Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
-
Randomized Controlled Trial
Objective assessment of postoperative gastrointestinal motility in elective colonic resection using a radiopaque marker provides an evidence for the abandonment of preoperative mechanical bowel preparation.
It has been suggested that mechanical bowel preparation (MBP) has no benefit in terms of anastomotic healing, infection rate, or improvement in the postoperative course in patients undergoing elective colorectal surgery, and that it should be abandoned. However, the effect of MBP on postoperative gastrointestinal motility has been assessed subjectively. In this randomized trial, we objectively assessed the effect of MBP on postoperative gastrointestinal motility and mobility in elective colonic resection. ⋯ Our data provide additional evidence to support the abandonment of MBP in elective open colonic surgery.
-
Randomized Controlled Trial
An epidural initial dose is unnecessary in combined spinal epidural anesthesia for Caesarean section.
Combined spinal epidural anesthesia is widely used for Caesarean section. Bolus administration of an epidural initial dose introduces the risk of drug flux from the epidural space to the subarachnoid space, and the volume effect of the initial dose may cause epidural top-up and extension of subarachnoid blockade. These problems may be avoided if the initial dose is not administered. ⋯ Between the initial dose group and the continuous group, there was no significant difference in the number of times flurbiprofen or pentazocine were used for postoperative pain relief. However, the number of times that pentazocine was used was significantly higher in the spinal group than in other groups. This finding suggests that an epidural initial dose is unnecessary for postoperative pain relief in combined spinal epidural anesthesia for Caesarean section.
-
Randomized Controlled Trial
Effect of bicarbonated Ringer's solution on the acid-base balance in patients undergoing abdominal aortic aneurysm repair.
The present study was designed to assess whether prophylactic use of bicarbonated Ringer's solution ameliorates metabolic acidosis in patients undergoing aortic surgery. ⋯ Aortic cross-clamping leads to the development of metabolic acidosis, with a decrease in pH and BE. The effect of administration of bicarbonated infusion fluid during elective abdominal aortic surgery had not significant compared with that of acetated Ringer's solution with respect to acid-base homeostasis.
-
Randomized Controlled Trial Clinical Trial
Oral clonidine premedication exacerbates hypotension following tourniquet deflation by inhibiting noradrenaline release.
Clonidine premedication prevents tourniquet pain and reduces sympathetic nerve activity. We evaluated hemodynamic changes and catecholamine release following tourniquet deflation during spinal anesthesia in patients who received oral clonidine premedication. The final analysis included 24 otherwise healthy patients undergoing lower-limb surgery randomly assigned to two groups: those receiving approximately 5 micrograms/kg of oral clonidine 1 hr before anesthesia (clonidine group, n = 12), and those receiving no premedication (control group, n = 12). ⋯ After receiving clonidine premedication, the plasma noradrenaline concentrations in the clonidine group were significantly lower than those in the control group. Noradrenaline concentration increased in the control group from 162.3 +/- 89.2 pg/mL before tourniquet deflation to 199.3 +/- 95.7 pg/mL afterward (P < 0.01), but there was no significant change in noradrenaline concentration after tourniquet deflation in the clonidine group. We conclude that oral clonidine premedication exacerbated the reduction in mean blood pressure following tourniquet deflation by inhibiting noradrenaline release.
-
Randomized Controlled Trial Clinical Trial
Effects of intravenous infusion rate of oxytocin on thoracic epidural pressure in parturients undregoing elective cesarean section.
The effects of intravenous oxytocin on thoracic epidural pressure during cesarean section were studied in 90 parturients (American Society of Anesthesiologists physical atatus class I or II) after obtaining informed consent. The subjects were randomized to either a control (control group; n=30), bolus (bolus group; n=30) or drip treatment group (drip group; n=30). The subjects were anesthetized with 11 approximately 12 mg of intrathecal isobaric bupivacaine (0.5%). ⋯ Epidural pressure immediately after placental delivery in the bolus group was higher than in the control group (p<0.0001) and epidural pressure at 5 minutes after fetus delivery in the drip group was higher than in the control group (p=0.0452). There were no significant differences in changes in blood pressure and heart rate among the three groups. We concluded that the increase in epidural pressure with intravenous administration of oxytocin 10 units over 5 minutes was lower than with intravenous administration of oxytocin 10 units over 30 seconds after fetus delivery.