Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2004
Randomized Controlled Trial Comparative Study Clinical TrialMidazolam: an effective antiemetic after cardiac surgery--a clinical trial.
Cardiac surgery has been associated with a significant incidence of postoperative nausea and vomiting (PONV). To assess the antiemetic property of midazolam, we undertook this double-blinded, randomized trial in 200 patients undergoing cardiac surgery involving cardiopulmonary bypass, and we compared its efficacy with that of ondansetron in preventing PONV. Assessments on the occurrence of PONV were made at regular intervals for the first 24 h after tracheal extubation, along with sedation and pain scoring. ⋯ All 21 patients (18 women and 3 men) in the ondansetron group and none of the 6 patients (all women) in the midazolam group required a rescue antiemetic drug (P < 0.001). The sedation scores and postoperative pain scores were comparable in both groups. We conclude that midazolam, instituted as a continuous infusion in a dose of 0.02 mg. kg(-1). h(-1), is a more effective antiemetic than ondansetron in a dose of 0.1 mg/kg IV every 6 h for the prevention of PONV after cardiac surgery.
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Anesthesia and analgesia · Aug 2004
ReviewKetamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review.
Animal studies on ketamine and opioid tolerance have shown promising results. Clinical trials have been contradictory. We performed a systematic review of randomized, double-blind clinical trials of ketamine added to opioid analgesia. ⋯ Five of 8 trials with epidural ketamine showed beneficial effects. Adverse effects were not increased with small dose ketamine. We conclude that small dose ketamine is a safe and useful adjuvant to standard practice opioid-analgesia.
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Anesthesia and analgesia · Aug 2004
Randomized Controlled Trial Clinical TrialNerve stimulator-assisted evoked motor response predicts the latency and success of a single-injection sciatic block.
Variable onset latency of single-injection sciatic nerve block (SNB) may result from drug deposition insufficiently close to all components of the nerve. We hypothesized that this variability is caused by the needle tip position relative to neural components, which is objectified by the type of evoked motor response (EMR) elicited before local anesthetic injection. One-hundred ASA I-II patients undergoing reconstructive ankle surgery received infragluteal-parabiceps SNB using 0.4 mL/kg (maximum 35 mL) of levobupivacaine 0.625%. ⋯ Patients with an EMR of I demonstrated shorter mean times (+/-95% confidence interval [CI]) to complete the block with 8.5 (95% CI, 6.2-10.8) min compared to 27.0 (95% CI, 20.6-33.4) min after PF (P < 0.001) and 30.4 (95% CI, 24.9-35.8) min after E (P < 0.001). No rescue blocks were required in group I compared with 24% (P = 0.001) and 71% (P < 0.001) of patients in groups PF and E, respectively. We conclude that EMR type during nerve stimulator-assisted single-injection SNB predicts latency and success of complete SNB because the observed EMR is related to the positioning of the needle tip relative to the tibial and common peroneal nerves.
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Anesthesia and analgesia · Aug 2004
Randomized Controlled Trial Comparative Study Clinical TrialDoes halothane really preserve cardiac baroreflex better than sevoflurane? A noninvasive study of spontaneous baroreflex in children anesthetized with sevoflurane versus halothane.
Heart rate profiles during the induction of anesthesia differ markedly between the administration of sevoflurane and halothane. Previous investigations have shown that halothane preserves cardiac parasympathetic activity more than sevoflurane. Because vagal drive to the sinus node is the main effector of arterial baroreflex control of heart rate, halothane may preserve cardiac baroreflex better than sevoflurane. ⋯ Similarly, the cross-spectral analysis between systolic blood pressure and RRI showed a decrease of the gain calculated in the low-frequency band, but the gain in the respiratory band was higher with halothane compared with sevoflurane. In children, the induction of anesthesia with halothane and sevoflurane is associated with a marked decrease of cardiac baroreflex activity. The persistence of respiratory RRI fluctuations under halothane might reflect reflex respiratory arrhythmia rather than efficient parasympathetic baroreflex activity.
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Anesthesia and analgesia · Aug 2004
Randomized Controlled Trial Clinical TrialThe analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery.
We investigated the efficacy and safety of gabapentin in rhinoplasty or endoscopic sinus surgery patients. Patients received either oral placebo or gabapentin 1200 mg 1 h before surgery. After standard premedication, 25 patients in each group received propofol, fentanyl, and local anesthesia at the operative site. ⋯ Fentanyl (122 +/- 40 microg versus 148 +/- 42 microg; P < 0.05) and diclofenac (33 +/- 53 mg versus 111 +/- 92 mg; P < 0.001) consumption was smaller and the time to first analgesic request (18 +/- 9 h versus 9 +/- 7 h; P < 0.001) was longer in the gabapentin group. A more frequent incidence of dizziness was found in the gabapentin (versus placebo) group (24% versus 4%, respectively). We conclude that gabapentin provided a significant analgesic benefit for intraoperative and postoperative pain relief in patients undergoing ambulatory rhinoplasty or endoscopic sinus surgery; however, dizziness may be a handicap for ambulatory use.