Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Comparative Study Clinical TrialSpinal 2-chloroprocaine: a comparison with procaine in volunteers.
Recent studies using preservative-free 2-chloroprocaine (2-CP) for spinal anesthesia have shown it to be a reliable short-acting drug that provides similar anesthesia to lidocaine. In this randomized, double-blind, crossover study, we compared the characteristics of spinal 2-CP (30 mg) with those of procaine (80 mg) in eight volunteers to determine whether either drug produces spinal anesthetic characteristics ideal for outpatient surgery. By using sensation to pinprick, transcutaneous electrical stimulation, tolerance to thigh tourniquet, and motor blockade as surrogates for surgical efficacy, 2-CP compared similarly to procaine. ⋯ Procaine did produce overall longer sensory blockade (P = 0.0011) and motor blockade at the gastrocnemius (P = 0.0004) and quadriceps (P = 0.0146) muscles. Times until the resolution of sensory blockade (103 +/- 12 min versus 151 +/- 26 min; P = 0.0003), ambulation (103 +/- 12 min versus 151 +/- 26 min; P = 0.0003), and micturition (103 +/- 12 min versus 156 +/- 23 min; P < 0.0001) were all prolonged after procaine. In conclusion, at the doses tested, spinal 2-CP (30 mg) may be a better choice for short outpatient procedures because it provides anesthesia with similar efficacy as procaine (80 mg) but with more rapid fulfillment of discharge criteria.
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Clinical TrialThe interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy.
Both dextromethorphan (DM) and IV lidocaine improve postoperative pain relief. In the present study, we evaluated the interaction of DM and IV lidocaine on pain management after laparoscopic cholecystectomy (LC). One-hundred ASA physical status I or II patients scheduled for LC were randomized into four equal groups to receive either: (a) chlorpheniramine maleate (CPM) intramuscular injection (IM) 20 mg and IV normal saline (N/S) (group C); (b) DM 40 mg IM and IV N/S (group DM); (c) CPM 20 mg IM and IV lidocaine 3 mg . kg(-1) . h(-1) (group L); or (d) DM 40 mg IM and IV lidocaine (group DM+L). ⋯ Patients of the DM+L group exhibited the best pain relief and fastest recovery of bowel function among groups. Patients in the DM and L groups had significantly better pain relief than those in the C group. The results showed an additional effect on pain relief and a synergistic effect on recovery of bowel function when DM was combined with IV lidocaine after LC.
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Comparative Study Clinical TrialSpinal 2-chloroprocaine: a comparison with small-dose bupivacaine in volunteers.
Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. ⋯ However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 +/- 14, bupivacaine 191 +/- 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine.
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Clinical TrialSpinal 2-chloroprocaine: the effect of added clonidine.
Preservative-free 2-chloroprocaine (2-CP) is being investigated for short-acting spinal anesthesia. Clonidine improves the quality of spinal bupivacaine and ropivacaine, but in traditional doses (1-2 microg/kg) it produces systemic side effects. It has not been studied in combination with 2-CP. ⋯ Clonidine increased tourniquet tolerance from 33 to 45 min (P = 0.06) and increased time to ambulation, spontaneous voiding, and discharge (99 +/- 18 min versus 131 +/- 15 min for all; P = 0.001). There were no differences in hemodynamic measurements, and no subject reported transient neurologic symptoms. We conclude that small-dose clonidine increases the duration and improves the quality of 2-CP spinal anesthesia without systemic side effects.
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Comparative Study Clinical TrialPressure support ventilation versus continuous positive airway pressure ventilation with the ProSeal laryngeal mask airway: a randomized crossover study of anesthetized pediatric patients.
Continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) improve gas exchange in adults, but there are little published data regarding children. We compared the efficacy of PSV with CPAP in anesthetized children managed with the ProSeal laryngeal mask airway. Patients were randomized into two equal-sized crossover groups and data were collected before surgery. ⋯ When compared with CPAP, PSV had lower ETco(2) (46 +/- 6 versus 52 +/- 7 mm Hg; P < 0.001), slower respiratory rate (24 +/- 6 versus 30 +/- 6 min(-1); P < 0.001), lower WOB (0.54 +/- 0.54 versus 0.95 +/- 0.72 JL(-1); P < 0.05), lower pressure time product (94 +/- 88 versus 150 +/- 90 cm H(2)O s(-1)min(-1); P < 0.001), lower delta esophageal pressure (10.6 +/- 7.4 versus 14.1 +/- 8.9 cm H(2)O; P < 0.05), lower inspiratory time fraction (29% +/- 3% versus 34% +/- 5%; P < 0.001), and higher expired tidal volume (179 +/- 50 versus 129 +/- 44 mL; P < 0.001). There were no differences in Spo(2), respiratory drive, mean arterial blood pressure, and heart rate. We conclude that PSV improves gas exchange and reduces WOB during ProSeal laryngeal mask airway anesthesia compared with CPAP in ASA physical status I children aged 1-7 yr.