Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyThe use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia.
An epidural catheter is used in some institutions for postoperative analgesia after liver surgery. However, anesthesiologists may not feel comfortable leaving a catheter in the epidural space because of concern about coagulation disturbances and possible bleeding complications caused by impaired liver function. In this study, we tested a single-shot intrathecal morphine technique and compared it to a continuous epidural naropine infusion for postoperative analgesia in liver surgery. ⋯ No postdural puncture headache and no spinal hematoma occurred. After liver resection, a single dose of intrathecal morphine followed by patient-controlled morphine analgesia can provide satisfactory postoperative pain relief. The quality of this treatment, according to the VAS, is not inferior to continuous epidural analgesia up to 48 h after surgery.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyDoes bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery?
In this randomized, double-blind and controlled study we evaluated and compared the analgesic efficacy of bilateral superficial cervical plexus block and local anesthetic wound infiltration after thyroid surgery. Forty-five patients were assigned to 3 groups. After general anesthesia induction, bilateral superficial cervical plexus block with 0.25% bupivacaine 15 mL in each side was performed in Group I, and local anesthetic wound infiltration with 0.25% bupivacaine 20 mL was performed in Group II. ⋯ Intravenous patient-controlled analgesia was used to evaluate postoperative analgesic requirement. Neither visual analog scale scores nor total patient-controlled analgesia doses were different among groups. We concluded that bilateral superficial cervical plexus block or local anesthetic wound infiltration with 0.25% bupivacaine did not decrease analgesic requirement after thyroid surgery.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyNitrous oxide induces paradoxical electroencephalographic changes after tracheal intubation during isoflurane and sevoflurane anesthesia.
In this randomized, double-blind, controlled study, we tested the hypothesis that nitrous oxide (N2O) affects bispectral index (BIS) and 95% spectral edge frequency (SEF95) in response to tracheal intubation during anesthesia with isoflurane and sevoflurane. In protocol 1, we randomly allocated 90 ASA physical status I patients to 6 groups (n = 15 each). Anesthesia was induced with isoflurane or sevoflurane with 0%, 33%, or 66% N2O. ⋯ In patients receiving 66% N2O-isoflurane or 66% N2O-sevoflurane, both BIS and SEF95 were significantly decreased after tracheal intubation and significantly lower than in those patients receiving only isoflurane or sevoflurane, respectively (P < 0.01 for both). In protocol 2, 3 microg/kg of IV fentanyl completely abolished the decrease of BIS and SEF95 after tracheal intubation during anesthesia with 66% N2O-isoflurane and 66% N2O-sevoflurane (n = 10). We conclude that 66% N2O induced a paradoxical decrease of BIS in response to tracheal intubation during anesthesia with isoflurane and sevoflurane.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyPreoperative peribulbar block in patients undergoing retinal detachment surgery under general anesthesia: a randomized double-blind study.
Retinal detachment surgery is frequently associated with significant postoperative pain and emesis in adults. In this randomized, double-blind, controlled study we sought to demonstrate that 1% ropivacaine peribulbar (PB) block in conjunction with general anesthesia (GA) improves operative conditions and postoperative analgesia compared with GA combined with subcutaneous normal saline injection into the inferior eyelid. Thirty-one patients were included in each group. ⋯ In the PB group, fewer patients presented an oculocardiac reflex (6 versus 17; P < 0.01); bleeding interfering with the surgical field was reduced (1 versus 11 patients; P < 0.01); mean time to first nefopam request was longer (148 +/- 99 versus 46 +/- 58 min; P < 0.01); mean nefopam consumption was diminished during the first 6 h after tracheal extubation (18.9 +/- 13.9 versus 28.5 +/- 14.7 mg; P < 0.05); immediate postoperative pain scores were lower; and fewer patients required rescue medication (5 versus 23; P < 0.01). The two groups were similar with respect to the incidence of postoperative nausea and vomiting. Overall, PB block combined with GA improved operating conditions and postoperative analgesia in retinal detachment surgery.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyGelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery.
We investigated the effect of postoperative administration of colloids on hemostasis in 45 patients after cardiac surgery. Patients were randomized to receive 15 mL kg(-1) of either 4% albumin, 4% succinylated gelatin, or 6% hydroxyethyl starch (molecular weight of 200 kDa/degree of substitution 0.5) as a short-term infusion. There was a comparable decrease in maximum clot firmness of thromboelastometry tracings in gelatin and hydroxyethyl starch groups immediately after completion of the infusion, whereas these values remained unchanged in the albumin group. ⋯ Fibrin formation (clot formation time, alpha-angle) and fibrinogen-dependent clot strength (maximum clot firmness and shear elastic modulus) were more disturbed in the hydroxyethyl starch group than in the gelatin group. We conclude that after cardiopulmonary bypass surgery, both gelatin and hydroxyethyl starch impair clot strength and fibrin buildup, which may predispose patients to increased blood loss. The greatest impairment in hemostasis was seen after hydroxyethyl starch administration, whereas albumin appeared to have the least effect on hemostatic variables.