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At least 937 records · Page 52Linked to original sources
PubMed1996

Recovery of psychomotor function following general anaesthesia in children: a comparison of propofol and thiopentone/halothane.

The present study was undertaken to compare immediate recovery and recovery of complex psychomotor function in 20 children (aged 6-12 years) following general anaesthesia with either thiopentone/halothane or propofol. Early recovery of psychomotor skills was significantly faster in the propofol group than in the thiopentone/halothane group. Compared to preanaesthesia baseline the sedation and cooperation scores, the reaction time to visual and auditory stimuli as well as the postbox test and the flicker fusion frequency were less impaired after propofol than after thiopentone/halothane anaesthesia up to 120 min postoperatively. In the propofol group most tests reached preanaesthesia levels after 120 min, while in the thiopentone/halothane group these levels were not reattained throughout the entire study period. The results indicate that the recovery of psychomotor function in paediatric patients following general anaesthesia with propofol is significantly faster than with thiopentone/halothane. This has important implications for parental satisfaction, the time over which patients need to be monitored in the recovery room and for the discharge criteria after daycase surgery.

Anesthesia Recovery Period↗
PubMedDate not supplied

Oxygen saturation post-gastroscopy and post-colonoscopy.

A standard of care for providing pulse oximetry monitoring for patients receiving conscious sedation during and after endoscopy has not been established. This study sought to clarify whether desaturation occurs after gastroscopy and colonoscopy and what characteristics are predictive of desaturation that does occur. The convenience sample consisted of 475 adult participants receiving meperidine and/or midazolam in a hospital-based outpatient setting. A baseline oxygen saturation level was obtained before the procedure. Assessment of the oxygen saturation continued in the recovery room for 1 hour, with readings recorded every 10 minutes. A saturation of 90% or less was used as the indicator to resume oxygen therapy. Data revealed that oxygen desaturation in the recovery phase is influenced by the preprocedure baseline oxygen saturation level, smoking history, and age. The incidence of oxygen desaturation was 24% in the recovery phase, with the majority of decreases occurring within the first 10 minutes.

Colonoscopy↗
PubMed1996

[Awakening from anesthesia and recovery of cognitive function after desflurane or isoflurane].

UNLABELLED: Desflurane is a new volatile anaesthetic with an extremely low blood/gas partition coefficient of 0.42. This should provide a rapid recovery from anaesthesia. METHODS: We studied 100 adult patients, ASA class I or II, undergoing elective orthopaedic surgery randomly assigned to anaesthesia with desflurane (n = 50) or isoflurane (n = 50) supplemented by nitrous oxide in oxygen. Clorazepat was given for premedication, fentanyl and thiopental for induction of anaesthesia, followed by maintenance with desflurane or isoflurane as clinically appropriate. Emergence from anaesthesia was measured as well as return of cognitive functions (extended Aldrete score, digit symbol substitution test, and visual analogue scales [VAS]). RESULTS: While the demographic characteristics and administrated doses of fentanyl and thiopental were comparable, the recovery profiles in both groups were different. After discontinuation of the volatile anaesthetics, times to extubation and ability to follow simple commands were significantly shorter after desflurane than after isoflurane. Extended Aldrete scores, estimation of the patients' physical condition, results of the digit symbol substitution test, measuring cognitive functions, and rates of drowsiness and weakness on VAS showed better recovery with less impairment of cognitive function in the desflurane group than in isoflurane patients even 120 min after anaesthesia. VAS pain scores and doses of analgesic drugs given within the first 2 postoperative hours, however, showed no significant differences. Desflurane patients were also judged fit for discharge from the recovery room significantly faster. CONCLUSIONS: Our results demonstrate that desflurane anaesthesia, even when supplemented by premedication, intraoperative opioids, and nitrous oxide may offer clinical advantages over isoflurane as far as the post-anaesthetic recovery profile is concerned.

Adult↗
PubMed2005

A comparison of patients' and health care professionals' preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting.

In this study we sought to examine the differences in patients' and health care professionals' preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting (PONV). The key differences between symptoms during immediate postoperative recovery (PONV, sedation, and pain) and management of PONV (prophylaxis, efficacy of antiemetic, and extra cost) were used to develop 14 scenarios in a questionnaire. Fifty-two health care professionals (anesthesiologists and recovery room nurses) and 200 women undergoing elective gynecological surgery were recruited (overall response rate, 97%). From patients' and health care professionals' perspectives, conjoint analysis showed that the most important attribute for immediate postoperative recovery was a reduction in the risk of PONV. Health care professionals placed more importance on postoperative sedation than patients did. They were more concerned about the cost of the antiemetic to the patient than the patients were themselves. There was no preference for a policy of effective treatment versus routine prophylaxis. This study shows that there were small differences in the importance of pain, sedation, efficacy of the antiemetic, and extra cost of treatment between patients and health care professionals.

Adult↗
PubMed2003

Comparison of remifentanil versus ketamine for paediatric day case adenoidectomy.

Few studies exist of using remifentanil and intravenous ketamine for anaesthetic induction in paediatric day case anaesthesia. Therefore, we studied 75 unpremedicated ASA I-II children (age 1-7 years) who were randomly assigned in a double-blind fashion to receive either remifentanil (1 microgram/kg), ketamine (0.7 mg/kg) or placebo before the anaesthetic induction. Anaesthesia was induced with propofol and maintained with O2-N2O-sevoflurane. Induction characteristics, recovery times and the need for postoperative analgesia were evaluated. The required induction dose of propofol was lower in the groups receiving remifentanil and ketamine compared with the group receiving placebo. After tracheal intubation heart rate and blood pressure were better attenuated with remifentanil than with ketamine or placebo. In the recovery room children in the placebo group required more doses of oxycodone than the other two groups but this did not reach statistical significance. There were no differences between the groups in achieving predetermined recovery end-points, attaining full points on the Steward score or in the well being at home. In conclusion, remifentanil provides haemodynamically more stable induction of anaesthesia compared with ketamine or placebo. Ketamine with its' longer duration of action does not prolong recovery but does not have a clear opioid-sparing effect either in the immediate postoperative period.

Adenoidectomy↗
PubMed1999

A review of recovery from sevoflurane anaesthesia: comparisons with isoflurane and propofol including meta-analysis.

BACKGROUND: Sevoflurane has a lower blood:gas partition coefficient than isoflurane and thus should be associated with a more rapid recovery from anaesthesia. METHODS: A review and meta-analysis were employed to examine the recovery profiles of adult patients following anaesthesia, comparing sevoflurane to isoflurane and sevoflurane to propofol. RESULTS: There were significant differences in times to several recovery events that favoured sevoflurane to isoflurane anaesthesia, including time to emergence, response to commands, extubation, and orientation. Likewise, there were significant differences in times to the same recovery events following anaesthesia with sevoflurane versus propofol. There were no differences in time to recovery room discharge when comparing sevoflurane to isoflurane or propofol. CONCLUSION: The observed differences between sevoflurane and isoflurane or propofol anaesthesia support the postulate that the use of sevoflurane is associated with a more rapid recovery from anaesthesia than either isoflurane or propofol.

Adult↗
PubMed1999

Profound bradycardia and hypotension following spinal anaesthesia in a patient receiving an ACE inhibitor: an important 'drug' interaction?

An 86-year-old man on whom a transurethral resection of prostate was performed under spinal anaesthesia developed profound bradycardia and hypotension with disturbance of consciousness during transfer to the recovery room. Initial treatment with atropine produced rapid improvement in cardiovascular and cerebral function. A further hypotensive episode (without bradycardia) occurred approximately 1 h later but responded rapidly to methoxamine. The patient made a full recovery during an overnight stay on the High Dependency Unit. Possible mechanisms for this event are discussed, with the proposal that the concomitant administration of captopril and the relative unavailability of Angiotensin II may have significantly contributed to the problem.

Adenocarcinoma↗
PubMed1995

Anaesthesia for urological endoscopic procedures in adult outpatients.

The aim of this study was to establish whether propofol in combination with fentanyl or ketamine provides a good quality of anaesthesia and recovery time in urological endoscopic outpatient surgery. Sixty patients (ASA I-II) were assigned randomly to receive either 2.5 micrograms kg-1 fentanyl or 1 mg kg-1 ketamine. In both groups anaesthesia was induced with propofol 1.5 mg kg-1 and maintained with 7 mg kg-1 h-1. Patients breathed nitrous oxide and oxygen 3:2 spontaneously. Cardiovascular parameters were more stable after ketamine. The most important side effect was the presence of apnoea lasting longer than 60 s in 14 patients receiving fentanyl. The time to establish alertness was shorter in the ketamine group, who also had a better (P < 0.05) as well as post-anaesthetic recovery room score.

Aged↗
PubMed2003

Pain relief for paediatric dental chair anaesthesia: current practice in a community dental clinic.

AIM: A review of different modes of pain relief for simple dental extractions under general anaesthesia in a community dental setting. PATIENTS AND METHODS: Different analgesia regimens are used by different anaesthetic teams working in a single community clinic. A total of 72 patients were reviewed post-operatively in the recovery room and followed up with a telephone survey 24 h later to assess pain experienced by the patients. The efficacy of different analgesia regimens was analysed. RESULTS: The majority of patients were pain free in recovery, independent of the method of pain relief used. Local anaesthetic injections appear superior to systemic analgesia, and patients with local anaesthetic injections were more settled in recovery. DISCUSSION: Simple dental extractions cause pain and efficient administration of appropriate analgesia should be an integral part of the community dental service.

Adolescent↗
PubMedDate not supplied

Local anesthesia for knee arthroscopy. Efficacy and cost benefits.

We performed a retrospective review of a series of knee arthroscopic procedures that were completed using local, general, or regional anesthesia to evaluate the efficacy of these anesthetic techniques. Operative time, complications or failures, procedures successfully performed, recovery room time and postoperative stay, and patient satisfaction were recorded. Local anesthesia with intravenous sedation compared favorably with the other techniques: operative time was not increased, a large variety of operative procedures were successfully completed, recovery time was significantly shortened, and patient satisfaction remained high. This technique offers several advantages over other types of anesthesia for knee arthroscopy, including improved cost effectiveness.

Adolescent↗
PubMed1996

Midazolam and awareness with recall during total intravenous anaesthesia.

PURPOSE: A double-blind study was undertaken to evaluate the influence of graded doses of midazolam on propofol infusion requirements, recovery characteristics and the quality of recovery, associated with propofol/alfentanil/O2 total intravenous anaesthesia (TIVA). METHODS: Ninety ASA Class I and II subjects scheduled for arthroscopic knee surgery were randomly allocated to receive either placebo (Group PLAC), or midazolam doses of 15, 30 or 45 micrograms.kg-1 (Groups M-15, M-30 and M-45, respectively). Anaesthesia was induced and maintained with propofol (infused initially at 100 micrograms.kg-1.min-1, and adjusted there after according to anaesthetic depth) and alfentanil (loading dose of 20 micrograms.kg-1, followed by infusion at 0.5 microgram.kg-1. min-1). Postoperatively, times to awakening, recovery, and discharge were evaluated, in addition to psychometric evaluations using the Trieger Dot Test (TDT). RESULTS: The study was discontinued prematurely, as six patients unexpectedly experienced intraoperative awareness with recall (4/21 = 19.1% of patients with PLAC vs 2/69 = 2.9% of patients in the midazolam groups, P < 0.04). Induction requirements of propofol were found to be lower in the M-30 and M-45 groups when compared with PLAC (P < 0.05), whereas propofol infusion requirements were similar among groups. Times to awakening and discharge from the Recovery Room and Day Care Unit, as well as TDT scores, were no greater in any midazolam group than in PLAC. CONCLUSIONS: Midazolam 30-45 micrograms.kg-1 decreases the amount of propofol required for anaesthetic induction, without influencing recovery profiles or patient discharge times from the Day Care Unit. Despite careful modulation of the propofol infusion rate, six patients unexpectedly experienced intraoperative awareness with recall, with the lowest incidence occurring in those groups where patients had received midazolam.

Adolescent↗
PubMed1990

[Two-years' experience of ambulatory anesthesia in otorhinolaryngology in children].

Three hundred children were anaesthetized for E.N.T. operations. The anaesthetic consultation took place one week prior to operation. The anaesthetic comprises premedication, inhalation of halothane for infants, or propofol drip for the others with tracheal tubing for 10% of them. Recovery in every case is supervised in the recovery room. There are few setbacks with this method. Eleven children were not accepted for operation for sociological or medical reasons (Willebrand diseases) and only 3 had to remain in hospital until the following day due to slow recovery from anaesthetic.

Adenoidectomy↗
PubMed2004

Sciatic nerve blockade improves early postoperative analgesia after open repair of calcaneus fractures.

OBJECTIVE: To determine the effectiveness of analgesia, with or without sciatic nerve blockade, after open repair of calcaneus fracture. DESIGN: Randomized, prospective trial involving 30 patients divided into 3 groups of 10, all having open repair of calcaneus fractures. Group 1 used morphine patient-controlled analgesia alone. Groups 2 and 3 had morphine patient-controlled analgesia and a "one-shot" bupivacaine sciatic nerve blockade, either presurgically (group 2) or postsurgically (group 3). SETTING: Harborview Medical Center operating rooms and orthopedic floors. OUTCOME MEASURES: Morphine use over 24 hours, visual analogue scale pain scores, and sciatic nerve blockade duration. RESULTS: In the absence of sciatic nerve blockade, initial postoperative pain was marked, even with a mean recovery room dose of intravenous morphine more than 30 mg. Sciatic nerve blockade with bupivacaine had a mean duration of 14 hours and substantially reduced pain for the first 24 postoperative hours. Presurgical blockade confers no advantage over postsurgical blockade. CONCLUSION: Sciatic nerve blockade confers significant benefit over morphine alone for analgesia after open repair of calcaneus fractures. Postsurgical sciatic nerve blockade provides the longest possible postoperative block duration.

Adult↗
PubMed1997

Reduction of propofol injection pain with a double lumen i.v. set.

STUDY OBJECTIVE: To investigate if the use of a new double lumen i.v. set (DLIS) decreases the incidence of propofol injection pain compared with single lumen i.v. set (SLIS) administration. DESIGN: Prospective, randomized, double-blinded study. SETTING: Operating rooms in a university hospital. PATIENTS: 50 adult ASA physical status I and II patients of both genders undergoing general anesthesia for elective surgery. INTERVENTIONS: Patients were injected with propofol either through a DLIS or a SLIS. MEASUREMENTS AND MAIN RESULTS: Three different pain indices were recorded to be present or absent: (1) verbal report of pain during propofol injection (2) grimacing during propofol injection, and (3) recall of injection pain in the recovery room. When the DLIS was used, the incidence of verbal pain, grimacing during propofol injection, and recall of pain during recovery were lowered significantly by 53%, 46%, and 52%, respectively (chi square analysis of contingency table with Yates correction, p < 0.05). CONCLUSIONS: The DLIS significantly reduced the incidence of propofol injection pain compared with SLIS. Further studies are indicated to evaluate the cost-effectiveness of this device.

Anesthetics, Intravenous↗
PubMed1996

Comparative effects of three doses of intravenous ketorolac or morphine on emesis and analgesia for restorative dental surgery in children.

PURPOSE: The optimal dose of intravenous ketorolac tromethamine (ketorolac), a non-steroidal anti-inflammatory drug has not been determined in children. There are only limited published data on the use of intravenous ketorolac for paediatric analgesia. This study compares the analgesic and emetic effect of three different doses of ketorolac with morphine in paediatric dental surgical out-patients. METHODS: Following institutional approval and parental consent, 120 ASA I or II children, age 2-10 yr were randomized to four groups and received ketorolac 0.75, 1.0, and 1.5 mg.kg-1 or morphine 0.1 mg.kg-1 iv at induction of a standardized anaesthetic. At 15 and 30 min after arrival in the recovery room a blinded observer assessed pain using the Objective Pain Score (OPS). Twenty-four hours after surgery a telephone interview was carried out with a parent at home. RESULTS: There were no differences in demographic data, anaesthesia time, recovery and day-care unit time, OPS and postoperative analgesic requirements in the four groups. Postoperative vomiting in the first 24 hr occurred more frequently in the morphine group than in the other groups (P < 0.0166). No patient had excessive surgical bleeding. CONCLUSIONS: Ketorolac, in all doses studied (0.75, 1.0 and 1.5 mg.kg-1) was as effective an analgesic as morphine 0.1 mg.kg-1 given intravenously at induction to children having restorative dental surgery. Its use was associated with a significant reduction in the incidence of postoperative vomiting.

Analgesia↗
PubMed1997

Ondansetron is not superior to moderate dose metoclopramide in the prevention of post-operative nausea and vomiting after minor gynaecological surgery.

Peri-operative nausea and vomiting (PONV), remain a considerable problem. Ondansetron is being promoted currently as the drug of choice for the prevention and treatment of PONV. Experiments to investigate efficacy of ondansetron in PONV have been made with placebo or single doses of other drugs, e.g. metoclopramide, and often with different anaesthetic regimes with different emetic potential. This study investigated the relative benefits, in the prevention of PONV, of ondansetron compared with metoclopramide used at a dose higher than used in previous studies. Ninety-six patients undergoing minor gynaecological surgery were randomized to receive either ondansetron 4 mg or metoclopramide 0.4 mg kg-1. The patients were then assessed in the recovery room, in the day ward prior to discharge and the following day for the occurrence of PONV. Emetic symptoms occurred in similar proportions of patients who received ondansetron and metoclopramide. Nausea scores were similar between the groups in the recovery ward and 24-h follow-ups but there were higher post-operative nausea scores in the ondansetron group in the day ward (P = 0.001). There were no significant side effects due to either drug. We conclude that moderate dose metoclopramide is an effective alternative to ondansetron in the control of PONV.

Adult↗
PubMed2001

Analgesic efficacy of tramadol 2 mg kg(-1) for paediatric day-case adenoidectomy.

We studied the analgesic efficacy of tramadol 2 mg kg(-1) for post-operative analgesia after day-case adenoidectomy in children aged 1-3 yr. Eighty children were allocated randomly to receive tramadol 2 mg kg(-1) i.v. or placebo immediately after induction of anaesthesia. Anaesthesia was induced with alfentanil 10 microg kg(-1) and propofol 4 mg kg(-1) followed by mivacurium 0.2 mg kg(-1) for tracheal intubation. Anaesthesia was continued with sevoflurane in nitrous oxide and oxygen. All children were given ibuprofen rectally at approximately 10 mg kg(-1) before the start of surgery. Post-operative pain and recovery assessments were performed by a nurse blinded to the analgesic treatment using the Aldrete recovery score, the pain/discomfort scale and measurement of recovery times. Rescue medication (pethidine in increments of 5 mg i.v.) was administered according to the pain scores. A post-operative questionnaire was used to evaluate the need for analgesia at home up to 24 h after operation. Rescue analgesic at home was rectal or oral ibuprofen 125 mg. Children in the tramadol group required fewer pethidine doses than those in the placebo group (P = 0.014). Forty-five per cent of children receiving tramadol did not require post-operative analgesia at all compared with 15% of children receiving placebo (P = 0.003). Recovery times and the incidence of adverse effects were similar in the two groups in the recovery room and at home. The requirement for rectal ibuprofen at home did not differ between groups.

Adenoidectomy↗
PubMed1989

Monitoring of the inspired and end-tidal oxygen, carbon dioxide, and nitrous oxide concentrations: clinical applications during anesthesia and recovery.

Respiratory oxygen, carbon dioxide, and nitrous oxide concentrations were recorded in 20 patients breath-by-breath during general anesthesia and early recovery, using the Cardiocap multiparameter monitor. Several approved maneuvers were performed to demonstrate the usefulness of endtidal oxygen measurement. "Oxygrams" provided by the fast paramagnetic oxygen sensor confirmed the capnometric information in the diagnosis of hypoventilation, apnea, and disconnections. In one patient, the alarm for inspiratory oxygen concentration, set at 18%, appeared to prevent alveolar hypoxia and low arterial saturation from occurring when oxygen instead of nitrous oxide was turned off. Low end-tidal oxygen levels revealed inadequate fresh gas oxygen supplementation while low flow circuits were closed. During manual hypoventilation at the end of anesthesia, the inspiratory-expiratory oxygen difference increased almost twofold while end-tidal carbon dioxide increased by only 30%. Changes in nitrous oxide concentration often complemented oxygen-related information obtained in our observations. In the recovery room, a decrease in end-tidal oxygen concentration preceded low pulse oximetry readings. Therefore, it is suggested that all three gases should be monitored continuously to prevent mishaps related to insufficient ventilation and inappropriate gas concentrations during anesthesia and immediate recovery.

Abdomen↗