Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialThe side effects of morphine and hydromorphone patient-controlled analgesia.
Despite "clinical lore" among health care providers that treatment with hydromorphone results in improved pain control and fewer adverse side effects, morphine continues to be the first-line medication for postoperative patient-controlled analgesia (PCA). In this study, we compared the efficacy and side-effect profiles of morphine and hydromorphone at concentrations producing equivalent drug effect measured by pain score and miosis. ⋯ We found no systematic difference between morphine and hydromorphone in opioid-related side effects. Neither was there any difference in efficacy of pain control or patient satisfaction when patients self-titrated to equal drug effect as measured by equianalgesia and pupillary miosis. The choice between morphine and hydromorphone for use in PCA should be guided by patient history, as there may be idiosyncratic reactions to either drug.
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialMelatonin improves tourniquet tolerance and enhances postoperative analgesia in patients receiving intravenous regional anesthesia.
Melatonin has anxiolytic and potential analgesic effects. We assessed the efficacy of melatonin premedication in reducing tourniquet-related pain and improving analgesia in patients receiving IV regional anesthesia (IVRA). ⋯ Melatonin is an effective premedication before IVRA since it reduced patient anxiety, decreased tourniquet-related pain, and improved perioperative analgesia.
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Anesthesia and analgesia · Oct 2008
Case ReportsUltrasonography reinvents the originally described technique for ganglion impar neurolysis in perianal cancer pain.
Visceral pain in the perineal area associated with malignancies may be effectively treated with neurolysis of the ganglion impar. Since the first description of the technique of accessing the ganglion impar through anococcygeal ligament, many techniques for ganglion impar block have been described. We present a patient diagnosed with carcinoma of the anal canal who was successfully given ultrasound-guided ganglion impar block using a Chiba needle inserted through the anococcygeal ligament. In summary, ultrasound-guided ganglion impar neurolysis is a fast, safe, and cost-effective method, which can be used as a first-line pain relief intervention for good quality of life in patients with perianal cancers.
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialPulmonary cytokine responses during mechanical ventilation of noninjured lungs with and without end-expiratory pressure.
Positive end-expiratory pressure (PEEP) during mechanical ventilation may impose different degrees of stress on healthy lungs. On the assumption that stress is reflected by cytokine production, we performed a translational study investigating the effect of PEEP on bronchoalveolar and systemic mediator levels in isolated perfused mouse lungs (IPL) and in patients with healthy lungs. ⋯ On the basis of the premise that cytokine levels may indicate mechanical stress, our findings indicate that even low tidal volume ventilation causes some stress. PEEP is beneficial at high inspiratory pressure, but imposes moderate stress at low inspiratory pressure.
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialThe accuracy and clinical feasibility of a new bayesian-based closed-loop control system for propofol administration using the bispectral index as a controlled variable.
Closed-loop control of the hypnotic component of anesthesia has been proposed in an attempt to optimize drug delivery. Here, we introduce a newly developed Bayesian-based, patient-individualized, model-based, adaptive control method for bispectral index (BIS) guided propofol infusion into clinical practice and compare its accuracy and clinical feasibility under direct observation of an anesthesiologist versus BIS guided, effect compartment controlled propofol administration titrated by the anesthesiologist during ambulatory gynecological procedures. ⋯ The Bayesian-based closed-loop control system for propofol administration using the BIS as a controlled variable performed accurate during anesthesia for ambulatory gynecological procedures. This control system is clinical feasibility and can be further validated in clinical practice.