Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial / 대한마취과학회지

BACKGROUND: Propofol injection pain is a common problem that can be very distressing for patients. We compared the effects of injection with saline followed by injection with a fentanyl-propofol mixture, injection with fentanyl followed by a propofol injection, and injection with saline followed by propofol alone on propofol injection pain. METHODS: The patients were assigned randomly to one of three groups. A rubber tourniquet was placed on the forearm to produce venous occlusion for 1 min. Before anesthesia induction, group C (control, n = 50) and group M (fentanylpropofol mixture, n = 50) received 5 ml of isotonic saline, while group F (fentanyl, n = 50) received 2 microg/kg of fentanyl. After the tourniquet was released, groups C and F received 5 ml of propofol and group M received 5 ml of a mixture containing 20 ml of propofol and 4 ml of fentanyl. At 10 s after the study drugs were given, a standard question about the comfort of the injection was asked of the patient. We used a verbal rating scale to evaluate propofol injection pain. Statistical analyses were performed with Student's t-tests and Fisher's exact tests; P < 0.05 was considered to indicate statistical significance. RESULTS: The demographic data were similar among the groups. In group M, the number of patients reporting propofol injection pain was significantly lower than in groups F and C (both P < 0.001). No patient in group F or M experienced severe pain, whereas 24 patients (48%) had severe pain in group C (both P < 0.001). CONCLUSIONS: This study shows that a fentanyl-propofol mixture was more effective than fentanyl pretreatment or a placebo in preventing propofol injection pain.

Comparison of the effect of sevoflurane and halothane anesthesia on the fall in heart rate as a predictor of successful single shot caudal epidural in children

To investigate the effect of sevoflurane anesthesia on heart rate HR fall with the injection of the initial drug in caudal space to confirm the correct needle placement. After the ethical approval was obtained from the hospital-s ethics committee, a prospective, randomized, clinical study was designed in Yeditepe University Hospital, in 2007. Children aged 1-12 years, scheduled for infraumblical surgery under general anesthesia, and caudal block were included in the study. Anesthesia was induced, and maintained by sevoflurane in group S n = 85, and by halothane in group H n = 82. Baseline HR was recorded before the caudal block was performed. The HR changes during the initial dose, and total drug injection were recorded followed by 2 more HR recordings taken 5, and 10 minutes after caudal injection. The success of the block was recorded by a blind observer. There were 167 children included in the study. Caudal block success was 96.5% in group S, and 97.6% in group H. Basal HR was 110.9 +/- 10.9 in group S, and 105.9 +/- 10.1 in group H. Following the initial drug injection, mean HR was 109.8 +/- 10.9 in group S, and 102.9 +/- 9.9 in group H. It was significantly lower than the baseline in group H. The only significant decrease in the HR of the patients in group S was at the tenth minute following caudal injection. The decrease in HR with drug injection has no value to predict the success of caudal block under sevoflurane anesthesia

effect of 2 different concentrations of rectal ketamine on its premedicant features in children

To investigate whether changing concentration and volume of ketamine for rectal premedication would change the premedication and recovery characteristics. A prospective, randomized, clinical study was designed in Yeditepe University Hospital, Istanbul, Turkey in 2006-2007. The study group included children weighing 10-20 kg, American Society of Anesthesiologists grade I, scheduled for inguinal hernia repair or circumcision under general anesthesia with orotracheal intubation and caudal blockade. Children were rectally premedicated with 10 mg.kg-1 ketamine 5% in group K, and 2.5% in the Group K1/2, 45 minutes before anesthesia. Anesthesia was induced and maintained by inhalation. Sedation scores at 15 minutes intervals in the preinduction area, parental separation scores, induction and recovery characteristics, time to discharge and a questionnaire at 24th postoperative hour were recorded. One hundred children were randomized into 2 groups of 50. Thirty minutes 1.2 versus 0.48, p=0.018 and 45 minutes 2.24 versus 1.8, p=0.027 following premedication group K1/2 had significantly lower mean sedation scores than group K. Separation, induction quality scores, induction duration, secretion scores either during induction or postoperative period, and recovery characteristics were all comparable in both groups. Although adequate sedation was obtained for most of the children in both groups, rectal premedication with 5% ketamine resulted in higher levels of sedation appearing earlier than that of 2.5% ketamine, while change of volume and concentration had no effect on recovery characteristics