Dexamethasone as a Means Not Only for Controlling Vascular Pain Caused by the Administration of Oxaliplatin Via the Peripheral Vein But Also for Controlling Oxaliplatin-Induced Hypersensitivity Reactions.

Background and Aims: With the recent development of capecitabine and oxaliplatin (XELOX) therapy, implantation of a Central Venous (CV) port can be now avoided. However, vascular pain occasionally requires switching of the drip infusion route. Some investigators reported that addition of steroids to oxaliplatin drip infusion is useful in controlling vascular pain. However, the pharmacological use of steroids can make oxaliplatin unstable due to the elevation of pH; further, the effectiveness of steroid in this therapy is unknown. This study was undertaken to evaluate the effectiveness of dexamethasone (DEX) for controlling vascular pain caused by the administration of oxaliplatin via the peripheral vein. Study design: Retrospective study. Place and duration of the Study: Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, between April 2010 and November 2011. Methodology: The study included 69 patients who received XELOX + bevacizumab therapy for advanced or recurrent colorectal cancer. In all the patients, oxaliplatin (130 mg/m2) was administered in combination with DEX (6.6 mg) via the peripheral vein. Results: Vascular pain developed in 47 patients (68.1%), but it was transient. No patients required CV port implantation. Grade 3 or higher hemotoxicity was noted in 14.5% of the patients, and grade 3 or higher nonhematological toxicity was noted in 20.3% of the patients. The response rate was 59.4%. One patient experienced hypersensitivity reactions to oxaliplatin. Conclusions: The recorded response rate combined with the use of DEX suggests that DEX probably does not exert adverse effects on the therapy, ie, it does not affect the stability of oxaliplatin by elevating the pH. DEX may be useful not only for controlling vascular pain caused by the administration of oxaliplatin via the peripheral vein but also for controlling oxaliplatin-induced hypersensitivity reactions.

The effects of alfentanil pretreatment on vascular pain and cardiovascular response associated with intravenous / 대한마취과학회지

BACKGROUND: The intravenous injection of rocuronium bromide is often painful, and different methods have been used to minimize the incidence and severity of this pain. This study determined the effective dose of alfentanil to minimize the injection pain of rocuronium and the cardiovascular response after endotracheal intubation. METHODS: Eighty ASA physical status 1 and 2 adult patients were divided into four groups. Sixty seconds before administering rocuronium 0.6 mg/kg, the groups were given 10 ml of intravenous normal saline or alfentanil 10, 15, and 20microgram/kg. Pain was assessed after rocuronium injection. The mean arterial pressure and heart rate were measured before induction and before and after intubation. RESULTS: Both 15 and 20microgram/kg alfentanil minimized the rocuronium injection pain, although 20microgram/kg alfentanil caused an undesirable decrease in the mean arterial pressure. CONCLUSIONS: A 15microgram/kg bolus of alfentanil may be useful for minimizing the rocuronium injection pain and blunting the cardiovascular response after endotracheal intubation.

Comparison of the Quantitative Effect of Ketamine on the Vascular Pain Associated with Intravenous Rocuronium Administration / 대한마취과학회지

BACKGROUND: Rocuronium bromide can elicit a high incidence of pain when administered by intravenous injection. Several methods have been suggested to minimize the incidence and severity of this pain. In this study, we evaluated the quantitative effect of ketamine pretreatment on the incidence and severity of pain induced by intravenous rocuronium. METHODS: Sixty healthy female patients scheduled for general anesthesia were randomly divided into three groups; a saline group (n = 20), a ketamine 0.2 mg/kg group (n = 20), and a ketamine 0.5 mg/kg group (n = 20). Each patient received 2 ml of pretreatment solution via an 18 G angiocatheter inserted in a hand dorsal vein. After 30 seconds, 0.6 mg/kg of rocuronium bromide was administered intravenous. Anesthesia was induced by 2 mg/kg of propofol. Pain was assessed during rocuronium injection and pain severity was classified as none, mild, or severe. RESULTS: The incidence of pain was significantly lower in the ketamine 0.5 mg/kg group than in the saline or ketamine 0.2 mg/kg groups. Patients administered ketamine at 0.2 mg/kg were found to be less likely to suffer severe vascular pain than those in the saline group. CONCLUSIONS: Pretreatment with intravenous ketamine 0.5 mg/kg is more effective than ketamine 0.2 mg/kg at alleviating the incidence and severity of pain associated with rocuronium injection without significant side effects.

The Effect of Pretreatment with Ketamine on Vascular Pain Due to an Intravenous Rocuronium Injection in Pediatric Patients / 대한마취과학회지

BACKGROUND: Rocuronium has a high incidence of vascular pain when injected intravenous by, and diverse methods have been examined to reduced this pain. The aim of this study was to evaluate the effect of ketamine pretreatment on vascular pain during the injection of rocuronium in pediatric patients. METHODS: Sixty ASA physical status 1 patients scheduled for elective surgery were randomly divided into three groups; a control group (placebo: normal saline, n = 20), group 1 (ketamine 0.5 mg/kg pretreatment, n = 20), and group 2 (ketamine 1 mg/kg pretreatment, n = 20). The ketamine pretreatment was injected in the preanesthetic room. After being moved into the operation room, general anesthesia was induced using thiopental sodium 5 mg/kg in control group. All groups were followed during and after injecting rocuronium 0.9 mg/kg IV. Vascular pain was graded using a 4-point scale. RESULTS: The incidence of vascular pain diminished significantly in the ketamine pretreated group, as follows: 17 (85%) in control group, 4 (20%) in group 1 and 7 (35%) in group 2. CONCLUSIONS: Intravenous ketamine pretreatment at 0.5-1 mg/kg may effectively reduce or prevent vascular pain on injecting rocuronium in pediatric patients.