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Biomedical subjects

A C Van Elstraete

Publications and source records attributed to A C Van Elstraete.

12 recordsLinked to original sources
PubMed2004

Ketamine does not decrease postoperative pain after remifentanil-based anaesthesia for tonsillectomy in adults.

BACKGROUND: There are conflicting results concerning the pre-emptive effect of ketamine on central sensitization following surgery. The aim of this prospective, randomized, double-blind, placebo-controlled study was to assess the effect of the N-methyl-D-aspartate receptor antagonist ketamine on postoperative morphine consumption and pain score after remifentanil-based anaesthesia in adult patients scheduled for tonsillectomy. METHODS: We studied 40 adult patients undergoing elective tonsillectomy. Total intravenous anaesthesia was induced and maintained with remifentanil (0.125-1.0 microg kg(-1) min(-1)) and propofol target-controlled infusion. Patients in group K received a bolus dose of ketamine 0.5 mg kg(-1) immediately after anaesthetic induction, followed by a continuous infusion of 2 microg kg(-1) min(-1). Saline was administered in the same sequence in group S. Propofol, remifentanil, and the study drug infusions were discontinued at the end of surgery. RESULTS: Intraoperative remifentanil consumption (0.57 +/- 0.18 in group K vs. 0.55 +/- 0.14 microg kg(-1) min(-1) in group S), morphine requirement in the PACU (11 +/- 3 in group K vs. 9 +/- 4 mg in group S) and in the ward (22 +/- 11 in group K vs. 25 +/- 14 mg in group S), median time to first analgesia in the ward (338 +/- 126 in group K vs. 328 +/- 144 min in group S), and VAS pain scores were comparable in both groups. CONCLUSION: Small-dose of ketamine does not seem to be a useful adjunct to remifentanil-based anaesthesia during short, painful surgical procedures.

Adult↗
PubMed2001

Neostigmine added to lidocaine axillary plexus block for postoperative analgesia.

BACKGROUND AND OBJECTIVE: We have assessed the analgesic efficacy and side-effects of neostigmine when added to lidocaine for axillary brachial plexus block, in a prospective, randomized, double-blind, placebo-controlled study. METHODS: We studied 34 ASA I or II patients undergoing elective ambulatory carpal tunnel release. Axillary brachial plexus block was performed using a peripheral nerve stimulator to locate the median nerve. All patients were administered 1.5% lidocaine 450 mg and epinephrine 5 microg mL-1. Patients were allocated randomly to one of two groups. Neostigmine 500 microg was added in group N, and saline 1 mL in group S. RESULTS: The duration of analgesia did not significantly differ between groups [mean (SD)]: 812.5 (456.9) for group S vs. 746.7 (474.1) min for group N (P > 0.05). The need for supplementary analgesia did not significantly differ between groups: 4.4 (1.5) extra doses for group S vs. 3.8 (2.2) extra doses for group N (P > 0.05). Visual analogue pain scores and occurrence of side-effects did not significantly differ between groups. CONCLUSION: Neostigmine does not seem to be of clinical value for peripheral nerve blocks.

Aged↗
PubMed2000

Caudal clonidine for postoperative analgesia in adults.

We have assessed the analgesic efficacy and side effects of caudally administered clonidine in a prospective, randomized, double-blind, placebo-controlled study. We studied 64 adult patients undergoing elective haemorrhoidectomy. Caudal block was performed in all patients using a mixture of 0.5% bupivacaine 35 mg with 2% lidocaine 140 mg and epinephrine 5 micrograms ml-1. Patients were allocated randomly to one of two groups. Clonidine 75 micrograms was added in group C and saline 1 ml in group S. Median time to first analgesic requirements was significantly longer in group C (mean 729 (SD 120) min) than in group S (276 (131) min) (P = 0.01). Bradycardia occurred in seven patients in group C but did not affect mean arterial pressure.

Adult↗
PubMed1998

Nasotracheal intubation in patients with immobilized cervical spine: a comparison of tracheal tube cuff inflation and fiberoptic bronchoscopy.

UNLABELLED: Tracheal intubation may pose problems in patients with cervical spine injury (CSI). In patients without CSI, the success rate of blind nasotracheal intubation is increased by endotracheal tube (ETT) cuff inflation in the pharynx. The purpose of this study was to assess the efficacy of ETT cuff inflation in the pharynx as an aid to blind nasotracheal intubation in patients with an immobilized cervical spine. The technique was compared with fiberoptic bronchoscopy. Twenty ASA physical status I and II patients undergoing elective surgery in which the trachea was to be intubated nasally were enrolled in this prospective, randomized study. The cervical spine of each patient was immobilized. The trachea of each patient was intubated twice, once using fiberoptic bronchoscopy and once blindly using the technique of ETT cuff inflation in the pharynx. A maximum of three attempts was allowed for intubation using ETT cuff inflation. A maximum of 3 min was allowed for intubation using fiberoptic bronchoscopy. When ETT cuff inflation was used, intubation was successful in 19 of 20 patients (95%); the first attempt at intubation was successful in 14 of 20 patients (70%). Intubation was successful in 19 of 20 patients (95%) when using fiberoptic bronchoscopy. Mean times to intubate were 20.8 +/- 23 s when the ETT cuff was inflated in the pharynx and 60.1 +/- 56 s when using fiberoptic laryngoscopy (P < 0.01). We conclude that both ETT cuff inflation in the pharynx and fiberoptic bronchoscopy are valuable for nasotracheal intubation in patients with an immobilized cervical spine and that ETT cuff inflation can be used as an alternative to fiberoptic bronchoscopy in patients with CSI. IMPLICATIONS: We compared the technique of endotracheal tube cuff inflation in the pharynx for blind nasotracheal intubation in patients with an immobilized cervical spine with fiberoptic bronchoscopy. There was no significant difference between the success rates of the techniques.

Adolescent↗
PubMed1994

[Difficult intubation: nasotracheal tube cuff inflation as an aid to difficult intubation].

A case is reported of an unexpected difficult nasotracheal intubation for respiratory distress syndrome in a 72-yr-old obese woman with chronic obstructive pulmonary disease. After positioning the tip of the tracheal tube in the oropharynx, direct laryngoscopy did not allow exposure neither of the glottis nor of the corniculate cartilages. Fibreoptic tracheal intubation was decided. While preparing fibreoptic instruments, an attempt at blind intubation was performed. The tracheal tube cuff was inflated with 15 mL of air and then advanced gently until slight resistance was felt as the inflated cuff made contact with the vocal cords. At that time it was deflated and the tracheal tube advanced into the trachea. In the presence of normal pharyngeal anatomy, inflation of the tracheal tube cuff in the oropharynx is assumed to centre the tip of the tube and to direct it anteriorly towards the larynx. A recent prospective and randomized study has shown that tracheal tube cuff inflation in the oropharynx is effective in improving the success rate of blind nasotracheal intubation in paralysed patients with normal pharyngeal anatomy. Only case reports have shown the efficacy of tracheal tube cuff inflation in the pharynx as an aid to difficult blind nasotracheal intubation in emergency. Further controlled studies in this area would be valuable.

Aged↗
PubMed1993

Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia.

This study was designed to compare the efficacy of an ephedrine infusion with crystalloid administration for reducing the incidence of hypotension during spinal anesthesia. Fifty-four ASA I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 15 mL/kg of crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 70-90 mg of hyperbaric 5% lidocaine. Patients in the infusion group immediately thereafter received an ephedrine infusion at a rate of 5 mg/min for the first 2 min and then 1 mg/min for the next 18 min. The incidence of hypotension was 15/27 (55%) in the crystalloid group and 6/27 (22%) in the infusion group (P < 0.05). There was no significant difference between the groups in relation to the level of anesthesia or maximal heart rate, and hypertension did not occur in either group. We conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia and compares favorably with crystalloid administration in this patient population in terms of efficacy and incidence of side effects.

Adult↗