Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1998
Randomized Controlled Trial Clinical TrialPostoperative analgesia by D-myo-inositol-1,2,6-trisphosphate in patients undergoing cholecystectomy.
D-myo-inositol-1,2,6-trisphosphate (1,2,6-IP3) possesses antiinflammatory properties, such as reduced eicosanoid synthesis and inhibition of inflammation-induced edema. These properties suggest possible analgesic effects. The analgesic effect of 1,2,6-IP3 was evaluated in a double-blind, randomized study in 24 patients undergoing cholecystectomy. Ten patients received 1,2,6-IP3 as an intravenous (i.v.) bolus dose of 240 mg, followed by a continuous i.v. infusion at 90 mg/h for 24 h. The placebo group (n = 14) received corresponding volumes of isotonic saline. Postoperative pain (visual analog pain scale; VAS) and opiate analgesic requirements (ketobemidon) were evaluated during five postoperative days. Results showed significantly reduced pain during the first five postoperative days in patients treated with 1,2,6-IP3, as measured by using a VAS (P < 0.05). The requirements of opioid analgesics were significantly reduced during the first three postoperative days (P < 0.05). No drug-related side effects were observed. Results of the present study demonstrate a potent and long-lasting analgesic effect of 1,2,6-IP3, possibly related to its antiinflammatory properties. ⋯ A new antiinflammatory drug under investigation, inositol-1,2,6-trisphosphate, was evaluated as a possible analgesic in a pilot study during the postoperative period in cholecystectomized patients. Results showed significantly lower pain assessment and opioid consumption, which should encourage further studies.
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Anesthesia and analgesia · Jan 1998
Randomized Controlled Trial Clinical TrialThe efficacy and safety of a clonidine/bupivacaine combination in caudal blockade for pediatric hernia repair.
We evaluated the analgesic efficacy and hemodynamic and respiratory safety of clonidine when added to bupivacaine for caudal blocks in 58 children aged 38 +/- 2 mo (mean +/- SEM). Patients scheduled for ambulatory hernia repair were randomly given a caudal injection (0.75 mL/kg) of either saline placebo (P group), bupivacaine, 0.25% (B group), bupivacaine plus epinephrine 1:200,000 (BE group), bupivacaine plus clonidine 1 microgram/kg (BC1 group), or bupivacaine plus clonidine 2 micrograms/kg (BC2 group). Postoperative measurements included duration of analgesia, hemodynamics, and respiratory monitoring for 6 h. Thereafter, parents assessed their child's analgesic requirements at home every 3 h for 18 h. The duration of analgesia (median [range]) was significantly longer (P < 0.05) in the BC1 and BC2 groups (360 [270-360] min and 360 [355-360] min, respectively) compared with the P (77[45-190]), B (346[105-360]), or BE group (300[75-360]). Similarly, the BC1 and BC2 groups required less additional analgesic within the first 24 h. All groups showed a significant decrease in mean arterial pressure compared with baseline values, but the differences among the groups were not significant. Bradycardia and respiratory depression were not observed. Clonidine 1 and 2 micrograms/kg can be safely added to bupivacaine caudal blockade in small children for ambulatory hernia repair to achieve an increased duration of analgesia compared with bupivacaine alone or bupivacaine plus epinephrine. ⋯ The addition of clonidine, an antihypertensive drug with analgesic properties, to local anesthetics in caudal blocks prolongs postoperative pain relief and reduces the need for additional pain treatment in children after hernia operation.
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Anesthesia and analgesia · Jan 1998
Randomized Controlled Trial Clinical TrialTracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants.
Using alfentanil followed by an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without neuromuscular relaxants. Remifentanil, which has a clinical onset similar to that of alfentanil, has not been investigated for this indication. Accordingly, 80 ASA physical status I and II premedicated outpatients were randomly assigned to one of four groups (n = 20/group). Remifentanil 1, 2, 3, or 4 micrograms/kg (Groups I-IV, respectively) was infused intravenously over 90 s. Sixty seconds after beginning the remifentanil infusion, propofol 2 mg/kg was infused over 5 s. Ninety seconds after the administration of propofol, laryngoscopy and tracheal intubation were attempted and graded. Clinically acceptable intubating conditions (i.e., jaw relaxed, vocal cords open, and fewer than two coughs in response to intubation) were observed in 35%, 75%, 100%, and 95% of patients in Groups I-IV, respectively. Clinically acceptable intubating conditions were significantly (P < 0.05) less likely to occur in Group I compared with all other groups. Excellent intubating conditions (i.e., vocal cords open, no movement in response to intubation) were observed in 30%, 50%, 80%, 80% of patients in Groups I-IV, respectively. Overall conditions at intubation were significantly (P < 0.05) better in Groups III and IV compared with Groups I and II. The mean time to resumption of spontaneous ventilation after induction was < 5 min in all groups. No patient manifested clinically significant muscle rigidity. The mean arterial pressure decreased 16%, 20%, 28%, 26% immediately before tracheal intubation in Groups I-IV, respectively. No patient was treated for hypotension or bradycardia. In conclusion, healthy, premedicated patients with favorable airway anatomy can be reliably intubated with good or excellent conditions 90 s after the administration of remifentanil 3-4 micrograms/kg and propofol 2 mg/kg. ⋯ Remifentanil 3 micrograms/kg and propofol 2 mg/kg co-administered intravenously may reliably provide adequate conditions for tracheal intubation in healthy patients without neuromuscular relaxants. This combination of drugs may allow the rapid return of spontaneous ventilation.
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Anesthesia and analgesia · Jan 1998
Randomized Controlled Trial Clinical TrialRecovery from opioid anesthesia: the clinical implication of context-sensitive half-times.
The context-sensitive half-time, the time required for a 50% decrease in drug concentration, has been proposed to predict the speed of recovery after infusions of i.v. anesthetics. We studied 40 patients to compare the clinical recovery characteristics of alfentanil and sufentanil. Patients were randomly allocated to receive either sufentanil/propofol (Group 1) or alfentanil/propofol (Group 2) total i.v. anesthesia by target-controlled infusions (TCI), assuming an equipotency ratio of 500:1. After discontinuation, times to tracheal extubation and to discharge from the postanesthesia care unit were measured, as were drug concentrations up to 24 h. The TCI bias was -17.1% for sufentanil and -16.9% for alfentanil. We found no difference in mean extubation times between the groups (48.7 min in Group 1 versus 46.4 min in Group 2), whereas discharge criteria were fulfilled significantly (P = 0.039) earlier after alfentanil (99.5 min) compared with sufentanil (131.3 min). The relative decrement values to tracheal extubation were 62.1% for sufentanil and 48.0% for alfentanil, compared with 75.7% and 65.0% for discharge, respectively. Based on a difference in propofol requirements, we suggest an actual sufentanil to alfentanil equipotency ratio of 1:300. We conclude that the decay in pharmacodynamic effect is not only the result of pharmacokinetics. ⋯ Computer simulations may help to anticipate the clinical behavior of anesthetic drugs. In a clinical setting, we tested whether the recovery characteristics after i.v. anesthesia could be explained by a pharmaco-kinetic value, which describes the decline of drug concentrations in the body. This was not fully achieved.
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Anesthesia and analgesia · Jan 1998
Randomized Controlled Trial Clinical TrialThe effect of adenosine triphosphate on sevoflurane requirements for minimum alveolar anesthetic concentration and minimum alveolar anesthetic concentration-awake.
We evaluated the effects of i.v. adenosine triphosphate (ATP) on sevoflurane minimum alveolar anesthetic concentration (MAC) and MAC-Awake. The study group included healthy patients 20-60 yr of age. The study groups for MAC-Awake determination included 49 patients who were scheduled for elective surgery. The study groups for MAC determination included 53 patients scheduled for elective surgery involving a skin incision. These patients were randomly assigned to two groups, an ATP group and a control group. The ATP group received 100 micrograms.kg-1.min-1 ATP i.v., and the control group received no medication. The ATP group and the control group were compared with regard to MAC-Awake (anesthetic concentration achieving 50% probability of eye opening in response to a verbal command) and MAC (anesthetic concentration achieving 50% probability of no movement in response to skin incision). The MAC-Awake was 0.7% +/- 0.1% in the control group (mean +/- SD) and 0.7% +/- 0.1% in the ATP group. MAC was 1.9% +/- 0.1% in the control group and 2.1% +/- 0.2% in the ATP group. The differences in MAC and MAC-Awake between the two groups were not statistically significant. We conclude that ATP infusion (100 micrograms.kg-1.min-1) has no effect on sevoflurane MAC and MAC-Awake. ⋯ We found that an i.v. adenosine triphosphate infusion (100 micrograms.kg-1.min-1) has no effect on sevoflurane minimum alveolar anesthetic concentration (anesthetic concentration achieving 50% probability of no movement in response to skin incision) and minimum alveolar anesthetic concentration-Awake (anesthetic concentration achieving 50% probability of eye opening in response to a verbal command) in humans.