Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Clinical TrialThe efficacy of RS-25259, a long-acting selective 5-HT3 receptor antagonist, for preventing postoperative nausea and vomiting after hysterectomy procedures.
We evaluated the safety and efficacy of RS-25259, a potent and long-acting selective 5-HT3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) in women undergoing hysterectomy procedures. In this randomized, double-blind, placebo controlled, dose-ranging study, 218 healthy, consenting women were assigned to one of the six treatment groups: placebo or RS-25259 0.1, 0.3, 1.0, 3.0, or 30 microg/kg. All patients underwent a standardized general anesthetic technique. The study medication was administered i.v. 20-30 min before the end of surgery. During the initial 24-h period after surgery, the incidence of vomiting, the need for rescue antiemetics, the time to the first episode of emesis, and administration of rescue antiemetic medication, as well as a nausea visual analog scale and verbal categorical scale scores were recorded. In addition, recovery times from the end of anesthesia and the incidences of perioperative side effects were noted. Only 30 microg/kg RS-25259 significantly decreased the incidence of vomiting and the requirement for rescue antiemetics. The largest dose of RS-25259 also delayed the time to the first emetic episode and reduced the number of treatment failures. However, no differences were found in the severity of postoperative nausea (versus saline), and postoperative headaches were more common after the administration of RS-25259 0.3-30 microg/kg i.v. In conclusion, RS-25259 30 microg/kg i.v. was effective in reducing the incidence of PONV after major gynecologic surgery, but the occurrence of headaches with the larger doses of RS-25259 is a concern. ⋯ RS-25259, a long-acting 5-HT3 antagonist, was effective in reducing postoperative vomiting only at the largest dose studied (30 microg/kg). However, RS-25259 had no antinausea activity, and the larger doses were associated with an increased incidence of headaches in the postoperative period.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Clinical TrialBetamethasone reduces postoperative pain and nausea after ambulatory surgery.
The aims of this study were to evaluate the effects of a single-dose glucocorticoid on the incidence and severity of pain and nausea and vomiting (PONV) after ambulatory surgery. Seventy-eight ASA physical status I-III patients scheduled for hemorrhoidectomy or hallux valgus correction were studied using a randomized, double-blind, placebo-controlled protocol. One group received 12 mg of betamethasone i.m. 30 min before the start of surgery (Group B), whereas the placebo group (Group P) received saline. General anesthesia was induced with propofol and fentanyl and maintained with isoflurane in both groups. Pain (measured using a visual analog scale, verbal score, and analgesic requirements), PONV, and other side effects were evaluated postoperatively. Patients in Group B experienced significantly less postoperative pain, less PONV, and better patient satisfaction during the first 24 h after surgery. In conclusion, a single dose of betamethasone (12 mg) seemed to produce analgesic and antiemetic effects after day-case surgery. ⋯ In a placebo-controlled study, the use of corticosteroid prophylaxis (betamethasone) produced a significant reduction in both postoperative pain and nausea in outpatients who received the corticosteroid injection before ambulatory foot or hemorrhoid operations.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Clinical TrialOnset time, endotracheal intubating conditions, and plasma histamine after cisatracurium and vecuronium administration.
Cisatracurium is a nondepolarizing muscle relaxant with a slow onset. We performed a prospective, randomized, double-blind clinical trial in 60 patients (ASA physical status I or II) to assess whether cisatracurium (0.15 or 0.25 mg/kg) or vecuronium (0.15 mg/kg), administered as a bolus immediately after induction of anesthesia with fentanyl and thiopental, would provide a faster onset time and better tracheal intubating conditions than previously reported. We sought to determine whether patients given muscle relaxants in this commonly used induction sequence would exhibit cutaneous, systemic, or chemical evidence of histamine release. Onset time of the relaxants was determined by using mechanomyography. Intubating conditions were scored on a defined interval scale by an anesthesiologist blinded to the relaxant administered. Heart rate and arterial blood pressure were measured noninvasively every minute from 10 min before to 5 min after the application of the muscle relaxant. Mean (+/- SD) onset times for 0.25 mg/kg cisatracurium (68.3 +/- 19.5 s) and for 0.15 mg/kg vecuronium (69.5 +/- 29.2 s) were significantly different from those in the 0.15 mg/kg cisatracurium group (105 +/- 41.2 s). The intubating conditions were better with the larger dose of cisatracurium or vecuronium (P < 0.03). Although plasma histamine levels were not statistically different among groups, levels >1 ng/mL were observed in 5 of 40 patients who received cisatracurium but in none of the 20 patients who received vecuronium. There were no significant hemodynamic differences among the groups. In a dose of 0.25 mg/kg, cisatracurium has as rapid an onset time as vecuronium 0.15 mg/kg, but the former shows evidence of histamine release. ⋯ Cisatracurium has been considered a drug with a relatively slow onset but that has the significant benefit of being devoid of chemically mediated histamine release. In this study, we describe an onset time faster than previously reported when cisatracurium was given immediately after thiopental. We also note that several patients had abnormal histamine levels after cisatracurium administration.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Comparative Study Clinical TrialTopical lidocaine-prilocaine cream (EMLA) versus local infiltration anesthesia for radial artery cannulation.
In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA was applied 2 h before radial cannulation, and lidocaine infiltration was performed 5 min before cannulation. The primary end point was pain as assessed by a verbal numerical scale (0 = no pain, 10 = extreme pain). Pain was less severe in the EMLA group than in the lidocaine infiltration group (Score of 2 vs 7; P = 0.0001). Additional lidocaine infiltration was required significantly less frequently in the EMLA group (relative risk 0.19). The failure rate of cannulation was significantly lower in the EMLA group (relative risk 0.38), and insertion time was shorter (4 versus 6 min). We conclude that EMLA, compared with lidocaine infiltration, reduces pain associated with radial artery cannulation and improves the success rate of the procedure. Routine application of EMLA should be performed in awake patients 2 h before radial artery cannulation. ⋯ In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA) with subcutaneous local lidocaine infiltration for radial artery cannulation in 538 adults patients. EMLA reduced pain associated with radial artery cannulation and improved the success rate of the procedure.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Comparative Study Clinical TrialNasotracheal intubation in patients with immobilized cervical spine: a comparison of tracheal tube cuff inflation and fiberoptic bronchoscopy.
Tracheal intubation may pose problems in patients with cervical spine injury (CSI). In patients without CSI, the success rate of blind nasotracheal intubation is increased by endotracheal tube (ETT) cuff inflation in the pharynx. The purpose of this study was to assess the efficacy of ETT cuff inflation in the pharynx as an aid to blind nasotracheal intubation in patients with an immobilized cervical spine. The technique was compared with fiberoptic bronchoscopy. Twenty ASA physical status I and II patients undergoing elective surgery in which the trachea was to be intubated nasally were enrolled in this prospective, randomized study. The cervical spine of each patient was immobilized. The trachea of each patient was intubated twice, once using fiberoptic bronchoscopy and once blindly using the technique of ETT cuff inflation in the pharynx. A maximum of three attempts was allowed for intubation using ETT cuff inflation. A maximum of 3 min was allowed for intubation using fiberoptic bronchoscopy. When ETT cuff inflation was used, intubation was successful in 19 of 20 patients (95%); the first attempt at intubation was successful in 14 of 20 patients (70%). Intubation was successful in 19 of 20 patients (95%) when using fiberoptic bronchoscopy. Mean times to intubate were 20.8 +/- 23 s when the ETT cuff was inflated in the pharynx and 60.1 +/- 56 s when using fiberoptic laryngoscopy (P < 0.01). We conclude that both ETT cuff inflation in the pharynx and fiberoptic bronchoscopy are valuable for nasotracheal intubation in patients with an immobilized cervical spine and that ETT cuff inflation can be used as an alternative to fiberoptic bronchoscopy in patients with CSI. ⋯ We compared the technique of endotracheal tube cuff inflation in the pharynx for blind nasotracheal intubation in patients with an immobilized cervical spine with fiberoptic bronchoscopy. There was no significant difference between the success rates of the techniques.