Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Clinical TrialThe analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery.
To assess the efficacy and safety of wound instillation of ropivacaine, when administered via a patient-controlled elastometric pump, 50 term parturients undergoing cesarean delivery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard spinal anesthetic was administered. After the surgery, a multihole 20-gauge epidural catheter (B. ⋯ However, blood ropivacaine accumulation was noted. All patients stated that the elastometric pump was easy to use. Ropivacaine wound instillation via an elastometric pump is a simple technique that provides safe and effective analgesia after cesarean delivery.
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We report a case of accidental epidural injection of vecuronium in a female patient who underwent hemorrhoidectomy using epidural anesthesia. Because epidural injection of muscle relaxants may have serious side effects, immediate establishment of airway protection, monitoring of muscle relaxation, and follow-up for clinical signs of neurotoxicity are recommended.
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Anesthesia and analgesia · Dec 2000
Comparative StudyThe comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats.
We compared the toxicity of systemic local anesthetics bupivacaine and ropivacaine administered at equivalent and equipotent doses. In the first experiments, 18 male Wistar rats were anesthetized with thiopental and maintained under positive controlled ventilation. Electrocardiogram, electroencephalogram, and invasive arterial blood pressure were continuously recorded. ⋯ In awake rats, all the animals intoxicated by ropivacaine easily recovered. In the bupivacaine group, two animals required cardiopulmonary resuscitation before any seizure activity could be detected, and only three rats survived. We conclude that, in the model used, ropivacaine, even at an equipotent dose, is less toxic than bupivacaine.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery.
The unique pharmacokinetic properties of remifentanil make it a potentially useful adjuvant during general anesthesia for ambulatory surgery. Fentanyl, inexpensive and easy to administer, is the most common opioid used for this purpose. As an adjuvant to general anesthesia for outpatient gynecologic surgery, we questioned if remifentanil was cost-effective as an alternative to fentanyl. ⋯ The incidence of rescue antiemetic treatment (2 of 16 vs. 8 of 18; P = 0.013) and the nausea visual analog scale scores during second stage recovery (0.2 vs. 0.6; P = 0.044) were more frequent in the study group. However, the incidence of intraoperative adverse events and other postoperative sequelae, recovery times, pain and nausea visual analog scale scores, opioid analgesic dosage requirements in the postanesthetic care unit, and satisfaction survey responses were similar between groups. Perioperative drug costs per patient were $17.72 more in the remifentanil (vs. fentanyl) group.
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Anesthesia and analgesia · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialThe use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study.
We sought to determine the minimum effective dose of dexamethasone in preventing postoperative nausea and vomiting in women undergoing thyroidectomy. Two hundred twenty-five women (n = 45 in each of five groups) undergoing thyroidectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. Immediately after the induction of anesthesia, patients received IV dexamethasone at doses of 10 mg (D10), 5 mg (D5), 2.5 mg (D2.5), 1.25 mg (D1.25), or saline (S). ⋯ Dexamethasone 2.5 mg reduced the total incidence of nausea and vomiting. Dexamethasone 1.25 mg was not effective. Dexamethasone 5 mg IV is the minimum effective dose in preventing postoperative nausea and vomiting in women undergoing thyroidectomy.