Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialNimesulide 90 mg orally twice daily does not influence postoperative morphine requirements after major chest surgery.
Cyclooxygenase 2 inhibition has proven analgesic efficacy in a variety of surgical procedures. We postulated that perioperative cyclooxygenase 2 inhibition significantly reduces postoperative morphine requirements after major thoracic surgery and investigated the site of this potential analgesic effect. ⋯ Nimesulide, at a dose of 90 mg twice daily in combination with a standard analgesic regimen, does not influence pain scores, morphine requirements, or CSF prostaglandin levels after major thoracic surgery.
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Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialIs the combination of morphine with ketamine better than morphine alone for postoperative intravenous patient-controlled analgesia?
The addition of ketamine to morphine for patient-controlled analgesia (PCA) is supported by previous basic and clinical research, but has been challenged by subsequent negative studies. Important limitations of previous studies are the low number of patients analyzed, the use of morphine-ketamine combinations that may not the optimal, and that not all the relevant outcomes have been analyzed. In this study, we compared the combination of morphine and ketamine with morphine alone for postoperative PCA in large patient groups. We used a morphine-ketamine combination identified by an optimization procedure in our previous study. ⋯ Small-dose ketamine combined with morphine for PCA provides no benefit to patients undergoing major orthopedic surgery and cannot be recommended for routine use.
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Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialA comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: a randomized controlled trial.
Dexmedetomidine, because it has both sedative and analgesic properties, may be suitable for conscious sedation during painful procedures. Extracorporeal shockwave lithotripsy (ESWL) is a minimal to mildly painful procedure that requires conscious sedation. We thus evaluated the utility of dexmedetomidine compared with propofol during an ESWL procedure. ⋯ A combination of dexmedetomidine with fentanyl can be used safely and effectively for sedation and analgesia during ESWL.
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Anesthesia and analgesia · Jan 2008
Comparative StudyNoninvasive cardiac output determination using applanation tonometry-derived radial artery pulse contour analysis in critically ill patients.
Conventional thermodilution cardiac output (CO) monitoring is limited mainly to intensive care units and operating rooms because it requires the use of invasive techniques. To reduce the potential for complications and to broaden the applicability of hemodynamic monitoring, noninvasive methods for CO determination are being sought. Applanation tonometry allows noninvasive CO estimation through pulse contour analysis, but the method has not been evaluated in critically ill patients. ⋯ There was no significant difference in bias between the patients who were receiving vasopressor support and those who were not (P = 0.874) or between patients with good and poor applanation tonometry pressure waveform signal quality (P = 0.071). Whereas a significant increase in the invasively determined CO was observed when a fluid bolus was administered (n = 7, P = 0.016), these changes were not reflected by the noninvasive method. We conclude that radial artery applanation tonometry is not suitable to determine CO in critically ill hemodynamically unstable patients.
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Anesthesia and analgesia · Jan 2008
Clinical TrialThe effects of dexmedetomidine on cardiac electrophysiology in children.
Dexmedetomidine (DEX) is an alpha2-adrenergic agonist that is approved by the Food and Drug Administration for short-term (<24 h) sedation in adults. It is not approved for use in children. Nevertheless, the use of DEX for sedation and anesthesia in infants and children appears to be increasing. There are some concerns regarding the hemodynamic effects of the drug, including bradycardia, hypertension, and hypotension. No data regarding the effects of DEX on the cardiac conduction system are available. We therefore aimed to characterize the effects of DEX on cardiac conduction in pediatric patients. ⋯ DEX significantly depressed sinus and atrioventricular nodal function in pediatric patients. Heart rate decreased and arterial blood pressure increased during administration of DEX. The use of DEX may not be desirable during electrophysiology study and may be associated with adverse effects in patients at risk for bradycardia or atrioventricular nodal block.