Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparison of the infusion requirements and recovery profiles of vecuronium and cisatracurium 51W89 in intensive care unit patients.
The selection and administration of neuromuscular blocking (NMB) drugs in intensive care unit (ICU) patients remain controversial. We compared the dose-response and recovery pharmacodynamics of a new intermediate-acting NMB drug, cisatracurium besylate, to the intermediate-acting NMB drug, vecuronium (VEC), in a prospective, randomized, double-blind, multicenter study in critically ill adults. After informed consent, 58 mechanically ventilated ICU patients from five medical centers were randomized to receive either cisatracurium or VEC. ⋯ Seven VEC and one cisatracurium patients died during the infusion of study drug or within 48 h after discontinuation of the NMB drug infusion. In summary, we found recovery of neuromuscular function after discontinuation of NMB drug infusion in ICU patients is significantly faster with cisatracurium than with VEC. In addition, routine neuromuscular monitoring was not sufficient to eliminate prolonged recovery and myopathy in ICU patients.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous regional anesthesia using lidocaine and ketorolac.
Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. ⋯ Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of N-methyl-D-aspartate antagonist (ketamine) on single and repeated nociceptive stimuli: a placebo-controlled experimental human study.
Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor channel blocker known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. We sought to assess the effect of ketamine on single and repeated nociceptive stimuli. A placebo-controlled, human (12 volunteers) experimental study was conducted in which several psychophysical (pain detection and tolerance thresholds, magnitude ratings) and electrophysiologic (withdrawal reflex) techniques were used 1) to investigate whether a ketamine (0.5 mg/kg) bolus followed by a 20-min infusion (9 micrograms.kg-1.min-1) inhibits central temporal summation to repeated nociceptive electrical stimuli, and 2) to assess quantitatively the hypoalgesic potency using several experimental nociceptive stimuli (argon laser, pressure, electrical). ⋯ The pressure pain detection and tolerance thresholds were increased significantly by ketamine, whereas the laser heat pain and tolerance thresholds remained stable compared with placebo. The stimulus response function showed that ketamine reduced the responses to the highest electrical stimulus intensities (1.4, 1.6, and 1.8 times the reflex threshold). We conclude that ketamine inhibits central temporal summation in humans and has a marked hypoalgesic effect on high intensity nociceptive stimuli.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialUse of sevoflurane during elective cesarean birth: a comparison with isoflurane and spinal anesthesia.
This randomized study compared sevoflurane 1% and isoflurane 0.5% in terms of maternal and neonatal outcomes. In addition, neonatal outcome in both groups was compared with a cohort of patients delivered by cesarean birth using spinal anesthesia. Fifty-five patients presenting for elective cesarean birth under general anesthesia were randomly assigned to receive either sevoflurane 1% or isoflurane 0.5% in a 50% nitrous oxide and oxygen mixture for maintenance. ⋯ Similarly, the level of postoperative comfort was the same in both groups. Comparing the general and the spinal anesthetic groups, no differences could be detected in neonatal outcome. Fluoride concentrations were modestly increased above preoperative levels in maternal and umbilical blood samples after sevoflurane administration.(ABSTRACT TRUNCATED AT 250 WORDS)