Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2000
Randomized Controlled Trial Clinical TrialThe use of intravenous atropine after a saline infusion in the prevention of spinal anesthesia-induced hypotension in elderly patients.
We investigated the efficacy of IV atropine for preventing spinal anesthesia-induced hypotension in elderly patients. Seventy-five patients undergoing transurethral prostate or bladder surgery were randomized to receive either placebo (n = 25), atropine 5 microg/kg (small-dose atropine, n = 25) or atropine 10 microg/kg (large-dose atropine, n = 25) after the induction of spinal anesthesia. All the patients received an IV infusion of 10 mL/kg 0.9% normal saline over 10 min before the induction of anesthesia. The systolic blood pressure decreased in all three groups after spinal anesthesia. There was a significant increase in the mean heart rate in both atropine groups as compared to the placebo group (placebo group: 78 bpm, 95% confidence interval [CI]: 76.6-78.5; small-dose atropine group: 86 bpm, 95% CI 83.9-88.8; large-dose atropine group: 97 bpm, 95% CI 94.5-100.3; P: = 0.001). There was a significant decrease in the incidence of hypotension in patients who received atropine (placebo group: 76%, small-dose atropine group: 52%, large-dose atropine group: 40%, P: = 0.03). The mean dose of ephedrine required was significantly decreased in the atropine groups (placebo group: 12.2 mg [SD= 10.5], small-dose atropine group: 7.4 mg [SD= 10.0], large-dose atropine group: 5.4 mg [SD= 8.7 mg], P: = 0.048). The total amount of IV fluid and number of patients requiring metaraminol in addition to 30 mg of ephedrine were not significantly different among the three groups. Significant side effects, such as confusion, ST segment changes or angina were not detected in any of the patients. We conclude that IV atropine may be a useful supplement to the existing methods in preventing hypotension induced by spinal anesthesia. ⋯ IV atropine increases heart rate in a dose-dependent manner in elderly patients undergoing spinal anesthesia. It reduces the incidence of hypotension and the dose of ephedrine required. Small-dose atropine may be a useful supplement in preventing spinal anesthesia-induced hypotension in elderly patients.
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Anesthesia and analgesia · Nov 2000
Comparative StudyPressure control ventilation: three anesthesia ventilators compared using an infant lung model.
We compared three ventilators-Servo 900C (Siemens Medical Systems, Danvers, MA), Aestiva 3000 (Datex-Ohmeda, Madison, WI), and NAD 6000 (North American Dräger, Telford, PA)-set to deliver pressure control ventilation using an infant test lung model. Ventilator settings were selected to test "near-maximum" settings that would be used for a neonatal patient (peak inspiratory pressure [PIP] 30 cm H(2)O) or older child (PIP 60 cm H(2)O). When adjusted for set inspiratory pressure and compliance, the average tidal volume (V(t)) produced by the NAD 6000 was 5.8 mL less than the Servo 900C (P: = 0. 103), and the average V(t) produced by the Aestiva 3000 was 18.9 mL less than the Servo 900C (P: < 0.001). The Servo 900C generated increased peak pressures, tending to overshoot the set maximum inflating pressures, especially during rapid respiratory rates with decreased inspiratory times. The Aestiva 3000 did not achieve the set PIP during testing conditions of decreased inspiratory times, and the NAD 6000 was not greatly affected by changes in inspiratory time. All three ventilators measured expiratory V(t) to be larger than the actual V(t) delivered to the lung; however, the NAD 6000 was more accurate. ⋯ There are differences in performance of ventilators when set to deliver pressure control ventilation to an infant test lung model.
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Anesthesia and analgesia · Nov 2000
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia with tramadol versus tramadol plus lysine acetyl salicylate.
By using a patient-controlled analgesia (PCA) delivery system, we compared the clinical advantages and disadvantages of PCA with tramadol and PCA with a mixture of tramadol plus lysine acetyl salicylate (a soluble aspirin). Fifty adult patients who had undergone major orthopedic surgeries were enrolled into a prospective, randomized, and double-blinded study. The general anesthesia was performed in a standard manner. At the beginning of wound closure, an equal volume dose of either tramadol 2.5 mg/kg (Group 1) or tramadol 1.25 mg/kg + lysine acetyl salicylate 12.5 mg/kg mixture (Group 2) was administered slowly IV. These solutions were continued postoperatively for IV PCA. Pain control, patient satisfaction, vital signs, and adverse effects were assessed for 48 h. Visual Analog Scale =3 could be achieved with either group. Total tramadol consumption was significantly less in Group 2 than in Group 1 (614 +/- 259 mg vs 923 +/- 354 mg) (P: < 0.05). Patients in Group 2 were more alert (P: < 0.05). Blood loss from the surgical drain was similar, 865 +/- 275 mL (Group 1) vs 702 +/- 345 mL (Group 2). We conclude that aspirin can be used as an effective and safe adjuvant to tramadol for PCA after orthopedic surgery. ⋯ Injectable aspirin can be used as an effective and safe adjuvant to tramadol for patient-controlled analgesia (PCA) in orthopedic patients. The tramadol requirement is therefore reduced. This combination supports the concept that drugs other than opioids can be used for PCA.
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Anesthesia and analgesia · Nov 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPostoperative nausea and vomiting after sevoflurane with or without ondansetron compared with propofol in female patients undergoing breast surgery.
We studied 180 female patients undergoing breast surgery. The patients were randomly allocated to receive one of three anesthetic techniques. Compared with either propofol or sevoflurane alone, sevoflurane with ondansetron resulted in a decreased incidence of postoperative nausea and vomiting. Sevoflurane with ondansetron prophylaxis is a good alternative to propofol with respect to avoiding postoperative nausea and vomiting.