Effect of pre- vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy.

BACKGROUND: Since pre-incisional peritonsillar infiltrations of local anesthetic solutions have been suggested to reduce postoperative pain after tonsillectomy, we compared the efficacy of either pre- or postoperative local anesthetic infiltration upon post-tonsillectomy pain. METHODS: After the induction of general anesthesia, 68 consecutive healthy patients, ranging in age from 8 to 65 years, were randomly allocated to either receive peritonsillar infiltration with 0.25% bupivacaine (group 1) or normal saline (group 2) before incision. A third group (group 3) had their peritonsillar region infiltrated with 0.25% bupivacaine after the completion of surgery but before the patients were awakened from anesthesia. All the patients were treated in the same way in the postoperative period: NSAIDs were given intravenously to adults and rectally to children. Acetaminophen was given intravenously or rectally (children aged < 15 yr) if additional analgesic support was requested by the patient. Additional acetaminophen consumption was recorded daily. Pain scores were assessed on every patient with the use of a visual analogue scale (VAS) at rest, 1, 5, 9, 13, 17, 21 and 36 h after surgery, and also on swallowing during the first postoperative day. RESULTS: Global VAS pain scores were lower in the groups treated with bupivacaine infiltration during the first 24 h after surgery (P < 0.05). Supplementary analgesic consumption was lower in group 3 than in group 2 during the 0-9 h interval immediately following surgery (P < 0.05). There were no statistically significant differences for any other parameters between the 3 groups. CONCLUSION: These results suggest that the timing of peritonsillar infiltration with bupivacaine is not of clinical importance and does not affect the quality of postoperative analgesia in patients undergoing tonsillectomy.

Glutathione peroxidase activity and metabolism of arachidonic acid in peripheral blood mononuclear cells from elderly subjects.

1. Since ageing has been associated with a decrease in both immune responses and antioxidant defences, this study was undertaken to compare the glutathione peroxidase activity in peripheral blood mononuclear cells of healthy elderly and young donors. The mean value of glutathione peroxidase activity was significantly lower in the aged group (-36%) than that observed in the young control group (n = 10). 2. This defect was accompanied by a marked increase (+106%) in the oxygenated metabolism of endogenous arachidonic acid by lipoxygenases as judged by the radiolabel associated with hydroxyeicosatetraenoic acids in [3H]arachidonic acid-prelabelled peripheral blood mononuclear cells, whereas the cyclo-oxygenase activity, estimated by the radiolabel associated with thromboxane B2, was not significantly altered. 3. Upon stimulation by the mitogenic lectin concanavalin A, the radioactivity associated with total eicosanoids (free arachidonic acid plus hydroxyeicosatetraenoic acids plus thromboxane B2) was significantly increased over basal levels in the peripheral blood mononuclear cells of both the elderly and the control groups. However, the mitogen-induced increase was lower in the elderly group (+48%) than in the control group (+131%). Upon concanavalin A stimulation, the radioactivity of hydroxyeicosatetraenoic acids was increased by only 96% in peripheral blood mononuclear cells from the elderly group compared with 350% in control cells. Similarly, the radioactivity associated with thromboxane B2 was increased by only 82% in peripheral blood mononuclear cells from the elderly group compared with 218% in control cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related changes in arachidonic acid peroxidation and glutathione-peroxidase activity in human platelets.

Lipid peroxidation, vitamin E level and glutathione-peroxidase activity were determined in platelets from elderly (greater than 68 years) and young (21-43 years) people. To further assess the platelet lipid peroxidation, the metabolism of endogenous arachidonic acid in unstimulated platelets as well as that of the exogenous one were measured in the two groups. The oxygenated metabolites of arachidonic acid were enhanced in the elder population under both conditions tested. In addition, the platelet malondialdehyde content, a marker of the overall lipid peroxidation, was also found significantly increased in platelets from aged subjects. On the other hand, the platelet vitamin E level and the glutathione-peroxidase activity were significantly depressed in the elder group compared to the young one. These results suggest that the increased platelet activation observed with age could be linked to the accumulation of lipoxygenase-dependent peroxides associated with the decreased antioxidative defence of the cells, especially glutathione-peroxidase activity.

Bone mineral density of the hip measured with dual-energy X-ray absorptiometry in normal elderly women and in patients with hip fracture.

Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA) in 133 normal females on five regions of the femoral site: neck, trochanteric, intertrochanteric, Ward's triangle, and total area of the proximal femur. One hundred and twenty-five women (56 older than 65, range 65-97, and 69 with an age range of 21-65) were also examined for spinal bone mineral density. The mean in vivo precision (CV%) of the measurements with repositioning assessed on five young and eight elderly patients was ranged from 0.7% to 1.7% but lower for Ward's triangle (CV = 2.95% and 3.87%). Between 30 and 90 years, a linear age-related bone mineral decrease was found at all sites with a similar magnitude of bone loss for the femoral neck, total or intertrochanteric regions (-33% to -39%). A greater decrease was found for the Ward's triangle region (-61%). In the subgroup of elderly women (65-97 years old), the lumbar BMD measured with an anteroposterior incidence did not decrease significantly with age, contrasting with an average 27% decrease of the BMD of the hip between 65 and 90 years of age. In addition, 31 patients suffering either from a cervical (n = 12) or pertrochanteric (n = 19) fracture were measured on their contralateral femur 15 to 30 days after the fracture event. The mean calculated BMD values were, depending on the measured area, from 14% to 21% lower than those reported for age-matched controls (z-score from -1.11 to -0.65). A fracture threshold was determined for each site from this population and the elderly controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of chlormezanone in elderly patients.

The pharmacokinetics of Chlormezanone (CM) has been determined after a single oral dose of 400 mg CM in 5 young volunteers (28 y) and in 8 elderly patients (79 y). In the young subjects, CM was rapidly absorbed and distributed, and was slowly eliminated with a half-life of 38 h major metabolites were not detected in plasma or urine. Only 3% of CM was excreted unchanged in urine. In elderly patients absorption was delayed but not reduced; the Cmax and AUC did not differ from those in younger subjects, the elimination rate was reduced compared to the younger subjects (mean 54 h). The increase was in part related to the reduction in renal function and metabolism observed in aging. However, the change in pharmacokinetics was moderate and no adjustment in dosage seems necessary for treatments of limited duration in elderly patients.