Evaluation of efficacy of Valsalva maneuver for attenuating propofol injection pain: a prospective, randomized, single blind, placebo controlled study / 대한마취과학회지

BACKGROUND: Pain on injection is a limitation with propofol use. The effect of the Valsalva maneuver on pain during propofol injection has not been studied. This maneuver reduces pain through the sinoaortic baroreceptor reflex arc and by distraction. We aimed to assess the efficacy of the Valsalva maneuver in reducing pain during propofol injection. METHODS: Eighty American Society of Anesthesiologists class I adult patients undergoing general anesthesia were enrolled and divided into two groups of 40 each. Group I (Valsalva) patients blew into a sphygmomanometer tube raising the mercury column up to 30 mmHg for 20 seconds, while Group II (Control) patients did not. Anesthesia was induced with 1% propofol immediately afterwards. Pain was assessed on a 10-point visual analog scale (VAS), where 0 represented no pain, and 10, the worst imaginable pain, and a 4-point withdrawal response score, where 0 represented no pain, and 3, the worst imaginable pain. Scores were presented as median (interquartile range). RESULTS: We analyzed the data of 70 patients. The incidence of pain was significantly lower in the Valsalva than in the control group (53% vs 78%, P = 0.029). The withdrawal response score was significantly lower in the Valsalva group (1.00 [0.00-1.00] vs 2.00 [2.00-3.00], P < 0.001). The VAS score was significantly lower in the Valsalva group (1.00 [0.00-4.00] vs 7.00 [6.25-8.00], P < 0.001). CONCLUSIONS: A prior Valsalva maneuver is effective in attenuating injection pain due to propofol; it is advantageous in being a non-pharmacological, safe, easy, and time-effective technique.

The dose-dependent effect of alfentanil on the rocuronium induced withdrawal in children

BACKGROUND: The injection of rocuronium causes pain and withdrawal responses.This study was designed to determine an optimal dose of alfentanil to prevent the withdrawal responses associated with injection of rocuronium in children. METHODS: One hundred and ten ASA physical status I and II pediatric patients were randomly allocated into four groups; Group C (control; normal saline 3 ml, n = 28), Group A5 (alfentanil 5microgram/kg, n = 28), Group A10 (alfentanil 10microgram/kg, n = 27) and Group A15 (alfentanil 15microgram/kg, n = 27). After the induction of anesthesia with 5 mg/kg of thiopental sodium, the test drug was injected over 20 seconds, respectively. After one minute, rocuronium 0.6 mg/kg was injected over 5 seconds. The patient's response after injection was graded using a four-point scale. Additionally, the mean arterial pressure and heart rate were recorded upon arrival in the operating room, as well as 1 min before and 1 min after tracheal intubation. RESULTS: The incidence of withdrawal responses was 96%, 61%, 19% and 19% in groups C, A5, A10 and A15, respectively. The incidence and severity of withdrawal responses in group A10 and A15 were lower than group C and A5. CONCLUSIONS: After thiopental injection, alfentanil 10microgram/kg prevent the withdrawal responses on injecting rocuronium in pediatric patients.

The Effect of Lidocaine or Fentanyl on Withdrawal Movement during Rocuronium Injection / 대한마취과학회지

BACKGROUND: This study compared the efficacy of intravenous fentanyl with lidocaine as a pretreatment for the prevention of a withdrawal response after a rocuronium injection. METHODS: Eighty patients were divided into four groups according to the drugs used for pretreatment as follows: group I: normal saline, group II: lidocaine 0.5 mg/kg, group III: lidocaine 1.0 mg/kg, group IV: fentanyl 1microgram/kg. Twenty seconds after inducing anesthesia, each pretreatment drug was injected. After twenty seconds, rocuronium was injected. The incidence and severity of the withdrawal responses was assessed. The BIS value and heart rate was recorded at each point (T0: baseline, T1: pretreatment drug injection, T2: 10 seconds after pretreatment drug injection, T3: rocuronium injection, T4: 10 seconds after rocuronium injection, T5: 20 seconds after rocuronium injection). RESULTS: The incidence of withdrawal movement was significantly lower in groups II and III than in groups I and IV (P = 0.002). The BIS was significantly lower in group IV than in groups I, II and III at T2 and group I at T3 (P < 0.05). The heart rate at T4 was significantly lower in group IV than in group II (P < 0.05). An assessment of BIS at the withdrawal movements showed a significantly higher value in the severe group than in the none and mild groups at T5 (P < 0.05). CONCLUSIONS: A pretreatment with 0.5 mg/kg or 1.0 mg/kg of lidocaine effectively reduced the incidence of a withdrawal response by the rocuronium injection. However, 1.0 mg/kg of lidocaine most effectively prevented the withdrawal response without causing any significant changes in heart rate.

Comparison of Withdrawal Responses Associated with Temperature and Gender on the Injection of Rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium produces various withdrawal responses if administered after loss of consciousness. We investgated the incidence of withdrawal response after injecting rocuronium in female and male patients, and also evaluated the effect of injecting rocuronium at room and low temperature (4-5oC). METHODS: We evaluated 240 in-patients undergoing various elective general surgeries. Patients were randomized into two groups of 120 patients in a blinded, prospective study; group I (rocuronium was stored at ambient temperature [20-24oC], n = 120 [60 male patients, 60 female patients]), group II (rocuronium was stored in a refrigerator [4-5oC], n = 120 [60 male patients, 60 female patients]). Ten seconds after the induction of anesthesia with 5 mg/kg of thiopentothal sodium, rocuronium 0.6 mg/kg was injected over 10 seconds using on intravenous cannula. Patient's response on injecting rocuronium was graded using a four-point scale. RESULTS: The incidence of withdrawal response was 29.2% (female 31.7%, male 26.7%) in group I and 31.7% (female 31.7%, male 31.7%) in group II. Moderate to severe movement was 18.4% (female 20%, male 16.7%) in group I and 142% (female 15%, male 13.2%) in group II. CONCLUSIONS: The incidence and the degree of withdrawal response on injecting rocuronium were no different in groups I or II, or between males and females.

Comparison of Withdrawal Movements Associated with the Injection of Rocuronium in Children and Adults / 대한마취과학회지

BACKGROUND: Rocuronium produces various withdrawal responses if administered after the loss of consciousness. We investgated the incidence of withdrawal response after injecting rocuronium in children and adults. METHODS: We evaluated 60 in-patients divided (30 children, 30 adults) undergoing general anesthesia for various elective surgeries. The patients were into two groups of 30 patients each in the prospective study; group I (children, n = 30), group II (adults, n = 30). After the induction of anesthesia with 5 mg/kg of thiopental sodium, rocuronium (0.6 mg/kg) was injected over 10 seconds, intravenously through a cannula. Patient's response after injection was graded using a four-point scale. RESULTS: The incidences of withdrawal response were 90% and 33.3% in groups I and II, respectively. Moderate to severe movement was observed in 80.0% and 20.0% of groups I and II, respectively. CONCLUSIONS: The incidence and the degree of withdrawal response after rocuronium injection were higher in children than in adults.