Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural opioid analgesia after caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine.
The quality of analgesia, patient satisfaction and incidence of side effects following a single bolus of epidural morphine were compared with patient-controlled epidural analgesia (PCEA) with meperidine during the first 24 hr after elective Caesarean section. Seventy-five women were randomly assigned to three equal groups. Group I received 30 mg epidural meperidine after delivery and PCEA with meperidine; Group 2 received 3 mg epidural morphine after delivery and PCEA with saline in a double-blind fashion. ⋯ Forty-six percent of patients in Group 1 were very satisfied with pain management, compared with 77% in Group 2 and 79% in Group 3. Nurse workload was higher in the PCEA study groups than in Group 3 (P < 0.05). A single bolus of epidural morphine provides superior analgesia and satisfaction at low cost, but with a higher incidence of nausea and pruritus than PCEA with meperidine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prophylactic oral ephedrine reduces the incidence of hypotension after subarachnoid block.
The purpose of this study was to demonstrate the efficacy of oral ephedrine in preventing hypotension following subarachnoid block. Two hundred women, ASA physical status I or II, undergoing lower abdominal surgery were randomly divided into two groups (n = 100 each). All patients were given routine oral premedication consisting of diazepam 10 mg and ranitidine 150 mg at bed time and at 90 min before surgery. ⋯ Despite a similar level of block (T3-T4) and i.v. fluids, the total dose of ephedrine supplement in Group I was 4.3 +/- 4.8 mg compared with 11.6 +/- 9.4 mg in Group II (P < 0.01). Also, 55 patients in Group I required intraoperative inotrope supplement compared with 83 in Group II (P < 0.01). We conclude that oral ephedrine premedication is a simple and effective way of reducing the incidence of hypotension in patients undergoing lower abdominal surgery under subarachnoid block.
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Anaesthetists choose daily among wide varieties of neuromuscular blocking drugs and rapidly acting hypnotic agents. This study sought to determine whether definitive, immediate knowledge of drug cost might influence clinician choices, ultimately reducing the cost of anaesthesia care. Faculty anaesthetists, residents in training, and nurse anaesthetists served as subjects in this prospective, sequential, blinded study of prescribing habits. ⋯ Ketamine usage normalized by total anaesthesia duration increased (P < 0.05) following sticker placement. The weekly cost of all drugs inventoried normalized for caseload did not differ during the measurement periods. Immediate cost awareness, implemented simply as price stickers on drug units, had minimal impact on clinicians' drug usage in a tertiary care setting.
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Epsilon-aminocaproic acid and tranexamic acid, two synthetic antifibrinolytics, and aprotinin, an antifibrinolytic derived from bovine lung, are used to reduce excessive bleeding and transfusion of homologous blood products (HBP) after cardiac surgery. This review analyzes the studies on the utilization of antifibrinolytics in adult cardiac surgery according to the epidemiological concepts of efficacy, effectiveness and efficiency. A majority of published studies confirm the efficacy of antifibrinolytics administered prophylactically to reduce postoperative bleeding and transfusion of HBP. ⋯ At this time, insufficient data have been published to perform a cost vs benefit analysis of the use of antifibrinolytics. This complex analysis takes into account not only direct costs (cost of the drug and of blood products), but also the ensuing effects of treatment such as: length of stay in the operating room, in the intensive care unit and in the hospital; need for surgical re-exploration; treatment of transfusion or drug-related complications, etc. In particular, the risk of thrombotic complications associated with antifibrinolytics is the subject of an ongoing, unresolved controversy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
The influence of arterial oxygenation on cerebral venous oxygen saturation during hyperventilation.
Cerebral venous oxygen desaturation may occur when hyperventilation is employed during neurosurgical procedures. In this study, we examined the effect of arterial hyperoxia (PaO2 > 200 mmHg) on jugular bulb venous oxygen tension (PjvO2), saturation (SjvO2) and content (CjvO2) in 12 patients undergoing anaesthesia for neurosurgical procedures. Under stable anaesthetic conditions, the inspired oxygen fraction (FIO2) was varied to give four different levels of arterial oxygen tension (PaO2 100-200, 201-300, 301-400, and > 400 mmHg), at two levels of controlled hyperventilation (PaCO2(25) and 30 mmHg). ⋯ From these lines we calculated the PjvO2, SjvO2 and CjvO2 at PaO2 of 100, 250 and 400 mmHg, at each level of PaCO2 for each patient. At PaCO2 of 25 mmHg, hyperoxaemia increased PjvO2 (from 27.6 +/- 1.1 mmHg at PaO2 of 100 mmHg to 30.6 +/- 1.4 and 33.6 +/- 1.8 mmHg at PaO2 of 250 and 400 mmHg respectively) and SjvO2 (from 54 +/- 3% at PaO2 of 100 mmHg to 60 +/- 3 and 65 +/- 3% at PaO2 of 250 and 400 mmHg respectively, P < 0.05). Hyperoxaemia had a similar effect on SjvO2 and PjvO2 at a PaCO2 of 30 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)