Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 7 Articles
Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative\npain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit.We determined ketamineââ?¬â?¢s\npostoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to\nreceive either intravenous ketamine (0.25mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24\nhours postoperatively using the numerical rating scale.The first complaint of pain requiring treatment was noted as ââ?¬Å?time to first\nbreakthrough pain.ââ?¬Â Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that\nreceived either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain\nscores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs\nshowed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous\nketamine (0.25mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores.\nWe recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number\nPACTR201404000807178....
Background: One-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However,\nthe effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human\nstudy. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil\nanesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.\nMethods: Adult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative\noxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion\nin both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung\nventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O.\nArterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of\none-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses\nincluded the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the\nserial changes in values.\nResults: Patients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in\ndesflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower\nin the desflurane group than the propofol group (170 Ã?± 72 vs. 202 Ã?± 82 mmHg; p = 0.039). Serial changes in PaO2 during\none-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean\ndifference, 45 mmHg; 95% confidence interval, 16ââ?¬â??75 mmHg; p= 0.003).\nConclusions: In conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with\nthat of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung\ncancer....
Objective. The aim of this meta-analysis is to evaluate the effects of dexmedetomidine on intraocular pressure (IOP) in patients\nwith general anesthesia administered via intubation. Methods. We searched randomized controlled trials (RCT) on the effects of\nintravenous injection of dexmedetomidine on IOP in patients with general anesthesia administered via intubation. Results. The\nmeta-analysis study showed that (1) a statistically significant difference[WMD= âË?â??3.40mmHg, 95% CI (âË?â??4.76, âË?â??2.04), ...
Backgrounds: Remifentanil has been reported to cause post-anesthetic shivering (PAS). Higher doses of\nremifentanil reportedly induce more intense PAS. Tramadol, a synthetic opioid that acts at multiple sites, is\nconsidered to be an effective treatment for PAS, but the evidence for its therapeutic benefit after remifentanil\nanesthesia is limited. We investigated the effect of tramadol on the incidence of PAS after remifentanil anesthesia.\nMethods: Sixty-three patients who had undergone upper abdominal surgery under general anesthesia were\nstudied retrospectively. Tramadol was administered at induction of anesthesia. The patients were divided into four\ngroups: HT(+), high dose remifentanil (1ââ?¬â??1.5 Ã?¼g/kg/min) with tramadol; HT(âË?â??), high dose remifentanil without\ntramadol; LT(+), low dose remifentanil (0.15ââ?¬â??0.25 Ã?¼g/kg/min) with tramadol; and LT(âË?â??), low dose remifentanil\nwithout tramadol. We recorded perioperative changes in nasopharyngeal temperature and episodes of PAS on\nemergence from anesthesia.\nResults: The incidences of PAS in both tramadol treatment groups were significantly lower than the groups that\ndid not receive tramadol. Nasopharyngeal temperature after surgery fell significantly more from baseline in the\ntramadol treatment groups compared with the non-treatment groups.\nConclusion: Tramadol administered at induction of anesthesia appears to suppress PAS following remifentanil\nanesthesia....
Objective: The aim of this study is to determine the role of preoperative low\ndose intravenous MgSO4 when given adjuvant to ultrasound guided transversus\nabdominis plane (TAP) block in augmenting postcesarean analgesic effects\nand reducing opioid requirements during the first 24 hours. Subjects and\nMethods: In this prospective, randomized double blind study, a total of sixty\nfull term pregnant women were recruited for the study underwent caesarean\nsection. Thirty patients were assigned to MgSO4 group (A) and another thirty\nto placebo group (B). Participants in group (A) received 50 mg/kg MgSO4 in\n100 ml isotonic saline intravenous (IV) over 20 minutes prior to induction of\ngeneral anesthesia by 30 minutes while participants in group (B) received 100\nml isotonic saline (placebo) by the same route and over the same duration as\ncontrol. Results: Visual Analogue Scale (VAS) was analysed within 24 hours\npostoperatively. The mean pain score at 6 and 12 hours postoperatively was\nsignificantly lower in MgSO4 group compared to control group (40.4 �± 5.12 vs\n53.6 �± 4.92; 26.1 �± 3.01 vs 35.5 �± 3.98 respectively, p = 0.012, 0.005). Comparing\nboth groups regarding the mean time interval of first rescue analgesia\n(morphine sulphate) requested by the patients, it was longer in MgSO4 group\ncompared to control group. The total dose of rescue analgesia consumed during\n24 hours was analysed and it was significantly higher in control group\ncompared to MgSO4 group (10.1 �± 0.95 vs 6.2 �± 0.87, p = 0.001). Conclusion:\nWe concluded that preoperative low doses (50 mg/Kg) of MgSO4 with general\nanesthesia combined with ultrasound guided TAP block offer longer postoperative\npain free periods thus reducing total opioid consumption. In addition\nto the safety of the drug to the mother and fetus so we recommend IV MgSO4\nas an adjuvant therapy with TAP block....
Background: Dexmedetomidine can facilitate a smooth extubation process and reduce the requirement of\nsevoflurane and emergence agitation when administrated perioperatively. We aimed to observe the extubation\nprocess and the recovery characteristics in pediatric patients undergoing tonsillectomy while anesthetized with\neither high-concentration sevoflurane alone or low-concentration sevoflurane combined with pre-medication of\nsingle dose of intravenous dexmedetomidine.\nMethods: Seventy-five patients (ASA I or II, aged 3ââ?¬â??7 years) undergoing tonsillectomy were randomized into three\nequal groups: to receive intravenous saline (Group D0), dexmedetomidine 1 Ã?¼g/kg (Group D1), or dexmedetomidine\n2 Ã?¼g/kg (Group D2) approximately 10 min before anesthesia. Before the end of surgery, sevoflurane were adjusted to 1.\n5 times, 1.0 time and 0.8 times the minimal effective concentration in groups D0, D1 and D2, respectively. The\nsevoflurane concentration for each group was maintained for at least 10 min before the tracheal deep-extubation was\nperformed. The extubation event, recovery characteristics and post-op respiratory complications were recorded.\nResults: All tracheal tubes in three groups were removed successfully during deep anesthesia. Nine patients in Group\nD0, three patients in Group D1, and two patients in Group D2 required oral airway to maintain a patent airway after\nextubation. The frequency of oral airway usage in groups D1 and D2 were significantly lower than that in Group D0. The\npercentages of patients with ED and the requirements of fentanyl in groups D1 and D2 were also significantly lower\nthan those in Group D0. The time from extubation to spontaneous eye opening in Group D2 was longer than that in\ngroups D0 and D1. The times of post-anesthesia care unit discharge in groups D0 and D2 were longer than that in\nGroup D1. No other respiratory complications and vomiting were observed.\nConclusion: A single dose of intravenous dexmedetomidine as pre-medication in combination with low-concentration\nsevoflurane at the end of surgery provided safe and smooth deep extubation condition and it also lowered the\nemergence agitation in sevoflurane-anaesthetized children undergoing tonsillectomy. Preoperative dexmedetomidine\nat 1 Ã?¼g/kg did not prolong postoperative recovery time....
Background: This study was designed to compare the efficacy of an intraoperative single dose administration of\ntramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation,\nemerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia.\nMethods: Seventy-seven patient, aged 2ââ?¬â??12, undergoing adenotonsillectomy with sevoflurane anesthesia was\nenrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T;\nn = 39) or 1 Ã?¼g/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure\n(MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores\n(OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ââ?°Â¥ 4 or PAED scale\nitems 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the\npostoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score >\n9 were recorded.\nResults: Dexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the\nRSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ââ?°Â¥4 or\nPAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference.\nExtubation time and time to have Alderete score > 9 was significantly longer in Group D.\nConclusion: Both tramadol and dexmedetomidine were effective for controlling pain and emergence agitation.\nWhen compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems\nrelated with dexmedetomidine administration....
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