Articles: anesthesia.
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Health Care Manage Rev · Jan 1995
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA multifactorial approach to understanding anesthesia selection.
A full hospital cost accounting model to track the total costs of surgery and anesthesia for inpatients, from the perspective of a hospital CFO, utilizing time-allocation methodology is presented. This model was tested in a prospective multicenter economic clinical trial in three settings.
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Multicenter Study Clinical Trial
Rocuronium (Org 9426) for caesarean section.
This was a prospective, non-randomized, multicentre study of rocuronium (Org 9426) in 40 elective Caesarean section patients at full term without fetal distress. Anaesthesia was induced with thiopentone 4-6 mg kg-1 i.v. and rocuronium 0.6 mg kg-1 and maintained with isoflurane and nitrous oxide in oxygen. Monitors included ECG, arterial pressure, pulse oximeter and train-of-four (TOF) produced by ulnar nerve stimulation. ⋯ Rocuronium had no clinically significant effect on maternal heart rate or arterial pressure. After administration of thiopentone and rocuronium in two patients, temporary erythema occurred, one along the site of injection and the other on the chest wall. Rocuronium had no untoward effects on the neonates, evaluated by 1- and 5-min Apgar scores, time to sustained respiration, total and muscular neuroadaptive capacity scores, acid-base status and blood-gas tensions in umbilical arterial and venous blood.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Cataract Refract Surg · May 1994
Multicenter StudyEfficacy and complication rate of 16,224 consecutive peribulbar blocks. A prospective multicenter study.
Although usually safe, retrobulbar anesthesia and peribulbar anesthesia have potentially sight- and life-threatening complications. Although it has been suggested that peribulbar anesthesia is as effective and safer than retrobulbar anesthesia, no large study has addressed the true rate of complications. To determine the efficacy and safety of peribulbar anesthesia, this study prospectively examined 16,224 consecutive peribulbar blocks. ⋯ There was one globe perforation (0.006%), two expulsive hemorrhages (0.013%), one grand mal seizure (0.006%), and no cases of cardiac or respiratory depression or deaths. Peribulbar is as effective as retrobulbar anesthesia and appears to lead to fewer sight- and life-threatening complications, even when slightly different peribulbar techniques are used. This is especially true when the anesthetic is administered with a 1 1/4-inch or shorter needle with the eye in the primary position, followed by ten to 15 minutes of ocular compression.
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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.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A single i.v. dose of ondansetron 8 mg prior to induction of anaesthesia reduces postoperative nausea and vomiting in gynaecological patients.
The effect of a single intravenous dose of ondansetron in preventing postoperative nausea and emesis (retching and vomiting) (PONV) was investigated in a randomized, double-blind, placebo-controlled, multicentre, international study. Women of ASA class I-III, requiring gynaecological laparotomy, vaginal hysterectomy, or major vaginal surgery were selected for study. Two hundred and thirty-five received placebo, 231 received 1 mg ondansetron, 228 received 8 mg ondansetron and 229 received 16 mg ondansetron, as an infusion over five minutes before the induction of anaesthesia. ⋯ Postoperative analgesia was achieved with morphine, and prochlorperazine or metoclopramide were given if a rescue antiemetic was required. A greater percentage of patients in the 8 mg and 16 mg ondansetron groups experienced no postoperative emesis (44% and 39% respectively) than in the placebo and 1 mg ondansetron groups (29% and 28% respectively) for the first 24 hr postoperative period (8 mg vs placebo and 1 mg: P < or = 0.001; 16 mg vs placebo: P < 0.05; 16 mg vs 1 mg: P < 0.05). Similarly, the percentage of patients who did not experience postoperative nausea were 20%, 26%, 31% and 28% for the placebo, 1 mg, 8 mg and 16 mg ondansetron treatment groups, respectively (8 mg and 16 mg vs placebo P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)