Omeprazole before emergency caesarean section.
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Anti-Ulcer Agents↗
Biomedical subjects
T Gin
Publications and source records attributed to T Gin.
Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting after major gynaecological surgery.
The efficacy of ondansetron 4 mg was compared with metoclopramide 10 mg for the prevention of post-operative nausea and vomiting in patients after major gynaecological abdominal surgery. Anaesthesia was standardized using thiopentone, atracurium and methadone for induction followed by isoflurane in nitrous oxide-oxygen mixture. Fifty patients were randomized in a double-blind fashion to either receive intravenous (i.v.) ondansetron 4 mg or metoclopramide 10 mg during closure of the pelvic peritoneum. The incidence and frequency of vomiting, and the incidence of severe nausea was recorded for 24 h after surgery. One patient was excluded because of respiratory depression. In the first 4 h after surgery, five patients (20%) in the ondansetron group (n = 25) and eight patients (33%) in the metoclopramide group (n = 24) vomited, whereas at 4-12 h, this increased to 11 patients (44%) and nine patients (37.5%) respectively. The incidence was 52 and 37.5% respectively in the subsequent 12-24 h. The highest incidence of nausea was in the first 4 h after surgery, being 56 and 37.5% in the ondansetron and the metoclopramide groups respectively. This decreased to less than 25% in both groups in the 12-24 h period. Ondansetron 4 mg and metoclopramide 10 mg had similar but short lasting efficacy for the prevention of vomiting in patients who received continued opioid analgesia after major gynaecological surgery.
Adolescent↗
CSF progesterone and spread of subarachnoid anaesthesia in pregnancy.
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Anesthesia, Obstetrical↗
Epidural meperidine after cesarean section. A dose-response study.
BACKGROUND: Epidural meperidine is effective for postoperative analgesia, but the optimum dose has not been evaluated. METHODS: Five doses of epidural meperidine (12.5, 25, 50, 75, and 100 mg) given at the first request for analgesia after cesarean section were compared. Visual analog pain scores, duration of analgesia as defined by time to first patient-controlled epidural analgesia demand, plasma concentrations of meperidine, side effects, and subsequent 24-h consumption of meperidine were evaluated. RESULTS: All doses were effective, but patients took longer to become pain-free after 12.5 mg (median 30 min) compared with 25 mg (median 12 min, P = 0.038), and duration of analgesia was shorter after 12.5 mg (median 83 min) compared with 25 mg (median 165 min, P = 0.0005). Increasing dose to more than 25 mg did not improve onset or duration of analgesia. Plasma concentrations of meperidine were less than minimum effective analgesia concentration for all doses except 100 mg. There was more frequent nausea (P = 0.004) and dizziness (P = 0.0002) after 100 mg compared with smaller doses. CONCLUSIONS: Epidural meperidine provides effective postoperative analgesia, although of relatively short duration. A single dose of 25 mg is superior to 12.5 mg, but there is no benefit from increasing the dose to 50 mg or greater.
Adult↗
Minimum alveolar concentration of halothane and enflurane are decreased in early pregnancy.
BACKGROUND: Minimum alveolar concentration (MAC) of isoflurane is decreased in early pregnancy but it is not known whether this occurs to the same extent with other inhalational anesthetics. The MAC of halothane and enflurane were compared in pregnant women undergoing elective termination of pregnancy and in nonpregnant women. METHODS: We studied 16 pregnant women scheduled for termination of pregnancy at 8 to 13 weeks gestation and 16 non-pregnant patients undergoing laparoscopic sterilization. Eight patients in each group received halothane and the others received enflurane. After inhalational induction of anesthesia and tracheal intubation, MAC was determined in each patient by observing the motor response to a 10-s, 50-Hz, 80-mA transcutaneous electric tetanic stimulus to the ulnar nerve at varying concentrations of either halothane or enflurane. The end-tidal concentration of inhalational anesthetic was kept constant for at least 15 min before each stimulus and the concentration was varied ultimately in steps of 0.05 vol% (halothane) or 0.10 vol% (enflurane) until a sequence of three alternate responses (move, not move, move) or (not move, move, not move) was obtained. Minimum alveolar concentration for each person was taken as the mean of the two concentrations just permitting and just preventing movement, and MAC for the group was the median of individual MAC values. Confidence intervals were calculated for the percentage decrease in MAC for pregnant women compared with nonpregnant women. RESULTS: The median (range) MAC of halothane, 0.58 vol% (0.53 to 0.58), and enflurane, 1.15 vol% (0.95-1.25), in the pregnant women were less than those in the nonpregnant women, 0.75 vol% (0.70 to 0.78), P = 0.0005 and 1.65 vol% (1.45 to 1.75), P = 0.0007, respectively. The percentage decrease (95% CI) in MAC for pregnant women was 27% (20 to 27%) for halothane and 30% (24 to 36%) for enflurane. CONCLUSIONS: The MAC of halothane and enflurane were reduced by a similar degree in pregnant women at 8 to 13 weeks gestation compared with nonpregnant women.
Adolescent↗
Acid aspiration prophylaxis for emergency Caesarean section.
Over a 3.5 year period, 384 patients requiring emergency Caesarean section under general anaesthesia received at random one of six acid aspiration prophylaxis regimens as soon as the decision was made for surgery. In the first phase of the study, sodium citrate administered orally 0.3 M, 30 ml (group C, n = 120) was compared with metoclopramide 10 mg administered intravenously and sodium citrate (group MC, n = 65). In the second phase, all patients received sodium citrate, and either intravenous administration of ranitidine 50 mg (group RC, n = 50), omeprazole 40 mg (group OC, n = 50), ranitidine 50 mg with metoclopramide 10 mg (group RMC, n = 50) or omeprazole 40 mg with metoclopramide 10 mg (group OMC, n = 49). Gastric contents were aspirated using a 16 FG Salem sump tube and acidity measured with a pH meter. Non-parametric tests were used for comparisons. There was no difference in gastric volume or pH between groups C and MC, or among OC, RC, OMC and RMC. After pooling the data, median (range) gastric volume in groups C and MC (55 (0-360) ml) was greater than in groups OMC and RMC (40 (3-270) ml, p < 0.05). Median (range) pH was lower in groups C and MC (4.97 (0.76-6.99)) than in groups OC, RC, OMC and RMC (5.76 (1.11-7.5), p < 0.001). The proportion of patients with pH < 3.5 and volume > 25 ml in the C and MC groups (43/185) was greater than that in the OC, RC, OMC and RMC groups (18/199, p < 0.001). Ranitidine and omeprazole administered intravenously were equally effective adjuncts to sodium citrate in reducing gastric acidity for emergency Caesarean section. Compared with sodium citrate alone, the addition of either ranitidine, omeprazole or metoclopramide alone did not reduce gastric volume while small reductions in gastric volume were seen with the addition of metoclopramide and either ranitidine or omeprazole.
Adult↗
Evaluation of a disposable device for patient-controlled epidural analgesia after caesarean section.
We evaluated a disposable device (Baxter PCA Infusor) for patient-controlled epidural analgesia (PCEA) using pethidine in twenty women after lower segment caesarean section. Efficacy, as measured by visual analogue pain scores, was comparable with historical controls from PCEA studies using electronic devices. Three patients reported inadequate analgesia, attributable in two cases to problems with epidural catheter. PCEA was stopped in one patient because of side-effects. Pethidine consumption ranged from 125 to 1500 mg (median 575 mg) in 48 hours. Plasma concentrations of pethidine varied widely. Disposable devices for PCEA after caesarean section provide an alternative to bolus administration or PCEA using more expensive and cumbersome electronic devices, although we suggest currently available apparatus requires modifications to improve clinical performance.
Adult↗
Organ specificity of antihypertensive therapy on ocular albumin vascular clearance and albuminuria in the hypertensive diabetic rat.
PURPOSE: The contributions of hypertension and diabetes to microvascular dysfunction in the kidney and eye were investigated. Two indices of microvascular dysfunction, urinary albumin excretion rate (AER) and albumin vascular clearance (AVC) in the eye, were studied in control and streptozocin diabetic Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR). METHODS: Studies were performed on four groups of untreated rats--nondiabetic and diabetic WKY and nondiabetic and diabetic SHR--and on three groups of diabetic SHR treated with a converting enzyme inhibitor (perindopril), a calcium-channel blocker (lacidipine), or triple therapy (hydrochlorothiazide, reserpine, and hydralazine). In all rats, AER and AVC were measured at 16 weeks. RESULTS: There was a progressive increase in both parameters in the order WKY, diabetic WKY, SHR, and diabetic SHR. When compared with nondiabetic WKY, diabetic SHR showed an approximately 30-fold increase in AER and an approximately threefold increase in AVC. Treatment of diabetic SHR with perindopril or triple therapy normalized AER compared to an equihypotensive dose of lacidipine, which had no effect. By contrast, the three antihypertensive regimens showed a different order of efficacy in preventing increases in ocular AVC. In diabetic SHR, the increase in retinal AVC was prevented largely by lacidipine, whereas the other two antihypertensive regimens showed lesser effects [AVC expressed as percentage nondiabetic WKY: untreated diabetic SHR 278% +/- 47%, lacidipine 93% +/- 10% (P < 0.001), triple therapy 132% +/- 37% (P < 0.05), and perindopril 167% +/- 9% (P < 0.05)]. Lacidipine also prevented the increase in AVC of the anterior and posterior uvea. By contrast, increases in AVC observed in the diabetic SHR were not prevented by perindopril in the posterior uvea or by triple therapy in the anterior uvea. Thus, hypertension and diabetes increased ocular AVC and AER, and effective antihypertensive therapy substantially prevented changes in both parameters. However, despite equivalent levels of blood pressure control for each regimen, discordant effects were noted on AVC and AER. Perindopril was associated with significantly lower AER than lacidipine, whereas lacidipine was more potent in preventing increases in ocular AVC. CONCLUSIONS: Results of this study suggest that different antihypertensive regimens in the diabetic rat may exert organ-specific effects on the retina and kidney despite equivalent effects on systemic blood pressure. These data also raise the possibility that retinal microvascular dysfunction in diabetes is ameliorated more readily by calcium-channel blockade than by converting-enzyme inhibition, whereas the reverse applies to renal microvascular dysfunction, as reflected by albuminuria.
Albuminuria↗
Gastric emptying following brain injury: effects of choice of sedation and intracranial pressure.
OBJECTIVE: To compare the effects of opioid and non-opioid sedation on gastric emptying. DESIGN: Prospective, randomized trial. SETTING: University teaching hospital ICU. PATIENTS: 21 brain injured patients requiring sedation, mechanical ventilation and intracranial pressure (ICP) monitoring for > 24 h. INTERVENTIONS: Patients were randomized to receive infusions of either morphine plus midazolam (M), or propofol (P). Gastric emptying was assessed by the paracetamol absorption technique and by residual volumes following a 200 ml test feed. MEASUREMENTS AND RESULTS: Pre-sedation Glasgow Coma Score, mean ICP and the presence of bowel sounds were noted. Plasma concentrations of paracetamol were measured over 3 h following a 1 g gastric dose. There were no differences in median peak paracetamol concentration (M, 18.5 versus P, 20.8 mg/l), median time to peak concentration (M, 20 versus P, 25 min), median area under the concentration-time curve (AUC), or in the median residual volumes at 1 h (M, 14 versus P, 10.5 ml) and 2 h (M, 5 versus P, 3 ml). In patients with ICP > 20 mmHg, paracetamol concentrations were lower (p < 0.05), and AUC after 30 min was lower (165 mg.min/l versus 411 mg.min/l, p = 0.023). Mean ICP was correlated with AUC (Kendall rank p = 0.027). Gastric emptying did not correlate with initial Glasgow Coma Score or presence of bowel sounds. CONCLUSIONS: Gastric emptying is not improved in patients with brain injury by avoiding morphine (1-8 mg/h) in the sedative regimen. Intracranial hypertension is associated with reduced gastric emptying.
Acetaminophen↗
Intravenous omeprazole before emergency cesarean section.
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Cesarean Section↗
Additive interactions between propofol and ketamine when used for anesthesia induction in female patients.
BACKGROUND: Propofol and ketamine may be paired for anesthesia induction and for total intravenous anesthesia. The nature of any sedative interactions occurring between propofol and ketamine are unknown. The combination when used for anesthesia induction in female patients was studied. METHODS: Quantal dose-response curves were determined in 180 female patients to whom the drugs were administered individually and in combination. Two minutes after administering the drugs, two endpoints were assessed. First, loss of response to verbal command (hypnosis) and then, in those who failed to respond to this endpoint, loss of response to a 5-s transcutaneous tetanus (anesthesia). Interactions were analyzed by fitting the data to a mathematical model in which response was analyzed in terms of the doses of the two drugs and an additional term included to describe nonadditive interactions. The incidences of apnea, arterial pressure, and heart rate changes during the first 5 min were recorded. RESULTS: At the hypnotic endpoint, the ED50s were 1.10 mg/kg propofol (95% CIs 0.93-1.27), 0.39 mg/kg ketamine (95% CIs 0.27-0.46), and the combination of 0.63 mg/kg propofol and 0.21 mg/kg ketamine (95% CIs 0.53/0.18-0.73/0.24). At the anesthetic endpoint, the ED50s were 1.85 mg/kg propofol (95% CIs 1.58-2.36) 0.66 mg/kg ketamine (95% CIs 0.58-0.77), and the combination of 1.05 mg/kg propofol and 0.35 mg/kg ketamine (95% CIs 0.88/0.29-1.27/0.42). The effects were additive at both endpoints; there was no evidence of an interaction. The ED50s for apnea were 1.61 mg/kg propofol (95% CIs 1.39-1.94), greater than 0.85 mg/kg ketamine and for the combination 1.50 mg/kg propofol and 0.50 mg/kg ketamine (95% CIs 1.15/0.38-3.09/1.03). The addition of ketamine did not significantly alter the ED50 for apnea of propofol. There was a significant difference in the arterial pressures among the three groups (P < 0.001). Using the combination, the cardiostimulant effects of ketamine balanced the cardiodepressant effects of propofol. There was no change in arterial pressure or heart rate after the noxious stimulus. CONCLUSIONS: When using the combination, doses were additive at hypnotic and anesthetic endpoints. Ketamine had no influence on the incidence of apnea after propofol, and the net hemodynamic effects were minimal.
Adult↗
Postpartum changes in the minimum alveolar concentration of isoflurane.
BACKGROUND: Minimum alveolar concentration (MAC) is decreased in pregnancy, but it is not known how quickly after delivery MAC returns to normal. We measured the MAC of isoflurane in a group of women undergoing elective tubal ligation after delivery. METHODS: After delivery, 20 patients underwent inhalational induction of anesthesia with isoflurane and tracheal intubation. MAC was determined in each patient by observing the response to a 10-s, 50-Hz, 80-mA transcutaneous tetanic electric stimulus to the ulnar nerve at various concentrations of isoflurane. The end-tidal concentration of isoflurane was kept constant for at least 10 min before each stimulus, and the concentration of isoflurane was ultimately varied in steps of 0.05 vol% until we obtained a sequence of three alternate responses: move-not move-move or not move-move-not move. The MAC for each subject was taken as the mean of the two concentrations just permitting and just preventing movement. A venous blood sample was taken immediately before induction of anesthesia for measurement of progesterone concentration. MAC was compared with time after delivery and plasma progesterone concentrations by Kendall's rank correlation. RESULTS: There was a positive correlation between MAC and the time after delivery (P < 0.001). The median MAC of isoflurane was 0.775 vol% (range 0.675-0.775 vol%) in five women 24-36 h postpartum. MAC was more variable, 0.825 vol% (0.675-0.975 vol%) in nine women 36-72 h postpartum, whereas six patients more than 72 h postpartum had a MAC of 1.125 vol% (1.025-1.175 vol%). The correlation between MAC and plasma progesterone concentration was almost statistically significant (P = 0.060). CONCLUSIONS: The MAC of isoflurane was reduced in women 24-36 h postpartum and gradually increased to normal values by 72 h postpartum.
Adult↗
Anaesthesia in an infant with Rubinstein-Taybi syndrome.
The anaesthetic management of a 5-month-old Chinese infant with Rubinstein-Taybi syndrome requiring bilateral inguinal hernia repairs is described. This is a rare congenital syndrome characterised by mental retardation, broad thumbs and first toes, craniofacial abnormalities, recurrent respiratory infections and, in one third of cases, congenital heart disease. General anaesthesia combined with caudal block was successfully used. The main complications encountered were minor difficulties with intubation and easily precipitated episodes of oxygen desaturation.
Anesthesia, Caudal↗
An adaptation of the objective structured clinical examination to a final year medical student course in anaesthesia and intensive care.
The Department of Anaesthesia and Intensive Care at the Chinese University of Hong Kong provides a 4 week course in our specialty for final year medical students. Our curriculum covers basic concepts in anaesthesia and intensive care, management of common medical emergencies and the safe performance of basic practical skills. For the last 4 years we have used an adaptation of the Objective Structured Clinical Examination to assess learning. Question stations included the use of manikins to assess practical skills, such as cardiopulmonary resuscitation and airway management, identification and description of the use of equipment and interpretation of clinical scenarios and investigations. We believe that our adaptation of the Objective Structural Clinical Examination is better than traditional methods of examination and it has allowed us to identify deficiencies in our teaching methods. The Objective Structured Clinical Examination has been well received by our students and is perceived by them to be a fair reflection of their level of knowledge and skill attainment during the course.
Anesthesiology↗
Pressure support ventilation during isoflurane anaesthesia.
We have studied the respiratory effects of 5 and 10 cmH2O pressure support ventilation during anaesthesia with 1.5% end-tidal concentration of isoflurane in nine healthy, spontaneously breathing, adult patients. Some of the patients demonstrated an irregular respiratory pattern with periods of apnoea and we therefore went on to study a further seven patients with a continuous 500 s recording of airflow. Pressure support ventilation augmented mean (SD) tidal volume from 212 (56) ml to 360 (88) ml at 5 cmH2O and to 509 (108) ml at 10 cmH2O (n = 16, p < 0.05). Mean (SD) respiratory rate decreased from 26 (6) min-1 to 22 (6) min-1 at 5 cmH2O and 17 (5) min-1 at 10 cmH2O pressure support (n = 16, p < 0.05). Mean (SD) inspiratory work of breathing decreased from 1.77 (0.70) J. min-1 to 0.31 (0.36) J.min-1 at 5 cmH2O and 0.16 (0.26) J.min-1 at 10 cmH2O pressure support ventilation (n = 9, p < 0.05). Analysis of the respiratory rhythm in the second group of seven patients revealed an oscillating respiratory pattern in four patients at 5 cmH2O and six of the seven patients at 10 cmH2O pressure support ventilation. The metabolic advantage of the decreased work of breathing during pressure support ventilation during anaesthesia is unlikely to balance the disadvantage of an oscillating respiratory rhythm.
Adolescent↗
A comparison between ketorolac and diclofenac in laparoscopic sterilization.
We compared ketorolac and diclofenac for the prevention and treatment of post-operative pain in patients undergoing laparoscopic sterilization. Fifty ASA I or II women were allocated randomly to receive either diclofenac 75 mg or ketorolac 30 mg intramuscularly 30-90 min before general anaesthesia. Pain scores were assessed half-hourly in the recovery room and then at 2 h and 4 h in the ward. In the recovery room, pain was treated with a second dose of the study drug, followed by parenteral pethidine if necessary. Four patients in the diclofenac group and five patients in the ketorolac group requested no analgesics after surgery. Fifteen patients from each group had satisfactory analgesia after the second dose of study drug. Pain scores were similar between groups at all times. The median (range) initial pain score in the recovery room was 5 (0-9.5) in the diclofenac group and 5 (1-9) in the ketorolac group. Pain at the injection site was more common after diclofenac than ketorolac (12 vs. 3, P < 0.05). In conclusion, both intramuscular diclofenac and ketorolac were relatively ineffective in controlling the pain after laparoscopic sterilization. The drugs were equally well tolerated, but more patients complained of pain at the injection site after diclofenac.
Adult↗
Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments.
We have compared three methods of preventing hypotension during subarachnoid anaesthesia. We attempted to maintain systolic arterial pressure (SAP) greater than 75% of baseline by use of i.v. fluids (preloading with normal saline 16 ml kg-1 and, if necessary, three subsequent boluses of 2.5 ml kg-1), an infusion of metaraminol titrated as necessary between 0 and 5 mg h-1 and an infusion of ephedrine titrated as necessary between 0 and 120 mg h-1. SAP and mean arterial pressure (MAP) were measured by automated oscillotonometry, central venous pressure (CVP) by a manometer and cardiac index (CI), stroke index (SI) and heart rate (HR) by transthoracic electrical bioimpedance. Systemic vascular resistance index (SVRI) was derived. Fluids alone failed to maintain SAP in five of 10 patients. Although CI and CVP were maintained, SVRI decreased (25 (SD 15)%; P = 0.02). Metaraminol maintained SAP in all 12 patients. The main cardiovascular change was decreased HR (15 (8)%; P = 0.0001). Ephedrine failed to maintain SAP in two of 12 patients and was accompanied by several cardiovascular changes: HR (21 (12)%; P = 0.001) increased and SI (16 (10)%; P = 0.0001), CVP (3.8 (1.5) cm H2O; P = 0.0001) and SVRI (24 (6)%; P = 0.0001) decreased. Treatment failures resulted from failures to maintain SVRI in the fluid group and CVP and SVRI in the ephedrine group.
Aged↗
Haemodynamic effects of subarachnoid block in elderly patients.
We have studied the haemodynamic effects of subarachnoid block in elderly patients. Thirty patients were undergoing elective transurethral surgery and 18 non-elective orthopaedic surgery, predominantly fractured neck of femur. Systolic arterial pressure (SAP) was measured by automated oscillotonometry, central venous pressure (CVP) by manometer and cardiac index (CI), stroke index (SI) and heart rate (HR) by transthoracic electrical bioimpedance. Systemic vascular resistance index (SVRI) was derived. SAP decreased by more than 25% in 33 patients and SVRI showed similar decreases (P = 0.0001). CVP decreased (2.5 (SD 1.5) cm H2O) in all patients. CI was unaffected because a decrease in SI in some patients (13 (19)%; P = 0.01) was compensated for by an increase in HR (13 (13)%; P = 0.01). Decreases in SAP of 25% were treated initially with colloid solution 8 ml kg-1, which restored SAP in 19 patients. CVP, SI and HR were all restored to baseline values, however, SVRI was decreased further (P < 0.05). Fourteen patients required additional treatment with metaraminol which restored SVRI to baseline values. Patients with systolic hypertension were more likely to require treatment with metaraminol (P = 0.04).
Aged↗