Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1996
Randomized Controlled Trial Clinical TrialThe safety and efficacy of oral transmucosal fentanyl citrate for preoperative sedation in young children.
Oral transmucosal fentanyl citrate (OTFC) is a labeled preoperative pediatric sedative. Doses greater than 15 micrograms/kg are associated with a high incidence of post-operative nausea and vomiting and occasional respiratory depression. We studied the safety and efficacy of OTFC in children 6 yr old and younger at a dose of 15 micrograms/kg. ⋯ One OTFC patient developed rigidity during induction. Emergence and recovery were not delayed by OTFC despite a 50% incidence of postoperative vomiting. We do not recommend the use of OTFC in a 15 micrograms/kg dose as a routine preoperative sedative in children 6 yr old and younger.
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Anesthesia and analgesia · Dec 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of tenoxicam by intramuscular injection or wound infiltration for analgesia after inguinal herniorrhaphy.
We compared wound infiltration with small-dose tenoxicam (7.5 mg) to intramuscular (IM) administration of the same dose to treat pain after herniorrhaphy. In a randomized, double-blind study, 50 patients received either preoperative wound infiltration with tenoxicam, 7.5 mg in 40 mL of 0.9% saline (WI group; n = 25) or IM tenoxicam 7.5 mg (IM group; n = 25). In each group a saline placebo of equal volume was given by the alternate route, i.e., those who received wound infiltration with tenoxicam received 0.75 mL of 0.9% saline IM; those who received IM tenoxicam received 40 mL of 0.9% saline for wound infiltration. ⋯ The need for supplementary analgesics (acetaminophen and morphine) was registered. No differences were observed between groups in VAS pain scores, verbal rating pain scores, pain pressure thresholds, or in need for supplementary analgesics. We conclude that tenoxicam 7.5 mg has no local analgesic effect on postoperative pain after herniorrhaphy.
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Anesthesia and analgesia · Dec 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of a modified double-lumen endotracheal tube with a single-lumen tube with enclosed bronchial blocker.
This study compared the modified BronchoCath double-lumen endotracheal tube with the Univent bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath double-lumen tube (DLT), and 20 received a Univent tube with a bronchial blocker. ⋯ Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent, once position was corrected adequate surgical exposure was provided. In the Univent group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/ efficacy justification for routine use of this device.
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Anesthesia and analgesia · Dec 1996
Randomized Controlled Trial Clinical TrialMaternal posture influences the extent of sensory block produced by intrathecal dextrose-free bupivacaine with fentanyl for labor analgesia.
The cephalad extent of sensory block produced by intrathecal (IT) dextrose-free local anesthetics and opioids has been reported to be quite variable. Most reports describing the effects of IT analgesics do not control for patients posture. Because these medications are hypobaric relative to cerebrospinal fluid (CSF), parturients in a sitting position may develop greater cephalad extents of sensory block than those in a lateral position during IT injection. ⋯ Mean cephalad extent of block was greater in the sitting group at 20 and 30 min. When sensory block asymmetry was observed, the extent of block was greater on the nondependent side. Posture during IT injection of this dextrose-free analgesic combination affects extent of sensory block in laboring parturients.
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Anesthesia and analgesia · Dec 1996
ReviewCurrent understanding of patients' attitudes toward and preparation for anesthesia: a review.
A number of issues relating to patient education in anesthesia have been addressed in this review and, based upon the available data, some questions can be answered clearly. It is apparent both that a large minority of the American, British, and Australian public is under the misconception that anesthesiologists are not physicians and that the role of the anesthesiologist, both in and out of the operating room, is not fully understood. Many surgical patients, particularly younger ones, have fears about the anesthetic that are distinct from their fears about the surgery, the most common of them relating to waking up prematurely or not at all. ⋯ Advances in surgical diagnosis and treatment and critical care have depended upon the development of anesthesia as a specialty. Our ability to continue to develop may depend upon our success in educating the public, politicians, and other health care professionals about what we do. The evaluation of educational methods for disseminating information about anesthesia thus may be important in determining the very future of our specialty and the quality of surgical and pain therapy that patients will receive.