Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 1995
Comparative StudyResuscitation from bupivacaine-induced asystole in rats: comparison of different cardioactive drugs.
The objective of this study was to compare the success of resuscitation attempts with different cardioactive drugs after bupivacaine-induced asystole. Saline, amrinone (1 mg/kg), dopamine (5 micrograms/kg), norepinephrine (2 micrograms/kg), epinephrine (10 micrograms/kg), or isoproterenol (1 microgram/kg) were tested. Sixty rats assigned to six treatment groups (n = 10/group) were lightly anesthetized (0.5% halothane, 70% N2O), paralyzed (doxacurium), and given bupivacaine intravenously at 4 mg.kg-1.min-1 until asystole. ⋯ Cardiac rhythm disturbance disappeared within 20 min after successful resuscitation with norepinephrine. Amrinone was no more effective than saline in treating bupivacaine-induced asystole. A drug such as norepinephrine, which has both cardiostimulator (beta 1-receptor agonist) and peripheral vasoconstrictor (alpha 1-receptor agonist) activity, may be the drug of choice for treating asystole induced by bupivacaine.
-
Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for outpatient arthroscopic knee sugery with intraarticular bupivacaine and ketorolac.
Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Systemic ketorolac is also useful in the management of these patients. Ketorolac, a nonsteroidal antiinflammatory drug (NSAID), alters the sensitivity of peripheral nociceptors by reducing the local concentration of allogenic chemicals which are activated by peripheral tissue injury. ⋯ The results of this study revealed a significant difference in analgesia from the IA administration of ketorolac. The group who received a combination of IA bupivacaine and IA ketorolac had decreased postoperative pain, a decreased need for postoperative analgesics, and an increased analgesic duration. We conclude that the use of IA ketorolac improved comfort in patients undergoing knee arthroscopy.
-
Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Clinical TrialPeroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics.
The aims of this study were to investigate the influence of adenosine infusion, firstly, on postoperative analgesic requirements, and secondly, on peroperative isoflurane requirements. Seventy-five women, aged 18-70 yrs, ASA grades I and II, scheduled for breast surgery, were randomly assigned to peroperatively receive a double-blind intravenous infusion of either adenosine, 80 micrograms.kg-1.min-1, or placebo, during surgery under isoflurane/N2O/O2 anesthesia. ⋯ Further, the postoperative 24-h opioid requirements were reduced by 27% in the adenosine group (P < 0.03). In conclusion, we found that a peroperative infusion of a small dose of adenosine during breast surgery, reduces the peroperative anesthetic requirements, and the demand for post-operative analgesics.
-
Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialObjective and subjective impairment from often-used sedative/analgesic combinations in ambulatory surgery, using alcohol as a benchmark.
Impairment caused by different sedative/analgesic combinations commonly used in ambulatory settings was compared to that of alcohol at blood alcohol concentrations (BACs) higher than or equal to 0.10%. Impairment was measured via subjective (mood) and objective (psychomotor performance) assays. Twelve healthy human volunteers (10 males and 2 females; age range 21-34 yr) participated in this prospective, double-blind, randomized, cross-over study. ⋯ Psychomotor impairment caused by alcohol at 15 min postingestion (at a BAC of 0.11% +/- 0.03% [mean +/- SE]) was used as a benchmark with which impairment caused by other sedative/analgesic combinations was compared. All the study drug combinations produced impairment (i.e., impairment greater than that seen with PLC), similar to that observed with alcohol at a BAC of 0.11%. We have demonstrated that some sedative/analgesic drug combinations used in anesthesia for ambulatory procedures produce impairment similar to or greater than that observed with a large dose of alcohol.
-
Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparative analgesic efficacy of patient-controlled analgesia with ketorolac versus morphine after elective intraabdominal operations.
We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (by visual analog scale [VAS]), patients were randomly assigned to one of two groups. ⋯ Mean pain scores were less in Group 1 than in Group 2 at each time, but only significantly so at 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) after starting PCA. Time to acceptance of oral liquids was equivalent in Groups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, although well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.