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PubMed1990

Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients.

The purpose of this study was to determine if the timing of caudal block placement in relation to surgery affected either the duration of postoperative pain relief or the discharge time in children undergoing brief ambulatory surgical procedures. Forty ASA physical status I or II children ages 18 mo to 11 yr were randomly assigned to one of two groups. Group 1 patients received a caudal block with 0.5 ml.kg-1 of bupivacaine 0.25 per cent following the induction of anaesthesia but before the onset of surgery. Group 2 patients received a similar block at the completion of surgery but before emergence from general anaesthesia. An experienced observer, who was not aware of the timing of block placement, observed all patients from arrival to the post-anaesthetic recovery room until discharge from the ambulatory surgery unit. Pain was assessed at five-minute intervals using an Objective Pain Scale. No statistically significant differences were noted between Group 1 and Group 2 patients with regard to their postoperative pain/discomfort scores, the need for postoperative narcotic analgesia, or the time required for either group to meet standard discharge criteria. It is concluded that the duration of postoperative analgesia is not impaired by placing the caudal block prior to the start of a brief surgical procedure.

Ambulatory Surgical Procedures↗
PubMed1980

Air flow patterns in the operating theatre.

Bacteria-carrying particles and exhaled anaesthetic gases are the two contaminants found in the air flow patterns of operating rooms. Their origin, direction and speed were illustrated by a motion picture using Schlieren photography and smoke tracers. Compared with a conventionally well air conditioned operating theatre, it was shown that a downward flow of clean air reduced the number of bacteria-carrying particles at the wound site by sixty times. The Exflow method of achieving this without the restriction of any side panels or floor obstruction was described. The total body exhaust worn by the surgical team was shown to reduce the bacteria count by a further eleven times. Clinical results show that when both these systems are used together, patient infection was reduced from 9 per cent to between 0.3 per cent and 0.5 per cent, even when no pre-operative antibiotics were used. Anaesthetic gas pollution was measured and shown to be generally 1000 p.p.m. at the head of the patient, in induction, operating and recovery rooms, also in dental and labour rooms. A high volume low pressure active scavenging system was described together with its various attachments including one specially for paediatric scavenging. Results showed a reduction of nitrous oxide pollution to between zero and 3 p.p.m. The economy and cost effectiveness of both these pollution control systems was shown to be good due to the removal of health hazards from patients and theatre staff.

Air Microbiology↗
PubMed1987

Antagonism of postoperative opioid-induced respiratory depression: nalbuphine versus naloxone.

The authors compared naloxone and nalbuphine as antagonists of opioid-induced respiratory depression to determine the relative efficacies and safety of the two agents. In a double-blind, randomized fashion, 90 anesthetized patients received a mean dose of 25 micrograms/kg fentanyl during surgery. Inadequate spontaneous respirations at the end of anesthesia were treated with either naloxone 0.08 mg or nalbuphine 2.5 mg IV every 2 min while heart rate (HR), systolic and diastolic blood pressures (SBP, DBP), respiratory rate (RR), and tidal volume (TV) were measured at 2-min intervals. Arterial blood samples for analysis of PaCO2, PaO2, and pH were drawn when spontaneous ventilation resumed, and 30 and 60 min later. Narcotic antagonism and respiration were deemed adequate when TV was greater than or equal to 4 ml/kg and RR greater than or equal to 8 breaths/min. Heart rate, SBP, DBP, TV and RR were recorded, as were the occurrence of renarcotization (RR less than 8) and analgesic requirements every 5 min during the recovery room stay. Sixty of 90 patients required narcotic antagonism at the end of surgery. No patient required more than three doses (0.24 mg) of naloxone or four doses (10 mg) of nalbuphine. Both antagonists produced similar and moderate increases in SBP and HR while restoring adequate spontaneous ventilation. There were no significant differences in TV, RR, or arterial blood gases (ABGS) between the two groups after narcotic reversal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Distinct central anticholinergic syndrome following general anaesthesia.

The purpose of this prospective study was to identify the incidence of a distinct central anticholinergic syndrome following routine anaesthesia. For 2 months, all inpatients aged more than 15 years scheduled for elective procedures and cared for in the recovery room were investigated for symptoms of the syndrome. Patients with neuropsychiatric disease or other disorders that could alter consciousness were excluded. Prolonged action of anaesthetics or relaxants, respiratory depression and metabolic disorder were ruled out before making the diagnosis. Out of 962 patients (366 men, 596 women), 18 (4 men, 14 women) developed the syndrome. The difference between men and women was not statistically significant. Six out of 60 women developed the syndrome after a hysterectomy with or without adnectomy/oophorectomy, and this high incidence was significantly different from that observed after all other procedures in women (P = 0.003) or all other gynaecological procedures (P = 0.013). The reason for this is unknown. In six of the 18 cases, untreated prolonged somnolence lasted for more than 2 h. All patients woke up after an injection of physostigmine, but six of them relapsed into somnolence and needed a second, and in one case a third, injection. The findings of the study emphasize that, when there is delayed recovery from anaesthesia, the diagnosis of central anticholinergic syndrome should be considered if other accessible causes for that condition have been excluded.

Adolescent↗
PubMed2002

Scalene regional anesthesia for shoulder surgery in a community setting: an assessment of risk.

BACKGROUND: A retrospective review of shoulder procedures using scalene block anesthesia was performed. METHODS: The records of all 218 patients who had undergone scalene block anesthesia over a three-year period at two facilities were retrospectively reviewed. All blocks were performed with use of a standard blunt-needle technique with the patient awake and with use of preoperative nerve stimulation to localize the brachial plexus. RESULTS: Adjunctive general anesthesia was used for 179 (82%) of the 218 patients. Seventy-two patients (33%) required intravenous pain medication immediately on arrival in the recovery room, and twenty-eight blocks (13%) failed. One grand mal seizure, one episode of cardiovascular collapse, and four episodes of severe respiratory distress were noted. Two patients had temporary neurologic injuries that persisted at six weeks. The mean duration of the block was 9 +/- 4.6 hours. Two hundred (92%) of the 218 patients required parenteral narcotics despite the use of scalene block anesthesia. CONCLUSION: Informed consent discussions regarding scalene block anesthesia should include information on the prevalence of complications and the efficacy of the technique.

Adult↗
PubMed1997

A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery.

The efficacy and safety of remifentanil and alfentanil for patients undergoing major abdominal surgery were compared. Premedicated patients received a loading dose of remifentanil (1.0 microgram.kg-1; n = 116) and a continuous infusion of 0.5 microgram.kg-1.min-1, or a loading dose of alfentanil (25 micrograms.kg-1; n = 118) and a continuous infusion of 1.0 microgram.kg-1.min-1. Propofol was administered (10 mg every 10 s) until loss of consciousness. Patients' lungs were ventilated with 66% nitrous oxide and 0.5% (end-tidal) isoflurane in oxygen. The study drug infusion rate was reduced by 50% 5 min after intubation. Alfentanil was discontinued 15 min before the end of surgery, whereas remifentanil was continued in the immediate postoperative period at a reduced dose. Responses to intubation (28%) and skin incision (17%) occurred approximately twice as often in the alfentanil group (15% and 8%; p = 0.014 and p = 0.037, respectively). More patients receiving alfentanil had one or more responses to surgery (72% vs. 57%; p = 0.016). The time to spontaneous respiration, adequate respiration, response to verbal command and time to recovery room discharge were similar. However, owing to decreased variability, the time to extubation was shorter with remifentanil than with alfentanil (p = 0.048). There was a similar overall incidence of adverse events in both groups, 82% and 75% of patients, respectively. Adverse events associated with remifentanil were rapidly controlled by dose reductions. The incidence of intra-operative hypotension and bradycardia was higher in the remifentanil group (p < or = 0.033). An initial remifentanil infusion rate of 0.1 microgram.kg-1.min-1 titrated to individual need provided postoperative pain relief in the presence of adequate respiration in 71% of patients. When using remifentanil in the immediate postoperative setting, rapid administration of bolus doses and infusion rate increases resulted in a relatively high incidence of muscle rigidity, respiratory depression and apnoea. Changing the postoperative regimen to avoid rapid changes in remifentanil blood concentration resulted in more effective analgesia and dramatically reduced the incidence of adverse events during this period. In patients undergoing major abdominal surgery, remifentanil appears to offer superior intra-operative haemodynamic stability during stressful surgical events compared with alfentanil without compromising recovery from anaesthesia. Remifentanil can be administered as a postoperative analgesic agent at a starting dose of 0.1 microgram-.kg-1.min-1; however, it should only be used in the presence of adequate supervision and monitoring of the patient. Administration of bolus doses is not recommended in this setting.

Abdomen↗
PubMed1998

Effects of a low-cost protocol on outcome and cost in a group practice setting.

STUDY OBJECTIVE: To investigate, in a group practice setting, the effects of combining information about drug costs with adoption of a voluntary low-cost protocol. DESIGN: Prospective before-and-after intervention comparison study. SETTING: Private practice anesthesiology group (certified registered nurse-anesthetists and anesthesiologists) of a large midwestern for-profit hospital. MEASUREMENTS AND MAIN RESULTS: Clinical outcome and anesthesia-related drug cost were examined for coronary artery bypass grafts (CABG), laparoscopic cholecystectomy (LC), and lumbar laminectomy (LL). There were no restrictions on the use of any drug if warranted by the patient's condition. 135 consecutive prospective (P) cases performed by the anesthesiology group after the intervention were retrospectively matched by surgery type and surgeon to cases done 9 months prior to the protocol to form the retrospective control group (R) resulting in a total sample of 270 subjects. Significant cost reductions were seen in LC-(57%), LL-(42%), and CABG-(37%). The largest cost reductions were opioids (78%), induction drugs (50%), and muscle relaxants (41%). There were no differences in pain, nausea, or hypertension scores between the P and R groups, but there were minor differences in recovery room, oxygen therapy, and dismissal times between the R and P groups of LC and LL patients. There were no differences in anesthetic outcome for CABG patients between the P and R groups. A follow-up survey completed 4 months after the study demonstrated that muscle relaxant costs and fresh gas flow rates and costs had returned to preintervention levels, while opioid and induction drug savings were maintained. CONCLUSIONS: A private practice anesthesia group that followed a voluntary protocol could significantly reduce drug cost with little change in clinical outcome. However, the savings may not be completely maintained after the monitoring period.

Aged↗
PubMed1996

A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients.

PURPOSE: The safety and efficacy of a new sedation technique for children having dental procedures under local anesthesia were evaluated. MATERIALS AND METHODS: One hundred children between the ages of 2 and 7 years who required sedation for dental procedures were administered either a combination of midazolam (0.35 mg/kg) and ketamine (5 mg/kg) or midazolam alone (1 mg/kg) rectally 30 minutes before removal to the dental chair. Pulse rate, respiratory rate, arterial pressure, oxygen saturation, adverse reactions, postoperative recovery, and behavior were recorded. RESULTS: Satisfactory sedation and anxiolysis were achieved with both drugs used in the study. When evaluating postoperative recovery, statistically significantly more children receiving midazolam alone were fully awake on admission to the recovery room and 30 minutes later. Results of physiologic monitoring, behavioral ratings, and adverse effects are reported. Excessive salivation occurred in 26% of children receiving the combination of drugs, compared with 14% receiving midazolam alone. Seven (14%) of the children receiving the combination of drugs hallucinated, compared with 21 (42%) receiving midazolam alone. Both drug groups had reliably good anxiolysis and sedation without loss of respiratory drive or protective airway reflexes. CONCLUSION: The use of a combination of midazolam and ketamine or midazolam alone is a safe, effective, and practical approach to managing children for minor dental procedures under local anesthesia. With this technique, advanced airway management proficiency is recommended.

Administration, Rectal↗
PubMed1996

Single dose i.v. tropisetron in the prevention of postoperative nausea and vomiting after gynaecological surgery.

In a prospective, randomized, multicentre, double-blind, placebo-controlled study, we have compared the efficacy of a single i.v. dose of tropisetron 0.5 mg, 2 mg and 5 mg in the prevention of postoperative nausea and vomiting (PONV). We studied 385 ASA class I and II female patients undergoing abdominal or vaginal gynaecological surgery, including laparoscopy. Tropisetron or placebo were administered before a standardized general anaesthetic. The frequency of vomiting in the 24-h period after entry into the recovery room was reduced from 44% after placebo to 31%, 26% and 30% after tropisetron 0.5 mg, 2 mg and 5 mg, respectively (P = 0.06, P = 0.009 and P = 0.043; unadjusted). Compared with placebo, nausea was reduced from 55% to 46%, 34% and 46% (P = 0.25, P = 0.003, P = 0.22), and need for rescue treatment from 39% to 29%, 23% and 35% (P = 0.13, P = 0.017 and P = 0.59) for the same groups. Tropisetron 2 mg appeared to be the optimal dose for prophylaxis against PONV with a side-effect profile similar to that of placebo.

Adult↗
PubMed1999

Cost comparison of sevoflurane with isoflurane anesthesia in arthroscopic menisectomy surgery.

PURPOSE: To determine the "real world" cost of sevoflurane compared with isoflurane in balanced general anesthesia for daycare arthroscopic menisectomy, we prospectively investigated perioperative drug requirement and expense as well as recovery time. METHODS: Following intravenous induction, 40 consenting adult patients randomly received either sevoflurane- or isoflurane-based anesthesia with a standardized gas inflow rate of 3 l x min. Recovery was assessed in the postanesthetic recovery room (PARR) in a double-blind manner at 15 min intervals using the Aldrete scoring system until patients met discharge criteria. RESULTS: Patient demographics, anesthetic duration, volatile potency and adjunct drug requirements were similar in the two groups. Total perioperative drug cost per patient was CAN$38.10+/-10.13 (mean +/- SD) for the sevoflurane group and $23.87+/-6.59 for the isoflurane group (P<0.01). Although the nonvolatile drug cost was comparable between the two groups, the volatile drug cost per patient was $19.40+/-8.80 for sevoflurane and $4.50+/-1.90 for isoflurane (P<0.01). This four-fold sevoflurane-to-isoflurane cost difference was the product of two ratios, both based on the volume of liquid anesthetic: the ratio of consumption, 2.1; and the ratio of institutional price, 2.1. Intraoperative hemodynamic response, time until discharge from the PARR and incidences of postoperative nausea and vomiting did not significantly differ between the two groups. CONCLUSIONS: When used to maintain equipotent balanced general anesthesia for daycare arthroscopic menisectomy, volatile consumption and cost were greater for sevoflurane compared with isoflurane. Nonvolatile perioperative drug cost and recovery times were similar, however, in the two groups.

Adult↗
PubMed1997

[Efficacy of ketanserin on postanesthetic shivering].

OBJECTIVE: To evaluate the clinical and electromyographic (EMG) effects of ketanserin (K), a serotoninergic receptor antagonist (5-HT2), on postoperative shivering (POS). STUDY DESIGN: Prospective, randomised, double-blind study. PATIENTS: Fifty ASA class 1 and 2 patients with major clinical postoperative tremor were studied. METHODS: POS was assessed clinically (0 = nil, 1 = moderate, 2 = severe). Inclusion criterion was a POS of 2 at admission in the recovery room. The mean arterial blood pressure, rectal temperature, SpO2 were recorded at admission (T0) and subsequently at T5, T10, T15, T30 and T60 minutes. Either 10 mg of K (n = 25) or a corresponding volume of a placebo (P) (n = 25) were intravenously injected. The EMG activity of the deltoid and quadriceps muscles was recorded continuously. Blood lactic acid concentration was measured at the end of POS. Results are expressed as mean +/- SEM. Parametric values were analysed with unpaired Student's t-test, and nonparametric values with chi 2 analysis. P < 0.05 was accepted. RESULTS: Demographic data, duration of anaesthesia, postoperative temperature, oxygen saturation, blood pressure and blood lactate concentration were similar between groups. The POS duration in the K group was significantly shorter than in the P group: 8.8 +/- 1.5 min and 15.5 +/- 1.5 min respectively (P < 0.01). The number of patients in the K group experiencing POS at T5 and T10 was significantly lower, when compared with those who had received the P (P < 0.05). CONCLUSION: At a dose of 10 mg, K administered in patients with POS during recovery, reduced significantly the duration and intensity of the shivering without noticeable side effects. This study suggests that this 5-HT2 antagonist is an efficient therapeutic tool for POS in adults.

Adult↗
PubMed2001

The effects of small-dose ketamine on propofol sedation: respiration, postoperative mood, perception, cognition, and pain.

We compared the effects of coadministration of propofol and small-dose ketamine to propofol alone on respiration during monitored anesthesia care. In addition, mood, perception, and cognition in the recovery room, and pain after discharge were evaluated. In the Propofol group (n = 20), patients received propofol 38 +/- 24 microg x kg(-1) x min(-1). The Coadministration group (n = 19) received propofol 33 +/- 13 microg x kg(-1) x min(-1) and ketamine 3.7 +/- 1.5 microg x kg(-1) x min(-1). Respiration was assessed by using end-expiratory PCO(2) measurements at nasal prongs. After surgeries, mood, perception, and thought were assessed by using visual analog scales, and cognition was assessed by Mini-Mental State Examination (MMSE). Pain after discharge was assessed by a five-point rating scale in the evening for 5 days. End-expiratory PCO(2) was lower in the Coadministration group (P < 0.0001). Mood and MMSE scores were higher in the Coadministration group (P < 0.004 and P = 0.001, respectively). Pain scores and analgesic consumption after discharge were less in the Coadministration group (P = 0.0004 and P < 0.0001, respectively). We conclude that coadministration of small-dose ketamine attenuates propofol-induced hypoventilation, produces positive mood effects without perceptual changes after surgery, and may provide earlier recovery of cognition.

Adult↗
PubMed1994

[Early postoperative hypoxemia: incidence and effectiveness of oxygen administration].

OBJECTIVE: To determine the incidence of hypoxaemia and the efficacy of oxygen therapy in the early postoperative period. DESIGN: Prospective, randomized study. SETTING: Regional hospital. PATIENTS: 89 patients undergoing general anaesthesia divided into two groups, I (n = 45) and II (n = 44). INTERVENTIONS: Patients of group I breathed room air while patients of group II received supplementary oxygen. MEASUREMENTS AND MAIN RESULTS: Oxygenation was monitored continuously for 60 minutes with a pulse oximeter after the end of surgery; hypoxaemia was graded into four values of SpO2: mild (86-90%), moderate (81-85%), severe (76-80%), extreme (< or = 76%). One or more episodes of mild hypoxaemia were recorded in 68% of patients in group I and in 36% of patients in group II (p < 0.005); moderate hypoxaemia were recorded in 51% of patients in group I compared with 13% of patients in group II (p < 0.001). Episodes of severe or extreme hypoxaemia were recorded in 22% and in 6% of patients in group I; no patients in group II exhibited such small values of saturation. The smallest recorded SpO2 values were 81 +/- 5.94% in group I and 89 +/- 8.63% in group II (p < 0.001). CONCLUSIONS: There is a high incidence of clinically unsuspected hypoxaemia in the early postoperative period, the use of supplemental oxygen reduces but does not prevent hypoxaemic episodes, every patient should be monitored continuously with a pulse oximeter in the recovery room.

Adult↗
PubMed2000

Optimal technique to diagnose primary ciliary dyskinesia.

OBJECTIVE: To develop a cost-effective protocol for diagnosing primary ciliary dyskinesia (PCD). STUDY DESIGN: Retrospective chart review in a tertiary care academic medical center. METHODS: A review of the electron microscopy logbook identified all patients who had a suspected diagnosis of PCD. Biopsy of respiratory tract mucosa was performed using a cytology brush or a cup forceps in the outpatient clinic or operating room (OR). Outcome measures were to determine the diagnostic adequacy of cytological evaluation compared with tissue biopsy and to determine whether an adequate nasal mucosa sample can be collected in the outpatient clinic setting as compared with the OR and the use of general anesthesia RESULTS: Twenty-seven patients underwent 31 biopsies. Fifteen specimens were collected with a cup forceps, and 16 with a cytology brush. The sampling sites were nasal mucosa in 28 cases and trachea in the rest. Twelve specimens (39%) were collected in the clinic; the rest were obtained in the OR in conjunction with another procedure. Neither method of specimen collection nor mode of anesthesia made a significant difference in the probability of obtaining an adequate specimen. Ten samples were nondiagnostic: cytological evaluation, 31% (n = 16); tissue biopsy, 27% (n = 15); clinic, 42% (n = 12); and OR, 31% (n = 16). The cost of evaluating ciliary motion at our institution was $150, with an additional charge of $1,297 for electron microscopic evaluation. The nonprofessional fee for an outpatient nasal biopsy was $98; in the OR the cost of anesthesia supplies, surgical suite, recovery room, and day-surgery bed was at least $1,860. CONCLUSION: Our results suggest that the optimal method for diagnosis of PCD is in the outpatient clinic with specimen collection by means of either a cup forceps or a cytology brush.

Algorithms↗
PubMed1991

Effects of oral clonidine premedication and postoperative i.v. infusion on haemodynamic and adrenergic responses during recovery from anaesthesia.

The effects of clonidine, a central alpha 2-adrenoreceptor agonist, on haemodynamic and catecholamine changes were assessed during emergence from anaesthesia, a period which is associated with increased sympathetic nervous discharge, hypertension and tachycardia. According to a double-blind randomized design, 32 patients received either clonidine, preoperatively given by oral route (3.5 micrograms.kg-1) and postoperatively by i.v. infusion (0.3 microgram.kg-1.h-1), or a placebo. Perioperative management was similar in both groups. Measurements were made in the recovery room, before starting clonidine or placebo infusions for evaluation of clonidine premedication, and then during infusion as follows: when core temperature reached 37 degrees C; then 2 h, and 6 h later. Prior to starting infusions, mean blood pressure (88 +/- 15 vs 103 +/- 14 mmHg) (11.7 +/- 2.0 vs 13.7 +/- 1.9 kPa), heart rate (67 +/- 8 vs 87 +/- 17 beats.min-1) and plasma norepinephrine levels (462 +/- 393 vs 615 +/- 361 pg.ml-1) were lower in the clonidine group. Only at the latest measurement (6 h after core temperature reached 37 degrees C) did clonidine elicit significant effects. The values during clonidine infusion compared to placebo were at this time: mean blood pressure (73 +/- 10 vs 86 +/- 13 mmHg) (9.7 +/- 1.3 vs 11.5 +/- 1.7 kPa), heart rate (71 +/- 6 vs 93 +/- 13 beats.min-1) and plasma norepinephrine levels (240 +/- 224 vs 451 +/- 111 pg.ml-1). Our results suggest that: 1) preoperative clonidine may improve the haemodynamic profile associated with anaesthetic discontinuation, but 2) i.v. infusion (0.3 microgram.kg-1.h-1) did not prolong this effect during the early postoperative period in the face of the sympathetic nervous discharge of recovery.

Administration, Oral↗
PubMed1996

Is preoperative ketorolac a useful adjunct to regional anesthesia for inguinal herniorrhaphy?

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) have become a popular component of analgesia regimens, particularly in combination with narcotics. We questioned whether there might also be a place for their use in conjunction with regional anesthesia and whether there was a preferable route for NSAID administration. METHODS: Ilioinguinal and field blocks were performed preoperatively on seventy patients undergoing outpatient inguinal hernia repair. Patients were divided into a control group who received no ketorolac and four study groups who received a preoperative dose of 30 mg ketorolac by one of the following routes: i.v., i.m., p.o., or intrawound (i.w.). The ketorolac in the i.w group was mixed in the syringe with the local anesthetic used for the field block. i.v. and i.m. groups also received ketorolac at the time of the preoperative regional anesthesia and the PO group received the dose at least one hour preoperatively. All patients received a similar general anesthetic intraoperatively. RESULTS: Postoperative pain scores and analgesic requirements were lowest for the i.m., i.v., and i.w. groups. Pain scores and analgesic requirements for the PO group were less than for the control group but more than for the other three groups. Analgesic efficacy therefore ranked: i.m. = i.v. = i.w. > p.o. > control. Though no differences were found between groups in the time to discharge from the recovery room, the ease of nursing care paralleled the findings for pain scores and analgesia requirements. CONCLUSION: Beyond the analgesia provided by the regional anesthesia of the ilioinguinal and field blocks, the preoperative use of ketorolac further reduced postoperative pain scores and the need for additional postoperative analgesic medication. Comparable outcomes for the i.v., i.m. and i.w. groups indicate the lack of any benefit to concentrating the non-steroidal anti-inflammatory drug at the wound (i.w.) or to achieving high blood levels rapidly (i.v.). In conclusion, ketorolac is a useful supplement to ilioinguinal plus field block regional anesthesia for hernia surgery and is most effective administered parenterally.

Adjuvants, Anesthesia↗
PubMed1999

Assessment of the postoperative residual curarisation using the train of four stimulation with acceleromyography.

The aim of this study was to measure the incidence of patients with train of four ratio < 0.9 in the immediate postoperative period using acceleromyography. At arrival in recovery room, 257 patients were enrolled. Train of four ratio was assessed at the adductor pollicis using TOF-GUARD INMT apparatus. Patients were divided in two groups according to TOF ratio < (group 1) or > (group 2) to 0.9. Demographic variables, dose (mg), dose/weight ratio (mg.kg-1) of atracurium and surgery duration (min) were registered. There was no difference in demographic variables, duration of surgery (100.90 +/- 67.38/94.83 +/- 62.42 min), number of incidence reversal of neuromuscular block. Patients in group 1 (n = 72) received a higher dose (54.58 +/- 38.03/41.43 +/- 19.47 mg) of atracurium compared to group 2 (n = 176). Thirty percent of patients presented a train of four ratio < 0.7 and 13% < 0.9. TOF-GUARD INMT was easy to use.

Acceleration↗
PubMed1998

Infusion of propofol, sufentanil, or midazolam for sedation after aortic surgery: comparison of oxygen consumption and hemodynamic stability.

UNLABELLED: We conducted a prospective, randomized study to compare quality of sedation, hemodynamic stability, and oxygen consumption of three different drugs for continuous i.v. sedation in the immediate postoperative period in patients scheduled for aortic surgery (propofol [n = 12], sufentanil [n = 12], or midazolam [n = 12]). After arrival in the recovery room, patients were randomized into one of the following groups: Group P (continuous infusion of propofol 2 mg x kg(-1) x h(-1)), Group S (continuous infusion of sufentanil 0.25 microg x kg(-1) x h(-1), with bolus doses of midazolam 2 mg to maintain sedation at 3-4 on the Ramsay scale), and Group M (continuous infusion of midazolam 0.07-0.15 microg x kg(-1) x h(-1) to maintain sedation at 3-4 on the Ramsay scale). The three drugs were associated with similar hemodynamic stability, incidence of myocardial ischemia, and comparable kinetics and mean values for VO2, but a significant higher number of peaks for VO2 in Group S during the period of rewarming. To obtain an appropriate Ramsay score, we needed to increase the rate of administration of the drug in Group P, and to decrease this rate in Group M. After the drugs were discontinued, Group P required mechanical ventilation for less time. In conclusion, propofol is as effective as sufentanil or midazolam in controlling increased VO2 postoperatively. The initial dose of 2 mg x kg(-1) x h(-1) had to be increased for most patients. In addition, propofol sedation is associated with a quicker recovery compared with midazolam and sufentanil. IMPLICATIONS: A prospective, randomized comparison of propofol, sufentanil and midazolam infusions revealed similar effects on hemodynamics, oxygen consumption, and rate of myocardial ischemia after aortic surgery, although propofol was associated with a quicker recovery compared with midazolam and sufentanil.

Anesthetics, Intravenous↗