ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective:The authors reviewed efficacy and safety data for ondansetron for preventing postoperative nausea and vomiting (PONV).Methods:Systematically searched, randomized, controlled trials (obtained through MEDLINE, EMBASE, Biological Abstracts, manufacturer's database, manual searching of journals, and article reference lists) were analyzed. Relevant end points were prevention of early PONV (within 6 h after surgery) and late PONV (within 48 h) and adverse effects. Relative benefit and number‐needed‐to‐treat were calculated. The number‐needed‐to‐treat indicated how many patients had to be exposed to ondansetron to prevent PONV in one of them who would have vomited or been nauseated had he or she received placebo.Results:Fifty‐three trials were found that had data from 7,177 patients receiving 24 different ondansetron regimens and from 5,712 controls receiving placebo or no treatment. Average early and late PONV incidences without ondansetron were 40% and 60%, respectively. There was a dose response for oral and intravenous ondansetron. Best number‐needed‐to‐treat to prevent PONV with the best documented regimens was between 5 and 6. This was achieved with an intravenous dose of 8 mg and an oral dose of 16 mg. Antivomiting efficacy was consistently better than antinausea efficacy. Efficacy in children was poorly documented. Ondansetron significantly increased the risk for elevated liver enzymes (number‐needed‐to‐harm was 31) and headache (number‐needed‐to‐harm was 36).Conclusions:If the risk of PONV is very high, for every 100 patients receiving an adequate dose of ondansetron 20 patients will not vomit who would have vomited had they received placebo. The antinausea effect is less pronounced. Of these 100, three will have elevated liver enzymes and three will have a headache who would not have had these adverse effects without the drug.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:A quantitative scale of intubation difficulty would be useful for objectively comparing the complexity of endotracheal intubations. The authors have developed a quantitative score that can be used to evaluate intubating conditions and techniques with the aim of determining the relative values predictive factors of intubation difficulty and of the techniques used to decrease such difficulties.Methods:An Intubation Difficulty Scale (IDS) was developed, based on parameters known to be associated with difficult intubation. It was then evaluated prospectively in a group of 311 consecutive prehospital intubations and 315 intubations in an operating room. In the operating room, the IDS was compared with two other parameters: the time to completion of intubation and the visual analog scale (VAS). Time was measured by an independent observer. Operators in both groups completed a checklist regarding the conditions of intubation.Results:There is a good correlation between the IDS scale and the VAS assessment of difficulty and time to completion of intubation. VAS and time to completion have a significant but lesser correlation to each other. Comparison of IDS with operator‐assessed subjective categorical impression of difficulty by Kruskall‐Wallis was statistically significant.Conclusions:The IDS correlates with but is less subjective than the VAS and categorical classification. IDS correlates with time to intubation, but it offers details regarding the difficulty encountered that time alone does not. This score may not only aid in evaluation of factors linked to difficult intubations, but it may provide a uniform approach to comparing studies related to this subject.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:In the authors' clinical experience, preschool children are more likely to show delirium after sevoflurane than are older children.Methods:Sixty‐three preschool boys aged 3–5 yr (classified as American Society of Anesthesiologists [ASA] physical status I), and 53 school‐age boys aged 6–10 yr (ASA physical status I) who underwent minor urologic surgery were randomly assigned to receive either halothane or sevoflurane, thus creating four groups: preschool‐halothane (n = 32), preschool‐sevoflurane (n = 31), school‐halothane (n = 27), and school‐sevoflurane (n = 26). Anesthesia was induced by inhalation of halothane or sevoflurane in oxygen and was maintained at 1 minimum alveolar concentration of each agent throughout surgery. For intra‐ and postoperative analgesia, caudal block with 0.5–1.0 ml/kg 0.25% plain bupivacaine and topical infiltration with 3–5 ml 1% lidocaine were provided for all patients. Recovery characteristics and incidence of delirium on emergence were compared among the four groups.Results:Two patients in the preschool‐halothane group, one in the preschool‐sevoflurane group, and one in the school‐halothane group were excluded from the comparison because of insufficient analgesia or agitation before induction. In both age groups, the time to emergence from sevoflurane was significantly faster (about 3 min) than from halothane. The incidence of delirium during recovery in the preschool‐sevoflurane group (40%) was significantly greater than that in the other groups (preschool‐halothane, 10%; school‐halothane, 15.4%; school‐sevoflurane, 11.5%).Conclusion:Sevoflurane provided quicker emergence and early recovery compared with halothane, but the incidence of delirium was greater in preschool boys after sevoflurane.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:The “single‐needle” celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated.Methods:Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)‐guided single‐needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was cauded to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long‐lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed.Results:The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P < 0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P < 0.01). A significant difference in long‐lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81–100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15–72%) (P < 0.01). No patients showing two or one quadrant with contrast had long‐lasting pain relief.Conclusions:These findings suggest that, when the celiac area is free from anatomic distortions, and the single‐needle neurolytic celiac plexus block technique is used, the needle tip should be positioned cephalad to the celiac artery to achieve a wider neurolytic spread. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long‐lasting analgesia.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:For local anesthetics, the process of removal from the site of administration influences the duration of anesthesia and the risk for systemic toxicity to develop. The systemic absorption of epidural ropivacaine and the time profile of sensory and motor block were studied in healthy volunteers.Methods:Nine persons simultaneously received 150 mg ropivacaine hydrochloride (7.5 mg/ml) epidurally and 40 mg deuterium‐labeled (sup 2 H sub 3)ropivacaine hydrochloride (0.25 mg/ml) intravenously. Peripheral arterial and venous plasma samples were collected, and assessments of sensory and motor block were made.Results:The arterial plasma concentrations increased faster than the venous concentrations, with 50% higher maximum concentrations after both intravenous and epidural administration. The absorption was biphasic. A correlation was seen between the duration of sensory block and the slower absorption half‐life; that is, the longer the half‐life, the longer the duration. The extent of spread varied among the volunteers, with the median upper block level not exceeding T12. The motor block (Bromage score 1) was of slower onset (median, 0.4 h) and of shorter duration (median, 4.1 h) than the sensory block (onset, 0.2 h; duration, 6.5 h at L2 medians).Conclusions:As much as 50% differences were seen in the arteriovenous plasma concentrations of ropivacaine during the first hour, which has implications for the interpretation of systemic toxic plasma concentrations. The absorption into the general circulation was biphasic, with a correlation between the sensory block and the slower absorption half‐life. A faster onset and a longer duration of sensory compared with motor block was seen.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Intraoperative hypothermia is common and persists for several hours after surgery. Hypothermia may prolong immediate recovery by augmenting anesthetic potency, delaying drug metabolism, producing hemodynamic instability, or depressing cognitive function. Accordingly, the authors tested the hypothesis that intraoperative hypothermia prolongs postoperative recovery.Methods:Patients undergoing elective major abdominal surgery (n = 150) were anesthetized with isoflurane, nitrous oxide, and fentanyl. They were randomly assigned to routine thermal management (hypothermia) or extra warming (normothermia). Postoperative surgical pain was treated with patient‐controlled analgesia. Fitness for discharge from the post‐anesthesia care unit was evaluated at 20‐min intervals by investigators blinded to group assignment and postoperative core temperatures. Scoring was based on a modification of a previously published system that included activity, ventilation, consciousness, and hemodynamic responses. Patients were considered fit for discharge when they sustained a score of 80% (13 points) for at least two consecutive measurement periods.Results:Morphometric characteristics and anesthetic management were similar in each group. Final intraoperative core temperatures differed by [nearly =] 2 [degree sign] Celsius: 34.8 +/‐ 0.6 versus 36.7 +/‐ 0.6 [degree sign] Celsius (mean +/‐ SD, P < 0.001). Postoperative pain scores and postoperative use of patient‐controlled opioid were similar. Hypothermic patients required [nearly =] 40 min longer (94 +/‐ 65 vs. 53 +/‐ 36 min) to reach fitness for discharge, even when return to normothermia was not a criterion (P < 0.001). Duration of recovery in the two groups differed by [nearly =] 90 min when a core temperature > 36 [degree sign] Celsius was also required (P < 0.001).Conclusion:Maintaining core normothermia decreases the duration of postanesthetic recovery and may, therefore, reduce costs of care.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Sevoflurane is a useful anesthetic for inhalational induction in children because of its low solubility in blood and relatively nonpungent odor. Clonidine has sedative and anxiolytic properties and reduces the requirement for inhalation agents. Nitrous oxide (N2O) also decreases the requirement of inhaled anesthetics, but the effect is variable. The minimum alveolar concentration for tracheal intubation (MACTI) of sevoflurane was assessed with and without N2O and clonidine premedication.Methods:Seventy‐two patients, aged 3–11 yr, were assigned to one of six groups (n = 12 each). They received one of three preanesthetic medications (two groups for each premedication): placebo (control), 2 micro gram/kg oral clonidine or 4 micro gram/kg oral clonidine. In one group of each premedication, anesthesia was induced with sevoflurane in oxygen; in the other group, anesthesia was induced with sevoflurane in the presence of 60% N2O. Each concentration of sevoflurane at which tracheal intubation was attempted was predetermined according to Dixon's up‐and‐down method and held constant for at least 20 min before the trial.Results:The MACTIof sevoflurane in the absence of N2O (mean +/‐ SEM) was 3.2 +/‐ 0.2%, 2.5 +/‐ 0.1%, and 1.9 +/‐ 0.2% in the control, 2‐micro gram/kg clonidine, and 4‐micro gram/kg clonidine groups, respectively. Nitrous oxide (60%) decreased the MACTIof sevoflurane by 26%, 24%, and 27% in the control, 2‐micro gram/kg clonidine, and 4‐micro gram/kg clonidine groups.Conclusions:Oral clonidine premedication decreased the MACTIof sevoflurane. Nitrous oxide also decreased the MACTI. The combination of clonidine and N2O lessened the MACTIof sevoflurane more than did either drug alone.

ISSN:0003-3022    

出版商:OVID    

年代:1997

数据来源: OVID