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Biomedical subjects

Joseph E Pellegrini

Publications and source records attributed to Joseph E Pellegrini.

7 recordsLinked to original sources
PubMed2006

The effect of transdermal scopolamine on the incidence and severity of postoperative nausea and vomiting in a group of high-risk patients given prophylactic intravenous ondansetron.

Specific risk factors place patients at greater risk for postoperative nausea and vomiting (PONV). Routinely, these patients are treated prophylactically with intravenous (IV) ondansetron or transdermal (TD) scopolamine. No study has examined what effect using a combination of these prophylactic treatments would have on the incidence of PONV in a group of high-risk patients. A total of 56 patients at high risk for PONV were treated prophylactically with IV ondansetron and randomized to receive a TD scopolamine patch or placebo. Demographics, incidence, and severity of PONV and side effects and antiemetic requirements were measured. Nausea was measured using a 0 to 10 verbal numeric rating scale. Descriptive and inferential statistics were used for analysis. No difference in demographics or the incidence of side effects was noted between groups. Patients in the scopolamine group had a lower incidence of PONV (P = .043), longer time to first reported nausea (P = .044), longer time to first episode of emesis (P = .031), and decreased supplemental antiemetic requirements (P = .016) compared with the placebo group. Based on this study, we recommend using a combination of TD scopolamine and IV ondansetron to prevent PONV in patients identified as high risk for PONV.

Administration, Cutaneous↗
PubMed2006

Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid.

We conducted a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. Specific variables analyzed included overall success rates, time to achieve sensory and motor anesthesia, time to place block, and incidence of side effects. For the study, 81 patients were randomized to receive a brachial plexus blockade using the IS or ISCM approach followed by general anesthesia for their surgical procedure. Intraoperative analgesics were controlled for in both groups. No differences in demographics, block success rate, pain scale scores, and analgesia duration were noted between groups. The ISCM group required less time to complete the block (7.08 +/- 2.9 min) compared with the IS group (9.62 +/- 5.31 min) (P = .039), achieved a significantly higher rate of complete motor and sensory block at 30 minutes (P = .032), and had fewer side effects (P = .049). Based on our results, we found that using the ISCM approach to the brachial plexus resulted in a faster onset of anesthesia and a higher ratio of complete block at 30 minutes compared with the IS approach.

Adolescent↗
PubMed2005

The effect of Pencan needle orientation on spinal anesthesia outcomes.

Slow resolution of block and incidence of side effects deter many practitioners from choosing spinal anesthesia for out-patient surgical procedures. Some studies suggest that controlling bevel or side port orientation of a spinal needle during anesthetic injection can affect occurrence of side effects and time to block resolution. The objective of this study was to determine the effects of varying Pencan spinal needle (B-Braun, Bethlehem, Pa) side port orientations on duration of block and incidence of side effects in groups of patients receiving spinal anesthesia. We randomized 87 subjects scheduled for spinal anesthesia to receive a spinal anesthesia injection using a cephalad, lateral, or caudad side port orientation. Onset, duration, block height, incidence of side effects, and analgesic requirements were among the variables measured. No difference in onset, duration, or analgesic requirements was noted among groups. Differences were noted in time to discharge from the hospital (P = .027) and time to first voiding (P = .023) in the lateral compared with the cephalad and caudad orientation groups. Patients in whom the lateral needle side port orientation was used for injection were discharged earlier and had fewer side effects. This could translate into significant savings, financially and in terms of staff requirements.

Adjuvants, Anesthesia↗
PubMed2003

Comparison of inhaled isopropyl alcohol and intravenous ondansetron for treatment of postoperative nausea.

Postoperative nausea, a common complication in patients receiving general anesthesia, was studied in this randomized investigation to compare the efficacy of 70% inhaled isopropyl alcohol and intravenous ondansetron. For the study, 100 healthy women, ASA physical status I or II, scheduled for outpatient gynecologic laparoscopic procedures randomly received 4 mg of intravenous ondansetron or isopropyl alcohol for the treatment of postoperative nausea. Nausea was measured on arrival to the postanesthesia care unit, at first complaint of nausea, every 5 minutes after initiation of therapy until nausea resolution, and every 15 minutes thereafter using a 0 to 10 verbal numerical rating scale. At 5, 10, and 15 minutes, the median verbal numerical rating scores between the ondansetron and alcohol groups were 6.00 and 3.00, 5.00 and 3.00, and 5.00 and 2.00, respectively (P = .002, .015, and .036, respectively). No statistically significant differences were found at any other time interval. Mean times from initiation of therapy to a 50% reduction in nausea between the ondansetron and alcohol groups were 6.3 minutes and 27.7 minutes, respectively (P = 0.022). Based on this study, it seems postoperative nausea can be resolved quicker using 70% inhaled isopropyl alcohol compared with intravenous ondansetron in women undergoing outpatient gynecologic laparoscopic procedures.

2-Propanol↗
PubMed2003

An evaluation of the histological effects of intra-articular methadone in the canine model.

Methadone hydrochloride is an opiate that has pharmacodynamic and pharmacokinetic properties that suggest it may provide longer analgesia than morphine when administered via the intra-articular route. However, no studies to date have been conducted examining the effects of intra-articular methadone hydrochloride on local tissues. Therefore, the purpose of this study was to determine the histopathologic effects of intra-articular methadone hydrochloride on local tissues in the canine knee. Nine canines, 1 to 4 years old, weighing between 20 kg and 23 kg were used. All canines had their knees randomized to receive either bupivacaine, 0.5% with epinephrine 1:200,000 (4.5 mL), and 5 mg methadone hydrochloride (0.5 mL) for the study knee, or bupivacaine, 0.5% with epinephrine 1:200,000 (4.5 mL), and 0.5 mL normal saline for the control knee. Serum methadone hydrochloride levels were obtained on all canines at 6 and 24 hours. Canines were randomly assigned to 1 of 3 groups to be euthanized at either 24 hours, 14 days, or 28 days. Following euthanization and necropsy, synovial fluid levels and tissue samples were obtained and examined for histopathologic changes. Synovial fluid samples noted a few white blood cells at 24 hours and none at 14 and 28 days. Tissue samples showed no histopathologic changes, and serum concentration levels of methadone hydrochloride were negligible.

Analgesics, Opioid↗
PubMed2003

Comparison of the effects of propofol versus thiopental induction on postoperative outcomes following surgical procedures longer than 2 hours.

The use of propofol as an induction agent for surgeries lasting less than 2 hours has been shown to result in a faster emergence from anesthesia. Our study was performed to analyze the impact of propofol on surgical procedures lasting longer than 2 hours. A convenience sample of 84 men and women undergoing nonemergency laparoscopic procedures scheduled for longer than 2 hours were enrolled in this prospective study and randomly assigned to receive a standardized induction with thiopental or propofol. Nausea and pain were measured using a 0 to 10 verbal numeric rating scale. Recovery from anesthesia was measured using a modified Newman Bender Motor Gestalt Test. Statistical analysis was used to analyze all ordinal and interval data. A P value of less than, 05 was considered significant. No differences were found between the propofol and thiopental groups in demographics, total surgical time, anesthesia time, recovery times, postoperative analgesic and emetic requirements, satisfaction scores, or incidence of nausea and vomiting. Discharge times from the postanesthesia care unit and to home were similar between groups. Based on the results, we concluded that propofol offered no advantages over thiopental in postoperative outcomes in laparoscopic surgical procedures longer than 2 hours.

Adult↗