Anesthesia and analgesia
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialTransfusion of autologous, hydroxyethyl starch-cryopreserved red blood cells.
In this prospective, randomized study, we investigated the safety and efficacy of the transfusion of hydroxyethyl starch (HES) cryopreserved red blood cells (RBC) compared with the transfusion of liquid-stored RBC in patients undergoing major orthopedic or urologic surgery. Thirty-six patients donated autologous blood 35 +/- 6 days before elective surgery. Only the first of 3.5 +/- 1.3 donated units of RBC was randomly assigned to be stored in the liquid state at 4 degrees C in phosphate/adenine/guanosine/glucose/saline-Mannitol or frozen below -130 degrees C by means of liquid nitrogen after the addition of HES (molecular weight 200,000 Dalton, degree of substitution 0.5, final concentration 11.5% wt/wt) as a cryoprotectant. After induction of anesthesia, patients donated 900 mL of autologous blood before they received one unit of liquid-stored RBC in Group 1. In Group 2, one unit of cryopreserved autologous RBC was transfused after removal of the cryoprotectant HES. In Group 3, patients received one unit of cryopreserved RBC without any manipulation after thawing. Patients in Groups 1 and 2 received additional 500 mL of 10% HES. Hemodynamic variables, arterial blood gases, plasma hemoglobin, and arterial lactate concentrations were measured after the induction of anesthesia, after hemodilution, and at 10-min intervals after transfusion of the respective RBC concentrate over a period of 40 min. Skeletal muscle tissue oxygen tension was measured in the quadriceps muscle using an automatically stepwise-driven oxygen partial pressure electrode. We found no differences among groups concerning demographics, arterial blood gas values, and lactate concentrations and observed no adverse reactions after transfusion of the conventionally stored or cryopreserved RBC. Hemodynamic variables did not differ among groups, with the exception of an increased mean arterial blood pressure after the transfusion of cryopreserved unwashed RBC. In all groups, the skeletal muscle tissue oxygen tension remained constant after hemodilution and increased after transfusion of either washed or unwashed cryopreserved RBC. Although the free plasma hemoglobin concentration remained constant after the transfusion of liquid-stored RBC (26 +/- 8 mg/dL), the plasma hemoglobin concentration increased twofold after the transfusion of cryopreserved washed RBC (60 +/- 12 mg/dL) and threefold after transfusion of cryopreserved unwashed RBC (98 +/- 20 mg/dL). The authors conclude that transfusion of one unit of RBC after cryopreservation with HES is safe and well tolerated by patients. Intravascular volume replacement and skeletal muscle oxygenation characteristics by erythrocytes did not differ between liquid-stored and cryopreserved RBC. ⋯ This study examined whether a colloid should be used to store blood. Our data suggest that the transfusion of one unit of red blood cells after cryopreservation with hydroxyethyl starch is safe and well tolerated by patients. The effects of intravascular volume replacement and skeletal muscle oxygenation provided by red blood cells after liquid storage or cryopreservation were not different.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialEltanolone as an alternative to propofol for ambulatory anesthesia.
The intravenous (i.v.) steroid anesthetic, eltanolone, compares favorably to propofol with respect to its induction characteristics. This double-blind investigation was designed to compare the induction and recovery profile of eltanolone (versus propofol) when it was used for both induction and maintenance of ambulatory anesthesia. Eighty-three consenting ASA physical status I-III outpatients undergoing minor gynecologic or urologic procedures lasting 10-40 min were randomly assigned to one of three anesthetic treatment groups. All patients received midazolam, 2 mg i.v., and fentanyl, 50 micrograms i.v., before induction of anesthesia. The control group (Group 1) was induced with propofol, 2.4 mg/kg i.v. (18-60 yr or ASA physical status I or II) or 1.6 mg/kg i.v. (61-80 yr and/or ASA physical status III), followed by intermittent bolus doses of 0.6 mg/kg i.v. in combination with N2O 67% for maintenance of anesthesia. In Group 2, anesthesia was induced with eltanolone, 0.75 mg/kg i.v., (18-60 yr and/or ASA physical status I or II) or 0.5 mg/kg i.v. (61-80 yr and/or ASA physical status III), and maintained with intermittent bolus injections of 0.2 mg/kg i.v. and N2O 67%. Group 3 received eltanolone, 1.0 mg/kg i.v. (18-60 yr and/or ASA physical status I or II), or 0.75 mg/kg i.v. (61-80 yr and/or ASA physical status III), followed by intermittent bolus injections of 0.2 mg/kg i.v. and N2O 67%. In addition to recording the induction and recovery times and side effects, psychomotor testing was performed before and at 30-min intervals after anesthesia. Induction times (57 +/- 23, 67 +/- 26, and 61 +/- 22s, respectively) were similar in all three groups. Although eltanolone produced no pain on injection (versus 52% in the propofol group), 10% of the eltanolone-treated patients (versus none in the propofol group) developed transient cutaneous (rash-like) reactions. The total dose of study medication used during the anesthetic period was 9.2 +/- 3.7 mg.kg-1.h-1 in the propofol group compared with 3.3 +/- 1.4 mg.kg-1.h-1 and 3.3 +/- 1.9 mg.kg-1.h-1 in Groups 2 and 3, respectively. Early recovery times were significantly shorter after propofol anesthesia. However, times to ambulation, micturition, and being judged "fit for discharge," as well as recovery of cognitive function, were similar in all three groups. Although ethanolone seems to be a safe and effective i.v. anesthetic, these data suggest that it is unlikely to replace propofol in the ambulatory setting. ⋯ Eltanolone is an investigational steroid anesthetic that causes less pain on injection and less cardiovascular depression than propofol (the most widely used intravenous anesthetic in the outpatient setting). Unfortunately, emergence from anesthesia after ambulatory surgery is slower with eltanolone compared with propofol. Therefore, it is unlikely that eltanolone will replace propofol for outpatient anesthesia.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy.
We compared ondansetron with droperidol, given prophylactically, in a randomized, prospective, double-blind study of women undergoing outpatient gynecologic laparoscopy. One-hundred fifty-eight women received either ondansetron (4 mg) or droperidol (20 micrograms/kg) intravenously during induction of anesthesia. Nausea was measured at three intervals: at admission to the postanesthesia care unit (PACU), 1 h after admission to the PACU, and on Postoperative Day 1. The incidence of vomiting was tabulated in the PACU and on Postoperative Day 1. Sedation was assessed 1 h after admission to the PACU. No differences in nausea, sedation, or number of patients vomiting in the PACU were found. More patients in the ondansetron group reported vomiting on Postoperative Day 1 than subjects in the droperidol group (25 vs 11). No difference in opiate use was found among patients who vomited. We conclude that droperidol is equivalent to ondansetron for the prophylactic treatment of nausea and vomiting in patients undergoing gynecologic laparoscopy, and that significant cost savings can be appreciated if droperidol is used. ⋯ Either ondansetron or droperidol, frequently used antiemetics, was given to women before they underwent gynecologic laparoscopy. No difference in the number of women experiencing postoperative nausea and vomiting or their level of sedation was found. Equivalent effectiveness and significant cost-savings may be obtained by using droperidol prophylactically for laparoscopic surgery.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Clinical TrialThe effects of dexamethasone on antiemetics in female patients undergoing gynecologic surgery.
This randomized, double-blind study compared the effects of dexamethasone plus either droperidol, metoclopramide, or granisetron with each antiemetic alone for preventing postoperative nausea and vomiting (PONV) in 270 female patients undergoing general anesthesia for major gynecological surgery. Patients were randomly assigned to receive either droperidol 1.25 mg (Group D1, n = 45), droperidol 1.25 mg plus dexamethasone 8 mg (Group D2, n = 45), metoclopramide 10 mg (Group M1, n = 45), metoclopramide 10 mg plus dexamethasone 8 mg (Group M2, n = 45), granisetron 40 micrograms/kg (Group G1, n = 45), or granisetron 40 micrograms/kg plus dexamethasone 8 mg (Group G2, n = 45) immediately before the induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used throughout the study. Complete response, defined as no PONV and no administration of rescue antiemetic medication during the first 24 h after anesthesia, was 49% in Group D1, 60% in Group D2 (P = 0.199 versus Group D1), 51% in Group M1, 62% in Group M2 (P = 0.198 versus Group M1), 80% in Group G1, and 96% in Group G2 (P = 0.025 versus Group G1). Our results suggest that dexamethasone enhances the antiemetic efficacy of granisetron but does not potentiate the other antiemetics-droperidol and metoclopramide-in female patients undergoing major gynecological surgery. ⋯ We compared the efficacy of dexamethasone plus three different antiemetics-droperidol, metoclopramide, and granisetron-for the prevention of nausea and vomiting after gynecologic surgery. The granisetron-dexamethasone combination was the most effective for preventing post-operative emetic symptoms.
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Anesthesia and analgesia · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialSplanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method.
Carbon dioxide (CO2) pneumoperitoneum together with an increased intraabdominal pressure (IAP) induces a hemodynamic stress response, diminishes urine output, and may compromise splanchnic perfusion. A new retractor method may be less traumatic. Accordingly, 30 ASA physical status I or II patients undergoing laparoscopic cholecystectomy were randomly allocated to a CO2 pneumoperitoneum (IAP 12-13 mm Hg) (control) or to a gasless abdominal wall lift method (retractor) group. Anesthesia and intravascular fluids were standardized. Direct mean arterial pressure (MAP), urine output, urine-N-acetyl-beta-D-glucosaminidase (U-NAG), arterial blood gases, gastric mucosal PCO2, and intramucosal pH (pHi) were measured. Normoventilation was instituted in all patients. MAP increased (P < 0.001) only with CO2 pneumoperitoneum. Minute volume of ventilation had to be increased by 35% with CO2 insufflation. PaCO2 was significantly higher (P < 0.05) for 3 h postoperatively in the control group. Diuresis was less (P < 0.01) and U-NAG levels (P < 0.01) higher in the control group. The pHi decreased after induction of pneumoperitoneum up to three hours postoperatively and remained intact in the retractor group. We conclude that the retractor method for laparoscopic cholecystectomy ensures stable hemodynamics, prevents respiratory acidosis, and provides protection against biochemical effects, which reveal the renal and splanchic ischemia caused by CO2 insufflation. ⋯ A mechanical retractor method (gasless) was compared with conventional CO2 pneumoperitoneum for laparoscopic cholestectomy. The gasless method ensured stable hemodynamics, prevented respiratory acidosis, and provided protection against the renal and splanchnic ischemia seen with CO2 pneumoperitoneum.