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PubMed1995

Prevention of emesis after strabismus repair in children: a prospective, double-blinded, randomized comparison of droperidol versus ondansetron.

STUDY OBJECTIVE: To compare the effectiveness of ondansetron with droperidol in preventing postoperative emesis in children after strabismus repair. DESIGN: Randomized, double-blind study. PATIENTS AND SETTING: 57 ASA physical status I and II children aged 3 to 14 years, undergoing outpatient strabismus repair in two separate study centers. INTERVENTIONS: Patients were randomized to receive either 0.15 mg/kg intravenous (i.v.) ondansetron or 0.075 mg/kg i.v. droperidol shortly after induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Number of episodes of emesis and times to discharge from the recovery room and ambulatory center were assessed. Twenty-nine (94%) of 31 children who received ondansetron and 21 (81%) of 26 children who received droperidol were emesis-free (p = NS). There were no significant differences in the number of episodes of emesis on the day after surgery or times to discharge. CONCLUSIONS: Ondansetron is at least as effective as droperidol in reducing the frequency of emesis in children after strabismus repair, and it did not shorten times to discharge home. The low number of patients in our study may have masked a difference in effect between the two groups. The clinician should decide whether the increased cost of ondansetron justifies its use over other antiemetics.

Adolescent↗
PubMed1999

Ropivacaine 0.25% compared with bupivacaine 0.25% by the caudal route.

We compared in a randomized double-blind study, the postoperative analgesia and degree of motor block produced by the new local anaesthetic ropivacaine, with bupivacaine, for caudal anaesthesia in children. Eighty children, 2-5-years-old, ASA I, received one of two local anaesthetics; either ropivacaine 0.25% (1.0 ml x kg(-1)) or bupivacaine 0.25% (1.0 ml x kg(-1)). They were sedated with a continuous infusion of propofol (200 microg x kg(-1) min(-1). The lungs were ventilated with a mixture of 50% nitrous oxide with oxygen. 60 min after local anaesthetic injection, and every 60 min, the extent of the motor block in the recovery room was scored as 1-3, according to a modified Bromage scale. Adverse events and the time to the first analgesic requirement were reported. Patients in the two groups did not differ with respect to age, weight and height. There were no differences in heart rate and arterial pressure between the two groups(P>0.05). No adverse events were observed. The ropivacaine group showed a shorter duration of motor block than the bupivacaine group (P<0.05). The first postoperative analgesic requirement was a mean (sd) of 5 h+/-4.32 after the operation in the ropivacaine group and 5 h+/-3.81 for the bupivacaine group. These findings suggest that caudal anaesthesia with ropivacaine 0.25% in paediatric patients can be effective, with less motor blockade in the postoperative period.

Amides↗
PubMed1996

Autologous bone marrow harvesting in outpatients.

STUDY OBJECTIVE: To assess the experience with autologous bone marrow harvesting in outpatients. DESIGN: Retrospective analysis of outpatients who underwent autologous bone marrow harvesting from 1990 to 1992. SETTING: University-affiliated surgical day hospital. SUBJECTS: 235 outpatients who underwent 264 autologous bone marrow harvests. Patients are candidates for autologous bone marrow harvesting on an outpatient basis if they are Karnofsky performance status of 80-100 and ASA status I, II or III. MEASUREMENTS AND MAIN RESULTS: The incidence of perioperative complications and hospital admission from the Surgical Day Hospital, the duration of the harvesting procedure and postanesthesia care unit (PACU) stay, details of the postoperative pain management, and costs and charges of the outpatient procedure compared with the same procedure performed on inpatients were assessed. Mean age was 37.7 years +/- 10.5 SD; + 7.7% patients were male and 52.3% were female. The disease process included non-Hodgkin's lymph/ma (30.3%), leukemia (24.3%), metastatic breast cancer (18.4%), Hodgkin's disease (17.3%), testicular carcinoma (6.5%) and other (1.6%). The patients were ASA status II (54.5%) or ASA III (45.5%) and received general endotracheal anesthesia. Each patient had 10.7 ml/kg +/- 2.8 SD of marrow harvested over a period of 110.7 minutes + 30.4 SD and total recovery room time of 233.7 minutes +/- 85.5 SD. Of 251 harvest, only three (1.1%) required hospital admission. PACU complaints included transient hypotension and dizziness (5.3%), nausea (3.8%), vomiting (3.4%), and (1.9%) temperature elevation. 83.7% of patients were reached at home the following day and 4.1% complained of nausea and/or vomiting at home. 6.8% of patients experienced temperature elevation at home. Only 27.1% of patients took the acetaminophen with codeine that was prescribed. The reminder required no opioid at home. Outpatient charge/ inpatient charge was 51.1%, and outpatient cost/inpatient was 74.4%. CONCLUSION: Autologous bone marrow harvesting is an acceptable ambulatory surgical procedure that results in a very law postanesthesia complication rate. Postoperative pain is easily controlled. The outpatient setting offers cost and time advantages to the patient.

Adult↗
PubMed2004

Effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing non-ophthalmic surgery.

BACKGROUND AND OBJECTIVE: To compare the effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing elective non-ophthalmic surgery. METHODS: Thirty-two patients (ASA I-II) were randomized into two groups to receive either a continuous infusion of remifentanil (0.25-0.5 microg kg(-1) min(-1), n =16, Group R) or an intermittent bolus of fentanyl (2-5 microg kg(-1), n = 16, Group F) during the maintenance of anaesthesia. For the induction of anaesthesia, Group R received remifentanil 1 microg kg(-1) and Group F received fentanyl 2 microg kg(-1); both groups then received propofol 2 mg kg(-1) with vecuronium 0.1 mg kg(-1). Anaesthesia in both groups was maintained with a continuous infusion of propofol 4-8 mg kg(-1) h(-1). Ventilation of the lungs was controlled to a constant end-tidal PCO2 of 4.7-5.4 kPa. Blood pressure, electrocardiography, heart rate and oxygen saturation were monitored throughout anaesthesia. Intraocular pressure was determined before surgery, during the maintenance of anaesthesia, 2 min after emergence and in the recovery room using a Perkins hand-held applanation tonometer by an ophthalmologist blinded to the anaesthetic technique. RESULTS: After induction of anaesthesia, a significant decrease in intraocular pressure in the remifentanil group from 13.6 +/- 2.6 to 7.1 +/- 3.1 mmHg (P < 0.001) and in the fentanyl group from 13.7 +/- 2.2 to 9.7 +/- 3.4 mmHg (P < 0.001) was observed and maintained during anaesthesia. Thirty minutes after the end of anaesthesia, intraocular pressure returned to baseline values in both groups (remifentanil: 13.9 +/- 2.8 mmHg, P = 0.28; fentanyl: 13.6 +/- 2.3 mmHg, P = 0.59). The intraocular pressure and haemodynamic variables did not differ significantly between the two groups (intraocular pressure, P = 0.7327; blood pressure, P = 0.1295; heart rate, P = 0.8601). CONCLUSIONS: Remifentanil maintains intraocular pressure at an equally reduced level compared with fentanyl.

Adolescent↗
PubMed1999

Efficacy of ondansetron in prophylaxis of postoperative nausea and vomiting in patients following infratentorial surgery: a placebo-controlled prospective double-blind study.

In a prospective double blind placebo-controlled study, 45 patients scheduled for infratentorial surgery were randomly allocated into two groups. Five patients were later excluded from the study because of various reasons. Out of 40 analyzable patients, 20 received IV Ondansetron (4 mg), whereas the other 20 received the matching placebo approximately 1 hour before the skin closure. After conclusion of surgery and tracheal extubation, all patients were monitored in the recovery room for post operative nausea and vomiting (PONV) for 48 hours. The incidence of PONV within the first 24 hours was found to be 50% and 10% in the placebo and ondansetron groups, respectively (p<0.05). After 24 hours, however, both groups were comparable in relation to the incidence of emesis. Rescue antiemetic (RAE) was required in nine (45%) patients in the placebo group and in two (10%) patients in the Ondansetron group (p<0.05). A significantly higher number of patients remained sedated postoperatively in the Ondansetron group than in the placebo group (p<0.05). One patient in the Ondansetron group had protracted diarrhea for 48 hours postoperatively. These results indicate that administration of IV Ondansetron (4 mg) 1 hour before skin closure effectively reduces PONV after infratentorial surgery, and does not have significant adverse effects.

Adolescent↗
PubMed1992

[Disclosure of protein C deficiency with pulmonary embolism followed by cardiac arrest during the recovery period].

A case of unexpected cardiac arrest occurring in a 17-year-old male patient is reported. The patient had been admitted after sustaining hand trauma. A first emergency surgical procedure was carried out, followed about three weeks later by another one. No incidents occurred during or after either of these two operations. A third procedure was required about two months after the accident (free toe graft to the thumb of the left hand). The twelve-hour operation was carried out under general anaesthesia and axillary block. The patient was given intravenous heparin (800 IU.h-1) during the procedure on the arm. The patient recovered quickly, and was extubated before his transfer to the recovery room. Fifteen minutes later, the patient's heart rate decreased to 40 b.min-1, followed by a transient cardiorespiratory arrest. The suspicion of pulmonary embolism was confirmed by pulmonary scintigraphy. Thrombolysis was carried out with 2,000 IU.kg-1.h-1 of urokinase for a 72 h period, combined with continuous heparin administration (16 to 36 x 10(3) IU.day-1). The patient recovered after one week. No thrombophlebitis was found for origin of the emboli. Biological investigations carried out both before and after 10 minutes of anoxia revealed a normal fibrinolytic system, but a deficit in protein C (62% antigen, 64% activity). Two years after the episode of pulmonary embolism, the patient, still taking acenocoumarol, remained free from any sequela. Current perioperative management of patients with a known protein C deficit is discussed.

Adult↗
PubMed1993

Vascular access surgery as an outpatient procedure.

Construction of a vascular access site for hemodialysis has traditionally been done on an inpatient basis or more recently in a hospital operating room as a 1-day admission. Over 18 months we performed 49 vascular access procedures on 45 patients in a freestanding ambulatory surgical center. Four patients had an arteriovenous radiocephalic autogenous fistula constructed, 30 patients had a polytetrafluoroethylene (PTFE) prosthesis inserted as an arteriovenous bridge graft, 11 patients had a planned reconstruction of a previously placed graft, 1 patient had a false aneurysm corrected, 1 patient had a chronically infected graft removed, and 2 patients had a thrombectomy. All procedures were in the upper extremities except for one femorosaphenous PTFE graft and one excision of a false aneurysm in a thigh prosthesis. Only one patient, an 84-year-old woman, required hospitalization following the outpatient procedure because she was unable to care for herself. No postoperative infection had occurred at 1 month follow-up. A left upper extremity graft performed at another inpatient facility was removed because of infection. The protocol for outpatient vascular access surgery includes preoperative evaluation of the patient for determination of the access site within a week of operation; duplex scan of subclavian veins if central venous lines have been in place for more than 2 weeks; scheduling surgery for the afternoon or morning following routine hemodialysis; obtaining a hemoglobin level, serum/electrolyte study, and an ECG following the last hemodialysis; parenteral antimicrobial prophylaxis; local infiltration anesthesia with standby; a minimum of 1 hour of observation in the recovery room; and a repeat hematocrit study prior to discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

[Anesthetic and perioperative management of patient for breast reconstruction in an outpatient clinic].

BACKGROUND: Our clinic provides various reconstructive surgeries but does not have facilities for patient admission, but there is a hospital providing satisfactory post-operative treatments in our area. METHODS: During the past 3 years, 276 patients received reconstructive mammoplasty under general anesthesia at our clinic. Their post-operative conditions immediately after the recovery were evaluated with the Modified Post-Anesthesia Discharge Scoring System (MPADSS). After observation for 4 to 5 hours in a recovery room, all the patients were transferred to another hospital by car. RESULTS: The score was 9 or 10 points in 45% of the patients. This indicates that the patients can be transferred to another hospital without problems. Twenty percent of patients had 6-7 points. These patients had mild bleeding, pain and/or unsteadiness/nausea/vomiting while walking. Among the 256 patients who were transferred to another hospital by car, one patient vomited in the car and 5 patients had nausea after the transfer. The other 20 patients whose score was 7 or lower were transferred by special vehicle with a stretcher and their conditions did not aggravate at all. CONCLUSIONS: At present, it is dangerous to perform all breast reconstructive surgeries as a day surgeries. A system is indispensable in which patients are transferred after surgery to another hospital with over-night stay facilities enabling observation.

Adult↗
PubMed1988

Antagonism of midazolam sedation by flumazenil: a placebo-controlled study in patients recovering from intravenous anaesthesia with high doses of midazolam.

Twenty adult surgical patients were anaesthetized with high-dose midazolam and alfentanil by infusion, vecuronium, and intubated and ventilated with 50% N2O in O2. The midazolam and alfentanil infusions were stopped at the end of surgery. Residual neuromuscular blockade and ventilatory depression were antagonized and the patients extubated. In the recovery room, patients were randomly allocated to receive either flumazenil 1 mg of placebo i.v. Before, and until 2 h after injection, patients were asked to perform psychomotor tests. In addition, sedation, comprehension and orientation were scored. The flumazenil (n = 10) and the placebo (n = 10) groups were comparable. Prior to injection all patients were heavily sedated. After flumazenil all were awake within 2-3 min, but fell asleep again 15-60 min later. The improvement in test scores was sustained for a longer time. After placebo, patients awoke in 1-2 h. At 60 and 120 min, test scores in the two groups were similar. Heart rate, blood pressure and respiration rate did not change. No side-effects were observed or reported. It is concluded that flumazenil is an effective and safe antagonist of high dose midazolam, with a rapid onset but a short duration of action.

Adult↗
PubMed2000

Supplementary oxygenation with the laryngeal mask airway: a comparison of four devices.

The provision of supplementary oxygen via the laryngeal mask airway used in the recovery room is important for patient safety. Several devices have been described for this purpose, but these studies have not included an accurate measurement of the most clinically important variable, the end-tidal oxygen concentration. We constructed an artificial model of spontaneous ventilation to compare the efficacy and safety of four devices; a circuit filter, a Hudson mask, the 'T-bag' device and a T-piece. We combined the use of oximetry with a pneumotachograph to provide a continuous picture of the oxygen delivery characteristics of the devices at flow rates of 2, 4 and 8 l.min-1. The performances of the T-bag and the T-piece were superior to those of the filter and Hudson mask, with end-tidal oxygen concentrations of 46.1%, 45.8% and 35.4%, 34.8%, respectively, at 8 l.min-1. Single point assessments of oxygen delivery, such as peak inspired oxygen concentration, may overestimate the efficacy of test devices.

Anesthesia Recovery Period↗
PubMed1989

Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia.

Recovery from inhalation anesthesia is often marked by the occurrence of postoperative tremor that resembles shivering, which is known to be associated with an increase in oxygen uptake (VO2), CO2 output (VCO2), and minute ventilation (VE). This study determined the time course of the ventilatory changes observed during the first hour of recovery from isoflurane anesthesia. Ten patients (ASA PS 1) scheduled for minor orthopedic surgery (knee arthroscopy) were included in this study. Anesthesia was induced with thiopental (5 mg/kg) and maintained with 70% N2O and isoflurane (1-2%) in oxygen, allowing spontaneous ventilation. In the recovery room, after N2O had been discontinued, patients were connected to a Beckman Metabolic measurement cart, which allowed a continuous monitoring of VE, VO2, VCO2, and PETCO2. Postoperative tremor was observed in all patients within 7.1 +/- 1.2 min (mean +/- SEM) after isoflurane discontinuation and was associated with a marked increase in the following: VO2, from 173 +/- 26 ml/min at the end of anesthesia to 457 +/- 88 ml/min; VCO2, from 149 +/- 18 ml/min at the end of anesthesia to 573 +/- 98 ml/min; and VE, from 6.8 +/- 0.7 l/min at the end of anesthesia to 16.6 +/- 2.8 l/min (values obtained 20 min after isoflurane discontinuation). In three patients during intense shivering, VO2, VCO2, and VE reached peak values higher than 800 ml/min, 1,300 ml/min and 30 l/min, respectively. This study shows that postoperative tremor following isoflurane anesthesia may be associated with prolonged and large increases in oxygen uptake, CO2 output, and minute ventilation.

Adolescent↗
PubMedDate not supplied

Evaluation of the efficacy of a forced-air warmer (Bair Hugger) during spinal surgery in children.

STUDY OBJECTIVE: To evaluate the efficacy of a forced-air warmer during spinal surgery for correction of scoliosis in children. DESIGN: Prospective randomized study (group allocation based on the availability of the warming device). SETTING: Children's teaching hospital. PATIENTS: 51 ASA physical status I and II children (mean age, 15 years; mean weight, 45 kg) scheduled for posterior spinal fusion with general anesthesia. INTERVENTIONS: Study group (warmed; n = 26)--legs covered with the forced-air warmer (Bair Hugger, Augustine Medical, Inc., Eden Prairie, MN) after installation of the patient in prone position--versus control group (n = 25)--400W heat lamp placed over the head during surgery as is usually done in our institution. MEASUREMENTS AND MAIN RESULTS: Rectal temperature was taken every 15 minutes during surgery and during the first 2 hours in the recovery room. Time required for the wake-up test, time to extubation, and blood loss also were noted. Temperature profiles were very different in the 2 groups. In the control group, rectal temperature decreased during the first 180 minutes to a minimum of 34.8 degrees C +/- 0.6 degrees C, followed by a slow rewarming phase. In the warmed group, the lowest temperature (35.6 degrees C +/- 0.5 degrees C) was recorded 45 minutes after placement of the forced-air warmer, followed by an effective warming phase. At the end of surgery, temperature was significantly higher in the warmed group than in the control group (36.5 degrees C +/- 0.8 degrees C vs. 35.4 degrees C +/- 0.9 degrees C). However, time required for the wake-up test, time to extubation, and blood loss did not differ between groups. CONCLUSION: The forced-air warmer (Bair Hugger) is effective during spinal surgery, although only about 20% of body surface area can be covered.

Adolescent↗
PubMed1981

Management of severe forearm injuries.

A review of principles and an operative guideline for repair of severely mutilating injuries to the forearm have been set forth. These concepts and their application have been illustrated in a series of clinical cases. The following key concepts have developed from these clinical experiences: 1. The surgeon must evaluate each case based upon the potential for return of sensation and function. One cannot justify the statement that a replanted arm is always superior to a prosthesis, even if its only purpose is cosmetic. 2. Care must be taken in the emergency room to evaluate the entire patient, and not to ignore other injuries while concentrating on a mangled extremity. 3. The crush-avulsion nature of injuries seen in a large referral center necessitates aggressive debridement of damaged soft tissue and bone. Wounds that have avulsion of skin, muscle, and nerve throughout the length of the arm do not lend themselves to repair. Destruction of an elbow joint generally precludes repair. 4. A well stabilized skeleton is essential before definitive soft tissue repairs can be performed. 5. Vascular repairs are meticulously performed using magnification. All vessels are reconstructed in an effort to recreate the original anatomy. 6. Wide destruction of muscle and tendon is frequent necessitating ingenuity in connecting proximal motor units to distal tendon. After repair, early active motion of the extremity is emphasized. 7. Perhaps the strongest contraindication to reconstruction of a severely damaged upper limb is avulsion of the nerves throughout the length of the forearm. Sharply divided nerves can be repaired by group fascicular suture. Crushed, divided nerves do well with accurate epineural approximation. Crushed nerves with epineural continuity ar best treated by observation and secondary grafting as required. 8. Primary coverage of areas denuded of skin is by split graft of local transposition flaps. More sophisticated techniques may be used at a later time (myocutaneous flaps or free flaps) if further reconstruction is contemplated. 9. Dressing must be carefully applied without constricting the extremity. A protective plaster is applied beginning from above the elbow and ending in a bonnet over the hand; this allows the recovery room nurse to monitor the vascular status of the repair. 10. The physiotherapist and occupational therapist are integrated into the perioperative care. Active range of motion exercises are begun as soon as the third day after the operation. Lightweight static and dynamic splints help to restore mobility.

Adolescent↗
PubMed1988

The efficacy of flumazenil versus physostigmine after midazolam-alfentanil anaesthesia in man.

The effects of flumazenil and physostigmine were studied in adult surgical patients recovering from midazolam-alfentanil anaesthesia. Thirty-two patients were anaesthetized with midazolam (0.2 mg kg-1 and 0.36-0.66 mg kg-1 h-1 by infusion) and alfentanil (0.15 mg kg-1 and 0.03-0.15 mg kg-1 h-1 by infusion), vecuronium, 50% nitrous oxide in oxygen, intubated and ventilated. The midazolam and alfentanil infusions were stopped at the end of surgery. Residual neuromuscular blockade and ventilatory depression were antagonized and the patients were extubated. In the recovery room, patients received either flumazenil 1 mg or physostigmine 2 mg i.v. over 10 min in a randomized, double-blind way. Before and up to 2 h after injection, patients were asked to perform two psychomotor tests. The degree of sedation and orientation in time and space were also determined. Seventeen patients received flumazenil and 15 patients received physostigmine. Before injection all patients were heavily sedated. After flumazenil, patients were fully awake within 6-7 min but sedation recurred 10-20 min later. After physostigmine, the degree of sedation did not change. The difference in the degree of sedation was significant until 30 min after injection. The time-course of test scores and orientation were similar to that of sedation. No serious side-effects or haemodynamic changes were observed after flumazenil. After physostigmine, seven patients had an increase in heart rate to 140 beats min-1 and blood pressure decreased in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Antiemetic prophylaxis with promethazine or droperidol in paediatric outpatient strabismus surgery.

This randomized, double-blind study evaluated the antiemetic efficacy and the side-effects of promethazine pretreatment (0.5 mg.kg-1 IV + 0.5 mg.kg-1 IM) versus droperidol + placebo pretreatment (droperidol, 0.075 mg.kg-1 IV + physiological saline, 0.02 ml.kg-1 IM). One hundred unpremedicated ASA physical status I children ranging from two to ten years, and undergoing outpatient strabismus surgery were studied. All children received inhalational anaesthesia with halothane, nitrous oxide and oxygen. Neither opioids nor muscle relaxants were used. The incidence of vomiting and/or retching and the incidence of side-effects were determined in the post-anaesthesia recovery room (PARR), in the short-stay surgical unit (SSSU), and after discharge from the hospital (including the journey and the stay at home during the first postoperative day). Promethazine and droperidol were equally effective in reducing the incidence of vomiting before discharge to two and eight per cent respectively. On the contrary, the incidence of vomiting after discharge and overall were significantly less with promethazine (ten and ten per cent) than with droperidol pretreatment (54 and 56 per cent) (P less than 0.0001). Promethazine permitted the time to discharge from the hospital to be reduced to an average of three hours, without increasing the incidence of vomiting postdischarge. Promethazine pretreatment is much less expensive than droperidol pretreatment. The incidence of restlessness was significantly less with droperidol (eight per cent) than with promethazine (36 per cent) (P less than 0.001). Promethazine pretreatment demands the use of an analgesic like acetaminophen in order to reduce the incidence of postoperative pain and restlessness.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1995

Oxygen saturation in children in the postoperative period.

Some adult patients have periods of significant oxygen desaturation after surgery but, other than for immediately after surgery in the recovery room, few data are available in children. We monitored overnight paired preoperative and postoperative oxygen saturations in 19 children, and overnight postoperative saturations in 50 additional children to determine whether children have periods of desaturation in the postoperative period. The children underwent surgery usually associated with moderate to severe postoperative pain, and were treated with epidural, intravenous, or intramuscular opioids. In the group of 19 children mean (SD) preoperative oxygen saturation was 96.6% +/- 1.3%, and the mean postoperative saturation was 95.7% +/- 1.2%. The average change was 0.88% +/- 1.52%. The 95% confidence interval of the paired difference was 0.13% to 1.6%. There was no significant difference in the percent of monitored time that the patients spent with an oxygen saturation less than 95%, 90%, 85%, or 80%. In the 50 children monitored only in the postoperative period, mean (SD) saturation was 97.8% +/- 1.9%. The data show that, in contrast to some reports in adults, this group of children did not have multiple episodes of clinically significant oxygen desaturation in the postoperative period.

Adolescent↗
PubMed2005

Dose minimization study of single-dose epidural morphine in patients undergoing hip surgery under regional anesthesia with bupivacaine.

BACKGROUND: In order to decrease the rate of adverse effects, we aimed to identify the lowest analgesic dose of epidural morphine administered to patients undergoing hip surgery. METHODS: Forty-five ASA I-II children undergoing surgical correction of hip dysplasia under caudal or epidural anesthesia with bupivacaine were randomized to receive epidural morphine 11.2, 15 or 20 microg.kg(-1) (groups 1, 2 and 3, respectively; 15 patients per group) immediately after completion of surgery. Postoperative pain control, sedation, motor block, urinary retention, pruritus and vomiting were evaluated. RESULTS: In the recovery room, 46.7% of patients from group 1, 33.3% from group 2, and 93.3% from group 3 were sleeping but were easy to arouse (x(2) = 12.2; P < 0.005). The rest of the patients from each respective group were completely asleep. The cardiovascular and respiratory parameters were within normal limits. The ability to move the legs returned approximately 1 h after surgery in all three groups. Seven patients (46.7%) from group 1, nine (60%) from group 2, and 13 patients (86.7%) from group 3 vomited (x(2) = 5.4; P = 0.06). One patient receiving 20 microg.kg(-1) morphine experienced urinary retention. One patient receiving 15 microg.kg(-1) morphine suffered from pruritus. The duration of analgesia was similar, 12-14 h, in all three groups. CONCLUSIONS: In patients undergoing hip surgery under regional anesthesia with bupivacaine, epidural morphine at a dose of 11.2 microg.kg(-1) administered immediately after completion of the procedure resulted in adequate pain relief for more than 12 h. Explanation of the high rate of patients vomiting (>45%) remains to be elucidated.

Adolescent↗
PubMed1992

[Development of a method of continuous monitoring of spontaneous respiration in the postoperative phase. 1. Normal values for cutaneous pO2- and pCO2-partial pressure together with pulse oximetry determined oxygen saturation in healthy young volunteers].

METHODS: Twenty-eight healthy volunteers of both sexes (14 male, 14 female, age 31 +/- 7 years, weight 70 +/- 12 kg) breathing room air were monitored for cutaneous partial pressures of oxygen and carbon dioxide (pctO2, pctCO2) and partial oxygen saturation (psO2) as determined by pulse oximetry. Data triplets were collected and stored by a personal computer at 30-s intervals during a 4-h resting period to establish a confidence range for the devices in use (TCM 3 with a combination electrode E 5270, and Pulse Oximeter, Radiometer). This data range was intended to be used in later noninvasive, continuous respiratory studies with postoperative patients. Means, standard deviations, and ranges were calculated for individual data and data pooled from 15-min intervals. Data distribution over time was calculated for 30-min intervals. RESULTS: Contrary to the saturation data delivered by pulse oximetry, the pctO2 and pctCO2 readings needed about 15 min to stabilize. The mean +/- SD of a total of 12,600 pctO2 measurements (77.2 +/- 10.9 mmHg) could not simply be compared with arterial normal values, whereas the pctCO2 measurements (39.9 +/- 3.6 mmHg) fit well with arterial data from the literature. Interestingly, pctCO2 values in unmedicated healthy adults were not uniformly distributed, suggesting individual differences in either skin permeability of central regulation of respiration. Additionally, the pctO2 readings were characterized by serious inter-subject variability, which confirms earlier studies that pctO2 is not suitable for routine monitoring procedures in adults, the mean +/- SD of a total of 4500 psO2 measurements was 94.9 +/- 1.6%. A statistically significant correlation was found between pctO2 and psO2 (r = 0.358). Cutaneous carbon dioxide readings of greater than 50 mmHg were observed in only 0.06% of all 12,600 data sets (maximum 51.3 mmHg; 28 volunteers), desaturations (less than 90%) in only 0.24% of all 4,500 saturation measurements (minimum 86%; 10 volunteers). DISCUSSION AND CONCLUSION: Monitoring of spontaneous respiration in the recovery room is regarded as essential to prevent serious complications resulting from surgery and anesthesia. This has become particularly true with newer analgesic techniques like spinal opiates or patient-controlled analgesia. Since minor degrees of opiate-induced respiratory depression are easily influenced by external stimulation, it is mandatory that any monitoring of spontaneous respiration must be nonstimulant, and prefereably noninvasive. The present communication is the first of a series of investigations to develop of monitoring technique for postoperative patients. Because normal values for the parameters studied are either lacking or dependent on the monitoring devices in use, the present paper defined the respective data ranges. It is concluded that pulse oximetry and pctCO2 measurement are both useful and sensitive for continuous, non-invasive respiratory monitoring in adults, whereas pctO2 measurements are of lesser value. Results in volunteers treated with opiates and postoperative patients under patient-controlled analgesia using the above mentioned equipment will be reported in following publications.

Adult↗