Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2005
Randomized Controlled Trial Clinical TrialEvaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study.
We evaluated the optimal preemptive dose of gabapentin for postoperative pain relief after single-level lumbar diskectomy and its effect on fentanyl consumption during the initial 24 hours in a randomized, double-blinded, placebo-controlled study in 100 patients with American Society of Anesthesiologists physical status I and II. Patients were divided into five groups to receive placebo or gabapentin 300, 600, 900, or 1200 mg 2 hours before surgery. After surgery, patients were transferred to the postanesthesia care unit (PACU). ⋯ Patients who received gabapentin 600, 900, and 1200 mg had lower VAS scores at all time points than patients who received gabapentin 300 mg (P < 0.05). Increasing the dose of gabapentin from 600 to 1200 mg did not decrease the VAS score, nor did the increasing dose of gabapentin significantly decrease fentanyl consumption (702.5, 635, and 626.5 microg). Thus, gabapentin 600 mg is the optimal dose for postoperative pain relief following lumbar diskectomy.
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J Neurosurg Anesthesiol · Apr 2005
Dexmedetomidine and awake fiberoptic intubation for possible cervical spine myelopathy: a clinical series.
For many anesthesiologists, awake fiberoptic endotracheal intubation (AFOBI) is the preferred method of intubation when treating patients with symptoms or signs of cervical spinal cord compression. The advantage of this method is to minimize cervical spine movements that could contribute to neurologic impairment. In patients who are anxious or poorly cooperative, adequate sedation in addition to topicalization of the airway may be key to minimize patient discomfort and assist in successful intubation, but imposes the risk of respiratory depression. ⋯ We did not encounter any loss of airway or airway obstruction during the intubation. The patients had excellent cooperation for post-intubation neurologic examination. Thirteen patients developed transient hypotension after induction of general anesthesia that was managed with boluses of phenylephrine or ephedrine.
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J Neurosurg Anesthesiol · Apr 2005
Clinical TrialResponse entropy increases during painful stimulation.
Frontal electromyography (FEMG) may increase during painful stimulation and indicate patient arousal. The Datex-Ohmeda Entropy Module calculates state entropy (SE) of the electroencephalogram (EEG; 0.8-32 Hz) and response entropy (RE) of EEG and FEMG (0.8-47 Hz). We determined whether RE increases above SE (RE--SE), an indication of FEMG, increase during painful stimuli and if this is related to paralysis or level of anesthesia. ⋯ The remaining 12 patients did not show an increase in RE--SE during tetanic stimulation and SE did not increase. We conclude that increased RE during painful stimulation was not dependent on recovery from paralysis but was seen more often in patients anesthetized with 0.8% compared with 1.4% isoflurane. This suggests that RE reflects FEMG and may be useful to identify inadequate anesthesia and patient arousal during painful stimuli.