ABSTRACT
BACKGROUND: This study was designed to compare the hemodynamic changes in response to direct laryngoscopy of the McCoy blade and the Macintosh blade. METHODS: Sixty patients scheduled for elective gynecologic surgery were randomly allocated into two groups. The induction of anesthesia was done with thiopental sodium 5 mg/kg, fentanyl 2 mcg/kg, vecuronium 0.1 mg/kg. When the train of four arrived came at 0/4, the vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade for 10 seconds. Heart rate and blood pressure were recorded at 1 minute intervals for 5 minutes. RESULTS: Laryngoscopy caused significant increases in arterial blood pressure in both groups, while it had no effect on heart rate in either group. There were no significant differences in blood pressure and heart rate responses to laryngoscopy in the blades. CONCLUSIONS: The McCoy and the Macintosh blade show similar changes in heart rate and blood pressure after laryngoscopy.
Subject(s)
Female , Humans , Anesthesia , Arterial Pressure , Blood Pressure , Fentanyl , Gynecologic Surgical Procedures , Heart Rate , Hemodynamics , Laryngoscopes , Laryngoscopy , Thiopental , Vecuronium Bromide , Vocal CordsABSTRACT
BACKGROUND: This study was done to compare vacuum delivery and cesarean section rates in a large population before and after on-demand labor epidural analgesia became available. METHODS: We retrospectively investigated the overall sets of delivery modes in patients who gave birth during a 12-month period before the introduction of on-demand labor epidural analgesia, and those giving birth after labor epidural analgesia became available. Additionally, we compared the rates of cesarean section or vacuum delivery in patients delivering before and after the availability of on-demand labor epidural. RESULTS: Included were 3905 patients who delivered before, and 4318 patients who delivered after epidural analgesia became available. Labor epidural rates were 0.3% vs 14.7% for the before and after groups. The rates of cesarean delivery for dystocia in primary cesarean operation did not change (10% vs 10.5%), and vacuum delivery rates in the total vaginal delivery patients were not changed (15.1% vs 14.7%) for the before and after group. CONCLUSIONS: Increased epidural analgesia did not change the overall cesarean delivery rates for dystocia and vacuum - assisted delivery rates.
Subject(s)
Female , Humans , Pregnancy , Analgesia, Epidural , Cesarean Section , Dystocia , Parturition , Retrospective Studies , VacuumABSTRACT
BACKGROUND: In spite of adverse reactions, morphine has been used as a basic constituent for patient controlled analgesia (PCA). Because morphine affects various immune functions, PCA with morphine may deteriorate immune mechanisms further after surgery. In this study we decided to determine how different is the morphine PCA from the combination of morphine and ketorolac in Interleukin-6 (IL-6) and IL-10 responses, analgesia and side effects. METHODS: Twenty two patients undergoing abdominal hysterectomy were randomly divided to two groups: PCA with morphine and PCA with the combination of morphine and ketorolac. Blood samples to measure cytokines were collected before induction of anesthesia, immediately after surgery, 1, 4, 24 h after PCA. Plasma was separated and frozen until the analysis of cytokines with ELISA. Postoperative pain was assessed using a visual analog score (VAS). Sedation was checked according to our protocol. RESULTS: In both groups IL-6 response rose immediately after surgery and stayed increased until 24 h, and IL-10 level peaked at 1 h after PCA then progressively declined. In the comparison of cytokines between the two groups there were significant differences in IL-6 at 24 h (P=0.026) and IL-10 at 4 h after PCA (P=0.03). In morphine consumption between the two groups there were significant differences (P=0.037 at 4 after PCA, P=0.015 at 24 h after PCA), however, pain scores, sedation and side effects were unaffected by the PCA regimen. CONCLUSIONS: We conclude that the supplementation of ketorolac with morphine modify the cytokine responses and in this way may contribute immune alterations during post-operative period.
Subject(s)
Humans , Analgesia , Analgesia, Patient-Controlled , Anesthesia , Cytokines , Enzyme-Linked Immunosorbent Assay , Hysterectomy , Interleukin-10 , Interleukin-6 , Ketorolac , Morphine , Pain, Postoperative , Passive Cutaneous Anaphylaxis , PlasmaABSTRACT
BACKGROUND: Patient-controlled analgesia (PCA) provides excellent pain relief in the management of postoperative pain, but is associated with unpleasant side effects such as nausea and vomiting. The transdermal scopolamine patch (TSP) has been shown to have effective antiemetic actions. We evaluated the effectiveness of TSP in patients receiving morphine and fentanyl via intravenous PCA. METHODS: Sixty patients were scheduled for an elective intra-abdominal gynecologic surgery under general anesthesia, and had elected to receive intravenous PCA postoperatively. Soon after their arrival in the operating room, the patients were randomised to receive either a placebo patch (group P) or TSP (group S) on the right postauricular area. Nausea, vomiting and sedation were scored at the postoperative care unit (PACU) and at 12, 24, 48, and 72 h postoperatively. Patients were treated with metoclopramide as deemed necessary by the primary care nurse. RESULTS: No differences were found between the groups in scores and incidence of nausea and vomiting at the PACU and at 12, 24, 48, and 72 h postoperatively. The patients who received metoclopramide were significantly fewer in group S than in group P (6.7% vs 43.3%, P < 0.05). The sedation score was significantly lower in group S than in group P (1.3 0.5 vs 1.8 0.9, P < 0.05) at 12h postoperatively. CONCLUSIONS: TSP did not reduce the incidence and score of nausea and vomiting in postoperative patients during intravenous PCA. However, patients who received TSP required less antiemetic medication. TSP appears to be effective for supplemental antiemetic medication.
Subject(s)
Female , Humans , Analgesia, Patient-Controlled , Anesthesia, General , Fentanyl , Gynecologic Surgical Procedures , Incidence , Metoclopramide , Morphine , Nausea , Operating Rooms , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Postoperative Care , Postoperative Nausea and Vomiting , Primary Health Care , Scopolamine , VomitingABSTRACT
BACKGROUND: Patient-controlled analgesia (PCA) provides excellent pain relief in the management of postoperative pain, but is associated with unpleasant side effects such as nausea and vomiting. The transdermal scopolamine patch (TSP) has been shown to have effective antiemetic actions. We evaluated the effectiveness of TSP in patients receiving morphine and fentanyl via intravenous PCA. METHODS: Sixty patients were scheduled for an elective intra-abdominal gynecologic surgery under general anesthesia, and had elected to receive intravenous PCA postoperatively. Soon after their arrival in the operating room, the patients were randomised to receive either a placebo patch (group P) or TSP (group S) on the right postauricular area. Nausea, vomiting and sedation were scored at the postoperative care unit (PACU) and at 12, 24, 48, and 72 h postoperatively. Patients were treated with metoclopramide as deemed necessary by the primary care nurse. RESULTS: No differences were found between the groups in scores and incidence of nausea and vomiting at the PACU and at 12, 24, 48, and 72 h postoperatively. The patients who received metoclopramide were significantly fewer in group S than in group P (6.7% vs 43.3%, P < 0.05). The sedation score was significantly lower in group S than in group P (1.3 0.5 vs 1.8 0.9, P < 0.05) at 12h postoperatively. CONCLUSIONS: TSP did not reduce the incidence and score of nausea and vomiting in postoperative patients during intravenous PCA. However, patients who received TSP required less antiemetic medication. TSP appears to be effective for supplemental antiemetic medication.