Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1997
Comparative StudyManagement of patient-controlled analgesia: a comparison of primary surgeons and a dedicated pain service.
Although Patient-Controlled Analgesia (PCA) is routinely available in most hospitals in the United States, there appears to be little standardization regarding who provides this valuable service to postoperative patients. This study evaluates the differences in PCA management practices and patient outcomes between primary service (PS) physicians and acute pain service (APS) physicians. Over a 3-mo period, 40 patients prescribed PCA by PS physicians were prospectively studied without the knowledge of the physicians or nurses involved in PCA management. ⋯ Although pain scores were not different between groups, APS patients had fewer side effects, were more likely to receive a loading dose, had their PCA settings adjusted more often (P < 0.05), and used more opioid. PS patients were more likely to receive intramuscular medications after PCA discontinuation (P < 0.05). This study demonstrates potentially important PCA management differences between APS and PS physicians.
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The purpose of this study was to examine the extent and evolution of pain after common major surgical procedures and to establish correlates of three types of pain: pain at rest, pain with movement, and maximum pain over the previous 24 h. Patients completed a preoperative questionnaire to obtain data on age, gender, narcotic use, baseline level of pain, chronicity of pain, and level of anxiety. Patients were then interviewed on Postoperative Days 1, 2, and 3 to assess their pain on a scale of 0 (none) to 10 (worst imaginable). ⋯ Preoperative narcotic use and high baseline preoperative pain, defined as a score > or = 4, were significantly (P < 0.05) associated with increased pain at rest, pain with movement, and maximum pain. Epidural analgesia was the only mode of analgesia significantly associated with both decreased postoperative pain at rest and decreased pain with movement (P < 0.05). These relatively high pain scores and minimum decreases in pain from Postoperative Days 1 to 3 emphasizes the need for more effective pain management continuing into the postoperative period to facilitate mobilization and recovery.
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Anesthesia and analgesia · Jul 1997
Comparative StudyComparative pharmacokinetics of ropivacaine and bupivacaine in nonpregnant and pregnant ewes.
We determined the pharmacokinetics and protein binding of ropivacaine and bupivacaine after intravenous administration to nonpregnant and pregnant sheep. All animals were in good condition throughout the study. The highest mean total serum drug concentrations were found at the end of infusion. ⋯ In conclusion, the pharmacokinetics of ropivacaine and bupivacaine are altered by ovine pregnancy in a similar way. If these data are applicable to humans, an unintended intravascular injection of either drug could be expected to result in higher total serum concentrations in the pregnant than in the nonpregnant patient, but drug levels would decline at similar rates in both groups of individuals. However, differences between the two drugs, particularly in T(1/2)beta and MRT, may make ropivacaine preferable for use in obstetric anesthesia.
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Anesthesia and analgesia · Jul 1997
Comparative StudyNoninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants: end-tidal versus transcutaneous carbon dioxide.
We prospectively compared the accuracy of two noninvasive monitors of arterial CO2 (end-tidal and transcutaneous) in mechanically ventilated infants and toddlers with respiratory failure. The study included infants and toddlers less than 48 mo of age who required tracheal intubation and mechanical ventilation for respiratory failure. In each patient, both ETCO2 and transcutaneous CO2 (TC-CO2) were simultaneously monitored and compared with PaCO2 when an arterial blood gas analysis was performed. ⋯ The absolute difference of the TC-CO2 and PaCO2 was 4 mm Hg or less in 96 of the 100 values, while the ETCO2 to PaCO2 difference was 4 mm Hg or less in 38 of the 100 values (P < 0.0001). Bland-Altman analysis revealed a bias of -0.68 with a precision of +/-2.35 when comparing the TC-CO2 and the PaCO2 and a bias of -6.68 with a precision of +/-5.01 when comparing ETCO2 with PaCO2. In neonates and infants with respiratory failure, TC-CO2 monitoring provided a more accurate estimation of PaCO2 than ETCO2 monitoring.