The Journal of international medical research
-
Randomized Controlled Trial Comparative Study
Comparison of an intraoperative infusion of dexmedetomidine or remifentanil on perioperative haemodynamics, hypnosis and sedation, and postoperative pain control.
This prospective, randomized, double-blind study compared the effects of dexmedetomidine and remifentanil on haemodynamic stability, sedation and postoperative pain control in the postanaesthetic care unit (PACU). Fifty consecutive patients scheduled for total laparoscopic hysterectomy were randomly assigned to receive infusions of either dexmedetomidine (1 μg/kg) i.v. over 10 min followed by 0.2 - 0.7 μg/kg per h continuous i.v. infusion or remifentanil (0.8 - 1.2 μg/kg) i.v. over 1 min followed by 0.05 - 0.1 μg/kg i.v. per min, starting at the end of surgery to the time in the PACU. ⋯ Blood pressure and heart rate in the dexmedetomidine group were significantly lower than that recorded in the remifentanil group in the PACU. Dexmedetomidine, at the doses used in this study, had a significant advantage over remifentanil in terms of postoperative haemodynamic stability.
-
Randomized Controlled Trial
The sparing effect of low-dose esmolol on sevoflurane during laparoscopic gynaecological surgery.
This double-blind, randomized, placebo-controlled study evaluated the sparing effect of esmolol on sevoflurane during laparoscopic gynaecological surgery in 54 patients between December 2009 and May 2010. The concentration of sevoflurane required to maintain adequate anaesthesia was determined. Patients received either a 0.5 mg/kg esmolol intravenous loading dose followed by infusion of 30 μg/kg per min or an identical volume of normal saline (placebo). ⋯ Infusion of esmolol resulted in an 18.2% decrease in mean sevoflurane input concentration. Patients receiving esmolol had an earlier discharge from the postanaesthetic care unit and a lower mean fentanyl dose. In conclusion, intraoperative esmolol infusion decreased both the requirement for sevoflurane and postoperative administration of fentanyl.
-
Multicenter Study
The Bowel Function Index for evaluating constipation in pain patients: definition of a reference range for a non-constipated population of pain patients.
Opioid-induced constipation (OIC) is a severe, persisting side-effect of opioid therapy. The Bowel Function Index (BFI(a), numerical analogue scale 0 - 100), calculated as the mean of three variables (ease of defaecation, feeling of incomplete bowel evacuation, and personal judgement of constipation) was developed to evaluate bowel function in opioid-treated patients with pain. This clinician-administered tool allows easy measurement of OIC from the patient's perspective. ⋯ The BFI scores were assessed and compared with those of patients with confirmed OIC obtained from two previously published trials. Results were analysed and a reference range of BFI values of 0 - 28.8, into which 95% of non-constipated chronic pain patients fell, was defined. This permits discrimination between chronic pain patients with, or without, constipation.
-
The bolus effective dose of ketamine required to prevent withdrawal movement on injection of rocuronium was determined in 27 paediatric patients undergoing elective surgery. A predetermined dose of ketamine was given intravenously on arrival in the operating room and anaesthesia (2.5% thiopental, 5 mg/kg) was administered 1 min later. After loss of consciousness, 1% rocuronium at 0.6 mg/kg was injected over 5 s and the presence or absence of withdrawal movement recorded. ⋯ The bolus effective dose of ketamine for preventing withdrawal movement after injection of rocuronium following thiopental anaesthesia in 50% of paediatric patients (ED(50)) was 0.21 mg/kg according to the modified Dixon up-and-down method. Probit analysis indicated an ED(50) of 0.18 mg/kg and an ED(95) of 0.33 mg/kg. The latter was the most satisfactory dose in the clinical setting.
-
This study investigated 151 patients undergoing cardiac surgery to determine whether measurement of regional cerebral oxygen saturation (rS(c)O(2)) using near-infrared spectroscopy (NIRS) can indicate a low haematocrit after initiation of hypothermic cardiopulmonary bypass (CPB). Haematocrit, rS(c)O(2), haemoglobin level, arterial partial pressures of carbon dioxide and oxygen, systemic blood pressure, and nasopharyngeal and rectal temperatures were determined 5 min after the initial administration of heparin for CPB and 90 s after completion of the first cardioplegic solution injection. ⋯ No significant correlations were found between the change in haematocrit and changes in left, right and mean rS(c)O(2); thus, changes in rS(c)O(2) before and after initiation of hypothermic CPB did not reflect changes in haematocrit values. This indicates that NIRS cannot provide early warning of a low haematocrit immediately after initiation of hypothermic CPB in cardiac surgery.