Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2002
Randomized Controlled Trial Comparative Study Clinical TrialTramadol infusion for postthoracotomy pain relief: a placebo-controlled comparison with epidural morphine.
We compared continuous IV tramadol as an alternative to neuraxial or systemic opioids for the management of postthoracotomy pain in a prospective, randomized, double-blinded, controlled study. General anesthesia was supplemented by thoracic epidural analgesia with 0.25% bupivacaine. At rib approximation, patients received one of the following: IV tramadol (150-mg bolus followed by infusion, total 450 mg/24 h, n = 29), epidural morphine (2 mg, then 0.2 mg/h, n = 30), or patient-controlled analgesia (PCA) morphine only (n = 30). All patients received PCA morphine and rescue morphine as necessary postoperatively. For the first 24 h, pain and sedation scores and respiratory, cardiovascular, and side effect measures were monitored. There was no significant difference in pain scores and PCA morphine use between tramadol and epidural morphine. Pain scores at rest and on coughing were lower in the Tramadol and Epidural Morphine groups than in the PCA Morphine group at various time points over the first 12 h. The Tramadol and Epidural Morphine groups used significantly less hourly PCA morphine than the PCA Morphine group at specific time points in the first 10 h. Vital capacities in the Tramadol group were significantly closer to baseline values at the 20-h point than in the PCA Morphine group. We conclude that an intraoperative bolus of tramadol followed by an infusion was as effective as epidural morphine and avoided the necessity of placing a thoracic epidural catheter. ⋯ A prospective, randomized, double-blinded, placebo-controlled study of postthoracotomy pain relief showed that IV tramadol in the form of a bolus followed by continuous infusion was as effective as epidural morphine. The use of tramadol avoids the necessity of placing a thoracic epidural catheter.
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Anesthesia and analgesia · Mar 2002
Randomized Controlled Trial Clinical TrialThe effects of urapidil on thermoregulatory thresholds in volunteers.
In a previous study we have shown that the antihypertensive drug, urapidil, stops postanesthetic shivering. One possible mechanism in the inhibition of postanesthetic shivering by urapidil may be alterations in thermoregulatory thresholds. We therefore studied the effects of urapidil on vasoconstriction and shivering thresholds during cold-induced shivering in volunteers. Seven healthy male volunteers were cooled by an infusion of saline at 4 degrees C on two study days separated by 48 h. Thermoregulatory vasoconstriction was estimated using forearm minus fingertip skin-temperature gradients, and values exceeding 0 degrees C were considered to represent significant vasoconstriction. The rectal core temperatures at the beginning of shivering and at vasoconstriction were considered the thermoregulatory thresholds. Before cooling, either 25 mg of urapidil or placebo was administered randomly and blindly to each volunteer. When shivering occurred continuously for 10 min, another 25 mg of urapidil was administered IV to completely stop shivering. Urapidil led to a decrease in core temperature at vasoconstriction and shivering threshold by 0.4 degrees C plus/minus 0.2 degrees C (P < 0.001) and 0.5 degrees C plus/minus 0.3 degrees C (P < 0.01), respectively. Oxygen consumption increased during shivering by 70% plus/minus 30% (P < 0.01) in comparison with baseline and decreased levels after shivering stopped, despite the continued low core temperature. Our investigation shows that urapidil stops postanesthetic shivering by decreasing important thermoregulatory thresholds. This means that shivering, not hypothermia, is treated, and hypothermia will need more attention in the postanesthesia care unit. ⋯ In this study we show that the antihypertensive drug urapidil stops cold-induced shivering and decreases normal thermoregulatory responses, i.e., the thresholds for vasoconstriction and shivering, in awake volunteers.
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Anesthesia and analgesia · Mar 2002
Randomized Controlled Trial Comparative Study Clinical TrialSpinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions.
We compared, in this prospective, randomized, double-blinded study, the characteristics of spinal anesthesia with plain and hyperbaric ropivacaine for elective cesarean delivery. We hypothesized that the addition of glucose would change the onset, offset, and extent of motor and sensory block from intrathecal ropivacaine. Forty ASA physical status I--II women were given 25 mg of either ropivacaine (n = 20) or ropivacaine in 8.3% glucose (n = 20) intrathecally, via a combined spinal/epidural technique in the right lateral position. Sensory changes to ice and pinprick and motor block (Bromage score) were recorded at 2.5-min intervals. Adequate anesthesia for surgery was achieved in all patients in the Hyperbaric group, whereas in the Plain group, five (25%) patients required epidural top-up because of insufficient rostral spread (P < 0.05). With hyperbaric ropivacaine, we found the following: higher cephalic spread (median [range] maximum block height to pinprick, T1 [T4 to C2] versus T3 [T11 to C3], P < 0.001); lower coefficient of variation of maximum block height (17.7% vs 21.9%); faster onset to T4 dermatome (mean [SD] 7.7 [4.9] vs 16.4 [14.1] min, P = 0.015); and faster recovery to L1 (189.0 [29.6] vs 215.5 [27.0] min, P = 0.01). The onset of complete motor block (9.9 [5.3] vs 13.8 [5.4] min, P = 0.027) and complete recovery (144.8 [28.4] vs 218.5 [56.8] min, P < 0.001) was also faster. No neurologic symptoms were found at 24 h. ⋯ We compared hyperbaric and plain ropivacaine for combined spinal/epidural analgesia in the lateral position in patients undergoing elective cesarean delivery. Hyperbaric ropivacaine produced more rapid block with faster recovery and less requirement for epidural supplementation compared with plain ropivacaine.
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Anesthesia and analgesia · Mar 2002
Randomized Controlled Trial Clinical TrialPhysostigmine does not antagonize sevoflurane anesthesia assessed by bispectral index or enhances recovery.
In this double-blinded study, we investigated the effect of physostigmine on sevoflurane anesthesia and recovery. Forty female patients scheduled for breast biopsy were randomly assigned to receive either physostigmine 2 mg IV or an equal volume of normal saline after skin closure. Anesthesia was induced and maintained with sevoflurane in oxygen. After skin closure, a steady state of 0.6% inspired and end-tidal sevoflurane concentration was obtained, heart rate, blood pressure, and Bispectral index (BIS) baseline values were recorded, and physostigmine or normal saline was administered. Hemodynamics and BIS values were also recorded 5, 8, and 10 min after treatments. Anesthesia was discontinued, and orientation, sedation, sitting ability, and "picking up matches" scores were recorded immediately after extubation and 15 and 30 min later. No differences were found between the two groups in BIS (69, 70, 70, and 71 in the Physostigmine group versus 70, 74, 75, and 76 in the Control group) or blood pressure. Only heart rate was increased 8 min after physostigmine (P < 0.05 versus the control). Scores assessing early recovery were similar in the two groups at all time points. We conclude that physostigmine does not change BIS or enhance recovery after sevoflurane anesthesia. ⋯ This double-blinded, randomized study investigated the impact of physostigmine of BIS values during 0.6% sevoflurane anesthesia as well as in the postoperative recovery, when sevoflurane is administered as a sole anesthetic. Physostigmine has no effect on BIS values or on the tests assessing recovery.
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Anesthesia and analgesia · Mar 2002
Case Reports Randomized Controlled Trial Clinical TrialFast-track eligibility of geriatric patients undergoing short urologic surgery procedures.
Our primary objective was to assess the feasibility of geriatric patients (>65 yr) bypassing the postanesthesia care unit (PACU) after ambulatory surgery. A secondary objective was to compare recovery profiles when using three different maintenance anesthetics. Ninety ASA physical status I--III consenting outpatients (>65 yr) undergoing short urologic procedures were randomly assigned to one of three anesthetic treatment groups. After a standardized induction with fentanyl and propofol, anesthesia was maintained with propofol (75-150 microg center dot kg(-1) center dot min(-1) IV), isoflurane (0.7%-1.2% end tidal), or desflurane (3%-6% end tidal), in combination with nitrous oxide 70% in oxygen. In all three groups, the primary anesthetic was titrated to maintain an electroencephalographic-bispectral index value of 60-65. Recovery times, postanesthesia recovery scores, and therapeutic interventions in the PACU were recorded. Although emergence times were similar in the three groups, the time to achieve a fast-track discharge score of 14 was significantly shorter in patients receiving desflurane compared with propofol and isoflurane (22 +/- 23 vs 33 +/- 25 and 44 +/- 36 min, respectively). On arrival in the PACU, a significantly larger percentage of patients receiving desflurane were judged to be fast-track eligible compared with those receiving either isoflurane and propofol (73% vs 43% and 44%, respectively). The number of therapeutic interventions in the PACU was also significantly larger in the Isoflurane group when compared with the Propofol and Desflurane groups (21 vs 11 and 7, respectively). In conclusion, use of desflurane for maintenance of anesthesia should facilitate PACU bypass ("fast-tracking") of geriatric patients undergoing short urologic procedures. ⋯ Geriatric outpatients undergoing brief urologic procedures more rapidly achieve fast-tracking discharge criteria after desflurane (versus isoflurane and propofol) anesthesia. Use of isoflurane was also associated with an increased need for nursing interventions in the early recovery period compared with desflurane and propofol.