Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2006
Randomized Controlled Trial Comparative StudyThe additive interactions between ondansetron and droperidol for preventing postoperative nausea and vomiting.
Prophylactic ondansetron or droperidol reduces the incidence of postoperative nausea and vomiting (PONV). Previous studies showed that the combination of these two drugs produced better antiemetic effect than either drug alone. We present a nonparametric method to determine the pharmacologic interaction between ondansetron and droperidol and compared the observed response of the drug combination with that predicted from additivity. ⋯ We conclude that the interaction between ondansetron and droperiodol was additive. Both drugs acted independently of each other through their specific mechanisms of action. The incidence of QTc prolongation did not increase with the drug combination.
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Anesthesia and analgesia · Nov 2006
Comparative StudyNeurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy.
The risk of severe neurologic injury after neuraxial blockade is extremely rare among the general population. However, patients with preexisting neural compromise may be at increased risk of further neurologic sequelae after neuraxial anesthesia or analgesia. ⋯ The risk of severe postoperative neurologic dysfunction in patients with peripheral sensorimotor neuropathy or diabetic polyneuropathy undergoing neuraxial anesthesia or analgesia was found to be 0.4% (95% CI 0.1%-1.3%). Clinicians should be aware of this potentially high-risk subgroup of patients when developing and implementing a regional anesthetic care plan.
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Anesthesia and analgesia · Nov 2006
Comparative StudyThe effect of tracheal gas insufflation on gas exchange efficiency.
Transtracheal gas insufflation (TGI) improves gas exchange efficiency, but is associated with hyperinflation, and usually requires ventilator adjustment to compensate for the increased gas flow. Although bidirectional TGI (Bi-TGI) minimizes hyperinflation, it does not preclude the need to reduce tidal volumes to prevent hyperinflation. A flow-compensation system was developed by Respironics (Murrysville, PA) to match TGI flows; however, neither that nor the efficacy of Bi-TGI have been tested in vivo. ⋯ Bi- and Uni-TGI could be delivered at constant minute ventilation without adjusting ventilatory setting when the flow compensation circuit was present. Uni-TGI produced more hyperinflation than did Bi-TGI with all sizes of endotracheal tube, and hyperinflation was universally present as tube size decreased to 7.5F. We conclude that this new flow compensation system allows for the delivery of TGI without the need for adjustments to the ventilator settings, and that Bi-TGI produces less hyperinflation than does Uni-TGI, even with small diameter endotracheal tubes.