Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPreoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy.
In a randomized, double-blind, placebo-controlled trial, we evaluated the use of preoperative local anesthesia with regard to postoperative pain. Before surgery in 66 patients scheduled for cholecystectomy, the abdominal wall along the proposed line of incision was infiltrated with 70 mL of 0.25% ropivacaine, 70 mL of 0.125% ropivacaine, or 70 mL of saline. Wound pain at rest, wound pain during mobilization, and pressure exerted to reach maximum pain tolerance were assessed after 6, 26, 50, and 74 h and after 7 days. ⋯ The median time to first request for postoperative analgesics was significantly shorter (P = 0.014) in the saline group than in the ropivacaine 0.25% group. These effects are suggested to be a residual anesthetic effect of ropivacaine. The study gives no support to the hypothesis that preoperative local anesthetics dampen the inflammatory response and ensuing hyperalgesia.
-
Anesthesia and analgesia · Jan 1994
Multicenter Study Comparative StudyThe postoperative interview: assessing risk factors for nausea and vomiting.
Most studies of postoperative nausea and vomiting have concentrated on single etiologic factors and have not detailed the method of assessing these symptoms. This study used postoperative interview data from patients at four teaching hospitals during 1988-89, to determine 1) risk factors for nausea/vomiting, 2) whether the type of surgery affected the rate of nausea/vomiting among female patients, 3) whether differences in rates across hospitals were due to differences in patient case-mix, and 4) whether there were differences in the rate of nausea/vomiting among the patients of individual anesthesiologists. Research nurses performed 16,000 interviews (59% of all inpatients) from a closed-question standardized format. ⋯ We found marked variations in the rate of nausea/vomiting across hospitals (range, 39% to 73%), and these variations were not explained by the case-mix of patients. The rate of nausea/vomiting varied substantially across anesthesiologists in each hospital and the differences were not explained by differences in the patients they managed. Thus in the time period immediately preceding the introduction of newer antiemetic drugs, we found that the rates of this common problem were persistently high as perceived from the patients' point of view.
-
Anesthesia and analgesia · Oct 1993
Multicenter Study Clinical TrialAdverse events in a multicenter phase IV study of propofol: evaluation by anesthesiologists and postanesthesia care unit nurses.
Phase II and III studies are tightly controlled trials investigating adverse effects before government approval of a new drug. However, because postapproval Phase IV studies involve a much larger and more complex population, the true nature of adverse effects can be seen. We analyzed Phase IV data for the new drug propofol with regard to the incidence of adverse events, and evaluations of such events by anesthesiologists versus postanesthesia care unit (PACU) nurses. ⋯ The PACU nurse was more influenced by nausea, vomiting, or postoperative pain; and the anesthesiologist was more influenced by postoperative confusion or delayed emergence from anesthesia. For only 0.6% of patients did both evaluators rate recovery as poor. Anesthesiologists gave more weight to intraoperative adverse events, and nurses to postoperative events.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Oct 1993
Multicenter Study Clinical TrialHemodynamic effects of propofol: data from over 25,000 patients.
To investigate clinically important hypotension and bradycardia after induction of anesthesia with propofol, we analyzed data from a Phase IV stepwise study involving 25,981 patients, 1722 institutions, and 1819 anesthesiologists. In Step 1, propofol was used for induction only. In Step 2, propofol was used for induction and then maintenance by intermittent injection. ⋯ Giving this new drug by protocol, even inexperienced anesthesiologists incurred few adverse hemodynamic changes. Hemodynamic changes were transient and rarely (< 0.2%) required drug therapy. Cardiovascular changes and drug interactions were predictable and manageable based on knowledge of the pharmacology of propofol.
-
Anesthesia and analgesia · Oct 1993
Multicenter Study Clinical TrialEffects on recovery when isoflurane is used to supplement propofol-nitrous oxide anesthesia.
During propofol-nitrous oxide (N2O) anesthesia, volatile anesthetics are frequently administered to treat signs of inadequate anesthesia and to decrease the possibility of intraoperative awareness. Because the clinical effects of this combination have not been examined rigorously, we used data from the 1989-90 Phase IV clinical trial with propofol to evaluate recovery from propofol-N2O anesthesia with and without supplementation with isoflurane. In this study involving 15,806 patients at 1722 institutions, propofol was administered for induction and maintenance of anesthesia with N2O for procedures lasting less than 60 min. ⋯ Adjunctive use of isoflurane prolonged the time to awakening and to becoming oriented, but discharge times were similar for the two groups. The incidence of postoperative nausea, vomiting, recall, and excitement did not differ between the two groups. We conclude that the addition of isoflurane to a propofol-N2O anesthetic does not alter recovery from anesthesia.