Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialThe effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery.
In a randomized, double-blinded study, we evaluated the analgesic effect of ketamine in the management of pain in a surgical intensive care unit after major abdominal surgery. Patients received morphine patient-controlled analgesia with either placebo (Group M) or ketamine (Group K). Morphine was administered with initial loading doses of 2 mg until the visual analog scale (VAS) score was <30 and thereafter with bolus doses of 1 mg and a lockout time of 7 min. ⋯ VAS scores at rest and at mobilization were similar. The cumulative consumption of morphine was significantly smaller in Group K (P < 0.05). We concluded that small doses of ketamine were a valuable adjunct to opioids in surgical intensive care unit patients after major abdominal surgery.
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialAwake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil.
Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. ⋯ Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialOnset time, quality of blockade, and duration of three-in-one blocks with levobupivacaine and bupivacaine.
Levobupivacaine is the isolated S(-)-stereoisomer of racemic bupivacaine. Important pharmacodynamic properties of levobupivacaine have not been determined for the femoral three-in-one block. In this randomized, controlled, double-blinded trial, we studied 60 ASA physical status I-III patients scheduled for surgery of the lower limb. ⋯ The analgesic quality of the blockade was also not significantly different among the three groups, whereas a complete sensory block was achieved in significantly fewer patients in the levobupivacaine 0.25% group (P = 0.02). The duration of blockade was significantly shorter with levobupivacaine 0.25% compared with the other groups: bupivacaine 0.5%, 1053 min (802-1304 min); levobupivacaine 0.5%, 1001 min (844-1158 min); and levobupivacaine 0.25%, 707 min (551-863 min) (P = 0.01). Levobupivacaine 0.5% is recommended instead of bupivacaine 0.5% for the three-in-one block.
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Anesthesia and analgesia · Sep 2003
ReviewPharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review.
A number of drugs have been tested in clinical trials to decrease cardiac complications in patients undergoing noncardiac surgery. To compare the results of these studies, we conducted a quantitative systematic review. Medline, Embase, and Cochrane databases were searched for randomized trials that assessed myocardial ischemia, myocardial infarction, 30-day cardiac mortality, and adverse effects. ⋯ The effect of alpha(2)-agonists on myocardial infarction was not significant (6.1% versus 7.3%; OR 0.85 [95% CI, 0.62-1.14]). beta-blockers significantly decreased the risk of cardiac death from 3.9% to 0.8% (OR 0.25 [95% CI, 0.09-0.73], NNT 32). alpha(2)-agonists significantly decreased the risk of cardiac death from 2.3% to 1.1% (OR 0.50 [95% CI, 0.28-0.91], NNT 83). For calcium channel blockers and nitroglycerin, evidence of any benefit was lacking. The most common adverse effect was bradycardia, which occurred in 24.5% of patients receiving a beta adrenergic blocker versus 9.1% of controls (OR 3.76 [95% CI, 2.45-5.77], NNH 6).
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Anesthesia and analgesia · Sep 2003
Randomized Controlled Trial Clinical TrialThe efficacy of 5% lidocaine-prilocaine (EMLA) cream on pain during intravenous injection of propofol.
Topical anesthesia using 60% lidocaine tape reduces the incidence of propofol injection pain. We conducted a randomized prospective double-blinded placebo-controlled study to assess the analgesic efficacy of pretreatment with topical 5% lidocaine-prilocaine (EMLA) cream in 90 ASA physical status I and II adult patients scheduled to undergo day-case gynecological surgery. Propofol injection pain was not reduced by pretreatment with EMLA cream, whereas the addition of lidocaine to propofol did significantly reduce propofol injection pain compared with the control group (P = 0.002). We conclude that topical anesthesia with EMLA cream applied for 60 min does not significantly reduce propofol injection pain.