Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2002
Randomized Controlled Trial Clinical TrialCisapride does not prevent postoperative vomiting in children.
The peripherally acting prokinetic drug cisapride can overcome opioid-induced gastrointestinal paresis and may thereby eliminate a stimulus for postoperative vomiting. We conducted a prospective, randomized, double-blinded, controlled trial of 96 children undergoing inguinal surgery to determine whether cisapride would reduce the incidence of postoperative vomiting after general anesthesia supplemented with morphine. Group C1 patients (n = 38) received cisapride 0.3 mg/kg orally 1 h before surgery and placebo 6 h later, Group C2 (n = 28) received cisapride both before and after surgery, and Group P (n = 30) received placebo. Mean age (5.0 +/- 2.7 yr) and weight (21.0 +/- 8.6 kg), median pain scores and parent satisfaction scores, and incidence of rescue analgesic administration were similar across groups. Contrary to our hypothesis, incidences of postoperative vomiting in the hospital (32% vs 20%, P = 0.33) and at home (53% vs 46%, P = 0.33) did not vary by treatment group (with [C1 and C2] and without [P] cisapride, respectively). There was a trend toward more severe postoperative vomiting (three or more episodes) in children who received cisapride versus those who did not, both in hospital (6% vs 0%, P = 0.3) and at home (22% vs 8%) (P = 0.13). We conclude that cisapride does not prevent postoperative vomiting in this patient population and speculate that factors other than reduced gastrointestinal motility associated with general anesthesia and opioids are more important determinants of postoperative vomiting. ⋯ Cisapride does not prevent postoperative vomiting in children and may increase its severity.
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Anesthesia and analgesia · Jan 2002
Randomized Controlled Trial Clinical TrialRemifentanil provides hemodynamic stability and faster awakening time in transsphenoidal surgery.
In this prospective study, we evaluated the effects of remifentanil in ASA I-II patients undergoing transsphenoidal surgery. After the induction of anesthesia, patients were randomly allocated to the Isoflurane (n = 22, 60% nitrous oxide, isoflurane up to 2% end-tidal) or Remifentanil group (n = 21, 60% nitrous oxide, 0.5% end-tidal isoflurane, remifentanil up to 2 microg x kg(-1) x min(-1)). If mean arterial pressure (MAP) increased >80 mm Hg during maximal dosage of isoflurane or remifentanil, labetalol was administered. At the end of anesthesia, extubation and awakening times, respiratory rate, SpO(2), MAP, heart rate, and adverse effects were recorded. Hemodynamics and bleeding (minimal, mild, moderate, severe) were not different between groups. Bleeding grade increased with MAP >80 mm Hg (P < 0.001). Labetalol was administered to 20 patients in the Isoflurane group, and 10 patients in the Remifentanil group (P < 0.01). The dose of labetalol was larger in the Isoflurane group (1.0 +/- 0.6 versus 0.5 +/- 0.7 mg/kg, P < 0.05). Time to extubation did not differ, whereas time to follow commands was shorter in Remifentanil patients (16 +/- 8 versus 10 +/- 2 min, P < 0.01). No adverse effects occurred in the early postoperative period. ⋯ In patients undergoing transsphenoidal surgery, balanced anesthesia with remifentanil (0.22 +/- 0.17 microg x kg(-1) x min(-1)) provides faster awakening time, as compared with large-dose volatile-based anesthesia, without the risk of postoperative opioid respiratory depression.
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Anesthesia and analgesia · Jan 2002
Physiologic characteristics of cold perfluorocarbon-induced hypothermia during partial liquid ventilation in normal rabbits.
Because perfluorocarbon (PFC) liquid contacts closely with the alveolar capillaries during partial liquid ventilation (PLV), PLV with cold PFC may be used for the induction of hypothermia. Twenty rabbits were randomized to PFC-induced hypothermia (PH) (n = 7; core temperature 35 degrees +/- 1 degrees C), surface hypothermia (SH) (n = 7; 35 degrees +/- 1 degrees C), or normothermia (n = 6; 39 degrees +/- 1 degrees C). We induced PH by repeated in situ exchanges of 0 degrees C perfluorodecalin during PLV. At the establishment (0 min) of hypothermia in the PH group, oxygen consumption (P = 0.04) and oxygen extraction ratio (P = 0.01) decreased from normothermic condition. Metabolic (oxygen consumption, oxygen extraction ratio, serum lactate level) and hemodynamic variables (heart rate, blood pressure, cardiac output, pulmonary artery pressure) of the PH group were not different from those of the SH group at 0, 30, 60, 90, and 120 min of hypothermia. The difference in temperature between the pulmonary artery and rectum during the hypothermic period was smaller in the PH group compared with the SH group (P = 0.033). In conclusion, hypothermia may be induced during PLV by using cold PFC. This "pulmonary method" of cooling was comparable to a systemic method of cooling with regard to a few important physiologic variables, while maintaining a narrower interorgan temperature difference. ⋯ The induction of moderate hypothermia was feasible in rabbits by administrating cold perfluorocarbon liquid into the lung. Physiologic changes induced by this pulmonary cooling were comparable to those induced by systemic cooling. Our method may be regarded as a methodological advance in the field of therapeutic hypothermia.
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Anesthesia and analgesia · Jan 2002
Bispectral index values and spectral edge frequency at different stages of physiologic sleep.
Bispectral index (BIS) and spectral edge frequency (SEF) are used as measures of depth of anesthesia and sedation. We tested whether these signals could predict physiologic sleep stages, by taking processed electroencephalogram measurements and recording full polysomnography through a night's sleep in 10 subjects being investigated for mild sleep apnea/hypopnea syndrome. Computerized polysomnograph signals were analyzed manually according to standard criteria, classifying each 30-s epoch as a specific sleep stage. The BIS and SEF values were taken at the end of each period of sleep when the same stage had lasted for at least 2 min. Before sleep, median values for BIS were 97 +/- 12.1 and for SEF 23 +/- 4.2 Hz. After sleep initiation, the median BIS values for arousal, light, slow wave, and rapid eye movement sleep were 67 +/- 20.2, 50 +/- 16.5, 42 +/- 11.2, and 48 +/- 7.1, respectively, and the median SEF values were 20 +/- 4.7, 15 +/- 3.6, 10 +/- 2.6, and 19 +/- 4.1 Hz, respectively. Although both BIS and SEF decreased with increasing sleep depth, the distribution of values at each sleep depth was considerable, with overlap between each sleep stage. Neither BIS nor SEF reliably indicated conventionally determined sleep stages. In addition, the response of the BIS was slow and patients could arouse with low BIS values, which then took some time to increase. ⋯ Although computer processing of the electroencephalogram can provide an adequate index of depth of anesthesia, the same processing cannot reliably convey depth of natural sleep. At each sleep stage, the output signal has a wide range of possible values.
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Anesthesia and analgesia · Jan 2002
Comment Letter Case ReportsAnother cause of epidural catheter breakage?