Journal of clinical anesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The effect of intravenous ketorolac given intraoperatively versus postoperatively on outcome from gynecologic abdominal surgery.
To examine the effect of timing of an intravenous (i.v.) dose (intraoperative vs. postoperative) of ketorolac tromethamine on pain scores and overall outcome after total abdominal hysterectomy (TAH) and myomectomy. ⋯ Although it is possible to demonstrate an improvement in early postoperative pain scores with intraoperative ketorolac and better overall ratings of ketorolac both intraoperatively and postoperatively as compared with placebo, the lack of clinically significant differences in analgesic efficacy in the two active study groups indicates the need for a careful consideration by the clinician of the risks versus benefits involved in the administration of antiplatelet medication in the perioperative period.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Intravenous dolasetron mesilate in the prevention of postoperative nausea and vomiting in females undergoing gynecological surgery.
To evaluate a range of doses of intravenous (i.v.) dolasetron mesilate, in preventing postoperative nausea and vomiting (PONV). ⋯ Dolasetron was effective and well tolerated for the prevention of PONV in female patients undergoing gynecologic surgery with general anesthesia.
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Randomized Controlled Trial Clinical Trial
Effects of anesthetic technique on side effects associated with fentanyl Oralet premedication.
To evaluate the efficacy of 5 to 10 micrograms/kg of oral transmucosal fentanyl citrate (OTFC) as an anesthetic premedication, and to determine whether propofol induction reduces postoperative nausea and vomiting (PONV) in pediatric patients premedicated with OTFC undergoing outpatient surgery. ⋯ OTFC in doses of 5 to 10 micrograms/kg was effective in producing sedation and facilitating cooperation with induction; however, it was associated with significant PONV in our study. Although propofol induction did not significantly reduce PONV in our study, further study with a larger sample, and with propofol as the sole anesthetic, may be warranted.
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Clinical Trial
The utility of routine postoperative chest radiography in the postanesthesia care unit.
To evaluate the clinical significance and cost effectiveness of routine chest radiographs in the postanesthesia care unit (PACU). ⋯ Abnormal chest radiographic findings resulted in a change in the management of only 4% of the patients. Therefore, the yield of a routine postoperative chest radiograph in the PACU is low. Performing a chest radiograph for a specific indication rather than on a routine basis, may decrease work load and save expenses. Postoperative chest radiography can be safely evaluated by a staff anesthesiologist.
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We treated a patient with a 30-year history of ethanol and benzodiazepine abuse who, on emerging from general anesthesia, was combative and confused. Our working diagnosis was acute ethanol withdrawal, and the patient received intravenous (i.v.) propofol, and midazolam. Initially small doses (10 to 20 mg) of propofol, combined with a midazolam infusion (50 mg/hr), produced sedation. ⋯ Immediate sedation was produced by thiopental bolus (500 mg) and i.v. infusion (200 mg/hr). The implication of the patient's initial appropriate response to propofol, followed by the lack of effect when much higher doses were employed, is discussed. While tachyphylaxis has been reported after long-term propofol use, we believe this to be the first case of acute tachyphylaxis.