Comparison of intravenous Lornoxicam and fentanyl combined with midazolam on analgesia during extracorporeal shock wave lithotripsy

Various sedative and analgesic medications have been used for shockwave lithotripsy [SWL]. This study compare the analgesic and side effects of intravenous lornoxicam with that of intravenous fentanyl, in combination with midazolam in ESWL. One hundred patients were randomly divided into two groups; group A [n = 50] received 16 mg lornoxicam i.v. 30 min before ESWL and group B [n = 50] received 2 microg/kg fentanyl i.v. 3 min before ESWL. All patients received 2 mg midazolam i.v. 3 min before ESWL for intraoperative sedation. Pain intensity was evaluated on a visual analog scale [VAS]. A supplemental analgesia with intravenous fentanyl 25 micro g was given when complained of pain, changed position, or grimaced in response to the shockwaves. The level of sedation was determined using the Observer's Assessment of Alertness/Sedation [OAS/S]. Oxygen supplement through a face mask was given when the SpO[2] fell below 94%. Side effects [nausea, vomiting, dizziness] and the time of discharge from post-anesthesia room [PAR] were recorded. There were no differences between two groups in the demographic data, number of shock waves, duration of ESWL procedure, and fentanyl supplement. The incidence of oxygen supplement was lower in lornoxicam group [5/50] compared with that of fentanyl group [20/50], P < 0.01. The frequency of dizziness was lower in lornoxicam group [3/50] than that in fentanyl group [15/50], P < 0.01. Five patients in fentanyl group complained of nausea, but two did in lornoxicam group. The discharge time from PAR was significantly shorter in lornoxicam group [24.4 +/- 3.23 min] than that in fentanyl group [37.14 +/- 5.82 min], P < 0.01. Intravenous lornoxicam plus midazolam could provide an adequate analgesia as good as fentanyl plus midazolam but with a lower incidence of desaturation, nausea/vomiting and dizziness and could be discharged from PAR earlier. Therefore, we suggest that a single-dose intravenous lornoxicam combined with midazolam is a safe and effective regimen for pain relief in ESWL

effect of remifentanil-midazolam on electrophysiological properties of normal conduction system and accessory pathways in wolff-parkinson-white syndrome in cardiac catheterization laboratories

The effects of remifentanil midazolam sedation upon the electrophysiologic [EP] properties of normal atrioventricular [A-V] and accessory pathway [AP] conduction were studied in twenty patients with Wolff-Parkinson-White [WPW] syndrome during accessory pathway ablation in cardiac catheterization laboratories [CCL] The presence of an AP was confirmed by baseline EP studies. Sedation was induced with remifentanil [0.5mcg/kg] over 30-60 second and midazolam [0.1 mg /kg] and maintained with remifentanil infusion [0.025-0.05mcg/kg/min]. A baseline EP study was performed which consisted of effective refractory period [ERP] and shortest cycle length [SCC] measurement during antegrade conduction in the normal A-V pathway arid AP, as well as during retrograde conduction in the AP. Comparison with baseline EP studies indicated that the administration of remifentanil-midazolam sedation had no effect upon conduction or ERP in either pathways. Haemodynamic stability and no significant blood gases changes oct urred throughout the ablation procedure with no development of dysrrhythmia. We conclude that a combination of remifentanil-midazolarn is suitable for sedation in patients undergoing ablative procedures for accessory pathways in cardiac catheterization laboratories [CCL]

Emergence agitation after sevoflurane anesthesia in children: prophylactic effect of clonidine versus two doses of fentanyl

Sevoflurane anesthesia in preschool children has been associated with an increased incidence of emergence agitation. Many factors may be incriminated in this phenomenon, but most important of them [other than anesthetic technique] is postoperative pain. We designed a study that included a non-surgical procedure in order to eliminate pain and we compared the effects of different drugs to attenuate this anesthesia related complication. Eighty children undergoing examination under anesthesia between the ages of 18 months and 6 years were randomly assigned to receive fentanyl lug/kg, fentanyl 2 ug/kg, clonidine 2 ug/kg or placebo after receiving sevoflurane anesthesia. Blood samples were collected before discharge from the PACU to evaluate the hormonal part of stress response associated with agitation. The children's behavior was assessed with a special agitation scale in the PACU and total hospital discharge time was measured. Clonidine 2ug/kg and fentanyl lug/ kg were found to decrease much the incidence of postoperative agitation without increasing discharge time, vomiting or itching among preschool children exposed to sevoflurane anesthesia in nonpainful procedures