Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyPrevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia.
Magnetic resonance imaging (MRI) requires long-lasting immobilization that frequently can only be provided by general anesthesia in pediatric patients. Sevoflurane provides adequate anesthesia but many patients experience emergence agitation. Small doses of ketamine and nalbuphine provide moderate sedation but their benefits have subsided at the time of emergence. ⋯ All patients met discharge criteria at 30 min but significantly more children were awake and quiet in the K-group and still more in the N-group. In conclusion, small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge. Nalbuphine provided better results than ketamine.
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Anesthesia and analgesia · Apr 2006
The role of anesthesiologists in the selection and administration of perioperative antibiotics: a survey of the American Association of Clinical Directors.
The importance of timely administration of antibiotics for prophylaxis of surgical site infections has led to pressure on anesthesiologists to administer antibiotics. We present a survey of members of the American Association of Clinical Directors designed to evaluate the role of the anesthesiologist in the selection and administration of perioperative antibiotics. ⋯ Based on the responses received, anesthesiologists appear to be integrally involved with the administration, but not selection, of perioperative antibiotics, despite what respondents perceive as inadequate training in antibiotic therapy. Furthermore, perioperative antibiotic therapy in general appears to be poorly monitored, and responsibility for selection and administration of perioperative antibiotics appears to be poorly defined.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyA prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients.
Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication. ⋯ Children exposed to opioids for an average of 3 wk showed no difference in the number of agitation events requiring opioid rescue (3 consecutive neonatal abstinence scores >8 every 2 h) in either wean group. Most of the events requiring rescue occurred on day 5 and 6 of the wean in both treatment groups. Patients may be able to be weaned successfully in 5 days once converted to oral methadone, with a follow-up period after medication wean to observe for a delayed withdrawal syndrome.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyPrevention of postoperative nausea and vomiting with granisetron and dolasetron in relation to CYP2D6 genotype.
We investigated the efficacy of granisetron and dolasetron in preventing postoperative nausea and vomiting. Because the metabolism of the various antiemetic 5-hydroxytryptamine type 3 (5-HT3) antagonists involves different isoforms of the hepatic cytochrome P450 system, we examined the relationship between the clinical efficacy of these drugs and polymorphic cytochrome P450 2D6 (CYP2D6) genotype. This prospective, randomized, double-blind study involved 150 adult patients with a moderate to high risk for postoperative nausea and vomiting. ⋯ A complete response was more frequent in the granisetron group (54.7%) compared with the dolasetron group (38.7%, P < 0.05). In subjects receiving dolasetron, carriers of the duplication of the CYP2D6 allele predicting ultrarapid metabolizer status had more frequent vomiting episodes (P < 0.05) than patients in the granisetron group. It is postulated that the difference in the antiemetic efficacy between two investigated 5-HT3 receptor antagonists may be associated with differences in the carrier status for the duplication of the CYP2D6 allele.