ABSTRACT
Ketamine is a strong acting analgesic drug, used mainly in trauma and emergency medicine settings, as well as for minor procedures. Its pharmacological properties make it a useful drug for military anaesthesia. Ketamine acts by blocking activation of the spinal and supraspinal NMDA-type glutamate and opioid receptors. It produces dissociative anaesthesia, which means that patients might remain conscious, though insensitive to pain and amnesic (anterograde). Dysphoria and hallucinations are the main side effects in the early recovery period. We studied the incidence of post operative nausea and vomiting, vigilance disturbances and haemodynamic instability during combined ketamine and propofol anaesthesia. No patient suffered from postoperative nausea and vomiting. No haemodynamic instability could be observed in any of the patients. The interesting point is that though there were no unpleasant emergence phenomenons, no patient reached the preoperative state of vigilance within two hours after extubation. These results indicate that for plastic/dermatological surgical procedures, patients undergoing ketamine/propofol anaesthesia do not require excessive haemodynamic monitoring, but do need prolonged personal observation in the postoperative period.
Subject(s)
Anesthesiology/methods , Anesthetics , Ketamine , Postoperative Care/methods , Propofol , Adult , Female , Hallucinations/chemically induced , Hemodynamics , Humans , Infusions, Intravenous , Male , Surgery, PlasticABSTRACT
UNLABELLED: Nonsteroidal antiinflammatory drugs are routinely administered in the perioperative period. Because of the absence of cyclooxygenase-2 in platelets, cyclooxygenase-2-selective drugs are thought not to cause platelet inhibition. Because platelets play an important role in the coagulation process, the absence of platelet function inhibition may lead to fewer bleeding complications after surgery. We studied the influence of aspirin, diclofenac, lornoxicam, and rofecoxib on arachidonic acid and collagen-induced CD 62 P (P selectin) expression by using flow cytometry. Blood from 68 volunteers was obtained before and 1, 3, and 12 h after the oral ingestion of 1 of the randomly assigned study medications. Aspirin, diclofenac, and lornoxicam had a significant effect on arachidonic acid and collagen-induced CD 62 P expression in platelets, whereas rofecoxib did not show this effect. We conclude that rofecoxib is safe to use perioperatively with respect to inhibition of platelet function. IMPLICATIONS: We compared the effect of rofecoxib and three nonselective nonsteroidal antiinflammatory drugs on platelet function, measured by CD 62 P expression. Platelet function was not altered by rofecoxib, but it was inhibited by aspirin, diclofenac, and lornoxicam. Rofecoxib may be safer than classic NSAIDs with respect to platelet function during the perioperative period.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Aspirin/adverse effects , Blood Platelets/metabolism , Cyclooxygenase Inhibitors/adverse effects , Diclofenac/adverse effects , Lactones/adverse effects , Piroxicam/analogs & derivatives , Piroxicam/adverse effects , Selectins/biosynthesis , Adult , Arachidonic Acid/pharmacology , Blood Platelets/drug effects , Collagen/pharmacology , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Double-Blind Method , Female , Flow Cytometry , Humans , Isoenzymes/metabolism , Male , Membrane Proteins , Platelet Function Tests , Prospective Studies , Prostaglandin-Endoperoxide Synthases/metabolism , SulfonesABSTRACT
Human vasoactive intestinal peptide (VIP) and epoprostenol (prostacyclin) have vasodilatative effects in the pulmonary circulation. Both VIP and epoprostenol are successfully used to treat pulmonary hypertension in humans and experimental animal models. The positive effects of epoprostenol on the course of this disease are achieved through vasodilatation and inhibitory effects on platelet activity. Since VIP also binds specifically to platelets, we compared the in vitro effects of VIP and epoprostenol on platelet P-Selectin (CD62P) expression and primary haemostasis. Anti-aggregative effects of VIP (10(-6) mol and 10(-8) mol) and epoprostenol (50, 5 and 0.5 ng/ml) on platelets were determined by agonist-induced CD62P expression and in vitro bleeding time (PFA-100 trade mark system). Blood from healthy individuals was either incubated with epoprostenol, VIP or saline control and was analysed by whole blood flow cytometry and the PFA-100 trade mark. Prior to flow cytometric analysis, the platelets were stimulated with either arachidonic acid (AA) or adenosine diphosphate (ADP). Whole blood flow cytometry analysis showed that epoprostenol inhibited dose-dependently agonist-induced CD62P expression, whereas VIP did not inhibit CD62P expression. PFA analysis revealed substantial closure time prolongation by epoprostenol and again no effects of VIP. These results indicate that VIP, in contrast to epoprostenol, has no effect on platelet CD62P expression and primary haemostasis.
