Canadian journal of anaesthesia = Journal canadien d'anesthésie
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As more extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee and shoulder reconstruction, hysterectomy) are being performed on an outpatient basis, the availability of sophisticated postoperative analgesic regimens are necessary to optimize the benefits of day-case surgery for both the patient and the health care provider. However, outcome studies are needed to evaluate the effects of these newer therapeutic approaches with respect to postoperative side effects, cost and important recovery variables. Recent studies suggest that factors other than pain per se must be controlled in order to reduce postoperative morbidity and facilitate the recovery process. ⋯ In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress free" anaesthesia with minimal postoperative discomfort is now possible for most patients undergoing ambulatory surgical procedures. The aim of any analgesic technique should not only be to lower the pain scores but also to facilitate earlier mobilization and to reduce perioperative complications, in particular PONV. In future, clinicians should be able to effectively treat postoperative pain using a combination of "balanced," "preemptive," and "peripheral" analgesia techniques without producing emetic sequelae.
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Randomized Controlled Trial Clinical Trial
Intrathecal fentanyl prolongs sensory bupivacaine spinal block.
The purpose of investigation was to study the effect of intrathecal fentanyl on the onset and duration of hyperbaric bupivacaine-induced spinal block in adult male patients. Forty-three patients undergoing lower extremity or genitourinary surgery were enrolled to receive either 13.5 mg hyperbaric bupivacaine 0.75% + 0.5 ml CSF it, (Group I) or 13.5 mg hyperbaric bupivacaine 0.75% + 25 micrograms fentanyl it, (Group II) according to a randomized assessor-blind protocol. The onset and duration of sensory block were assessed by pinching the skin with forceps in the midclavicular line bilaterally every two minutes for first twenty minutes and then every five to ten minutes. ⋯ Fewer patients demanded pain relief in the fentanyl-treated group than in the control group in the early postoperative period (19% vs 59%; P < 0.05). Episodes of hypotension were more frequent in the fentanyl-treated group than in the control group (43% vs 14%; P < 0.05). We conclude that fentanyl, 25 micrograms it, prolonged the duration of bupivacaine-induced sensory block (sensory regression to L1 dermatone) by 28% and reduced the analgesic requirement in the early postoperative period following bupivacaine spinal block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral clonidine premedication reduces vomiting in children after strabismus surgery.
This is a prospective randomized double-blind trial conducted to determine whether preoperative orally administered clonidine causes or potentiates postoperative vomiting in 140 children (3-12 yr) undergoing strabismus surgery. They were all inpatients and classified randomly into four groups (n = 35 each); placebo (control), diazepam 0.4 mg.kg-1, clonidine 2 micrograms.kg-1, and clonidine 4 micrograms.kg-1. These agents were administered 93-112 min (mean; 100 min) before the anticipated time of induction of anaesthesia. ⋯ However, low-dose clonidine was ineffective. These data suggest that preanaesthetic medication with clonidine 4 micrograms.kg-1 may be useful for preventing emesis following strabismus surgery. This property of clonidine indicates that it may be superior to other sedative premedicants such as diazepam and midazolam.
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Randomized Controlled Trial Comparative Study Clinical Trial
The triple airway manoeuvre for insertion of the laryngeal mask airway in paralyzed patients.
The efficacy of the triple airway manoeuvre (mouth opening, head extension and jaw thrust) for insertion of the laryngeal mask airway (LMA) was compared with the standard insertion method. One hundred paralyzed patients were allocated randomly into two groups: in the control group (n = 50) the LMA was inserted by the standard method, and in the other (TAM group, n = 50) by the triple airway manoeuvre. In ten patients of each group, the position of the LMA and the epiglottis was assessed radiographically before insertion, after insertion but before cuff inflation, and after cuff inflation. ⋯ After cuff inflation the glottis was completely visible fibreoptically in 66% in the TAM group, compared with 14% in the control group (P < 0.001). Complete downfolding of the epiglottis was seen in 10% in the control group and none in the TAM group (P < 0.05). We conclude that in paralyzed patients LMA insertion with the triple airway manoeuvre provides wider pharyngeal space and decreases the incidence of epiglottic downfolding by the LMA compared with the standard method.