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Biomedical subjects

N R Connelly

Publications and source records attributed to N R Connelly.

At least 37 records · Page 2Linked to original sources
PubMed1999

Postoperative analgesia for outpatient arthroscopic knee surgery with intraarticular clonidine.

UNLABELLED: Intraarticular (i.a.) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Clonidine prolongs the duration of local anesthetics. We designed this study to determine whether clonidine added to an i.a. injection would result in an analgesic benefit. Fifty patients were randomly assigned to one of five groups that received clonidine (either via the subcutaneous or i.a. route) or saline placebo with or without i.a. bupivacaine, as follows: Group 1 received 30 mL of 0.25% bupivacaine i.a.; Group 2 received 30 mL of 0.25% bupivacaine with clonidine (1 microg/kg) i.a.; Group 3 received 30 mL of 0.25% bupivacaine i.a. and subcutaneous clonidine (1 microg/kg); Group 4 received 30 mL of 0.25% bupivacaine with epinephrine (5 microg/mL) i.a.; and Group 5 received clonidine (1 microg/kg) in 30 mL of saline i.a.. The results of this study revealed a significant difference in analgesia from the i.a. administration of clonidine. The group who received a combination of i.a. bupivacaine and clonidine had a significantly decreased need for oral postoperative analgesics and an increased analgesic duration (P < 0.0001). We conclude that i.a. clonidine improved comfort in patients undergoing knee arthroscopy. IMPLICATIONS: The intraarticular administration of clonidine along with bupivacaine results in a significant improvement in analgesia compared with either drug alone. There was an increased time to first analgesic request and a decreased need for postoperative analgesics.

Adult↗
PubMed1999

Postoperative analgesia with controlled-release oxycodone for outpatient anterior cruciate ligament surgery.

UNLABELLED: Reconstruction of the anterior cruciate ligament (ACL) of the knee is associated with a considerable degree of postoperative pain. Although immediate-release oral opioids are usually effective in relieving moderate to severe pain, they must be given every 4-6 h. A controlled-release (CR) formulation of oxycodone maintains therapeutic opioid concentrations for a more prolonged period, thus providing sustained pain relief. We designed this study to determine whether CR oxycodone is more effective and clinically acceptable than immediate-release oxycodone for managing pain after ambulatory ACL repair surgery. All patients received a standard general anesthetic and postoperative analgesic regimen with one of three oxycodone dosing regimens: oxycodone 10 mg every 4 h as needed, oxycodone 10 mg every 4 h, and CR oxycodone 20 mg every 12 h. Rescue analgesic consisted of oxycodone 5 mg every 6 h as needed. At 24, 36, 48, 60, and 72 h, there was a difference in pain scores among the groups (P < 0.0001); there was less pain in the CR oxycodone group. At most times, the fixed-dose group had lower pain scores than the as-needed group. The sedation scores were significantly different at 12 h (P < 0.02) and at 24, 36, 48, 60, and 72 h (P < 0.0001); the patients were more alert in the CR oxycodone group. The 72-h consumption of oxycodone was less in the CR oxycodone group (P < 0.0001). The patients had less sleep disturbance (P < 0.0001), were more satisfied (P < 0.0001), and experienced less vomiting (P < 0.02) in the CR oxycodone group compared with the other two groups. In conclusion, using CR oxycodone in the immediate 72 h after ambulatory ACL surgery provides more effective analgesia with less sedation, sleep disturbance, and postoperative vomiting compared with oxycodone prescribed on either a fixed dose or as-needed schedule. IMPLICATIONS: A controlled-release formulation of oxycodone in patients undergoing anterior cruciate ligament repair on an ambulatory basis provides significant analgesic benefit and a lowering of side effects compared with either fixed-dose or as-needed oxycodone regimens.

Adult↗
PubMed1998

Pregnancy and delivery in a patient with recent peripartum cardiomyopathy.

We present a case of successful pregnancy and delivery in a patient with peripartum cardiomyopathy who conceived only 3 months after a vaginal delivery complicated by peripartum cardiomyopathy. Following the onset of labor, an arterial pressure catheter and pulmonary artery catheter were placed. A combined epidural spinal technique was performed without difficulty for labor analgesia. After a few hours of labor, the fetal heart rate tracing revealed repetitive variable decelerations, and a decision was made to proceed with operative delivery. The mother's hemodynamic changes are presented, and the specifics of the anesthetic care are outlined.

Journal Article↗
PubMed1998

Dose-response of ketorolac as an adjunct to patient-controlled analgesia morphine in patients after spinal fusion surgery.

UNLABELLED: This randomized, blind study was designed to determine the appropriate dose of ketorolac (a drug used as a supplement to opioids) to administer to patients who have undergone spinal stabilization surgery. The ketorolac was administered every 6 h, in addition to patient-controlled analgesia (PCA) with morphine, to 70 inpatients undergoing spine stabilization by one surgeon. The study was performed to determine the analgesic efficacy and incidence of side effects with different doses of ketorolac. The patients were divided into seven groups. They were given either i.v. saline (control group) or i.v. ketorolac (5, 7.5, 10, 12.5, 15, or 30 mg) every 6 h. The outcomes measured included pain scores, 24-h morphine usage, level of sedation, and side effect profile six times during the first 24 h postoperatively. The total dose of morphine was significantly larger in the control and 5 mg ketorolac groups than in the other five groups. Morphine consumption was similar in all groups receiving > or = 7.5 mg of ketorolac. The pain scores were significantly higher in the control group than in some of the larger dose groups at three of the study intervals. The 5 mg group had higher pain scores than the other groups at most of the time intervals studied. There were no significant differences in pain scores among the other five groups. Sedation scores were higher (i.e., patients were more sedated) in the control group than in the other six groups at three of the time periods. We conclude that the administration of ketorolac 7.5 mg every 6 h has a morphine-sparing effect equivalent to that of larger doses in patients undergoing spine stabilization surgery. Using larger doses of ketorolac did not result in less somnolence, lower morphine use, or less pain. We recommend that ketorolac 7.5 mg be given every 6 h to patients undergoing spinal fusion surgery in addition to PCA morphine. IMPLICATIONS: Using smaller doses of ketorolac (e.g., 7.5 mg every 6 h) as a supplement to morphine patient-controlled analgesia is as effective as larger doses in patients who have undergone spine stabilization surgery.

Adult↗
PubMed1998

Intrathecal sufentanil versus epidural lidocaine with epinephrine and sufentanil for early labor analgesia.

UNLABELLED: Intrathecal sufentanil provides approximately 2 h of excellent labor analgesia with minimal motor blockade. Epidural sufentanil has received less scrutiny but may provide the same benefits as intrathecal sufentanil. In this study, we compared epidural sufentanil 40 microg after a lidocaine with an epinephrine test dose with intrathecal (i.t.) sufentanil 10 microg with respect to onset and duration of analgesia, degree of motor block, side effect profile, and mode of delivery. Seventy ASA physical status I or II parturients in early labor (< or = 4 cm cervical dilation) were randomized to receive either i.t. sufentanil 10 microg with a combined spinal-epidural technique (CSE) or epidural sufentanil 40 microg (e.p.) after epidural catheter placement and testing with 3 mL of 1.5% lidocaine with epinephrine (15 microg). After the administration of analgesia, pain scores and side effects were recorded for each patient at 5, 10, 15, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used. The study period was completed when the patients requested additional analgesia. All patients, except one, achieved adequate analgesia with the initial study dose and satisfactorily completed the study. There were no demographic differences between the two groups. Pain relief was rapid for all patients; pain scores were significantly lower at 5 and 10 min in the i.t. group versus the e.p. group. The mean duration of analgesia was similar between the e.p. group (127 +/- 40 min) and the i.t. group (110 +/- 48 min). No patient experienced any motor block. Side effects were similar between the two groups, except for pruritus-both the incidence and severity were significantly more profound at 5, 10, 15, 20, and 30 min in the i.t. group. There was no difference in time from analgesic to delivery, incidence of operative or assisted delivery, or cervical dilation at the time of redose. For early laboring patients, epidural sufentanil 40 microg after a lidocaine test dose provides analgesia comparable to that of i.t. sufentanil 10 microg with less pruritus. IMPLICATIONS: We compared the efficacy and side effects of intrathecal sufentanil with epidural sufentanil with a local anesthetic test dose for analgesia during labor. Analgesia was equally good, although the intrathecal group experienced more itching.

Adult↗
PubMed1998

Gastric contents in children presenting for upper endoscopy.

UNLABELLED: Previous studies of gastric contents in children presenting for surgery specifically excluded those with gastrointestinal disorders. Because these children often need sedation or anesthesia for procedures such as upper endoscopy, it is important to determine the gastric fluid volume and pH in this group to better characterize their risk of aspiration. We therefore analyzed the gastric fluid volume and pH of children with a variety of gastrointestinal symptoms presenting for upper endoscopy. After obtaining institutional review board approval, the stomach contents of 248 children (aged 2 mo to 18 yr) presenting for upper endoscopy were prospectively measured under direct endoscopic vision. Children were fasted for both solids and liquids for at least 6 h (<6 mo) or 8 h (>6 mo). Gastric fluid pH was measured using pH paper. Children received either deep sedation or general anesthesia and were grouped according to their presenting diagnosis. Results were analyzed by using analysis of variance, Kruskal-Wallis, and correlation (P value < 0.05). The mean gastric fluid volume was 0.35 +/- 0.45 mL/kg (range 0-3.14 mL/kg), and the mean gastric fluid pH was 1.37 +/- 1.6 (range 1-7). Of the children, 33% had gastric fluid volumes >0.4 mL/kg, 87% had gastric fluid pH <2.5, and 30% had gastric fluid volume >0.4 mL/kg and pH <2.5. Children with the presenting complaint of abdominal pain had the largest gastric fluid volumes. These data are not appreciably different from historical controls (healthy children fasted for an equivalent period of time who did not have gastrointestinal symptoms). IMPLICATIONS: When fasted for at least 6-8 h, children with a history of gastrointestinal symptoms presenting for upper endoscopy did not have gastric contents with increased volume and acidity compared with previously published groups of children without gastric symptoms who were fasted the same length of time. These results do not support the argument that children with gastrointestinal symptoms pose an increased anesthetic risk for aspiration.

Adolescent↗
PubMed1997

The adult Bullard laryngoscope in paediatric patients.

PURPOSE: The adult Bullard laryngoscope (BL) is effective in managing both normal and abnormal airways. Although its name implies use in the adult population, its size does not preclude its use in paediatric patients. Thus we evaluated whether the adult BL could be used in the paediatric population and whether its efficacy was related to age, weight, or height. METHODS: Fifty consecutive patients, between the ages of 1 and 10 years and scheduled for general anaesthesia, were examined. Exclusion criteria included obvious craniofacial abnormalities or indications for rapid sequence intubation. All patients had intravenous access secured before laryngoscopy. The laryngeal view, attempts at intubation, time to intubation and the reason for any difficulty with intubation were recorded. Correlation was then sought relating attempts and time to intubation with age, weight and height. RESULTS: Mean time to intubation was 38 +/- 13 sec. Multiple attempts occurred most frequently because of right aryepiglottic fold contact or anterior vocal cord contact. The latter appears to be unique to the adult BL use in the paediatric population. No relationship was found between the time to intubation and age, height, or weight. Four tracheas, all in patients < 38 mo, could not be intubated with the BL after four attempts. CONCLUSION: The adult BL appears to be an effective alternative tool in the management of the normal paediatric airway.

Adult↗
PubMed1997

Nalmefene or naloxone for preventing intrathecal opioid mediated side effects in cesarean delivery patients.

This study was designed to evaluate the efficacy of nalmefene vs. naloxone in preventing side effects resulting from intrathecal opioids, in patients undergoing cesarean delivery. Eighty patients who were scheduled for elective cesarean delivery under spinal anesthesia were included in a double-blind, placebo-controlled study. Patients were randomized into four groups: saline; intravenous nalmefene 0.25 micro.kg(-1) every 12 h x 2; intravenous nalmefene 0.5 microg.kg(-1) every 12 h x 2; and naloxone infusion 48 microg.h(-1) (1.2 microg.ml(-1)). There were no significant differences among the groups with respect to pain, sedation, satisfaction, or the occurrence or treatment of pruritus or nausea. There was a significant difference among the groups with respect to the occurrence of vomiting (P < 0.03): both nalmefene groups had a higher rate of vomiting than did the control group; the 0.25 microg.kg(-1) nalmefene group had a higher rate than did the naloxone group. The use of narcotic antagonists does not result in improved comfort in obstetrical patients receiving intrathecal morphine and fentanyl.

Clinical Trial↗
PubMed1996

The use of the iSTAT portable analyzer in patients undergoing cardiopulmonary bypass.

OBJECTIVE: To evaluate the utility of the iSTAT blood analyzer, a bedside device for hematocrit, sodium, potassium, and glucose measurement during cardiopulmonary bypass (CPB). METHODS: Forty patients scheduled for elective CPB were evaluated prospectively. In addition to using the iSTAT analyzer, blood samples were analyzed at four time points: following induction of anesthetic, 10 min. after initiation of CPB, 60 min. after initiation of CPB, and following heparin neutralization by protamine. Blood glucose concentration was measured by the hospital laboratory using a Kodak Analyzer and by a glucose meter, electrolytes were evaluated by the Kodak Analyzer and BGE (a device which is commonly used for "satellite laboratory" determinations of electrolyte and blood gas results), and hematocrit samples were measured by the hospital laboratory using an NE 8,000 and a centrifuge. The means and standard deviations of the differences between the methods were calculated. RESULTS: The hematocrit values determined by the iSTAT machine, when adjusted for the level of total protein (according to manufacturer's directions), differed from the laboratory values by 0.53 +/- 1.46 percentage points. An alternative to measuring total protein and making the adjustment is simply adding 1% to the hematocrit in the pre-CPB period and 3% on-CPB or post-CPB, which we found to yield values that differed from the laboratory by 0.52 +/- 1.42 percentage points. For all four tests (hematocrit, sodium, potassium, and glucose) the iSTAT had a similar relationship to the laboratory values as did the other commonly used means (centrifuge, BGE, and glucose meter) of clinical evaluation. CONCLUSION: In summary, we found that in patients undergoing CPB, the iSTAT values agreed sufficiently well with standard laboratory values and that the iSTAT instrument can be relied upon for bedside measurements.

Blood Chemical Analysis↗
PubMed1996

Discomfort associated with regional anesthetic placement in obstetrics: does alkalinization help?

Lidocaine is commonly used prior to intravenous catheter insertion as well as before instituting a regional anesthetic[ but it often causes a burning discomfort during injection. We undertook this study to determine if the addition of bicarbonate to lidocaine would decrease the discomfort associated with the initiation of regional anesthesia in obstetrics. Forty patients who were scheduled for elective cesarean section or who were in active labor were selected. Lidocaine was prepared before infiltration using 9 ml of preservative-free 1% lidocaine with either 1 ml of preservative-free normal saline or 1 ml of sodium bicarbonate (1 mEq.ml(-1)). A skin wheal was raised with 0.5 ml of the solution; the remainder (1.5 ml) was injected into the deep tissues. Pain was assessed using visual analog scales on three occasions, immediately after lidocaine placement, following introducer needle insertion (in the spinal group) or following epidural needle insertion (in the epidural group), and following the successful placement of the local anesthetic (in the spinal group) or the epidural catheter (in the epidural group). There was no difference in the visual analog scale scores at any of the assessment periods. We found no benefit from adding sodium bicarbonate to lidocaine used for infiltration before needle placement when initiating an obstetrical regional anesthetic.

Journal Article↗
PubMed1996

Postarthroscopic meniscus repair analgesia with intraarticular ketorolac or morphine.

Both ketorolac, a nonsteroidal antiinflammatory drug, and morphine, an opioid agonist, provide enhanced patient analgesia after arthroscopic knee surgery when administered via the intraarticular route. This study was designed to determine whether ketorolac or morphine results in better patient analgesia and whether their combination would provide superior analgesia to either drug alone. Patients undergoing arthroscopic knee meniscus repair under local anesthesia with sedation were evaluated. Each of the study groups evaluated received ketorolac (either via the parenteral or intraarticular route) and morphine (via either the parenteral or intraarticular route). This study revealed a significant benefit from the individual intraarticular administration of both morphine and ketorolac. The combination of these drugs did not result in decreased postoperative pain or need for postoperative analgesics, and it did not result in an increased analgesic duration. We conclude that the use of either intraarticular ketorolac or intraarticular morphine improves the comfort in patients undergoing arthroscopic meniscus repair and that their combination offers no advantage over either drug alone.

Adult↗
PubMed1995

Recovery of train-of-four after mivacurium.

The present study was designed to determine the time-course of recovery of the train-of-four (TOF) ratio during spontaneous recovery from mivacurium-induced block. Fifteen patients, free of neuromuscular disease, undergoing general endotracheal anaesthesia with isoflurane were studied. After anaesthetic induction, patients received a bolus dose of mivacurium 0.15 mg.kg-1. The TOF was then recorded continuously every 12 sec with a mechanogram (adductor pollicis monitor). When the TOF ratio recovered spontaneously to 0.9, an additional 0.05 mg.kg-1 of mivacurium was given. The durations required for recovery from a TOF ratio of 0.3 to 0.7 (DUR0.3-0.7) and from a TOF ratio of 0.3 to 0.9 (DUR0.3-0.9) were determined. The DUR0.3-0.7 averaged 7.0 +/- 2.5 min (range 3.4-12.2 min). The DUR0.3-0.9 averaged 11.8 +/- 3.9 min (range 6.0-20.2 min). There was no evidence of prolongation of recovery times (cumulation) following repeated dosing. The present data indicate that, in patients with normal cholinesterase activity (clinical duration 7-25 min), waiting 20 min beyond the time when fade is no longer apparent by visual or tactile evaluation is sufficient to attain a TOF ratio greater than 0.7-0.9 during spontaneous recovery from mivacurium, and may enable anaesthetists to avoid antagonism of mivacurium-induced block.

Adolescent↗
PubMed1995

Postoperative analgesia for outpatient arthroscopic knee sugery with intraarticular bupivacaine and ketorolac.

Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Systemic ketorolac is also useful in the management of these patients. Ketorolac, a nonsteroidal antiinflammatory drug (NSAID), alters the sensitivity of peripheral nociceptors by reducing the local concentration of allogenic chemicals which are activated by peripheral tissue injury. It is interesting to speculate that placing a NSAID at the site of injury might result in more profound pain relief. However, IA ketorolac has not been evaluated in arthroscopic patients. This study thus was designed to determine which regimen would result in the most effective analgesic benefit. The four groups evaluated received ketorolac (either via the parenteral or IA route) or saline placebo with or without IA bupivacaine, as follows: Group 1 received IA bupivacaine; Group 2, intravenous ketorolac and IA bupivacaine; Group 3, IA bupivacaine with ketorolac; and Group 4, IA ketorolac. The results of this study revealed a significant difference in analgesia from the IA administration of ketorolac. The group who received a combination of IA bupivacaine and IA ketorolac had decreased postoperative pain, a decreased need for postoperative analgesics, and an increased analgesic duration. We conclude that the use of IA ketorolac improved comfort in patients undergoing knee arthroscopy.

Adult↗