ABSTRACT
Abstract Background and objectives: There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. Methods: This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. Results: Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p = 0.0007 and p = 0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p = 0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (p < 0.0001 and p = 0.009, respectively). There was no significant change in cough severity between pheniramine group and lidocaine group (p = 0.856). Conclusion: Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough.
Resumo Justificativa e objetivos: Há muitos estudos sobre a redução da frequência e da gravidade da tosse induzida por fentanil durante a indução da anestesia. Propomos que maleato de feniramina, um anti-histamínico, pode suprimir essa tosse. Nosso objetivo foi observar o efeito de feniramina sobre a tosse induzida por fentanil durante a indução da anestesia. Métodos: Este é um estudo clínico prospectivo, de três braços paralelos, randômico e duplo-cego, de 120 pacientes com estado físico ASA III e IV (de acordo com a Sociedade Americana de Anestesiologistas), ≥ 18 anos e programados para cirurgia cardíaca aberta eletiva sob anestesia geral. Os pacientes foram divididos aleatoriamente em três grupos de 40 pacientes cada, com números aleatórios gerados por computador: grupo placebo, grupo feniramina e grupo lidocaína. Resultados: A incidência de tosse diferiu significativamente entre os grupos. No grupo placebo, 37,5% dos pacientes apresentaram tosse, enquanto que a frequência foi significativamente reduzida no grupo feniramina (5%) e no grupo lidocaína (15%) (teste exato de Fischer, p = 0,0007 e p = 0,0188, respectivamente). Não houve alteração significativa na incidência de tosse entre os grupos feniramina (5%) e lidocaína (15%) (teste exato de Fischer, p = 0,4325). A gravidade da tosse também alterou entre os grupos. Testes post hoc com Bonferroni mostraram que a média da gravidade da tosse no grupo placebo diferiu significativamente das médias dos grupos feniramina e lidocaína (p < 0,0001 e p = 0,009, respectivamente). Não houve alteração significativa na gravidade da tosse entre o grupo feniramina e grupo lidocaína (p = 0,856). Conclusão: Feniramina por via intravenosa tem a mesma eficácia que lidocaína na prevenção da tosse induzida por fentanil. Os resultados enfatizam que feniramina é um medicamento conveniente para diminuir essa tosse.
Subject(s)
Humans , Male , Female , Pheniramine/pharmacology , Fentanyl/adverse effects , Cough/chemically induced , Cough/drug therapy , Double-Blind Method , Prospective Studies , Histamine H1 Antagonists/pharmacology , Analgesics, Opioid/adverse effects , Middle AgedABSTRACT
Aims: To present the combined spinal-epidural anesthesia and postoperative analgesia in two geriatric patients, with low Ejection Fractions (EF) that underwent hip fracture surgery. Presentation of Case: Herein, 90 and 106-years-old geriatric patients respectively, with low ejection fractions were admitted to the orthopaedic ward because of hip fracture. These patients were planned to undergo hip prosthesis surgery. Anesthesia and postoperative analgesia were achieved by Combined Spinal-Epidural (CSE) techniques in both patients. We observed that spinal anesthesia using low dose hyperbaric bupivacaine with fentanyl was an effective and safe method, and post-surgical patient controlled analgesia via an epidural catheter provided sufficient pain control for 48 h. Discussion: In older patients with hip fracture, comorbidities such as cardiac disease increase the risk of perioperative morbidity and mortality. Individuals that undergo hip prosthesis surgery are usually geriatric patients, and comorbidities can increase their risk of perioperative morbidity and mortality during surgery. Regional anaesthesia techniques are widely utilized for surgical procedures (especially obstetrics, orthopaedics, urology, general surgery) and pain management, and they are known to have favourable effects on the vital signs and endocrine and metabolic responses after the operation compared with those of general anesthesia. In addition, regional anaesthesia is preferable because of its superior results in relation to postoperative pain control. Conclusion: Combined spinal epidural anaesthesia with low-dose hyperbaric bupivacaine and fentanyl in hip fracture surgery is a safe and efficient method when used in geriatric patients with low EF. In addition, we find that patient controlled epidural analgesia is a considerably effective technique in postoperative pain management.