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At least 235 records · Page 13Linked to original sources
PubMed2001

[Influence of bispectral index monitoring on fentanyl requirements during total intravenous anesthesia for major gynecological surgery].

OBJECTIVE: To determine the influence that bispectral index (BIS) monitoring of hypnosis might have on need for analgesia during surgery under total intravenous anesthesia provided by bolus administration of fentanyl. PATIENTS AND METHOD: Prospective, randomized and partially double-blind study of 40 patients undergoing major gynecological surgery under total intravenous anesthesia with propofol and fentanyl. In the BIS group (n = 20) propofol administration was adjusted to maintain BIS between 40 and 60. In the control group (n = 20) standard doses were given: 10 mg/kg-1/h-1 after anesthetic induction and for 5 minutes, 8 mg/kg-1/h-1 over the next 5 minutes and 6 mg/kg-1/h-1 throughout the rest of the operation. All patients received intravenous bolus administration of 150 or 75 microg of fentanyl to maintain analgesia whenever systolic blood pressure and heart rate increased 20% over baseline. We compared propofol and fentanyl requirements, intraoperative changes in BIS, and awakening from anesthesia. RESULTS: Patient and surgical characteristics were similar in both groups. BIS monitoring allowed propofol administration to be decreased a mean 24% during maintenance of anesthesia, and this in turn was associated with a significant increase in mean dose of fentanyl (415 microg versus 253 microg in the BIS and control groups, respectively; p = 0.01). Mean values of BIS were higher in the BIS group (46.4 versus 42.2; p = 0.04) and patients in the BIS group awoke sooner (in 7.7 min versus 11.1 min; p = 0.01) and tended to report less pain upon arrival at the postanesthetic recovery room, although the difference was not statistically significant. CONCLUSIONS: BIS monitoring of depth of hypnosis can influence requirements for fentanyl during total intravenous anesthesia by bolus dosing for maintenance of analgesia. This is probably due to changes in the administration of propofol made possible by BIS monitoring.

Adult↗
PubMed2002

Perioperative changes in serum creatinine after gynecologic surgery.

OBJECTIVE: The purpose of this study was to prospectively determine the normal range of postoperative changes in serum creatinine levels when bilateral ureteral patency was confirmed by cystoscopy. STUDY DESIGN: A total of 187 consecutive patients who had undergone major gynecologic surgery were evaluated prospectively. All patients had undergone perioperative cystoscopy to evaluate for ureteral patency, and creatinine levels had been determined before and 24 hours after surgery. RESULTS: The mean change in serum creatinine level was 0.01 mg/dL, and the changes for the central 95% ranged from -0.2 to 0.3 mg/dL. With a previously defined cutoff value of an increase of >0.2 mg/dL after operation to indicate ureteral obstruction, specificity and negative predictive values (when compared with cystoscopic findings) were 98% and 100%, respectively. CONCLUSION: Creatinine levels change minimally during the immediate postoperative period in the absence of ureteral compromise. If bilateral ureteral patency was demonstrated after operation in our population, creatinine level elevations were always <0.3 mg/dL.

Creatinine↗
PubMed2004

[Postoperative pain relief after gynecologic surgery].

Early administration of analgesics, generally before awakening from general anesthesia is useful to improve the patient's comfort in the post-anesthesia care unit (PACU). Multimodal analgesia includes administration of several analgesics from different pharmacological classes but in almost every combination, morphine or one of its derivatives is included. In the PACU, morphine is titrated using the intravenous route to obtain adequate and rapid pain relief. Analgesics are administered orally as soon as possible and in the vast majority of cases, immediate postoperative administration can be performed orally. After minor surgery (for example: diagnostic or operative laparoscopy) often performed in out-patients, a combination of acetaminophen and of a non-steroidal anti-inflammatory drug with or without an oral preparation of morphine is efficient and safe. Intraperitoneal administration of a local anesthetic can be a useful addition. When the postoperative surgical stress is expected to be of moderate intensity (for example: hysterectomy), the same combinations can be used but are initially administered intravenously. Nefopam, which is available only by intravenous administration in France, can be safely added. Morphine is often applied using a patient-controlled analgesia device (PCA). After major surgery (especially after radical surgery for malignant disease), intrathecal or epidural analgesia, using a local anesthetic and an opioid is extremely efficient and is combined with other analgesics. Finally, because the affective dimension is extremely important after gynecologic surgery (especially in mutilating interventions), psychologic preparation, patient information and communication are essential components of care.

Analgesia, Patient-Controlled↗
PubMed1999

Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery.

BACKGROUND: Changes in acid-base balance caused by infusion of a 0.9% saline solution during anesthesia and surgery are poorly characterized. Therefore, the authors evaluated these phenomena in a dose-response study. METHODS: Two groups of 12 patients each who were undergoing major intraabdominal gynecologic surgery were assigned randomly to receive 0.9% saline or lactated Ringer's solution in a dosage of 30 ml x kg(-1) x h(-1). The pH, arterial carbon dioxide tension, and serum concentrations of sodium, potassium, chloride, lactate, and total protein were measured in 30-min intervals. The serum bicarbonate concentration was calculated using the Henderson-Hasselbalch equation and also using the Stewart approach from the strong ion difference and the amount of weak plasma acid. The strong ion difference was calculated as serum sodium + serum potassium - serum chloride - serum lactate. The amount of weak plasma acid was calculated as the serum total protein concentration in g/dl x 2.43. RESULTS: Infusion of 0.9% saline, but not lactated Ringer's solution, caused a metabolic acidosis with hyperchloremia and a concomitant decrease in the strong ion difference. Calculating the serum bicarbonate concentration using the Henderson-Hasselbalch equation or the Stewart approach produced equivalent results. CONCLUSIONS: Infusion of approximately 30 ml x kg(-1) x h(-1) saline during anesthesia and surgery inevitably leads to metabolic acidosis, which is not observed after administration of lactated Ringer's solution. The acidosis is associated with hyperchloremia.

Acidosis↗
PubMedDate not supplied

A double-blind comparison of the abdominal wall relaxation produced by epidural 0.75% ropivacaine and 0.75% bupivacaine in gynecologic surgery.

BACKGROUND AND OBJECTIVES: Ropivacaine is a long-acting local anesthetic agent with similar potency to that of bupivacaine when administered for epidural anesthesia. Ropivacaine, however, may be less cardiotoxic than bupivacaine. Epidural bupivacaine and ropivacaine have been shown to be equally effective in providing sensory block for lower extremity surgery, but they have not been compared for their ability to produce abdominal wall relaxation. METHODS: Sixty-six American Society of Anesthesiologists I-III women, 18-70 years old undergoing elective gynecologic surgery were studied in a randomized, double-blind manner after giving informed consent in an institutionally approved protocol. Thirty-four patients received a single epidural injection of 20 ml 0.75% bupivacaine at the L2-L3-L4 interspace and 32 patients received 20 ml 0.75% ropivacaine in a similar manner. Sensory block was tested with pinprick; motor block with a modified Bromage scale, rectus abdominis muscle (RAM) test and surgeon satisfaction. Statistical analysis was performed using the SigmaStat for Windows computer software. Parametric data were analyzed with Student's t-test, while nonparametric data was analyzed using the Mann-Whitney rank sum test. RESULTS: Results are expressed as mean +/- SD. Times to maximal sensory block and peak sensory level achieved were similar in both groups. However, time to complete sensory regression was significantly longer with bupivacaine than ropivacaine (458 +/- 77 vs. 404 +/- 62 minutes, P < .03). Bupivacaine lower extremity motor block onset was significantly faster than ropivacaine (9 +/- 3 vs. 12 +/- 3 minutes, P < .0013). Time to maximum lower extremity motor block was significantly shorter with bupivacaine than ropivacaine (28 +/- 12 vs. 40 +/- 15 minutes, P < .0234). Duration of lower extremity motor block was significantly longer with bupivacaine than ropivacaine (371 +/- 97 vs. 310 +/- 65 minutes P < .069). There was no significant difference between the two groups for changes in RAM scores or the time to achieve those changes. Maximum motor block scores using the modified Bromage score and surgeon satisfaction with operating conditions also did not demonstrate a significant difference between the two groups. In one instance (with ropivacaine), anesthesia was judged clinically inadequate despite evidence of bilateral epidural anesthesia. CONCLUSIONS: Both 0.75% ropivacaine and 0.75% bupivacaine provide adequate surgical anesthesia for lower abdominal surgery when administered epidurally. However, lower extremity motor block with ropivacaine is significantly shorter and of slower onset and sensory block shorter at these concentrations.

Abdominal Muscles↗
PubMed2003

[Evidence-based medicine: principles and applications to obstetrics and to gynecologic surgery].

Evidence-based medicine is a concept developed by David Sackett and colleagues since 1980 at the Medical University center MacMaster, Hamilton city, Ontario. The main idea was to propose an evaluating tool of medical practice allowing a structured way of reasoning and the elimination of self-made opinion. We present a short explanation of evidence-based medicine and compare our daily practice in obstetrics and gynecologic surgery with this new practice paradigm.

Evidence-Based Medicine↗
PubMed1984

Naproxen sodium vs. a combination of aspirin, phenacetin, caffeine and codeine phosphate for pain after major gynecologic surgery. A multicenter comparison.

In this multicenter study a nonnarcotic analgesic available for moderate pain, naproxen sodium, 550 mg, was compared to a combination that is used extensively for moderate to severe pain, aspirin, phenacetin, caffeine and codeine phosphate (APC/C) (60 mg of codeine phosphate). Women with pain after major gynecologic surgery reported a similar pattern in pain reduction with the two medications except for a relatively sharper increase in pain intensity between four and six hours after administration of APC/C. A smaller number of patient complaints suggested that naproxen sodium was better tolerated than APC/C.

Aspirin↗
PubMed1993

[The treatment of postoperative pain in obstetrical-gynecologic surgery. A comparative study between ST-679 and paracetamol].

In double-blind conditions, ST-679 (a single oral 1200 mg dose in 20 patients), or paracetamol (a single oral dose of 1000 mg in 20 patients) was administered to forty patients who presented pain as a result of obstetrical-gynecological surgery. The study proposed to evaluate the analgesic efficacy and tolerability of ST-679, a new non-steroid antiphlogistic drug, as compared to a reference drug amply utilized in clinical practice such as paracetamol. The average estimation of tolerability, with regard to paracetamol, was significantly in favor of ST-679.

Acetaminophen↗
PubMed1997

[Friedrich Rumpf and his contributions to modern gynecologic surgery].

The German gynecologist Friedrich Rumpf from Berlin performed the first radical hysterectomy in Europe. This pioneering achievement is even more remarkable as Rumpf was working in private practice without the support of one of the major Berlin university hospitals. Very few biographical data can be found. Fortunately, his views of gynecologic surgery are expressed in his publications. This aim of this article is to remind us of Rumpf's reflections on surgical technique which are still relevant today and to contribute to Rumpf's memory.

Female↗
PubMed2005

[Comparison of the bispectral index and spectral entropy in gynecological surgery].

OBJECTIVES: Spectral entropy quantifies variations in cortical electrical activity measured by electroencephalography and frontal activity measured by electromyography. The aim of this study, in the context of general anesthesia, was to compare bispectral index values with the two components of spectral entropy: state entropy and response entropy. MATERIAL AND METHODS: Sixteen women (ASA I-II) undergoing gynecological surgery were enrolled. The bispectral index was maintained between 40 and 50 for all patients. Both sensors, for monitoring the bispectral index and spectral entropy, were placed on each patient. Simultaneous readings were recorded at the following moments: operating room arrival, induction, relaxation, intubation, switching on the vaporizer, start of surgery, traction of the intestinal mesenteries and maneuvering of the electric scalpel, switching off the vaporizer, end of surgery, during cough, extubation, and eye opening. The data sets were subjected to analysis of variance, and the intraclass correlation coefficient (ICC) was used to analyze agreement. RESULTS: Differences between mean values of the bispectral index, state entropy and response entropy were observed at operating room arrival, intubation, and induction. Differences when the patient awakened from anesthesia were observed only between the bispectral index and response entropy, on the one hand, and state entropy on the other. There was no agreement (ICC<0.7) upon operating room arrival, maneuvering the electric scalpel, or awakening from anesthesia. CONCLUSION: The bispectral index, state entropy, and response entropy show good agreement during recordings that reflect the effects of anesthesia. The differences observed at baseline and upon awakening can be attributed to frontal electromyographic activity. Distinguishing cortical electrical activity from frontal electromyographic activity may provide additional information in these situations.

Anesthesia, General↗
PubMed1992

Transdermal fentanyl for postoperative pain management in patients recovering from abdominal gynecologic surgery.

The current placebo-controlled double-blinded study was undertaken to assess the safety and efficacy, as well as the potential clinical role, of the transdermal therapeutic system (TTS) of fentanyl delivery in the postoperative setting. TTS patches releasing 25 micrograms.h-1 or 50 micrograms.h-1 or placebo were applied to 95 women 1 h before abdominal gynecologic surgery during general anesthesia. Postoperatively, patients self-administered intravenous morphine as required using patient-controlled analgesia with a 1-mg incremental dose and a 6-min lockout interval. Each was assessed upon admission to the postanesthesia care unit and at intervals over the following 72 h with respect to vital signs, visual analogue scale pain and satisfaction scores, side effects, and cumulative morphine use. Data were analyzed using analysis of variance, Kruskal-Wallis, and chi-square. P less than 0.05 was considered significant. There were no demographic differences among groups. Beginning 32 h after TTS application, a statistically significant morphine-sparing effect was seen with the 50 micrograms.h-1 patch. There were no significant differences among groups with regard to visual analogue scale pain scores at rest, patient satisfaction, or the incidence of side effects; a significant reduction in pain upon movement was noted at 24 h in patients treated with TTS 50 micrograms.h-1. This finding constituted the only benefit noted with this form of analgesic therapy in the present investigation.

Abdomen↗
PubMed2000

Transdermal nitroglycerine enhances spinal neostigmine postoperative analgesia following gynecological surgery.

BACKGROUND: Intrathecal neostigmine causes analgesia by inhibiting the breakdown of acetylcholine. Experimental data suggest that the production of endogenous nitric oxide is necessary for tonic cholinergic inhibition of spinal pain transmission. The purpose of this study was to determine whether association of transdermal nitroglycerine would enhance analgesia from a low dose of intrathecal neostigmine in patients undergoing gynecologic surgery during spinal anesthesia. METHODS: Forty-eight patients were randomized to one of four groups. Patients were premedicated with use of 0.05-0.1 mg/kg intravenous midazolam and received 15 mg bupivacaine plus 1 ml test drug intrathecally (saline or neostigmine, 5 microgram). Twenty to 30 min after the spinal puncture, a transdermal patch of either 5 mg nitroglycerin or placebo was applied. The control (Con) group received spinal saline and transdermal placebo. The neostigmine group received spinal neostigmine and transdermal placebo. The nitroglycerin group received spinal saline and a transdermal nitroglycerine patch. Finally, the neostigmine-nitroglycerin group received spinal neostigmine and transdermal nitroglycerine. Pain and adverse effects were evaluated using a 10-cm visual analog scale. RESULTS: Patients in the groups were similar regarding age, weight, height, and American Society of Anesthesiologists status. Sensory level to pin prick at 10 min, surgical duration, anesthetic duration, and visual analog scale score for pain at the time of administration of first rescue medication were statistically the same for all groups. The time to administration of first rescue analgesic (min) was longer in the neostigmine-nitroglycerin group (550 min; range, 458-1,440 min; median, 25-75th percentile) compared with the other groups (P < 0.001). The neostigmine-nitroglycerin group required fewer rescue analgesics in 24 h than did the control group (P < 0.0005), whereas the neostigmine group required less analgesics compared with the control group (P < 0.02). The incidence of perioperative adverse effects (nausea, vomiting, headache, back pain) was similar among groups (P > 0.05). CONCLUSION: Although neither intrathecal 5 microgram neostigmine alone nor transdermal nitroglycerine alone (5 mg/day) delayed the time to administration of first rescue analgesics, the combination of both provided an average of 14 h of effective postoperative analgesia after vaginoplasty, suggesting that transdermal nitroglycerin and the central cholinergic agent neostigmine may enhance each other's antinociceptive effects at the dose studied.

Administration, Cutaneous↗
PubMed2004

Postoperative infections and antibiotic prophylaxis for hysterectomy in Sweden: a study by the Swedish National Register for Gynecologic Surgery.

AIM: The purpose of the study was to evaluate the current use of antibiotic prophylaxis, the rate of postoperative infections, and risk factors for postoperative infections in patients undergoing elective hysterectomy for non-malignant pathology. METHODS: The study was performed during the time period July 2000 to 1 January 1 2003, using data from the Swedish National Register for Gynecologic Surgery, covering 26 of 49 clinics and approximately 50% of the Swedish population. During this time period, 3267 women undergoing elective hysterectomy for non-malignant pathology (mainly dysfunctional bleeding and fibromas) and with complete data on the use of antibiotic prophylaxis and postoperative follow up were included. A postoperative infection was considered to have developed if patients or the physician reported an infection related to the surgical site, together with reported use of antibiotic treatment. RESULTS: Among the 3267 patients, 341 (10.4%) were considered to have developed a postoperative infection. In cases where antibiotic prophylaxis had not been given, total abdominal hysterectomies and vaginal hysterectomies were associated with the highest frequency for postoperative infections P < 0.05 and P < 0.01, respectively. Notably, also women undergoing subtotal hysterectomy reported significantly lower rates of postoperative infections if prophylactic antibiotics had been given, P < 0.05. Risk factors for postoperative infection were non-use of antibiotic prophylaxis, hospital, age less than 40 years, and BMI > 30 kg/m(2). CONCLUSIONS: The study results have indicated the need of prospective clinical trials on antibiotic prophylaxis for patients undergoing supravaginal abdominal hysterectomy. Also, a need to further evaluate the current prophylactic antibiotic protocols used for obese patients and younger women undergoing any kind of hysterectomy is warranted.

Adult↗
PubMed1997

Comparison of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting after gynecologic surgery.

This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women undergoing gynecologic incontinence surgery with standardized general anesthesia. At the end of surgery, the patients received either tropisetron 5 mg, droperidol 1.25 mg, or 0.9% saline intravenously (i.v.). As a rescue antiemetic, the patients received metoclopramide 10 mg i.v.. The episodes of nausea, retching, and vomiting; the need for rescue treatment; and the type and severity of adverse events were recorded at four occasions during the 48-h observation period. Pain, anxiety, drowsiness, and general satisfaction were also evaluated on a linear numerical scale of 0-10. Complete response (no PONV within the 48-h observation period) occurred similarly in the study groups (tropisetron 25%, droperidol 22%, and placebo 18%). Tropisetron and droperidol had no effect on the incidence of nausea and retching. However, the incidence of vomiting was significantly less in the tropisetron group than in the placebo group (tropisetron 19%, droperidol 45%, and placebo 57%). The number of emetic episodes (retching and/or vomiting) per patient within 48 h was significantly decreased under tropisetron when compared with placebo (tropisetron 2.5 +/- 3.4, droperidol 4.2 +/- 6.1, placebo 5.9 +/- 7.1). With regard to adverse events, the patients in the droperidol group had significantly more anxiety than the placebo group (2-6 h postoperatively), more drowsiness than the tropisetron and placebo groups (0-2 h postoperatively), and more dissatisfaction than the tropisetron (0-6 h postoperatively) and placebo groups (2-6 h postoperatively). We conclude that tropisetron given 5 mg i.v. during anesthesia in gynecologic incontinence surgery effectively prevents vomiting but not nausea and retching, while 1.25 mg i.v. droperidol fails to prevent any of these emetic symptoms and results in adverse events.

Antiemetics↗