Anesthesia and analgesia
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Comparative Study Clinical TrialHemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter.
Sixty elderly patients (> 70 yr old) undergoing surgery for hip fracture were prospectively studied in order to compare hemodynamic tolerance of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia (CSA) versus single-dose spinal anesthesia (SDSA). Patients were randomized into two groups (CSA group: n = 30; SDSA group: n = 30). The SDSA patients received 10-15 mg of 0.5% hyperbaric bupivacaine (based on age and height), and the CSA patients received a starting dose of 5 mg of 0.5% hyperbaric bupivacaine, followed after 15 min by optional reinjection of 2.5 mg every 5 min until a T10 level sensory block was reached. ⋯ The mean dose of ephedrine was significantly less in the CSA group (1.8 +/- 0.7 mg, administered to only 37% of patients) than in the SDSA group (19.4 +/- 3.3 mg administered to all patients, P < 0.0001). No late complications related to the spinal anesthesia technique were observed in either group. We concluded that CSA, using small titrated doses of 0.5% hyperbaric bupivacaine, is safe, efficient, and provides better hemodynamic stability than SDSA in elderly patients.
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Clinical TrialIntravenous lidocaine does not attenuate the cardiovascular and catecholamine response to a rapid increase in desflurane concentration.
This study was designed to investigate the effect of intravenous lidocaine on the sympathetic activity after a rapid increase in desflurane concentration. Twenty ASA grade I and II patients, were allocated randomly to a control group (C) and a lidocaine group (L). After induction of anesthesia with intravenous propofol 2 mg/kg and muscle relaxation with intravenous vecuronium 0.1 mg/kg, desflurane was given to achieve an end-tidal minimum alveolar anesthetic concentration (MAC) of 0.7 Group L received 1.5 mg/kg lidocaine intravenously, while Group C received an equal volume of 0.9% sodium chloride solution intravenously. ⋯ Plasma catecholamines were not significantly different between the groups. Intravenous lidocaine did not attenuate the sympathetic response to a rapid increase in desflurane concentration. It is unlikely that airway irritation is the cause of this phenomenon.
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Clinical TrialTropisetron for the prevention of postoperative nausea and vomiting in women undergoing gynecologic surgery.
The aim of this study was to evaluate the efficacy of tropisetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, versus placebo in the prevention of postoperative nausea and vomiting in patients undergoing general anesthesia for gynecologic surgery. Ten minutes before induction of general anesthesia, 80 patients received in a double-blind manner a single intravenous (IV) injection of either 5 mg tropisetron or a matching placebo. Anesthesia was induced with thiopental and maintained with nitrous oxide and enflurane in oxygen. ⋯ The incidence of nausea was 30% (12/40) in the tropisetron group and 52% (21/40) in the placebo group (P < 0.05). A total effective antiemetic response showed 26 patients (65%) in the tropisetron group and 16 patients (40%) in the placebo group (P < 0.05). We conclude that tropisetron given IV prior to gynecologic procedures in general anesthesia significantly reduces postoperative nausea and vomiting when compared to placebo without causing any adverse effect.
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Comparative Study Clinical TrialCompound motor action potential recording distinguishes differential onset of motor block of the obturator nerve in response to etidocaine or bupivacaine.
The purpose of this investigation was to establish an objective (quantitative) method for determining onset time of motor block induced by different local anesthetics. Twenty-four consenting patients undergoing transurethral surgery during spinal anesthesia were randomized to receive direct obturator nerve block with 10 mL of plain bupivacaine 0.5% (n = 12) or 10 mL of plain etidocaine 1% (n = 12). Another 14 patients (control group) received obturator nerve "block" with saline. ⋯ While CMAP amplitudes in the control group returned to their initial (baseline) values after 3-6 min, the patients receiving etidocaine or bupivacaine achieved > or = 90% motor blockade after 6 and 13 min, respectively. In the present report, the time to > or = 90% block was significantly faster in patients given etidocaine compared with those given bupivacaine. We conclude that electromyographic recording of CMAPs can be used to compare the ability of different local anesthetics to induce motor block.
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Anesthesia and analgesia · Feb 1996
Randomized Controlled Trial Clinical TrialOral clonidine premedication reduces postoperative pain in children.
Clonidine is an effective preanesthetic medication in children, providing a preoperative sedative effect. The analgesic properties of the drug have been well documented in adults. The current study was designed to investigate the effect of oral clonidine given preoperatively on postoperative pain in children undergoing minor surgery. ⋯ Postoperative pain was assessed by a blinded observer using an objective pain scale (OPS). Clonidine 4 micrograms/kg provided lower OPS (highest) scores during 12 h after surgery and reduced requirement for postoperative supplementary analgesic (diclofenac suppository) compared with the other two regimens. These data suggest that oral clonidine premedication (4 micrograms/kg) is a possible approach to facilitating postoperative analgesia in children undergoing minor surgery.