35) were induced with propofol and fentanyl, and all patients were maintained with 1.5%-2.0% isoflurane plus nitrous oxide. The mean Hamilton Depression Rating (HDR) score was 12.7 +/- 5.4 for Group A and 12.3 +/- 6.0 for Group B 2 days before surgery and 9.9 +/- 4.1 for Group A and 14.4 +/- 3.8 for Group B 1 day after surgery. The HDR score in Group A 1 day after surgery was significantly (P < 0.05) lower than that in Group B. The HDR score in Group C was 4.2 +/- 1.7 2 days before surgery and 4.8 +/- 1.6 1 day after surgery. Depressed mood, suicidal tendencies, somatic anxiety, and hypochondriasis significantly decreased in Group A as compared with Group B. Postoperative pain scores in Group A at 8 and 16 h after the end of anesthesia were 26.6 +/- 8.7 and 24.9 +/- 8.2, respectively, which were significantly (P < 0.05) lower than 34.3 +/- 12.0 and 31.1 +/- 8.8 in Group B. In conclusion, small-dose ketamine improved the postoperative depressive state and relieved postoperative pain in depressed patients. ⋯ NMDA receptor antagonists are reported to be effective for improving depression. It remains unclear whether ketamine, which is an NMDA receptor antagonist, postoperatively affects the psychological state in depressed patients. We investigated the effect of 1.0 mg/kg of ketamine on postoperative outcomes in depressed patients.
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Anesthesia and analgesia · Jul 2002
Comparative Study Clinical TrialLevobupivacaine for axillary brachial plexus block: a pharmacokinetic and clinical comparison in patients with normal renal function or renal disease.
We compared the pharmacokinetics and clinical characteristics of 0.5% levobupivacaine for axillary block in patients with normal renal function versus patients with end-stage renal disease (ESRD). Twenty patients with normal renal function and eight patients with ESRD received an axillary block with 50-60 mL of 0.5% levobupivacaine. Patients were evaluated for onset and duration of sensory/motor block. Eleven patients with normal renal function and eight patients with ESRD underwent pharmacokinetic analysis. No differences between groups were found in the onset, duration, or quality of block. The median time to sensory block was 12.5 min and 12.9 min, and mean duration of the block was 19 h and 22 h in normal versus ESRD patients, respectively. No significant differences in noncompartmental pharmacokinetic variables (median) were found between normal and ESRD patients with an AUC(0-t) (microg. h(-1). mL(-1)) of 11 and 13, peak concentration (C(max)) (microg/mL) of 1.2 and 1.6, and a time to peak concentration (T(max)) (min) of 55 and 48, respectively. This study demonstrates the clinical efficacy and equivalence of the pharmacokinetic characteristics of 0.5% levobupivacaine for axillary brachial plexus block in patients with ESRD and normal renal function. ⋯ This study demonstrates the clinical efficacy and equivalence of the pharmacokinetic characteristics of 0.5% levobupivacaine for axillary brachial plexus block in patients with renal disease and normal renal function.
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Anesthesia and analgesia · Jul 2002
Clinical TrialInsufficiency in a new temporal-artery thermometer for adult and pediatric patients.
SensorTouch is a new noninvasive temperature monitor and consists of an infrared scanner that detects the highest temperature on the skin of the forehead, presumably over the temporal artery. The device estimates core temperature (T(core)). We tested the hypothesis that the SensorTouch is sufficiently precise and accurate for routine clinical use. We studied adults (n = 15) and children (n = 16) who developed mild fever, a core temperature of at least 37.8 degrees C, after cardiopulmonary bypass. Temperature was recorded at 15-min intervals throughout recovery with the SensorTouch thermometer and from the pulmonary artery (adults) or bladder (children). Pulmonary artery (T(core)) and SensorTouch (T(st)) temperatures correlated poorly in adults: T(core) = 0.7. T(st) + 13, r(2) = 0.3. Infrared and pulmonary artery temperatures differed by 1.3 +/- 0.6 degrees C; 89% of the adult temperatures thus differed by more than 0.5 degrees C. Bladder and infrared temperatures correlated somewhat better in pediatric patients: T(core) = 0.9. T(st) + 12, r(2) = 0.6. Infrared and bladder temperatures in children differed by only 0.3 degrees C, but the SD of the difference was 0.5 degrees C. Thus, 31% of the values in the infants and children differed by more than 0.5 degrees C. ⋯ We evaluated a noninvasive infrared forehead thermometer (SensorTouch) in adult and pediatric cardiac patients. Accuracy was poor in the adults and suboptimal in infants and children.
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Anesthesia and analgesia · Jul 2002
Comparative Study Clinical TrialRepeated deflation of a gas-barrier cuff to stabilize cuff pressure during nitrous oxide anesthesia.
Although a nitrous oxide (N(2)O) gas-barrier cuff effectively limits the increase of cuff pressure during N(2)O anesthesia, there are few data assessing whether an N(2)O gas-barrier cuff is more beneficial for stabilizing intracuff pressure than standard endotracheal tubes when cuffs are repeatedly deflated to stabilize pressure during N(2)O anesthesia. In the present study, the pressure of air-filled standard-type cuffs (Trachelon; Terumo, Tokyo, Japan) and N(2)O gas-barrier type endotracheal tube cuffs (Profile Soft-Seal Cuff [PSSC]; Sims Portex, Kent, UK) was measured during 67% N(2)O anesthesia (n = 8 in each), during which the cuffs were repeatedly deflated every 30 min (Trachelon) or 60 min (PSSC) for the first 3 or 4 h. After aspirating the cuffs for 3 h, the cuff pressure exceeded 22 mm Hg in more than half of the patients in both groups. However, aspiration of the cuffs for 4 h decreased the maximal cuff pressure between deflation intervals in both groups (P < 0.01 for each), and increased the intracuff N(2)O concentration (P < 0.0001 for each). After deflating the cuffs over 4 h, the cuff pressure in both groups never exceeded 22 mm Hg during the subsequent 3 h, and intracuff N(2)O concentrations did not significantly change. Therefore, deflation of cuffs for 4 h during N(2)O anesthesia sufficiently stabilized cuff pressure and equilibrated the intracuff N(2)O concentrations in both groups. The use of the PSSC endotracheal tube might be more practical because of the smaller number of cuff deflations required, but the PSSC does not reduce the duration of cuff deflations to stabilize the pressure. ⋯ We demonstrated that the N(2)O concentration and pressure in the N(2)O-barrier Profile Soft-Seal Cuff stabilized when the cuff was aspirated once an hour for 4 h during N(2)O anesthesia. The Profile Soft-Seal Cuff might be easier to use in clinical practice than standard endotracheal tubes because of the smaller number of cuff deflations required.
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Anesthesia and analgesia · Jul 2002
Clinical TrialElectro-acupuncture at the Zusanli, Yanglingquan, and Kunlun points does not reduce anesthetic requirement.
We tested the hypothesis that electro-acupuncture at the Zusanli, Yanglingquan, and Kunlun acupuncture points on the legs decreases anesthetic requirement. Fourteen young, healthy volunteers were anesthetized with desflurane on two separate days. Needle electrodes were positioned at the three acupuncture points thought to produce a generalized sedative and analgesic effect. Needles were percutaneously placed on treatment days; on control days, they were insulated and taped near the insertion points. The electrodes were stimulated on the treatment day. Stimulation consisted of 2-Hz and 100-Hz currents alternated at 2-s intervals. When the end-tidal desflurane concentration of 5.5% was stable for 15 min, noxious electrical stimuli were administered via 25-gauge needles on both thighs (70 mA at 100 Hz for 10 s). Desflurane concentration was increased 0.5% when movement occurred and decreased 0.5% when it did not. An investigator, blinded to treatment, determined movement. These up-and-down sequences were continued until volunteers crossed from movement to no movement four times. A logistic regression determined the partial pressure of desflurane that produced a 50% likelihood of movement in response to noxious stimulation and consequently identified the minimum alveolar anesthetic concentration equivalent for desflurane. There was no significant difference in minimum alveolar anesthetic concentration equivalents between the electro-acupuncture (4.6% +/- 0.6%, mean +/- SD) and control (4.6% +/- 0.8%) days (P = 0.8). These data provided an 80% power for detecting a difference of 0.35 volume-percent between the groups. ⋯ Electro-stimulation of three general acupuncture points on the leg did not reduce desflurane requirements. This type of acupuncture is thus unlikely to facilitate general anesthesia or decrease the need for anesthetic drugs.