Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2006
Randomized Controlled Trial Comparative StudyDesflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance.
Emergence agitation may occur after general anesthesia with volatile anesthetics in children. We designed this study to examine the emergence behavior of children undergoing ear-nose-throat surgery after sevoflurane induction and desflurane maintenance versus both sevoflurane induction and maintenance using a recently published Pediatric Anesthesia Emergence Delirium (PAED) scale. In 38 premedicated children aged 12 mo to 7 yr mask induction with sevoflurane was performed and they were randomly assigned to receive either sevoflurane (n = 19) or desflurane (n = 19) for maintenance of general anesthesia. ⋯ The modified Aldrete score on arrival in the postanesthesia care unit (PACU) was significantly lower in children receiving sevoflurane for maintenance. Time to discharge from PACU to normal ward and the incidence of adverse effects were not significantly different between the groups. In conclusion, the use of desflurane for maintenance of anesthesia after sevoflurane induction in children is associated with less severe emergence agitation and faster emergence times.
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Anesthesia and analgesia · Feb 2006
Randomized Controlled TrialResidual gastric fluid volume and chewing gum before surgery.
In this study we sought to determine if chewing gum preoperatively increases gastric fluid volume (GFV) and changes gastric acidity. Children, 5-17 yr old, were randomized to one of three groups: a control group that was not given any gum, a group that was given sugarless bubble gum, and a group that was given sugared bubble gum. Patients in the two gum groups were instructed to chew their gum for a period of 30 min. ⋯ We found that children who did not chew gum had significantly smaller GFV as compared with children who chewed sugared and sugarless gum (0.35 [0.2-0.5] mL/kg versus 0.88 [0.6-1.4] mL/kg versus 0.69 [0.4-1.6] mL/kg; P = 0.0001). Children who did not chew gum also had a significantly lower gastric fluid pH as compared with children chewing sugared and sugarless gum (geometric mean, 1.91 versus 2.25 versus 2.19; P = 0.007). We conclude that children who present for surgery while chewing gum have significantly larger GFV and higher pH.
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Anesthesia and analgesia · Feb 2006
Randomized Controlled TrialCaudal regional anesthesia, ropivacaine concentration, postoperative analgesia, and infants.
In this randomized, double-blind trial we evaluated the quality and duration of analgesia and motor effects after caudal block using 1 mL/kg of ropivacaine 0.1% (Group 1), 0.15% (Group 2), 0.175% (Group 3) compared to 0.2% (Group 4) in infants 1-12 mo old. Postoperatively, the number of infants who received pain medication differed among the groups (P < 0.0005). There were more infants in Groups 1 and 2 compared with Group 4 and there was no difference between Groups 3 and 4. ⋯ Infants in Groups 1 and 2 had a shorter duration, and there was no difference between Groups 3 and 4. Infants in Group 4 took longer to regain their motor power compared with those in Group 3 (P = 0.0347). We conclude that in infants, ropivacaine 0.175% provided postoperative analgesia and duration similar to that of ropivacaine 0.2%, whereas ropivacaine 0.1% and 0.15% did not, and it was associated with fewer motor effects.
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Anesthesia and analgesia · Feb 2006
Randomized Controlled Trial Comparative StudyA comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient.
Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement. ⋯ Eighty-four percent of patients reported no pain at the time of J-Tip lidocaine application compared to 61% in the EMLA group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA.
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Anesthesia and analgesia · Feb 2006
Randomized Controlled Trial Comparative StudySpinal versus general anesthesia for orthopedic surgery: anesthesia drug and supply costs.
Total hip or knee replacement surgeries are common orthopedic interventions that can be performed with spinal anesthesia (SA) or general anesthesia (GA). No study has investigated the economic aspects associated with the two anesthetic techniques for this common surgery. We randomized 40 patients to receive either SA or GA and analyzed the drug and supply costs for anesthesia und recovery. ⋯ Patients in the GA group were admitted to the postanesthesia care unit with a higher pain score and needed more analgesics than patients in the SA group (both P < 0.01). We conclude that SA is a more cost-effective alternative to GA in patients undergoing hip or knee replacement, as it is associated with lower fixed and variable costs. Moreover, SA seems to be more effective, as patients in the SA group showed lower postoperative pain scores during their stay in the postanesthesia care unit.