The Journal of international medical research
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Randomized Controlled Trial
The effect of ketamine with remifentanil for improving the quality of anaesthesia and recovery in paediatric patients undergoing middle-ear ventilation tube insertion.
This prospective randomized study evaluated the effects of ketamine with remifentanil to improve the quality of anaesthesia and postoperative recovery, following brief procedures, in 60 paediatric patients undergoing middle-ear ventilation tube insertion (MEVTI). Patients were randomly assigned to either ketamine 2 mg/kg intravenous [i.v.] bolus plus normal saline by i.v. infusion (K group, n = 30) or ketamine 2 mg/kg i.v. bolus, plus remifentanil 0.15 μg/kg per min i.v. infusion (KR group, n = 30). ⋯ Time to recovery was significantly shorter in the KR group than in the K group. In conclusion, remifentanil was a good adjuvant to ketamine, improving the quality of anaesthesia and postoperative recovery in children undergoing MEVTI.
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Total intravenous anaesthesia (TIVA) can reduce the risk of postoperative nausea and vomiting (PONV) almost as much as a single antiemetic. This study compared TIVA (using propofol and remifentanil) with prophylactic palonosetron (a 5-hydroxytryptamine type 3 receptor antagonist) combined with inhalation anaesthesia using sevoflurane in 50% nitrous oxide, for the prevention of PONV. ⋯ The incidence of PONV was around 50% in both groups and the severity of nausea was similar in both groups. Prophylactic palonosetron with inhalational anaesthesia using sevoflurane in 50% nitrous oxide reduced the incidence of PONV after gynaecological laparoscopic surgery almost as much as TIVA using propofol and remifentanil.
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Randomized Controlled Trial
Effects of predistention with normal saline containing adrenaline on blood-vessel injury during epidural catheter placement.
This study investigated the effects of predistention with normal saline containing adrenaline on vascular plexus injury during epidural catheter placement. Three hundred parturients undergoing caesarean sections were randomly divided into three groups. Group I (n = 102) received an epidural injection with 5 ml normal saline; group II (n = 93) received 5 ml normal saline containing adrenaline (5 μg/ml); group III (n = 100) received direct epidural catheter placement. ⋯ The incidence of bloody fluid in the epidural needle was significantly lower in groups I and II compared with group III (eight [7.8%] and seven [7.5%] versus 17 [17.0%], respectively). There were no significant differences in the incidence of bloody fluid in the epidural catheter or in the incidence of intravascular epidural catheter placement between the three groups. Predistention with 5 ml normal saline before catheter insertion reduced the incidence of blood-vessel injury during epidural catheter placement, but adrenaline provided no additional protective effects.
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Randomized Controlled Trial
Reduction of microemulsion propofol-induced injection pain via target-controlled remifentanil infusion.
The intravenous injection of microemulsion propofol to induce anaesthesia causes more intense and frequent pain than lipid emulsion propofol. This study investigated whether different target effect-site concentrations of remifentanil could prevent pain due to microemulsion propofol injection. ⋯ Although no difference in pain reduction between the two remifentanil-treated groups was observed, those receiving a target effect-site concentration of 6 ng/ml exhibited an increased rate of complications, compared with those receiving 4 ng/ml. In conclusion, prior administration of remifentanil at a target effect-site concentration of 4 ng/ml is a useful strategy to decrease the injection pain of microemulsion propofol.
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Randomized Controlled Trial
The sparing effect of low-dose esmolol on sevoflurane during laparoscopic gynaecological surgery.
This double-blind, randomized, placebo-controlled study evaluated the sparing effect of esmolol on sevoflurane during laparoscopic gynaecological surgery in 54 patients between December 2009 and May 2010. The concentration of sevoflurane required to maintain adequate anaesthesia was determined. Patients received either a 0.5 mg/kg esmolol intravenous loading dose followed by infusion of 30 μg/kg per min or an identical volume of normal saline (placebo). ⋯ Infusion of esmolol resulted in an 18.2% decrease in mean sevoflurane input concentration. Patients receiving esmolol had an earlier discharge from the postanaesthetic care unit and a lower mean fentanyl dose. In conclusion, intraoperative esmolol infusion decreased both the requirement for sevoflurane and postoperative administration of fentanyl.