Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Clinical TrialBetamethasone reduces postoperative pain and nausea after ambulatory surgery.
The aims of this study were to evaluate the effects of a single-dose glucocorticoid on the incidence and severity of pain and nausea and vomiting (PONV) after ambulatory surgery. Seventy-eight ASA physical status I-III patients scheduled for hemorrhoidectomy or hallux valgus correction were studied using a randomized, double-blind, placebo-controlled protocol. One group received 12 mg of betamethasone i.m. 30 min before the start of surgery (Group B), whereas the placebo group (Group P) received saline. General anesthesia was induced with propofol and fentanyl and maintained with isoflurane in both groups. Pain (measured using a visual analog scale, verbal score, and analgesic requirements), PONV, and other side effects were evaluated postoperatively. Patients in Group B experienced significantly less postoperative pain, less PONV, and better patient satisfaction during the first 24 h after surgery. In conclusion, a single dose of betamethasone (12 mg) seemed to produce analgesic and antiemetic effects after day-case surgery. ⋯ In a placebo-controlled study, the use of corticosteroid prophylaxis (betamethasone) produced a significant reduction in both postoperative pain and nausea in outpatients who received the corticosteroid injection before ambulatory foot or hemorrhoid operations.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Clinical TrialOnset time, endotracheal intubating conditions, and plasma histamine after cisatracurium and vecuronium administration.
Cisatracurium is a nondepolarizing muscle relaxant with a slow onset. We performed a prospective, randomized, double-blind clinical trial in 60 patients (ASA physical status I or II) to assess whether cisatracurium (0.15 or 0.25 mg/kg) or vecuronium (0.15 mg/kg), administered as a bolus immediately after induction of anesthesia with fentanyl and thiopental, would provide a faster onset time and better tracheal intubating conditions than previously reported. We sought to determine whether patients given muscle relaxants in this commonly used induction sequence would exhibit cutaneous, systemic, or chemical evidence of histamine release. Onset time of the relaxants was determined by using mechanomyography. Intubating conditions were scored on a defined interval scale by an anesthesiologist blinded to the relaxant administered. Heart rate and arterial blood pressure were measured noninvasively every minute from 10 min before to 5 min after the application of the muscle relaxant. Mean (+/- SD) onset times for 0.25 mg/kg cisatracurium (68.3 +/- 19.5 s) and for 0.15 mg/kg vecuronium (69.5 +/- 29.2 s) were significantly different from those in the 0.15 mg/kg cisatracurium group (105 +/- 41.2 s). The intubating conditions were better with the larger dose of cisatracurium or vecuronium (P < 0.03). Although plasma histamine levels were not statistically different among groups, levels >1 ng/mL were observed in 5 of 40 patients who received cisatracurium but in none of the 20 patients who received vecuronium. There were no significant hemodynamic differences among the groups. In a dose of 0.25 mg/kg, cisatracurium has as rapid an onset time as vecuronium 0.15 mg/kg, but the former shows evidence of histamine release. ⋯ Cisatracurium has been considered a drug with a relatively slow onset but that has the significant benefit of being devoid of chemically mediated histamine release. In this study, we describe an onset time faster than previously reported when cisatracurium was given immediately after thiopental. We also note that several patients had abnormal histamine levels after cisatracurium administration.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Comparative Study Clinical TrialTopical lidocaine-prilocaine cream (EMLA) versus local infiltration anesthesia for radial artery cannulation.
In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA was applied 2 h before radial cannulation, and lidocaine infiltration was performed 5 min before cannulation. The primary end point was pain as assessed by a verbal numerical scale (0 = no pain, 10 = extreme pain). Pain was less severe in the EMLA group than in the lidocaine infiltration group (Score of 2 vs 7; P = 0.0001). Additional lidocaine infiltration was required significantly less frequently in the EMLA group (relative risk 0.19). The failure rate of cannulation was significantly lower in the EMLA group (relative risk 0.38), and insertion time was shorter (4 versus 6 min). We conclude that EMLA, compared with lidocaine infiltration, reduces pain associated with radial artery cannulation and improves the success rate of the procedure. Routine application of EMLA should be performed in awake patients 2 h before radial artery cannulation. ⋯ In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA) with subcutaneous local lidocaine infiltration for radial artery cannulation in 538 adults patients. EMLA reduced pain associated with radial artery cannulation and improved the success rate of the procedure.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Comparative Study Clinical TrialNasotracheal intubation in patients with immobilized cervical spine: a comparison of tracheal tube cuff inflation and fiberoptic bronchoscopy.
Tracheal intubation may pose problems in patients with cervical spine injury (CSI). In patients without CSI, the success rate of blind nasotracheal intubation is increased by endotracheal tube (ETT) cuff inflation in the pharynx. The purpose of this study was to assess the efficacy of ETT cuff inflation in the pharynx as an aid to blind nasotracheal intubation in patients with an immobilized cervical spine. The technique was compared with fiberoptic bronchoscopy. Twenty ASA physical status I and II patients undergoing elective surgery in which the trachea was to be intubated nasally were enrolled in this prospective, randomized study. The cervical spine of each patient was immobilized. The trachea of each patient was intubated twice, once using fiberoptic bronchoscopy and once blindly using the technique of ETT cuff inflation in the pharynx. A maximum of three attempts was allowed for intubation using ETT cuff inflation. A maximum of 3 min was allowed for intubation using fiberoptic bronchoscopy. When ETT cuff inflation was used, intubation was successful in 19 of 20 patients (95%); the first attempt at intubation was successful in 14 of 20 patients (70%). Intubation was successful in 19 of 20 patients (95%) when using fiberoptic bronchoscopy. Mean times to intubate were 20.8 +/- 23 s when the ETT cuff was inflated in the pharynx and 60.1 +/- 56 s when using fiberoptic laryngoscopy (P < 0.01). We conclude that both ETT cuff inflation in the pharynx and fiberoptic bronchoscopy are valuable for nasotracheal intubation in patients with an immobilized cervical spine and that ETT cuff inflation can be used as an alternative to fiberoptic bronchoscopy in patients with CSI. ⋯ We compared the technique of endotracheal tube cuff inflation in the pharynx for blind nasotracheal intubation in patients with an immobilized cervical spine with fiberoptic bronchoscopy. There was no significant difference between the success rates of the techniques.
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Anesthesia and analgesia · Aug 1998
The effect of thoracic paravertebral blockade on intercostal somatosensory evoked potentials.
The paravertebral nerve blocks used in upper abdominal or thoracic surgery provide excellent pain relief and can inhibit some aspects of the neuroendocrine stress response to surgical trauma, which suggests that a very high-quality afferent block can be effected. To confirm this, we evaluated intercostal somatosensory evoked potentials (SSEPs) in 10 patients undergoing paravertebral nerve blocks as a treatment for chronic pain. SSEPs were recorded before and after ipsilateral thoracic paravertebral deposition of 1.5 mg/kg bupivacaine 0.5%. Sensory loss to temperature was demonstrated in all patients at the level of injection and had a mean superior spread of 1.4 (range 0-4) dermatomes and a mean inferior spread of 2.8 (range 0-7) dermatomes. SSEPs were abolished (the normal waveform was rendered unrecognizable with unmeasurable latencies and a mean amplitude of zero) in all patients at the level of injection. In addition, a two-dermatome SSEP abolition was found in four patients and a three-dermatome abolition was found in two patients. SSEPs were modified, but not significantly, at all other test points. We conclude that cortical responses to thoracic dermatomal stimulation can be abolished at the block level and adjacent dermatomes by thoracic paravertebral nerve blockade. Equivalent results have not been demonstrated with more central forms of afferent blockade, which suggests that thoracic paravertebral nerve blocks may be uniquely effective. ⋯ To improve outcomes after major surgery, as much nociceptive information as possible should be prevented from entering the central nervous and neuroendocrine systems. We have shown that local anesthetics alongside the vertebral column can abolish the usual brain recordings that follow intercostal nerve stimulation, which suggests that paravertebral nerve blocks may be uniquely effective.