Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1996
Randomized Controlled Trial Comparative Study Clinical TrialAn evaluation of antidepressants in rheumatic pain conditions.
In a randomized, double-blind, parallel study, fluoxetine and amitriptyline were compared with placebo in the treatment of chronic rheumatic pain. A total of 59 patients were evaluated during 4 wk of treatment and received 20 mg fluoxetine, 25 mg amitriptyline, or placebo daily. Pain intensity, pain relief, vital variables, and global evaluation were used to assess efficacy. ⋯ At the end of the fourth week, fluoxetine was superior in efficacy to amitriptyline. The incidence of adverse effects was significantly greater with amitriptyline; dryness of the mouth was the most predominant side effect. We conclude that fluoxetine is an effective analgesic with fewer side effects.
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Anesthesia and analgesia · Aug 1996
Randomized Controlled Trial Comparative Study Clinical TrialEffects of ondansetron on emesis in the first 24 hours after craniotomy in children.
Children undergoing neurosurgical resection are at high risk for postoperative nausea and vomiting. Ondansetron, a selective serotonergic (5-HT3) antagonist, is effective in reducing postoperative vomiting in several high-risk populations. In a prospective, randomized study, we compared the prophylactic use of intravenous ondansetron, 0.15 mg/kg, versus placebo for the prevention of emesis in 60 children, aged 2-18 yr, undergoing craniotomies for resective procedures. ⋯ For the entire 24-h interval, the incidence of emesis in children who received ondansetron (57%) was not significantly different from that in those who received placebo (66%); however, in the first 8 h, the incidence was 25% (ondansetron) vs 44% (placebo) (P = not significant). In those receiving placebo, there was no difference in emesis between patients undergoing operations above versus below the tentorium. Although our sample size was too small to completely exclude any beneficial effect, ondansetron appears ineffective in preventing postoperative emesis in this patient population.
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Anesthesia and analgesia · Aug 1996
Randomized Controlled Trial Clinical TrialThe effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure.
The value of intravenous crystalloid administration in preventing spinal-induced hypotension in the parturient has recently been questioned. Also, the association between increasing crystalloid volume and decreasing postpartum colloid osmotic pressure (COP) raises concern regarding the risk of maternal and fetal pulmonary edema. To study the dose-response effect of varying amounts of crystalloid volume prior to spinal anesthesia, we measured maternal hemodynamic variables and maternal and fetal COP in three groups of healthy parturients receiving spinal anesthesia for elective cesarean delivery. ⋯ Total ephedrine and additional intravenous (i.v.) fluid administered did not differ among groups. The 20- and 30- mL/kg groups showed a larger decline in maternal COP than the 10-mL/kg group; no differences in neonatal COP were seen with varying preload. We conclude that increasing the amount of i.v. crystalloid administered to 30 mL/kg in the healthy parturient does not significantly alter maternal hemodynamics or ephedrine requirements after spinal anesthesia and has no apparent benefit.
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Anesthesia and analgesia · Aug 1996
Comparative StudyClinical evaluation of a prototype motion artifact resistant pulse oximeter in the recovery room.
The frequency and nature of spurious pulse oximetry readings were compared using both a conventional pulse oximeter (CPO) and a prototype Masimo signal extraction technology pulse oximeter (Masimo SET). At a university hospital, 50 ASA physical status I-IV adult patients who underwent general or spinal-epidural anesthesia were selected from a group of 250 patients on the basis of high-alarm generation with routine postoperative pulse oximetry. Pulse oximetry data were recorded simultaneously from both devices with a computer. ⋯ The prototype Masimo SET device alarm frequency was once every 30 min, and 59% of these were considered false. During arm motion with 15 patients, the CPO device produced spurious signals on 54 occasions compared with five for the prototype Masimo SET. The incidence of artifactual pulse oximetry events during patient motion appear to be substantially reduced with the prototype Masimo SET device, relative to a CPO device.