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PubMed1977

Eelvated postoperative renal clearance of amylase without pancreatitis after cardiopulmonary bypass.

Two postoperative cardiopulmonary bypass patients who had pancreatitis within a two week period provided the impetus for pursuing this study. Amylase-creatinine clearance ratios (ACCR) were measured in a series of ten thoracic surgery patients: six coronary artery bypass patients with cardiopulmonary bypass (cardiac group), and four exploratory thoracotomy patients (pulmonary group). These ratios were obtained in the preoperative, recovery room, and postoperative periods. Comparisons were made among the following data: clinical history, pre- and postoperative medications, intraoperative vital signs, drugs, and anesthetics. The preoperative mean ACCR was 3.34 per cent. All cardiac patients had a significantly elevated ACCR in the recovery room with a mean of 17.36 per cent (p less than 0.05). The ACCR had returned to preoperative levels by the second postoperative day in five of six cases. There were no elevated ACCR levels in the pulmonary group. All patients were asymptomatic for pancreatitis. The intraoperative course of the cardiac patients involved four common factors, besides cardiopulmonary bypass, which were not present in the pulmonary group. These similarities included transfusion of citrated fresh whole blood activated by calcium chloride, hypotension treated with ephedrine, administration of mannitol, and intraoperative morphine analgesia. The mechanisms of increased amylase secretion by calcium chloride or ephedrine administration and transient sphincter of Oddi constriction by morphine or the alpha-adrenergic response of ephedrine are considered with the theoretical implications toward pancreatitis. The background and significance of the ACCR are also analyzed, especially in association with the osmotic diuresis of mannitol and a subsequent low urine creatinine level.

Aged↗

PubMed1992

Evaluation of outpatient experience with vitreoretinal surgery.

The experience of 55 consecutive individuals undergoing outpatient vitreoretinal surgery was evaluated. Objective variables, including preoperative and intraoperative information, subjective postoperative pain, and discomfort were measured with a previously validated 100 mm visual analogue scale. Patients also ranked the overall experience. Average pain and discomfort scores in the recovery room were 21.8 and 22.6 and overnight were 26.7 and 30.4 (scale 0 to 100), respectively. Eighty eight per cent of subjects were satisfied with the experience. Elevated pain and discomfort scores were statistically correlated with scleral buckling, prolonged surgical or recovery room time, requirement for parenteral pain medications, and high intraocular pressure on the first postoperative visit. None of the patients needed further hospital treatment. This study suggests that vitreoretinal surgery in an appropriately selected population does not require routine inpatient care.

Adult↗

PubMed1990

[Intramuscular methohexital. A simple and reliable means of sedation for cerebral computed tomography in children].

Intramuscular methohexital sedation was retained as an easy and reliable method to sedate children for a C.T. scan. In this retrospective study of 50 cases of children aged from 2 months to 7 years all the children were administrated an oral premedication (diazepam: 1 drop/kg and atropine: 0.02 mg.kg-1) one hour before the scanner examination. Once in the operating room, they were administrated 10 mg.kg-1 methohexital saline 2.5% solution, intramuscularly deep in the buttock. E.C.G. was the main monitoring. Spontaneous breathing was evidenced by means of a simple device. At the end of the scan, the child was taken care for in the recovery room. The methohexital dose provided adequate sedation in most cases. Once the injection was given, a motionless state was reached in 4.20 minutes. The insertion of an intravenous catheter induced movements in 96% cases, which did not interfere with the successful intravenous puncture. In 33% cases, 1 to 2 mg.kg-1 ketamine was necessary because of a failed attempt at obtaining the required state, or of an awakening due to iodized injection. Among those cases, half the children were overweight for their ages. In this situation an adjusting dose should be considered. On average, a child under the influence of the drug slept for 35 minutes and the required time for a C.T. scan is 23.3 minutes. Time in the recovery room is on average 20 minutes. There was no episode of cardiovascular or respiration failure, or local reaction at the injection site. There was also no episode of seizure.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

PubMed2006

Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on post-tonsillectomy pain in children.

BACKGROUND: Enteral acetaminophen, when used alone, is not very effective for postoperative analgesia because of delayed absorption and sub-therapeutic plasma concentrations. In contrast, i.v. acetaminophen is devoid of these shortcomings and could potentially provide adequate postoperative analgesia as a single agent. This randomized double-blind study compared the analgesic effects of i.v. acetaminophen and i.m. meperidine in paediatric patients undergoing tonsillectomy. METHODS: Eighty children undergoing tonsillectomy were randomized to receive either acetaminophen 15 mg kg(-1) i.v. (acetaminophen group) or meperidine 1 mg kg(-1) i.m. (meperidine group), intraoperatively. Anaesthesia was induced with either sevoflurane inhalation or propofol, and was maintained with sevoflurane. After operation, the objective pain scale (OPS), Ramsay sedation score and Aldrete score were recorded every 5 min, and nurses' satisfaction was determined on a 7-point scale (1-7). RESULTS: On admission to the recovery room, OPS scores were 3.1 (sem 0.3) for the acetaminophen group and 2.1 (sem 0.3) for the meperidine group (P=0.147); however, Ramsay sedation scores were 3 (sem 0.2) and 4 (sem 0.3) for the acetaminophen and meperidine groups, respectively (P<0.05). Patients in the meperidine group continued to be more sedated 5 min after arrival in recovery (P<0.05). Acetaminophen group patients achieved an Aldrete score of 10 min sooner than those in the meperidine group [median (IQR) time: 15 (0-20) min vs 25 (15-30) min, respectively, P=0.005]. Adjusted nurse satisfaction scores were similar in both groups [6.1 (sem 0.2) vs 5.7 (sem 0.2) min, P=0.311]. CONCLUSION: Compared with i.m. meperidine, i.v. acetaminophen provided adequate analgesia, less sedation and earlier readiness for recovery room discharge among paediatric patients undergoing tonsillectomy.

Acetaminophen↗

PubMed1985

Regular interval preventive pain relief compared with on demand treatment after hysterectomy.

Eighty otherwise healthy women, aged 22-64 years, admitted for elective hysterectomy were studied in a prospective randomized trial. The aim was to compare two different postoperative pain relief schedules--one with the analgesic given at regular intervals and the other with the analgesic given on demand. All the patients had a neuroleptanaesthesia with fentanyl. Forty patients received an initial dose of buprenorphine 0.3 mg intravenously before termination of anaesthesia and continued with sublingual buprenorphine 0.4 mg 6 hourly postoperatively (regular interval (RI) group). Forty patients received the standard postoperative medication, meperidine 1 mg/kg on demand in the recovery room, followed by ketobemidone 5 mg subcutaneously on demand in the surgical ward (on demand (OD) group). There was no difference between groups concerning pain relief following a single dose of analgesic (P greater than 0.05, type II error 1-5%). In the recovery room 17.5% of the patients in the RI group received an analgesic compared to 87.5% in the OD group (P less than 0.05). Among patients in the RI group who had previously got injections for postoperative pain relief on demand 95% preferred regular interval sublingual buprenorphine for future treatment. The nurses found that 90% of the patients in the RI group were treated adequately compared to 62.5% of the patients in the OD group (P less than 0.05). It is concluded, that regular interval preventive pain relief is superior to conventional on demand analgesic therapy in postoperative pain.

Adult↗

PubMed2006

Passive smoke exposure as a risk factor for airway complications during outpatient pediatric procedures.

OBJECTIVE: Determine if passive smoke exposure (PSE) increases airway complications during outpatient mask anesthesia procedures in children. METHODS: A prospective cohort of children who underwent surgical procedures under mask anesthesia was studied with the American Thoracic Society children's questionnaire on environmental and respiratory factors. Double-blinded outcomes with respect to adverse airway events were recorded both intraoperatively and in the recovery room for patients with and without passive smoke exposure. Multivariate comparisons assessing the likelihood of these airway complications were conducted between the PSE and nonexposed groups. RESULTS: Of 405 children, 168 (41.5%) had PSE. The incidence of airway complications during anesthesia or postanesthetic recovery was higher for all outcome measures for PSE children (all P </= 0.005), except for recovery room breath holding (P = 0.086). Intraoperative laryngospasm and airway obstruction were 4.9 and 2.8 times more likely with PSE, respectively. CONCLUSIONS: PSE significantly increases the risk of anesthesia-related airway complications during outpatient pediatric procedures. EBM RATING: A-1b.

Adolescent↗

PubMed2006

Injection dexamethasone in preventing postoperative nausea and vomiting: a comparison with placebo in the patients undergoing laparoscopic cholecystectomy.

OBJECTIVE: To determine the efficacy of intravenous dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy (lap-chole) and comparing it with normal saline (placebo). STUDY DESIGN: Single blinded, randomized, placebo controlled, interventional study. PLACE AND DURATION OF STUDY: This study was conducted in the department of Anaesthesiology of Civil Hospital, Karachi and Dow University of Health Sciences, Karachi, from June 2005 to April 2006. PATIENTS AND METHODS: After the approval of the hospital's ethical committee, the study was conducted on 60 patients who were randomly divided into two groups, each group containing 30 patients. All belonged to A.S.A-I and A.S.A-II. Randomization was done by envelope draw method. Injections dexamethasone (8 mg in 2mls) and normal saline ( 2 mls ) were given intravenously to respective groups just before induction of anesthesia. Fisher's exact test was applied to compare proportion of PONV between two groups for the recovery room data, while Chi-square test was applied to compare the proportion of PONV between two groups during first 12 hours and second 12 hours. The p-value was calculated at the level of significance chosen as 0.05. RESULTS: In the recovery room where the patient stayed for one hour 10% of patients in the dexamethasone group in comparison with 33% of the patients in the placebo group experienced PONV (p=0.028). In the ward, during first 12 hours observation period, 27% of the patients in the dexamethasone group in comparison with 43% of the patients in the placebo group experienced PONV (p=0.176). During the second 12 hours observation period, 30% of the patients in the dexamethasone in comparison with 80% of the patients in the placebo group experienced PONV (p < 0.001). CONCLUSION: In this study, the frequency of postoperative nausea and vomiting (PONV) in the dexamethasone administered group was significantly less as compared to placebo group. As the former is freely available, economical and the single dose is not associated with any significant side effects, it should, therefore, be used more frequently in the patients undergoing lap-chole.

Adult↗

PubMed1996

Effect of intramuscular intraoperative pain medication on narcotic usage after laparoscopic cholecystectomy.

The purpose of this randomized, double-blind, clinical trial was to determine whether intraoperative, intramuscular (IM) injections of meperidine or ketorolac would improve postoperative pain relief in patients undergoing elective laparoscopic cholecystectomy. A total of 125 patients were entered into five study groups: 1) (N = 23) control placebo; 2) (N = 31) meperidine 100 mg IM intraoperative preprocedure; 3) (N = 20) meperidine 100 mg IM intraoperative postprocedure; 4) (N = 25) ketorolac tromethamine 60 mg IM intraoperative preprocedure; 5) (N = 26) ketorolac tromethamine 60 mg IM postprocedure. All groups were analyzed by comparing the amount of pain medication received in the recovery room, the time until first oral pain medication was requested, the overall amount of pain medication used in the first 24 hours, the percent requiring IM medication, and the pain score ratings from each group. There was decreased pain medication usage in the recovery room in all groups compared to control (P < 0.05). Group 4 had a longer painfree interval than meperidine groups or control. Both Groups 4 and 5 had decreased postoperative narcotic usage. Finally, the analogue pain scores showed that both ketorolac groups had significantly less postoperative pain compared to control, whereas the meperidine groups showed no improvement in postoperative pain relief. Intraoperative ketorolac given preprocedure or postprocedure significantly improved postoperative pain management and facilitated the transition to oral pain medication.

Adolescent↗

PubMed2001

Effects of local bupivacaine instillation on pain after laparoscopy.

STUDY OBJECTIVE: To evaluate the effect of preincisional and intraperitoneal bupivacaine administration on immediate and late pain after operative laparoscopy. DESIGN: Randomized study (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: One hundred fifty women undergoing laparoscopy for various gynecologic indications. INTERVENTION: A dose of 0.5% bupivacaine 10 ml (50 mg) was injected into cannula sites before incisions and another 10 ml diluted with 100 ml saline into the peritoneal cavity at completion of the procedure. Equal amount of physiologic saline was used in controls. MEASUREMENTS AND MAIN RESULTS: Modified McGill pain intensity scores and amount of analgesic required in the recovery room and within 24 hours postoperatively were evaluated. Of 150 women, 142 completed the study (71 bupivacaine group, 71 controls). Groups did not differ significantly in body mass index, duration of surgery, return to consciousness, and analgesic requirement during 3-hour observation in the recovery room and 24 hours after discharge. Pain scores were highest 30 minutes after the procedure in both groups. At that time the pain score in the bupivacaine group was lower than that in the control group (1.8 +/- 0.2 vs 2.3 +/- 0.2, p <0.05). Beyond that time, the groups did not differ in pain scores and analgesic requirements. CONCLUSION: Postoperative pain is the highest within 30 minutes after laparoscopy. Local instillation of bupivacaine before incision and intraperitoneally was effective in reducing pain immediately after operative laparoscopy, but the effect was not seen beyond 30 minutes.

Anesthetics, Local↗

PubMed1995

Recovery from neuromuscular blockade: residual curarisation following atracurium or vecuronium by bolus dosing or infusions.

We conducted a survey of the incidence of Postoperative Residual Curarisation (PORC) in two groups of patients following the use of atracurium or vecuronium. In the first group (B) the neuromuscular blocking drugs were administered by bolus dosing, and in the second group (I) by continuous fusion. On arrival in the recovery room, neuromuscular function was assessed both by compound evoked electromyogram (EMG) in a train of four pattern and also clinically, by the ability to sustain a headlift for > 5 seconds, and to cough. Results were obtained from 150 patients (100 in group B and 50 in group I). The incidence of PORC, as defined by a train of four ratio of < 0.7, on arrival in the recovery room was 12% in group B, and 24% in group I. Clinical criteria of adequate neuromuscular reversal revealed different results, with the majority of patients being unable to perform either clinical test on arrival in recovery. Those patients in whom a peripheral nerve stimulator was used intra-operatively did not have a reduced incidence of PORC. We have demonstrated that PORC is still a common occurrence even with intermediate duration of action neuromuscular blocking drugs.

Adolescent↗

PubMed1992

Dreaming and anaesthesia: total i.v. anaesthesia with propofol versus balanced volatile anaesthesia with enflurane.

Sixty consecutive ASA Grades I and II patients scheduled for elective ear, nose and throat surgery were randomly assigned to receive either total i.v. anaesthesia with propofol ('propofol group') or 'balanced technique' with thiopentone induction followed by N2O and enflurane. Patients were asked whether they had experienced dreams immediately after extubation when verbal communication was established, in the recovery room and in the ward on the evening of the day of surgery. Thirteen patients in the propofol group (43%) and three patients in the enflurane group (10%) reported dreaming (P less than 0.05) when asked as soon as verbal communication was established. In the recovery room and in the ward only three patients of the propofol group (10%) and one patient in the enflurane group (3%) remembered that they had been dreaming (NS). To avoid underestimating the frequency of peri-operative dreaming, post-operative interviews should take place as soon as possible after conversing is possible.

Adult↗

PubMedDate not supplied

Interpleural bupivacaine for postoperative analgesia following cholecystectomy: a randomized prospective study.

The effect of interpleural analgesia on postoperative hospital course was analyzed ina prospective randomized study of patients undergoing cholecystectomy. Control patients were treated in the standard manner with systemic narcotics alone; catheter patients had an interpleural catheter placed at the end of surgery and, in addition, could receive systemic narcotics if necessary. The catheter group received interpleural 0.5% bupivacaine with epinephrine every six hours for a total of four injections. Thirteen patients were in each group. Pain score, pulmonary function and narcotic requirement were measured over the first postoperative day. Catheter patients had a lower average pain score (visual analog scale (VAS), 3.6 versus 5.2), decreased narcotic requirement in the recovery room and improved oxygen saturation (96% versus 93%). However, there was no statistical difference in amount of morphine (catheter, 25 +/- 14 mg; control, 31 +/- 15 mg), number of narcotic injections (catheter, 3.8 +/- 1.5; control, 3.5 +/- 1.5), forced vital capacity (catheter, 44% preoperative control, 41% preoperative), recovery room time (catheter, 129 +/- 54 minutes, control, 117 +/- 39 minutes) or total hospital stay (catheter, 4.1 +/- 0.9 days; control, 3.7 +/- 0.8 days). Analysis of hourly VAS scores following a bolus indicated that the analgesia disappeared within approximately four hours. The mean time to a request for narcotic following a bolus was 4.2 hours (excluding 17 of a potential total of 52 instances when narcotic was not requested at all). Therefore, the duration of pain relief for subcostal incisions using interpleural 0.5% bupivacaine is approximately four hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

[The causes of perioperative mortality. A trial of the German "CEPOD study."].

UNLABELLED: We performed a prospective multi-center study in order to determine the causes of 30-day perioperative mortality. METHODS: In accordance with the CEPOD-Study and with the kind permission of Dr. N. Lunn, we forwarded two different questionnaires to 135 hospitals. One questionnaire was to be answered by the anaesthetist and the other one by the surgeon involved in cases o perioperative death within the first 30 days after the operation. 12 out of 135 addressed hospitals agreed to participate in the study. These included four small hospitals, six medical centres of medium capacity (about 500 beds) and two University hospitals. In order to obtain an exact description of the events leading to perioperative death, the questionnaires consisted of approximately 60 questions for the collection of demographic data and the surgical as well as anaesthesiological perioperative management. RESULTS: From 1989 to 1993 more than 300 cases of perioperative death were reported. Only 200 cases could be analyzed due to incompletely answered or unreturned questionnaires. The mean risk-classification (ASA) was 3.46, mean age 74.6 years. Approximately 40 percent of deaths occurred in patients older than 80 years. More than 80 percent of patients had at least one pre-existing cardiovascular disease with prevalence of 41% for pulmonary and gastrointestinal diseases. In the majority of cases abdominal operations were performed, followed by hip-surgery and surgery of the aorta. In 86% of the cases, the surgeon was experienced and had performed the respective operation more than 20 times. In 38.2% an anaesthetist in training was responsible for anaesthesia, but only 11.6% were without supervision of a specialist anaesthetist. The majority of patients received general anaesthesia (78%) and 8.5% had a combination of EDA and general anaesthesia. Regional anaesthesia was performed in 12.5%, local anaesthesia in only 1%. The average blood loss was approximately 1.600 ml (with a very wide range) and 42.5% of the patients needed a transfusion of blood components, primarily in the form of packed red blood cells. Seventeen serious incidents occurred intraoperatively, including three "exitus in tabula". Four patients died shortly after the operation in the ICU, the other ten incidents were managed in the operating room. In 11 of 17 incidents the patients suffered a cardiac arrest; nine patients were resuscitated. Two patients were not resuscitated in view of pre-existing diseases and inoperability. All of the hospitals had an ICU for postoperative care, but two of the smaller hospitals had no recovery rooms. In 22 cases of emergency operations, there was a delay due to a lack of personnel or to logistic problems. In five of these cases, the delay was described as a possible cofactor of perioperative mortality. The most frequent causes of perioperative death were myocardial failure (33.7%) and multi-organ-failure (19.2%), followed by respiratory insufficiency (13%) and septic shock in 9.3%. A necropsy was carried out in only 28 of 200 perioperative deaths (14%); 13% of the cases were discussed in a surgical and only 2.5% in an anaesthesiological mortality-conference. In 9 out of 12 hospitals no mortality-conferences were held. All surgeons and anaesthetists were asked for self-assessment on the basis of an analog scale ranging from 0 and 10 points. The average score was 8.52 points (surgical management) and 9.36 points (anaesthesiological management respectively), which is not always in correspondence with the information provided in the questionnaires. CONCLUSIONS: In order to further reduce perioperative mortality in critically ill patients, every hospital should aim to optimize the structure of the surgical and anaesthesiological departments. A delay due to logistical or personnel problems may be a co-factor in perioperative mortality. Recovery rooms with experienced personnel should be the standard in postoperative anaesthesiological care. (ABSTRACT TRUNCATED)

Adult↗

PubMed1986

A survey of 112,000 anaesthetics at one teaching hospital (1975-83).

This paper describes the outcome of a nine-year post-anaesthetic followup program in a large teaching hospital (N = 112,721 anaesthetics). Between time periods 1975-78 and 1979-83, more seriously ill patients (higher ASA physical status) were being treated. Anaesthetic practice also changed, with an increased use of balanced (multiple drug) anaesthetic procedures, a decrease in the use of halothane and an increase in the use of monitoring. Nonfatal anaesthetic complications--intraoperative, recovery room and postoperative--were rare but there was an increase in the reported complication rate over time. From 1975-78, 7.6 per cent of all cases had at least one intraoperative complication and from 1979-83, this rose to 10.6 per cent of all cases. For recovery room complications, there was an increase to 5.9 per cent in 1979-83 from 3.1 per cent in 1975-78. In time period 2 there was a 9.4 per cent chance of having a postoperative anaesthetic-related complication, and a 0.45 per cent chance of a significant morbidity as a result. This represents an increase over time period 1 (8.9 and 0.40 per cent respectively). It is concluded that the anaesthetic experience, while associated with low mortality rates in recent years, is still associated with significant morbidity. It is conjectural at present whether this is reflective of preoperative patient status, anaesthetic practice, or other undefined variables associated with an operative experience.

Anesthetics↗

PubMed2003

Influence of the cortical electrical activity level during general anaesthesia on the severity of immediate postoperative pain in the morbidly obese.

BACKGROUND: The objective of anaesthesia is to provide hypnosis, analgesia and adequate conditions during surgery. It is difficult to establish the appropriate dose of general anaesthetic drugs in the morbidly obese patient. Moreover, there are conflicting data concerning adequate anaesthesia levels and the severity of postoperative pain. The aim of this study was to investigate the relationship between the spectral edge frequency (SEF) during general anaesthesia and the severity of immediate postoperative pain following gastric banding surgery in morbidly obese patients. METHODS: Seventy-one ASA 2 morbidly obese patients (BMI > 35%) undergoing elective laparoscopic gastric banding procedure were recruited for this study. Anaesthesia consisted of midazolam, fentanyl and thiopental for induction, vecuronium for muscle relaxation, N2O and isoflurane with additional fentanyl administrations, according to the clinical judgement of the anaesthesiologist, for maintenance. Continuous SEF monitoring was added to the standard monitors (SpO2, ETCO2, ECG, NIBP, O2 and isoflurane concentration), but the EEG monitor screen was hidden from the anaesthesiologist's sight. SEF postoperative analysis divided the patients into two groups: group 1, SEF-recommended target range of 8-12 Hz, more than 80% of the surgical time; and group 2, SEF-recommended target range of 8-12 Hz, less than 80% of the surgery duration. Pain intensity was assessed in the post anaesthesia care unit using a standard visual analogue scale (VAS) of 10 cm, when patients were awake enough to correct a deliberately given wrong own telephone or ID number. Intravenous morphine was administered for postoperative analgesia in 2-mg increments, every 3-4 min, until the patient felt comfortable. A recovery room nurse unaware of the SEF range recorded during surgery registered pain severity and morphine requirements. RESULTS: The end-tidal isoflurane concentration was significantly higher in group 1 than in group 2 (0.83 vs. 0.7 P = 0.016). The intensity of pain at admission into the recovery room and at discharge was significantly lower in group 1 than in group 2 (VAS 6.1 vs. 6.9-P = 0.0049, and 3.9 vs. 4.2-P = 0.00478, respectively). CONCLUSIONS: Keeping the SEF range between 8 and 12 Hz during anaesthesia for laparoscopic gastric banding for morbid obesity, both the immediate post operative pain intensity and morphine requirement, are significantly reduced.

Adolescent↗

PubMed2001

Effect of age on recovery from remifentanil anaesthesia.

In a prospective, randomized study, the effect of age on recovery from remifentanil anaesthesia was evaluated. Twenty consecutive patients classified as ASA 1 and 2 and having elective laparotomy were recruited to one of two groups based on age (Group 1 age <60 y and Group 2 age >60 y). Remifentanil boluses and infusion were used for induction and maintenance of anaesthesia. Dosage was titrated against clinical response to perioperative stimulation and the infusion was terminated at the end of the operation. Time intervals between termination of remifentanil infusion and 1) spontaneous respiration, 2) adequate respiration, 3) eye opening, 4) limb movement, 5) extubation, 6) Aldrete score >9, 7) discharge to recovery room and 8) discharge to the ward were recorded. Patient controlled analgesia with morphine was used for postoperative pain control. Student's t test was used to compare the differences in these time intervals between Groups 1 and 2. A P value <0.05 was taken as significant. We found that the younger age group regained spontaneous respiration (0.8+/-0.7 min vs 3.2+/-3.6 min), adequate respiration (3.4+/-3.7 min vs 7.6+/-5.8 min), opened their eyes (0.9+/-1.0 min vs 3.6+/-4.4 min), had their endotracheal tubes removed (5.0+/-4.6 min vs 9.0+/-6.5 min) and were discharged to recovery room (8.8+/-4.3 min vs 14.5+/-7.1 min) earlier than their older counterparts. In conclusion, age was a co-variate for recovery from remifentanil anaesthesia.

Adult↗

PubMed1990

The effect of prophylactic use of famotidine, ranitidine, and sodium citrate in upper abdominal surgery.

The effects of famotidine (40 mg), ranitidine (300 mg) and sodium citrate (30 ml) on the gastric pH and volume were tested in 114 patients undergoing upper abdominal surgery. Gastric content was aspirated through a multiorifice tube immediately after intubation, at the end of operation and after a recovery room period of one hour. All three drug regimens significantly increased the mean gastric pH value compared with the control group. Famotidine and ranitidine reduced the volume of gastric content in comparison with sodium citrate and the control group. However, the difference was significant only in the recovery room sample.

Abdomen↗

PubMed1996

Five Methods of Tubal Sterilization

We prospectively compared five methods of interval tubal sterilization: minilaparotomy Pomeroy (ML), laparoscopic coagulation (C), laparoscopic Falope ring (FR), laparoscopic Pomeroy with endoloops (E), and laparoscopic Hulka clip (H). The 114 women undergoing interval sterilization were interviewed by nurses using a structured data-abstraction instrument immediately postoperatively, and 24 hours and 2 weeks postoperatively to compare pain, vomiting episodes, overall satisfaction with the surgical experience, and time to resuming activities. Operating time, time in the recovery room, and cost of medical supplies also were compared. The measured variables were evaluated for significance by analysis of variance and Bonferroni's correction for multiple comparisons. Significant differences were found for postoperative pain (p = 0.01) between FR (6.96 ± 2.91) and C (4.36 ± 3.51); time in the recovery room (p <0.001) between ML (271.87 ± 57.95) and H (162.78 ± 48.79), FR (161.80 ± 47.78), and C (138.06 ± 41.77); and cost of surgical supplies (p <0.001) between E ($352.73 ± 42.76) and H ($133.28 ± 82.90), C ($131.09 ± 59.06), FR ($125.00 ± 72.98), and ML ($64.79 ± 14.07). It may be concluded that the cost of medical equipment used in laparoscopic Pomeroy ligation (and other variations of so-called pelviscopic sterilization) with endoloops is significantly greater than that of the other four methods, and that immediate postoperative pain is greater with the Falope ring than with tubal coagulation.

Journal Article↗