Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialProphylaxis for vomiting by children after tonsillectomy: dexamethasone versus perphenazine.
The effects of dexamethasone and perphenazine on vomiting after tonsillectomy in children were compared in 226 healthy children aged 2-12 yr. The study was randomized, stratified, blocked, and double-blind. Anesthesia was induced intravenously (I.V.) with propofol or by inhalation with halothane and N2O. Dexamethasone 150 microg/kg or perphenazine 70 microg/kg was administered I.V. after the induction of anesthesia in a double-blind fashion. Perioperative management of emesis, pain, fluids, and patient discharge was all standardized. The groups had similar demographic characteristics. Perphenazine significantly reduced the incidence of in-hospital vomiting compared with dexamethasone (13% vs 36%, P < 0.001). The incidence of out-of-hospital vomiting was almost identical. Overall, the incidence was significantly different for perphenazine vs dexamethasone (33% vs 46%, P = 0.04) using logistic regression analysis. Of note, sex and induction technique were significant predictors of postoperative vomiting (P < 0.05) using logistic regression analysis, with male patients and those patients undergoing I.V. induction vomiting less. In conclusion, perphenazine more effectively decreases vomiting by children after tonsillectomy in an ambulatory hospital setting compared with dexamethasone. ⋯ Postoperative vomiting can have many debilitating effects, and children undergoing tonsillectomy are at particular risk. We compared the effects of dexamethasone and perphenazine on vomiting after tonsillectomy in 266 children. We found perphenazine more effective than dexamethasone before discharge from hospital but that the two drugs have similar effects after discharge.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of light wand and suspension laryngoscopic intubation techniques in outpatients.
Endotracheal intubation can produce postoperative sore throat and hoarseness, as well as changes in cardiovascular variables. A major goal of ambulatory surgery is the prompt return of patients to their daily activities. Postoperative sore throat may impede this and may decrease patient satisfaction with their anesthetic and surgical experience. We conducted a prospective, randomized study in 40 outpatients having lower extremity arthroscopies to compare the effects of direct laryngoscopy and light wand intubation on cardiovascular changes, sore throat, hoarseness, and dysphagia. Subjects were randomly assigned to either Group A (endotracheal intubation by rigid laryngoscopy) or Group B (endotracheal intubation with a light wand). A standardized anesthetic technique was used. Heart rate and blood pressure were recorded before induction, after induction but before endotracheal intubation, and at 1-min intervals for the first 5 min after intubation. Sixteen to twenty-four hours postoperatively, the incidence and severity of sore throat, hoarseness, and dysphagia was assessed by a follow-up phone call. This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence and severity of sore throat, hoarseness, and dysphagia when a light wand was used for intubation. In conclusion, this study suggests that light wand intubation may decrease the incidence and severity of postoperative sore throat, hoarseness, and dysphagia, thereby potentially increasing satisfaction in ambulatory surgical patients. ⋯ This prospective, randomized study found that the incidence and severity of postoperative sore throat, hoarseness, and difficulty in swallowing among ambulatory surgical patients is more frequent when they are endotracheally intubated with a rigid laryngoscope than with a light wand. The authors, therefore, recommend more frequent use of the light wand for endotracheal intubation.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe laryngeal mask airway: a comparison between two insertion techniques.
The purpose of the study was to compare the ease of insertion of the laryngeal mask airway using the standard uninflated approach or with a fully inflated cuff. Two hundred consecutive patients undergoing anesthesia using a laryngeal mask airway were randomized to have the laryngeal mask inserted using either method. Successful insertion was judged primarily by the clinical function of the airway. The number of insertion attempts to achieve a satisfactory airway and whether an alternative technique was required for success were recorded. On removal of the laryngeal mask, a blind observer noted the presence or absence of blood. Just before leaving the recovery room, each patient was asked whether they had a sore throat. Insertion technique made no difference with regard to first attempt success. However, the presence of blood on the removed masks (P < 0.01) and sore throat (P < 0.01) were less frequent in the inflated cuff group. We conclude that the inflated cuff insertion technique is an acceptable alternative to the standard approach and has the advantage of reducing the incidence of minor pharyngeal mucosal trauma, as evidenced by mucosal bleeding and sore throat. ⋯ Insertion of the laryngeal mask airway with the cuff fully inflated is equally successful to the standard uninflated approach in experienced hands. The inflated technique was associated with less minor pharyngeal mucosal trauma and, consequently, a lower incidence of postoperative sore throat. This implies that the inflated technique would be acceptable to the general population of laryngeal mask users.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialEffects of oxygenation during selective lobar versus total lung collapse with or without continuous positive airway pressure.
Hypoxemia is common during anesthesia with one-lung ventilation (OLV). This study tested the hypothesis that selective lobar blockade would result in higher PaO2 values compared with those found with total lung collapse independent of continuous positive airway pressure (CPAP) application. Thirty patients undergoing lobectomy were randomly assigned to one of four groups with the following maneuvers during OLV: Group 1 (n = 8) total lung collapse (TLC) plus 5 cm H2O of CPAP to the nonventilated operative lung for 15 mins, followed by selective lobe collapse plus 5 cm H2O of CPAP (during selective collapse only the surgical lobe was collapsed and the rest of that lung was ventilated); Group 2 (n = 6) selective lobar collapse plus 5 cm H2O of CPAP to the operative lung, followed by TLC plus 5 cm H2O of CPAP; Group 3 (n = 8) total lung collapse without CPAP, followed by selective lobe collapse and no CPAP; Group 4 (n = 8) selective lobe collapse without CPAP, followed by TLC and no CPAP. To obtain selective lobe collapse, the bronchial blocker of the Univent (Vitaid, Lewiston, NY) endotracheal tube was guided into the operative bronchus with the aid of a fiberoptic bronchoscope. Blood pressure, heart rate, and arterial blood gas measurements were obtained during the following times: Time 1--while the patient was awake; Time 2--two-lung ventilation (2LV) in the supine position; Time 3--after 30 min of OLV in the lateral decubitus position (no CPAP or selective blockade); Time 4 and Time 5--during maneuvers described above (see group description); Time 6--2LV resumed; Time 7--30 min after extubation. Twenty-eight patients completed the study. There were no differences among groups with regard to arterial blood pressure, heart rate, or arterial oxygen saturation during the experimental maneuvers. All four groups showed a decrease in PaO2 from 2LV to OLV (P < 0.05). Both with and without CPAP application, oxygenation was improved with selective lobe collapse compared with TLC. When selective lobe collapse with 5 cm H2O of CPAP followed TLC (group 1), PaO2 values increased to values similar to those found for 2LV (PaO2 449 +/- 122 vs 394 +/- 105 mm Hg). This study indicates that by using a bronchial blocker, changing from total lung collapse to selective lobar blockade improves PaO2 during lung surgery. ⋯ This study examines how oxygen tension in arterial blood can be higher during one-lung ventilation. The use of a bronchial blocker, which changes a total lung collapse to selective lobar blockade, improves oxygenation during lung surgery.
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Anesthesia and analgesia · Sep 1997
Randomized Controlled Trial Clinical TrialOptimal dose of granisetron for prophylaxis against postoperative emesis after gynecological surgery.
We previously reported that 20 and 40 microg/kg of granisetron given during anesthesia prevented postoperative emesis with no severe complications. The aim of the current study was to determine the optimal dose of granisetron for the prevention of postoperative nausea and vomiting (PONV) after gynecological surgery. Two hundred female patients (ASA physical status I) were randomly allocated to one of five groups (n = 40 for each): saline (as a control), granisetron 2 microg/kg, granisetron 5 microg/kg, granisetron 10 microg/kg, and granisetron 20 microg/kg. Saline or granisetron was given intravenously immediately after induction of anesthesia. PONV was assessed 24 h after surgery. The percentage of emesis-free patients was significantly greater in the 5- to 20-microg/kg granisetron groups than in the control and 2-microg/kg granisetron groups (18%, 23%, 68%, 78%, and 75% of patients receiving saline or granisetron 2 microg/kg, 5 microg/kg, 10 microg/kg, and 20 microg/kg, respectively). Granisetron doses of 5 microg/kg or larger were also superior to the saline and 2-microg/kg granisetron treatment for the prevention of nausea over the 24-h study period (nausea visual analog scales 24 h after surgery: 49, 41, 18, 16, and 14 mm in the control and granisetron 2 microg/kg, 5 microg/kg, 10 microg/kg, and 20 microg/kg groups, respectively). A smaller proportion of patients received "rescue" antiemetic in the 5-microg/kg or larger granisetron groups than in the control and 2-microg/kg granisetron groups (48%, 40%, 18%, 13%, and 10% of patients in the control and granisetron 2 microg/kg, 5 microg/kg, 10 microg/kg, and 20 microg/kg groups, respectively). The antiemetic effect of granisetron was similar among the groups who received 5-microg/kg or larger doses. In conclusion, we suggest that the optimal dose of granisetron is 5 microg/kg for the prevention of PONV after gynecological surgery. ⋯ Nausea and vomiting postoperatively after gynecologic surgery is a significant problem. The authors found that granisetron, a selective antagonist of serotonin, markedly decreases the incidence of postoperative nausea and vomiting at doses of 5 microg/kg or larger.