ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

BackgroundKetorolac is a nonsteroidal antiinflammatory agent with opioid-sparing properties. The effect of ketorolac on postoperative opioid analgesic requirement and surgical outcome was evaluated in 198 women after abdominal hysterectomy procedures using a double-blind protocol design.MethodsPatients were randomly assigned to receive either 60 mg intravenous (2 ml) ketorolac, followed by 30 mg intravenously (in saline 20 ml) over 30 min every 6 h, or 2 ml intravenous saline, followed by saline 20 ml intravenously over 30 min every 6 h, for up to 72 h. The postoperative opioid analgesic requirement was assessed using a patient-controlled analgesia (PCA) device to self administer either morphine or meperidine. The authors also evaluated pain, sedation (or drowsiness), fatigue, quality of sleep, and postoperative side effects at 2–8-h intervals for up to 72 h after surgery.ResultsKetorolac decreased the PCA opioid usage on the night of operation and during the first postoperative day. Ketorolac also improved the quality of sleep during the first night after surgery. Although ketorolac- (vs. saline-) treated patients had a significantly shorter time to passage of bowel gas (50 ± 24 hvs.61 ± 25 h), there were no clinically significant differences in the times to oral intake, unassisted ambulation, or hospital discharge. There were also no differences in the overall incidence of side effects in the ketorolac- (vs.saline-) treated patients. However, the use of ketorolac with opioid PCA was associated with a reduced need for antiemetic therapy on the postsurgical ward.ConclusionsThe authors conclude that the opioid-sparing effects of ketorolac contributed few clinically significant advantages after abdominal hysterectomy procedures.

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

BackgroundIn synchronized intermittent mandatory ventilation, it is generally accepted that the work of the inspiratory muscles is decreased by the ventilator so that their activity can be modulated by the frequency of assisted breaths. We examined the validity of this concept, which recently has been questioned.MethodsWe studied five patients receiving synchronized intermittent mandatory ventilation because of an acute exacerbation of chronic obstructive pulmonary disease. The level of machine assistance, defined as the percentage of total ventilation delivered by the ventilator, was varied from a high (≥60%) to a medium (20–50%) and to the lowest tolerated value (0% in four patients). Esophageal pressure, air flow, and the electromyograms of the diaphragm and sternocleidomastold muscles were recorded. At each level of machine assistance, distinguishing assisted from spontaneous breaths, the duration of electrical activation, the integrated electromyograms, and the work of breathing were computed.ResultsThe durations of electrical activation and the integrated electromyograms of the diaphragm and sternocleidomastoid were similar in successive spontaneous and assisted breaths. At ≥60% of machine assistance, the cumulative values per minute of the integrated electromyograms of the diaphragm and sternocleidomastoid and the work of breathing were reduced only by 38,32, and 44%, respectively, compared with the lowest tolerated level of machine assistance. The durations of electrical activation did not change with increasing level of machine assistance.ConclusionsThe degree of inspiratory muscle rest achieved by synchronized intermittent mandatory ventilation is not proportional to the level of machine assistance; furthermore, the inspiratory motor output is not regulated breath by breath but rather is constant for a given level of machine assistance.

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

BackgroundAprotinin, a proteinase inhibitor, has been reported to reduce blood loss significantly during cardiac surgery. The mechanisms of this effect remain unclear. We studied the effect of aprotinin on blood loss and transfusion requirement during total hip replacement. Potential mechanisms of action and side effects also were investigated.MethodsForty patients scheduled for primary total hip replacement were randomized to receive, in double-blind fashion, either aprotinin given as a bolus of 2 X 104kallikrein inactivator units (KIU) followed by an infusion of 5 X 105KIU/h until the end of surgery or an equivalent volume of normal saline. Anesthesia and surgical techniques were standardized and systematic deep venous thrombosis prophylaxis was used. Peri- and postoperative blood loss and transfusion were measured. Fibrinolysis, coagulation pathways, and platelet function were assessed. Renal and hepatic function as well as the incidence of deep venous thrombosis also were assessed.ResultsAprotinin reduced total blood loss from 1,943 ± 700 ml to 1,446 ± 514 ml (P< 0.05). This reduction of blood loss occurred during surgery (P< 0.05) and postoperatively (P< 0.001). Total amounts of blood transfused were 3.4 ± 1.3 units/patient in the control group and 1.8 ± 1.2 units/patient in the aprotinin group (P< 0.001). The activated partial thromboplastin time was significantly prolonged by aprotinin immediately after surgery, at 50.6 ± 12.4versus32.3 ± 4.6 s in control patients (P< 0.001), but results of the other coagulation tests were not different between the two groups. No side effects were observed in the aprotinin group. The incidence of deep venous thrombosis in the two groups was not significantly different.ConclusionsThe use of high-dose aprotinin during total hip replacement results in a reduction in both blood loss and the amount of blood transfused. Aprotinin's mode of action, however, remains to be elucidated.

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

BackgroundIntermittent self-administered nitrous oxide has long had widespread use as an analgesic in labor, but its efficacy has not been adequately established. Questions about its effect on maternal oxygenation between labor contractions also have been raised.MethodsTwenty-six women were recrulted to participate in a randomized, double-blind, cross-over, placebo-controlled study to assess the effect of intermittent nitrous oxide inhalation on labor pain and maternal hemoglobin oxygen saturation (SpO2) during the first stage of labor. Visual analog scale pain scores for each of five consecutive labor contractions were measured after administration of either nitrous oxide or compressed air.ResultsMean visual analog scale pain scores for five contractions were 5.1, 5.2, 5.7, 5.2, and 5.6 (nitrous oxide) and 4.9, 5.2, 6.1, 5.6, and 5.7 (compressed air). There were no statistically significant differences in pain when nitrous oxide as compared with compressed air was administered. Pain scores did not differ significantly over time as a function of inhaled substance (F = 0.41,P= 0.53). The mean lowest SpO2observed between these contractions after self-administration of nitrous oxide and air were 97, 97, 97, 97, and 97% (nitrous oxide) and 97, 96, 96, 96, and 96% (compressed air). SpO2was significantly higher after nitrous oxide administration (F = 8.8,P= 0.007).ConclusionsWhile intermittent self-administered 50% nitrous oxide in oxygen does not appear to predispose parturient women to hemoglobin oxygen desaturation, its analgesic effect has yet to be clearly demonstrated.

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

BackgroundThe primary purpose of this investigation was to determine the relative potency of eltanolone, a new steroid hypnotic, and propofol and thiopental when used for induction of general anesthesia. In addition, the induction characteristics of propofol and eltanolone were compared.MethodsOne hundred seventy-five patients, premedicated with lorazepam 1 mg orally, randomly received one of six different doses of either eltanolone or propofol. The probability of successful induction (deined as not responsive to verbal commands within 2 min) was related to the logarithm of the dose for each drug by means of logistic regression analysis. Estimates of ED50and ED95for each drug were obtained. The incidence of side effects was compared for eltanolone and propofol. The potency of thiopental was determined in a parallel study, using an identical methodology in 105 patients receiving one of seven different doses of the barbiturate.ResultsThe relative potency of eltanolone was 3.2 times (95% confidence interval 2.7–3.8) greater than propofol and 6.0 times (5.3–6.9) greater than thiopental. ED50and ED95values for eltanolone were 0.46 (0.40–0.52) and 0.82 (0.68–1.28) mg.kg–1, respectively. Compared to propofol, induction of anesthesia with eltanolone is characterized by a lower incidence of injection pain (3.5%vs.58%) and apnea (1.2%vs.11.2%).ConclusionsEltanolone appeared to be an effective induction agent that is 3.2 times more potent than propofol and 6 times more potent than thiopental. Its use was associated with less pain on injection than was propofol.

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

BackgroundThe principle underlying the use of the self-inflating bulb in differentiating esophageal from tracheal intubation is that the trachea is held open by rigid cartilaginous rings, whereas the esophagus collapses when a negative pressure is applied to its lumen. This investigation was designed to test the efficacy of the bulb in detecting esophageal intubation in the presence of a nasogastric tube and after tracheal tube cuff deflation.MethodsIn anesthetized patients, the trachea and esophagus were intubated with identical tubes. The efficacy of the bulb was tested after a nasogastric tube was placed (group 1, n = 70) and after cuff deflation (group 2, n = 60) by a second anesthesiologist.ResultsIn patients with nasogastric tubes (group 1), the anesthesiologists reported no reinflation of the compressed bulbs connected to tubes placed in the esophagus and immediate reinflation when connected to tracheally placed tubes in every case. In group 2, the determination of tube placement was correct in every case after cuff deflation. Mean (± SEM) negative pressures generated when compressed bulbs were connected to esophageally placed tubes were 57.8 ± 0.48 mmHg (group 1) and 55.3 ± 0.52 mmHg (group 2) and remained unchanged after the introduction of nasogastric tubes or after cuff deflation.ConclusionsThese results confirm that a nasogastric tube or cuff deflation does not interfere with the reliability of the self-inflating bulb in detecting esophageal intubation and thus does not contribute to false positive results. Confirmation of tracheal tube placement by this simple method makes it ideal for use with other recognized methods both in and outside the operating rooms and enables physicians and emergency personnel to proceed with other resuscitative measures.

ISSN:0003-3022    

出版商:OVID    

年代:1994

数据来源: OVID